When Mayor Rahm Emanuel closed six of the city’s 12 mental health clinics four years ago, the decision sparked sustained protest. With his announcement last month that the city’s Roseland clinic will be privatized, it looks like the mayor has decided it is now safe to go after the remaining clinics.
This move should not happen without public discussion, according to the Mental Health Movement, a coalition of clinic clients, grassroots groups and unions, has called for hearings on the Roseland clinic’s fate.
The Health Movement initially withheld judgment when the city announced on Oct. 7 that the Cook County Health and Hospital System would take over management of mental health services at the Roseland Neighborhood Health Center, one of the remaining Chicago Department of Public Health clinics. In fact, the county seems to have a stronger commitment than the city to providing public health services, an organizer said.
But it turned out that the real management entity would be the Community Counseling Centers of Chicago, known as C4, which is part of CountyCare, the county’s Medicaid health plan.
Activists are concerned because last year, C4 announced that it was closing its doors due to billing problems, sending its 10,000 patients elsewhere. A few weeks later, C4 announced it was joining CountyCare and would stay open.
The episode showed the importance of maintaining a public safety net and not outsourcing vital services to the private sector, said Health Movement leader N’Dana Carter.
“A lot of these nonprofits are a door knock away from closing,” she said. “If they lose one grant they could be gone just like that.”
But Mark Heyrman, a professor at the University of Chicago Law School and facilitator of the Illinois Mental Health Summit, said C4’s role at Roseland is “a positive with no negative” because it takes the city out of the position of serving Medicaid-eligible patients without being able to bill Medicaid.
Carter points out that the Mental Health Movement has been calling on the city to join CountyCare for several years, and the city has claimed to be working on it since 2014. Heyrman said he understands that joining CountyCare is complicated process. Yet joining wasn’t too complicated for C4, which figured it out over the span of the couple of weeks.
The city has said it will continue to cover costs for clinic clients who are uninsured, but it’s not clear whether that guarantee extends to new clients without insurance, or how long the guarantee will be in place, Carter said.
City playing a zero-sum game
The city describes C4’s takeover as an “increase [in] service options,” since the nonprofit would extend mental health services to children. Again, Carter points out that activists have long called on the city to expand services.
“The city can find the money for programs that they want,” she said. “Like $50 million for Maggie Daley Park.” In 2012, Emanuel claimed he was saving $3 million when he closed the six clinics. But, Carter said, “the city didn’t save any money, because crime went up, as we said it would, and homelessness went up.”
“I’m not saying we don’t need C4 [in Roseland],” Carter said. “We need more clinics, not less. Put C4 in another location [in the neighborhood], or put it down the street. Lord knows we could use it. They will always be busy.”
Instead, the Emanuel administration is playing a zero-sum game, promising that it won’t diminish current services – as if current services were adequate and there weren’t huge unmet needs, particularly on the South and West Side.
From the details of how clients and community members will be impacted by this change, to larger questions of how the city views its commitment to mental health going forward, there’s plenty of subject matter for a public hearing on this decision.
The Mental Health Movement is also calling on the City Council’s health committee, chaired by Ald. George Cardenas (12th), to hold a hearing on the Mental Health Safety Net Ordinance introduced by Ald. Jason Ervin (28th) last January and co-sponsored by 28 aldermen.
That ordinance would require the health commissioner to negotiate contracts within six months with three managed care networks for Medicaid reimbursement; call on the commissioner to ensure adequate staffing levels for psychiatrists; and require the department to undertake a mental health awareness campaign, including “workshops in communities disproportionately impacted by violence.”
But the Emanuel administration wants as little attention as possible on any of this, and as little discussion of these matters as possible. It’s worth asking why.