Mandatory Report
The white mental health system fails people of color
by Mark Harris

I am a mandatory reporter. That means I am legally bound to report you to the authorities, if I suspect, due to my training, that you are an immediate danger to yourself or vulnerable others. It also means that not only must I report the citizen to the system, but I must also report to the citizens that the system will fail them. 

I am a mandatory reporter for a system I would not trust a single blood relative to. Nor could I wholeheartedly, unreservedly, recommend or refer any person who looks like a blood relative of mine. I can’t even honestly say that even if you are blond-haired, blue-eyed and wealthy that the system will take adequate care of you. For the most part the system will do well by you, by many accounts, if you are white, but even a lot of white people question that. My colleagues all agree  that “the system sucks,” but they don’t change its dysfunctional status quo.

This mandatory report is triggered by the death of someone, an African-American woman — one of many self-referred to the system — whom the system failed for the usual predictable and preventable reasons. Those reasons are primarily that people receive either culturally competent care or patterned neglect, based not on the most current science but on the prejudice of those ostensibly providing the care.

She, like the other three African-American women at a local treatment facility, voluntarily recognized she had an addiction problem. A woman of color doing an internship at that treatment agency found herself being racially harassed by the staff there, as well as witnessing racial maltreatment of the clients of color by the staff. 

If you have a problem of some sort, whether indigent or armed with adequate financial resources, if you are the wrong color, the mental health and addictions cavalry ain’t comin’ to rescue you. Indeed, they will discharge you early for “treatment noncompliance,” or denial, or “you just haven’t hit your bottom yet.” But of course if you in effect live life on the bottom, there is no bottom to hit. What is needed is to follow the science, not 12-step based prejudice. It is from scientific evidence that we get concepts of self medication.

As an addictions and mental health professional of color with nearly a 40-year career, nearly 25 years in this state alone, I never have the option of being culturally incompetent with white clients — even racist skinheads, of which I’ve had four in Oregon. Is it so much of a stretch to see that African-American women in Oregon might be self-medicating themselves due to the quadruple whammy of classism, sexism, racism and heterosexism and the abuse suffered thereby? Is it possible that white addictions professionals could learn to impart appropriate coping skills to those clients rather than the hand of contempt they have shown? Here is the standard I’d like Oregon’s addictions and mental health system, even the so-called justice system, to operate at: Every person entering as a client be treated not only with the most current evidence-based science, but where the science is lacking (because it often is), they be treated along the lines suggested by community defined evidence. That is:  Discrimination exists, and you teach as part of treatment the successful skills to deal with it, or else you get repetitive relapse born of despair and frustration. Instead, majority white treatment personnel discharge clients of color according to their personal prejudices when clients raise real or imagined issues of prejudice. Community defined evidence as well as empirical science have shown patterned discrimination exists in the lives of people facing addiction issues.

The science says that even when incarcerated black people get substance abuse treatment, not only do they benefit from it, but they remain clean and sober. But generally they remain either undiagnosed or untreated. It still remains true: “White kids get rehab, Black kids get jail,” even if they are arrested at the same time showing the same symptoms. Equitable treatment would be a nice cure.

As a side note, I consulted with the state authority when the harrassed intern described above asked me what to do. I was informed by the area representative that the law reads that she must first complain to the agency, then have the issue resolved or not internally — and then then the state can act along with acting on behalf of the clients. I asked her to stay another week and initiate the complaint process. She didn’t last four days. 

The intern quit before making a complaint because she found it so intolerable. The African-American woman in treatment who independently confirmed what transpired died this winter. 

Mark Harris is a substance abuse prevention coordinator at Lane Community College.