Behavioral Health
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Dear County Executive: how will you address the impact of COVID, opioids, and structural racism on behavioral health?

September 13, 2022
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By: Eric Morse, MSSA, LISW-S, CEO, The Centers  

Dear County Executive,  

Cuyahoga County’s community behavioral health systems have been stretched thin by three overlapping public health crises: the COVID-19 pandemic, Ohio’s unremitting opioid epidemic, and structural racism. Even before the pandemic, 17% of adults in Cuyahoga County reported frequent mental distress in 2019.[1] While complete data capturing the pandemic’s impact on mental health is not yet available, the number of adults reporting symptoms of anxiety or depressive disorders increased fourfold nationwide during the pandemic.[2] Here in Cuyahoga County, nearly 500 people died from opioid-related overdoses in 2021, an increase of 16.3% over 2020. Although the need for services transcends class, racial, and ethnic lines, community behavioral healthcare access is also a racial equity matter. Black and Hispanic children are significantly more likely than white children to experience childhood trauma that leads to negative behavioral health outcomes later in life.[3] Likewise, racism itself is proven to inflict psychological suffering on those who experience discrimination and hate.[4]

 Even before the pandemic, 17% of adults in Cuyahoga County reported frequent mental distress

As demand grows, access to mental health and substance use disorder (SUD) services becomes a matter of “haves and have nots.” Although community behavioral health providers like The Centers are designed as safety nets for our low-income neighbors, industry-wide workforce shortages threaten to curtail our capacity. Across Ohio, staff have left community practice for private practice or other sectors altogether in search of higher wages and reduced burnout.[5] The passion and dedication of our behavioral health professionals are unmatched, but their jobs do involve significant stress, complexity, and attrition. When staff vacancies go unfilled, patient access suffers from increased wait times. When access to community treatment is limited, people either forego treatment—increasing their risk of overdose or crisis situations—or seek treatment in hospital emergency rooms, often resulting in poorer outcomes and higher costs for payers.  

Cleveland and Cuyahoga County have long fostered creative initiatives to address behavioral health challenges. Ohio’s oldest syringe exchange program was started in Cleveland and is now housed at The Centers. With support from the County, this life-saving program helps to connect people who inject drugs to counseling and medication-assisted treatment, as well as harm reduction supplies such as clean needles and fentanyl test strips to limit the risks of bloodborne disease and deadly overdose. Last year, the County opened a first-of-its-kind Diversion Center to ensure nonviolent offenders exhibiting signs of mental illness or addiction receive the care they need, rather than incarceration. This collaborative endeavor between the County Executive, Council, ADAMHS Board, and the courts is commendable, but the work is far from over.

 Last year, the County opened a first-of-its-kind Diversion Center to ensure nonviolent offenders exhibiting signs of mental illness or addiction receive the care they need, rather than incarceration.

The influx of the American Rescue Plan Act (ARPA) and opioid settlement funds afford a tremendous opportunity for the County to invest in the behavioral health of its most vulnerable residents. Recruitment and training, tuition reimbursement, capital improvements, and public awareness campaigns about behavioral health careers are all areas where one-time investments can be leveraged to expand system capacity. As you begin your administration, I encourage you to work with community behavioral health providers to understand and address the challenges we face in meeting this moment. I hope you will also use your position to advocate for more sustainable and flexible funding at the state and federal levels through innovative reimbursement structures like the Certified Community Behavioral Health Center (CCBHC) model.

 By bolstering the behavioral health safety net, we will ensure all Cuyahoga County residents can access the comprehensive treatment and supportive services they need to build equitable, healthier, and prosperous communities.

Together we must do better for those whose well-being has suffered from the public health crises of COVID-19, opioids, and racism, along with all our neighbors battling mental illness and addiction. By bolstering the behavioral health safety net, we will ensure all Cuyahoga County residents can access the comprehensive treatment and supportive services they need to build equitable, healthier, and prosperous communities.  

Eric Morse, MSSA, LISW-S  

Chief Executive Officer  

The Centers  

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[1] Behavioral Risk Factor Surveillance System, 2019  

[2] Kaiser Family Foundation (2021). The Implications of COVID-19 for Mental Health and Substance Use. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/  

[3] Sacks, V. & Murphy, D. (2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. Child Trends. https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity  

[4] Mental Health America (2022). Racial Trauma. https://www.mhanational.org/racial-trauma  

[5] The Ohio Council of Behavioral Health and Family Services Providers (2021). Breaking Point: Ohio’s Behavioral Health Workforce Crisis. https://www.theohiocouncil.org/assets/BreakingPoint/TheOhioCouncil%5FWhitepaper%5FBreakingPoint.pdf  

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