On Purpose: Building a Better, Stronger Future that is Truly Fair and Equal

Always in my mind are two pacesetting African America leaders with whom I was privileged to serve and from whom I learned much over two decades including: the Honorable Aubrey E. Robinson, Jr., who was the Chief Judge of the US District Court of the District of Columbia, where he presided for more than a quarter century in the Dixon matter addressing the constitutional right of people confined to St. Elizabeth’s Hospital to treatment in the community; and Billy E. Jones, MD, MS, who was the President/CEO, NYC Health and Hospitals Corporation; Commissioner, NYC Department of Mental Health, Mental Retardation and Alcoholism Services; CMO at Magellan Public Solutions; and Professor of Psychiatry who recently received the American Psychiatric Association’s John E Fryer, MD Award, which honors an individual whose work has contributed to the mental health of sexual and gender minorities. Recognizing and celebrating the many ways that Black Americans have contributed to our work, our communities, and our shared cultures - isn’t this what Black History Month is all about?

And yet the celebration seems inadequate without a hard, honest discussion of the systemic inequities and hardships that are not just part of Black history but also Black reality, even today. US Census data indicate that Black people are 2.7 times more likely than non-Hispanic white people to have incomes below the poverty line. And, in 2022, nearly 75 percent of White households owned their homes, compared with 45 percent of Black households — a gap of almost 30 points. This disparity likely is rooted in redlining, lack of access to mortgage loans, and other historical discrimination – but the present-day impact transcends past wrongs. As noted in a recent report by the Pew Charitable Trust, this gap between White and Black homeownership rates is wider now than it was in 1960, before practices like redlining were illegal.

Closer to home, a Suffolk County study published in 2020 found that 71 percent of Black individuals were discriminated against in the metro Boston rental market. Housing providers showed Black testers half as many apartments as they showed to White testers. They told White testers that more units were available, offered more incentives to rent, and made more positive comments about the units to White testers.

The mental health system is no exception to unequal treatment of Black Americans. Shockingly, at least one peer-reviewed study found that Black Americans are four times more likely to be diagnosed with schizophrenia than other races and ethnicities presenting with the same patient need characteristics and illness severity.

Disparities in income, home ownership, and access to culturally responsive mental health treatment may seem intractable, perhaps because they are complex or perhaps because we lack the political will to respond. But philosophers from Aristotle to Hannah Arendt to Ta-Nehisi Coates remind us that history is never behind us; it is always present. There can be no question that the disparities that exist today are rooted in our long history of slavery, violence, and oppression – and I believe that answers lie in acknowledging, understanding, and addressing that history.

It is exciting that Boston has created a Task Force on Reparations, to be chaired by MAMH Governing Board member Joseph Feaster, Jr., and I am looking forward to reading its findings. In the meantime, MAMH took advantage of Black History Month to renew and update our commitment to social justice and diversity. For us, this means that we will:

• Review periodically demographic data and local needs assessment data to be current on the diversity and needs of the people who live in the Commonwealth and the inequities in access they experience – and use those data to inform our policy and planning efforts.
• Implement mental health promotion initiatives that advance racial equity, including ensuring that programs we support or implement are culturally responsive to the needs of all Massachusetts residents.
  
• Strengthen collaboration with partners committed to racial justice and social equality.
• Review annually our Board membership to determine if there is sufficient representation of Black individuals and other leaders of color to reflect the cultural and linguistic makeup of the Commonwealth.
• Provide educational materials that are consistent with the linguistic diversity of the target populations MAMH is attempting to reach in its many outreach efforts.
• Continue to maintain and expand the Culturally Responsive Behavioral Health Resource Hub on Network of Care Massachusetts.

History may help shape us, but it does not define us. We are free to learn from past mistakes, understand their present-day impact, and commit to doing better. I hope you will join us at MAMH - throughout the year - in celebrating not just the contributions of Black leaders and Americans, but also the potential of facing history to help us build a better, stronger future that is truly fair and equal.

By Danna Mauch, MAMH President and CEO