The biggest controversy of Rahm Emanuel’s first year as mayor was caused by his decision to close six of the city’s twelve mental health clinics. For months, protestors from the Mental Health Movement disrupted Emanuel’s events. In another dramatic action, 23 were arrested when they barricaded themselves inside the Woodlawn clinic.
The protests didn’t stop the closings that year, but they may have prevented additional closings. And they laid the groundwork for the city to revisit the issue now, with Emanuel on the way out.
In January, the City Council passed a resolution by a margin of 48 to 0, noting that the clinic closings resulted in “leaving large areas of the city without adequate access to affordable safety-net mental health service,” and establishing a task force to conduct a “comprehensive study to determine which community areas shall be prioritized for re-opening mental health clinics.”
That’s getting some pushback from leaders representing private, nonprofit behavioral health providers, who have argued that “reopening the six public mental health clinics would be a step backward.”
Longtime MHM organizer Matt Ginsberg-Jaeckle recalls that leaders of nonprofit providers also backed the clinic closings seven years ago, promising that they stood ready to serve displaced clients.
It didn’t exactly work out that way. Hundreds of city patients fell through the cracks. City clients who were transferred to private providers often faced long wait times for appointments and long travel times and unaffordable copays when they got in. Psychiatric hospitalizations spiked after the clinic closings. Then, within a few months, two of the private agencies handling former city clients went out of business.
Since then, the subsidized private insurance provided to thousands of moderate-income Chicagoans by the Affordable Care Act — one of the rationales behind the clinic closings — has offered only spotty mental health coverage, often with deductibles that are cost-prohibitive.
Last year, the Collaborative for Community Wellness reported on what it called a “mental health crisis” on the Southwest Side. It found that while Chicago’s Near North Side had 4.45 licensed mental health professionals per thousand residents, low-income Southwest Side communities averaged 0.17 per thousand. In an earlier survey of the health concerns of Southwest Side residents, 82% listed mental health as their top concern. Last year, nearly half reported experiencing depression, and over a third reported experiencing anxiety.
Asked about barriers to accessing mental health care, 57% listed cost, and large proportions cited the lack of nearby services or not knowing where to go for help.
The Collaborative also investigated the claims that private providers could meet residents’ needs, checking up on 253 private providers identified by the Chicago Department of Public Health as offering mental health services. They could reach only 150 of those agencies; about a third had either closed, had a phone that was not in service, or did not respond to repeated calls.
Some 9% of the agencies that were reached didn’t actually provide mental health services. Only 15% provided free services. Of a smaller group of federally-qualified health centers, which provide a range of services, only 14% reported having rates from $5 to $15 per session, compared to 40% who charged from $20 to $50 per session. Another 11% only accepted patients who have insurance or did not offer sliding scale rates.
“Taken together, these findings point to the dire need for increased investment in a mental health service infrastructure in which services are more readily accessible to marginalized community residents throughout the city,” the Collaborative reported.
That increased investment must include re-opening the closed clinics, according to Arturo Carrillo, manager of mental health programs for the Community Wellness Program at St. Anthony Hospital and a leader of the Collaborative — particularly to address the “severe disparity in access to long-term, trauma-focused psychological care.”
That’s the kind of treatment that’s most needed in communities with high levels of violence and poverty, and it’s the kind of treatment St. Anthony’s provides, free of charge, at four community sites — in contrast to many FQHCs, which use a short-term, symptom-focused model, Carrillo said. “We see enormous need,” he said. “We have a year-long waiting list, and rely on the city’s Lawndale clinic” to treat people who need immediate help.
Critics of the city clinics say they fail to provide coordinated and integrated health care, but Carrillo says there’s no reason they couldn’t.
The Woodlawn clinic, which shared a building with a county health center, certainly did. With African American men serving as director, psychiatrist, and therapists, it was “a refuge for black men” — an extreme rarity in the mental health sector — according to a 2015 Social Justice News Nexus report. Clients could get a haircut, look for a job, get a physical checkup, or just drop in if they needed a place to collect themselves.
The clinic employed a “therapeutic social club strategy,” aimed at restoring “community functioning of clients” and including summer picnics, Christmas dinners, and game and movie nights. In order to get them out of the tightly constrained life situations associated with mental health and trauma issues, one therapist would take groups of clients to the lakefront to watch the sun rise, or out to play basketball and share a meal.
One key, clinic supporters say, was having the stability of a unionized staff, without the high turnover rates that characterize many private providers.
According to an analysis by MHM and AFSCME, which represents clinic staff, 54% of clients hit by clinic closings were African American, and every black male therapist was laid off in the closings. At the same time, the two city clinics primarily serving Latinos was also closed, and most of the city’s Spanish-speaking therapists were cut.
That lends credence to Carrillo’s contention that an increased investment by the city to reopen mental health clinics that provide free access in underserved communities is simply a matter of equity.