Well, it is just not about you and me and asking ourselves the personal question, “Am I a racist?” It extends far beyond people and into our society that we all live in together. Another term for systemic racism is institutionalized racism — as its very foundation racism resides in the institutions that make up our society — that make up America.
For many, it’s difficult to believe that racism lies not just within individuals, but also the governing bodies, the organizations that hold power, and the very way our society is set up to favor one race over another. I believe we are a nation founded on slavery and even though there was a civil war and the slaves were supposedly “freed,” there are many other ways to enslave black people in American society.
One of the places we can see this most clearly is within the criminal justice sector of our society. From the police that patrol our streets to the lawyers and judges who prosecute, defend, and give out sentences, to our for-profit federal prisons that make money off of the number of bodies in these places, racism resides in the very fabric of society in a way that is insidious.
What can white people do? What can multi-racial people do? What can black people do? I see the protests, I hear the chants, I see the economic disparity, I feel the pain, I read the outraged posts, and more. And yet it does not change. How do we change the very founding of America?
There are many people who want to do just that. We are busy reading books, talking with one another, becoming real and honest about the way we act with privilege each of our days, and growing our own personal consciousness can then lead to individual action. This is good, right, and just action.
However, if racism is institutionalized and a part of the system that is in place and resists change — and has leaders that support racism remaining in place – then how can our personal actions that become collective – actually get this to change. And it’s not a Democrat or a Republican thing, it is an American problem. And people in power do not want to be powerless — so that needle hardly moves. This thought often leads me to despair.
Is the fight good and just? Of course. Will people stop fighting? Of course not.
However, perhaps something more needs to shift – societally, institutionally – for any of this change to take hold.
This is what systemic racism does — it holds even as people are broken down.
I read an interesting article the other day in the Washington Post regarding how the current COVID-19 pandemic is pushing America to the brink of a mental health crisis. I cannot even believe it has taken a severe public health crisis like this one for the media to begin to pick up on how difficult it is for Americans to find and receive quality mental health care today.
Sitting from the vantage point of a therapist, I know this to be true for many reasons. While most articles, like the one in the Post above, focus on access to mental health care, there is something else one has to first realize. Access to mental health care starts with clinicians who are in training to work in the field and serve people in need of mental health services.
It is an unfortunate truth and one not often discussed in the media that to do the work of a therapist, or, as the traditional license is called, a Licensed Mental Health Counselor, is a costly and time-consuming journey. One cannot clinically practice one-on-one therapy with individuals without holding a Master’s Degree in counseling, social work, or marriage and family work. This type of degree takes 3-5 years to complete with significant amounts of debt taken on to complete the degree, upwards and over $100,000.
Along this journey, graduate students in training are called to do an internship with a significant number of clinical hours and supervision time spent in order to earn one’s degree. Although a person may have at least 2-3 years of training experience in school, one’s internship is unpaid. People must find paid jobs as they juggle their internship demands.
This is where it strikes me that the mental health system is failing at its core. Community Mental Health Agencies that serve the poor and mentally unwell, a segment of the population that would have very little access to mental health services, are staffed with interns from graduate schools who are seeing these people for free. The core of the mental health services offered to thousands of Americans is valued at an intern level who earn nothing.
From there, graduate students leave school and are permitted their first license. Where I live it is an Associate’s license, which means you have the ability to see patients, but you must be supervised for a set amount of hours as you work toward full licensure, which is additional hours. Often Associate Mental Health Counselors use this period of time to take clinician positions in mental health agencies. Now they are no longer serving for free, but for $17 to $23 per hour. The average case load for a new Clinician is upwards to 100 clients. Then add in the math of $100,000 of student loan debt.
It is from this vantage point that I see our mental health system failing in America. From the start, when people seek to train to become a mental health clinician, no value is given to the skills that they are learning and employing to help people with their mental health needs. From weighting people down with student loan debt, to not providing any value to the intern seeing clients, and then providing a very low income to the new clinician with a caseload that no one can keep up with — not only are the clinicians burned out, but the system is overwrought with little to no support for people who need tremendous care.
What happens after one has completed her Associate’s license requirements and you are now a fully licensed therapist? Unfortunately, most clinicians leave Community Mental Health and set up their own private practice. Even if the clinician charges a reduced fee, it is often three times the amount one was earning at the mental health agencies. It is unfortunate that the very poor and mentally unwell people in America are left to be churned through by clinicians who are in some training phase of their career burning out without proper care, support, or caseload numbers.
Insurance also plays a roll in the inequity of the Mental Health system in America. Are you in network and, if you are, your patients may benefit, but the Clinician will likely make very little money for their services when all is said and done. If you are out of network, then the Clinician works with the patient to determine the fee. A patient may submit a receipt to their insurance company which may provide them with a portion of the fee they have paid. In this way, the patient has to decide what can they afford given the insurance company will only be reimbursing some of the full fee and that is often after deductibles are met.
All of this to say that when we look at the mental health crisis in America, we need to critically think about how we value our clinicians in training as well as how we value the services provided to the mentally unwell, especially those accessing care through the community mental health agencies. It begins with both parties being valued and supported in terms of money and care.
Until this happens, the system is on crumbling crutches which is going to further lead to the black hole of inadequate care, funding, and a lack of people to serve during crisis such as the one we are in currently.