dani adams

Democratizing Mental Health

BY DANI ADAMS

In 2011, when then-Mayor Rahm Emanuel proposed a budget that closed half of the public mental health clinics in Chicago, City Council passed it unanimously. Less than a decade later, a progressive caucus in the council helped stall the confirmation of Dr. Allison Arwady, Mayor Lori Lightfoot’s choice for commissioner of the Chicago Department of Public Health (CDPH), citing concerns over her past statements regarding the closures. That sea change in political attitudes was the result of shifting public opinion driven by the tireless efforts of activists, advocates, and mental health providers. But the clinics remain closed, and the battle is far from over. T he modern era of mental health delivery in the United States can be traced to 1963, when President John F. Kennedy passed the Community Mental Health Act (CMHA). The act aimed to reduce the population in the nation’s psychiatric institutions—which offered few opportunities for constructive activities or therapy, let alone recovery—by half, and federal funding incentivized states and municipalities to create a robust system of community mental health agencies. In response, Chicago opened a system of nineteen public mental health centers that spanned nearly the entire city over a fifteenyear period.

Today, five of these public clinics remain. Operated by CDPH, they are financed through a mix of federal, state, and city dollars, in contrast to privately operated community mental health centers, which also sprang up in high numbers after the passage of the CMHA.

The city-run public mental health clinics have always served the city’s most marginalized individuals. Unlike privately operated community mental health centers (even nonprofit ones), city-run clinics have a mandate to serve everyone, including those whom private clinics may turn away for lack of ability to pay or due to the severity of their illness. This makes them a safety net for low-income patients who are not eligible for Medicaid and/or Medicare (including the undocumented). Privately operated mental health centers generally do not gain patient revenue from these individuals, so they have little incentive to accept them as clients.

CDPH representatives often point to Federally Qualified Health

How advocates put access to public mental health services back on the table

Centers (FQHCs), which receive federal funding and are also mandated to serve undocumented and uninsured individuals, as an alternative to city-run public mental health clinics. Advocates disagree. “There is a real limit to what [FQHCs] can do,” said Patrick Brosnan, the executive director of the Brighton Park Neighborhood Council. Brosnan said FQHCs have thin financial margins and lack flexibility to provide services that are not reimbursable by Medicaid for free. “In order to get funded, you need to have a diagnosis, you need to have a treatment plan, and those things are important, but it’s not necessarily the kind of services that everybody needs.”

Dr. Arturo Carrillo, who leads the Collaborative for Community Wellness (CCW), said that FQHCs are limited when it comes to serving individuals with severe mental illness and long-standing trauma. “When they say trauma, what we’re talking about is years, decades, of accumulated sense of loss, harm, and exploitation, and this is an issue that is more pronounced in low-income communities,” Carrillo said. FQHCs are set up to offer short-term treatment relative to the city-run public mental health clinics, which do not have limits on the number of sessions one can attend, he explained, but establishing trust and safety with patients—who are often dealing with complex trauma—takes time. The public clinic model “is set up to be a resource for communities where people can have a continuing relationship with a therapist,” he said. “FQHCs are about churning through patients.”

After the CMHA was passed in 1963, states, taking advantage of federal incentives and funding shifts, moved away from operating psychiatric institutions in favor of community-based care settings. At the same time, Medicaid and Medicare were created; Medicaid became the single largest funder of mental health services in the United States. As a result, today’s state mental health agencies rarely have direct responsibility for patient care, instead contracting services out to a variety of private entities, both forprofit and nonprofit. According to one 2006 analysis by health economists at Harvard and Columbia Universities, this fragmentation of public responsibility in caring for people with mental illness has reduced patients’ overall wellbeing.

Kennedy’s plan called for gradually replacing initial federal incentives with local (state and city) investment, but these funds were rarely, if ever, appropriated to sustain the system of adjusted dollars since their inception.

Chicago’s network of publicly funded and operated mental health clinics has contradicted aspects of national funding trends—but this has made them vulnerable “It is not stigma or lack of interest that stops community residents from seeking mental health services, but rather that residents are unable to obtain services due to structural and programmatic barriers”

community-based mental health centers that had been established from the CMHA. This left both public and privately operated community mental health centers reliant on meager state mental health agency budgets and shrinking federal dollars. Making matters worse, in 1981, thenPresident Ronald Reagan shifted states’ fiscal responsibility for community mental health services (both public and private) to shrinking federal block grants. What followed were cuts in state mental health agency budgets that occurred almost annually. State mental health agencies coped with cuts by reducing staff and services and closing state hospitals.

The switch to block grants didn’t just reduce the money available for mental health services—it also changed how it was distributed. To compensate for the annual funding decreases associated with block grants, states have shifted their mental health agency budgets to take advantage of Medicaid’s federal matching program, which decreases states’ financial responsibility for Medicaid-eligible individuals from a hundred percent to only seventeen-to-fifty percent of costs. While this budget shift increases the overall funding for Medicaideligible clients with mental illnesses, it reduces funds for services to non-Medicaid eligible clients—the primary population served by Chicago’s city-run public mental health clinics.

Currently, the majority of funding for the city-run public mental health clinics in Chicago comes from Community Development Block Grants, a federal-level Housing and Urban Development (HUD) initiative. The value of those grants has decreased seventy-four percent in inflationto neoliberal political whims. Richard M. Daley closed seven of the city’s original nineteen public clinics in the 1990s despite significant community backlash. The remaining twelve clinics were not unaffected; budget cuts forced them to cut staff and reduce services. In 2009, Daley, citing a $1.2 million reduction in state funding (which Springfield blamed on billing errors during the state’s transition to a fee-for-services system), floated the idea of closing still more clinics.

Daley never followed through, but when Emanuel took office in 2011, his first budget included closing half of the twelve clinics that remained—and the city council passed it unanimously. Chicago Reader columnist Ben Joravsky suggested that one explanation for aldermen’s acquiescence was that the budget vote coincided with the redrawing of ward maps—leading even the most progressive of aldermen to vote more out of deference to the mayor than commitment to their constituents’ interests. The impact, however, was evident. Four of the shuttered clinics were on the South and Southwest Sides. One of those was one of only two that offered bilingual services in Spanish and English.

Emanuel’s justification for the closures? Savings of roughly $3 million, or 0.04 percent of the city’s $8.2 billion budget. The administration also argued that the Affordable Care Act and expansions to Medicaid would extend insurance coverage and reduce the need for public clinics.

In 2016, another city-run clinic on the Far South Side was transferred to private management, leaving Chicago with only five publicly funded and operated mental health clinics—a quarter of what the city started with in the 1970s. I n the wake of pressures to shrink and privatize the mental health system, communities have responded in many ways. In the 1990s, a group of community advocates formed the Coalition to Save Our Mental Health Centers, which resisted clinic closures through the early 2000s. After Daley closed seven clinics, the Coalition refused to lose faith, but did switch tactics. In 2004, they turned their energy to organizing the Expanded Mental Health Services Program (EMHSP), which created an innovative model to finance and operate community-based mental health centers. Under the EMHSP, communities can place a referendum on their local ballot asking residents to vote on an increase in property taxes (approximately an extra $4 for every $1,000 paid in property taxes per year) to fund local mental health services. Communities can initiate, approve, and fund new mental health centers themselves. Bypassing the city to focus on statewide reform, the Coalition led efforts that resulted in passing the Community Expanded Mental Health Services Act in 2011, which allows any community in Chicago to create an EMHSP. To date, three communities have passed an EMHSP referendum, each with over seventy-four percent of the community voting in favor—a wide margin of approval indicating that Chicago communities are committed to helping finance communitybased mental health treatment.

At the same time that the Coalition to Save Our Mental Health Centers was working to create and pass a new funding stream for mental health services in Chicago, another group of advocates pressured the city to strengthen the city-run public mental health clinics. When threats of clinic closures began again in 2009, the Mental Health Movement (MHM), an initiative within the activist group Southside Together Organizing for Power (STOP), led a campaign of demonstrations against the closures. The MHM is composed primarily of individuals with lived experience of mental illness and consumers of mental health services.

Upon hearing the news of the Emanuelmandated clinic closings, the MHM acted quickly. On the day the Woodlawn clinic was slated to close, the group staged a protest in which more than twenty people were arrested. STOP activists chained themselves to the clinic, in some places three people deep. “It was hours before police were able to make it through a side door and arrest everyone,” said Amika Tendaji, STOP’s lead MHM organizer. “Those cases for the people who got arrested lasted way longer than they should have. It was a demonstration of Rahm’s cruelty.” Shortly after the protest, the Woodlawn clinic was permanently closed.

In 2016, without any public input or hearings, the city announced its plans to privatize the Roseland clinic, one of the six city-run public mental health clinics remaining. On a cold day in December of that year, MHM activists occupied the clinic. Ronald “Kowboy” Jackson, a MHM leader, chained himself to the clinic doors for hours until police forcibly removed him. Soon after, the Roseland clinic was privatized, displacing mental health providers and patients alike.

Tendaji said the impacts of displacement due to privatization were profound, causing disruptions in longstanding patient-provider clinical relationships. “It wasn’t just a switch in therapist,” she said. “This was their entire clinical environment.” Part of what inspired the resistance to clinic closures was a real fear among patients that they would lose therapists they had worked with for years, she explained.

Meg Lewis, director of special projects at AFSCME, the union that represents the public mental health clinic employees, says that even as therapists dealt with layoffs due to closures, they were concerned about how their clients would be impacted. “They really did not want to see people fall through the cracks,” Lewis said. “These are safety net services, and it was very unclear at that point if the city had a plan for continuity of care for people who were receiving services at the clinics.” F ollowing the closures, advocates knew they had to switch tactics once again. In 2018, in an effort to create a catalyst for mental health organizing that went beyond the issue of the clinic closures, the MHM created the Healing Village. By using an imaginative place-based organizing venue at 61st Street and Greenwood Avenue in Woodlawn, MHM advocates aimed to “challenge what mental health could be, looking at community building as an aspect of healing,” Tendaji said.

The group partnered with Project Fielding, an organization that trains women and gender nonconforming individuals in carpentry. Project Fielding volunteers had built two structures intended to go

to Dakota Access Pipeline protesters at Standing Rock., The buildings never made it, but went to Healing Village instead. The first vacant lot organizers chose for the Village belonged to corrupt Woodlawn property owner, longtime neighborhood power player, and pastorLeon Finney Jr. He complained to then-20th Ward Alderman Willie Cochran, who had initially given organizers permission to use the lot, according to the Reader. The alderman told the activists to move, so they packed up the structures and set up at 61st and Greenwood instead.

After organizers moved, Cochran drove by to tell them in person that he still did not like the space they had built. Cochran (who was under federal indictment at the time, and is now serving a year in prison for accepting bribes and misusing campaign funds) put a cease-construction order on the lot and told organizers that a bulldozer would be coming. MHM organizers stayed overnight to ensure the space would not be bulldozed.

Healing Village came at a critical time

for the community: the day after its launch, members of the South Shore community were attacked and beaten by Chicago police officers during a protest of the CPD’s murder of a local resident named Harith “Snoop” Augustus. Although the Village had planned to hold a barbecue and game day for its first event, it instead became a place where community members could decompress from the protest. The Village was filled with tears while community members held and comforted one other. A parent whose son had also been murdered by police delivered a powerful speech. “In ways that are difficult to describe, there was something more powerfully healing about being outside, being in the sun, being together with your community in that space,” Tendaji said.

Throughout that summer, community members—including those with and without mental health issues—came to the Healing Village for art therapy workshops, to tend to the garden, and to play games. Various organizations hosted resource fairs and facilitated intentional community building in the space. According to Tendaji, two mothers who lived adjacent to the block and had lost children to gun violence met for the first time at the Healing Village. Butterflies, a symbol the MHM adopted years prior, were prominent at the Healing Village, where they were attracted to the garden and a nearby field brimming with clover.

As fall arrived, and with it the first signs of another Chicago winter, organizers and community members disassembled the Healing Village. It had succeeded in educating community members about the lack of affordable services in their neighborhoods and the importance of public, rather than privatized, mental health clinics. O n the West Side, Saint Anthony Hospital’s Community Wellness Program (CWP), which includes mental health services, had also noticed a gap in mental health providers in the neighborhoods they served once the clinics closed. The CWP, which serves primarily Spanish-speaking individuals without insurance, saw that between 2012 and 2016, waitlists and referrals for individuals seeking services had nearly doubled. And after Donald Trump’s election in 2016, calls requesting appointments for mental health services at the CWP reached an all-time high. Recognizing that their program was unable to meet the needs of the communities they served, in 2016 the CWP convened the Collaborative for Community Wellness (CCW).

The CCW is a coalition of people with lived experience of mental health concerns, mental health service providers, and community-based organizations, including STOP, Pilsen Alliance, and Brighton Park Neighborhood Council. As a first step in their organizing campaign, CCW assessed mental health needs for individuals in ten high-poverty, primarily Latinx and AfricanAmerican neighborhoods on the Southwest side of Chicago.

The CCW’s research found that, contrary to a popular public narrative, it is not stigma or lack of interest that stops community residents from seeking mental health services, but structural obstacles that stand in the way of easy access. More than eighty percent of the approximately 2,850 individuals surveyed said they would seek professional help for personal problems, but reported barriers to service that included high costs, long waitlists, and lack of

6 SOUTH SIDE WEEKLY ¬ FEBRUARY 5, 2020 transportation or childcare.

With clear data showing there is a high need and desire for mental health services, especially in low-income Black and Latinx neighborhoods, the CCW began its advocacy campaign to pressure the city to reopen the closed clinics. In the fall of 2018, the MHM joined the CCW to protest and rally at the site of a closed public mental health clinic in Back of the Yards. In November, responding to pressure from CCW members who were constituents, 22nd Ward Alderman Ricardo Muñoz introduced a $25 million amendment for public mental health services. But the amendment was not included in the final budget, a signal to organizers that they needed to switch tactics and collect more city-wide data.

In 2018, Dr. Judy King, a key mental health advocate in Chicago and member of the Chicago Mental Health Board, used a FOIA request to obtain the CDPH’s list of 253 mental health service providers. Using King’s list, CCW members conducted a systematic assessment of the accessibility of the city’s mental health providers. They identified many barriers to access, most fundamentally an inability to contact providers: CCW researchers placed at least two phone calls to each organization, and approximately forty percent of listed providers (103 agencies) could not be reached, were duplicate listings, or had ceased to function. Other issues—long waitlists for services, a dearth of facilities offering services in Spanish, and limited free services for low-income individuals— overlapped with the findings of the earlier, ten-neighborhood survey. Furthermore, the data revealed spatial inequities in the distribution of mental health providers, with a markedly lower number of accessible providers on the city’s South and West Sides. I n January 2019, a ray of hope emerged for advocates who wished to move beyond simply protesting against closures to strengthening and growing the city’s public mental health system. The CCW and MHM partnered with AFSCME to lobby Alderman Sophia King, who helped advocates create and pass a resolution that established the Public Mental Health Clinic Service Expansion Task Force. The task force was directed to explore the possibility of reopening public mental health clinics.

At the Health and Human Services Committee’s hearing on the resolution, CCW advocates handed out their report

PHOTOS BY AISLINN PULLEY AND AMIKA TENDAJI

assessing CDPH’s list of mental health providers for real-world accessibility. Alderman Carlos Ramirez-Rosa cited the CCW’s research in his testimony supporting the passage of the resolution. Dr. Carrillo said the research “pushed a different discourse in the conversation that wouldn’t have been there if it were not for the work of the collaborative.” Additionally, CCW and MHM members provided key testimony during the committee hearing, and a strong community presence maintained public pressure to advocate for its passage. The measure passed unanimously through City Council, despite opposition from Dr. Julie Morita, then the city’s public health commissioner.

The resolution also mandated the task force hold a public hearing to assess the impact of the public mental health clinic closures and gather suggestions from community members on how to improve Chicago’s mental health system. The hearing was held in June 2019 at Malcolm X College with more than two hundred residents from across the city attending. For more than two hours, community residents shared oral and written testimony about how the closures severely limited their options for accessing mental health services and recovering from their mental illness. Researchers partnered with the CCW compiled the testimony into a report that was made public and shared with elected officials.

The public hearing and release of the report further increased pressure for aldermen to support public mental health services. In October 2019, aldermen in the Health and Human Services Committee, led by members of the Progressive Reform Caucus, took the highly unusual step of stalling the confirmation of Lightfoot’s nominee for Public Health Commissioner, Dr. Allison Arwady, because she had previously defended the public clinic closures in formal testimony. Arwady was later confirmed in January 2020, but only after Lightfoot, facing mounting public pressure to fulfill a campaign promise she made to reopen the clinics, made concessions that included an additional $9.3 million in mental health funding. Budget negotiations culminated in an increase of funding to upgrade the existing public mental health clinics, increase support staff, and fill clinical vacancies while prioritizing the hiring of bilingual staff. But Lightfoot’s first budget—which City Council passed— failed to reopen a single clinic.

Still, significant legislative progress has been made, not only to protect the remaining city-run public mental health clinics, but also to increase city funding and commitment for mental health services in Chicago. This likely would not have occurred without the public pressure mobilized by grassroots activists and bolstered with community-led research.

“Mental health is an approach to increase unity within our fractured communities, which have experienced violence,” Dr. Carrillo said. “If every community in the city had a community wellness program, a resource center in which people could walk in and get mental health support and a variety of family support, in a way that’s free and accessible, we would have a different city.” Though mental health clinics remained shuttered across the city, advocates will continue to push for a mental health system where high-quality and effective treatments are available to all Chicagoans, not just to those in high-income neighborhoods with private insurance.

Public mental health clinics are “the cornerstone of the mental health system, of the city’s safety net,” said Lewis. “In the same way that we need public schools and public libraries, we need a public health system. There’s other organizations that are doing great work, but ultimately we want to make sure that folks have free care, walk-in care, care in the neighborhoods where they need it.”

Dani Adams is a PhD student at the School of Social Service Administration at the University of Chicago. She lives in Pilsen and is a member of the Collaborative for Community Wellness, one of the coalitions discussed in this piece. She helped with the Collaborative’s most recent reports cited in this article, including the report assessing CDPH’s mental health provider list for real-world accessibility, and the report from public hearing testimony. This is her first contribution to the Weekly. ¬

What Happened to the Mental Health Task Force?

Public Health Commissioner Allison Arwady has proposed a new task force to “coordinate” mental health efforts

BY JIM DALEY

In January 2019, the City Council responded to pressure by community activists—who had been organizing for better public mental health services ever since then-Mayor Rahm Emanuel closed six of the city’s public mental health clinics—by establishing a task force to study where in the city clinics should be reopened. A year later, that task force appears to be defunct, and Dr. Allison Arwady, the newly-appointed commissioner of public health, told the Weekly that the Chicago Department of Public Health is forming a new one. As of this writing, none of the shuttered mental health clinics are slated to be reopened. Advocates have criticized the original task force’s accomplishments, and question the motives behind establishing a new one.

4th Ward Alderman Sophia King drafted the resolution that established the 2019 task force, and forty-six of the Council’s fifty aldermen co-sponsored it. The legislation mandated that the task force include two representatives of CDPH, two from AFSCME (the union that represents public mental health clinic workers), and two from the Chicago Community Mental Health Board (an advisory body to the CDPH), as well as two aldermen from among those who represent wards where clinics were closed. The task force was charged with studying “which community areas shall be prioritized for reopening mental health clinics” and making recommendations for “expanding and improving services at existing facilities.” The legislation also directed the task force to hold a public hearing, which it did at Malcolm X College on the Near West Side last June. (King, who represents parts of Hyde Park, Kenwood, Bronzeville, and the South Loop, declined the Weekly’s request for comment.)

Arwady said in an interview that the new task force will be run out of the mayor’s office, and will focus on coordinating the city’s assorted efforts around mental health. “There will be an overarching focus on mental health equity,” with subcommittees to address clinical spaces, diversion, and crisis intervention, she said. “There will be aldermen involved in it, there will be community folks involved in it, there will be providers, there will be people with lived experience.” She added that the new task force will replace the 2019 one, adding that the previous task force “is not active at the moment.”

“As a body, the [2019] task force didn’t accomplish anything,” said Dr. Judy King, one of the CCMHB representatives on the task force, in an email to the Weekly. “The individuals initially invited to the task force,” per the resolution, “met as a group once on May 16, 2019. The public was excluded. Two of us objected. It was the only meeting.” Dr. King added that the June public meeting “was not an official hearing of the task force. We never voted on it.”

More than two hundred community members attended the public hearing, where twenty-five individuals testified to their experiences with mental health services. Attendees also provided written testimony and filled out a survey about their experiences. Dr. Leticia Villareal Sosa, a professor of social work at Dominican University in suburban River Forest, moderated the hearing and drafted a report based on its findings.

The report identified barriers to accessing mental health services that included cost, lack of insurance, long distances to public clinics, and poor treatment from providers. The report also

8 SOUTH SIDE WEEKLY ¬ FEBRUARY 5, 2020 detailed the “systemic harm” that historical and ongoing trauma has on underserved communities. Recommendations included increasing funding and moving beyond solely using block grant funding for public clinics; expanding services to underserved communities on the South, West, and Southwest Sides of the city; and increasing access to trauma-informed mental health services (trauma-informed care describes an approach to care that is sensitive to the impact trauma has had on patients’ wellbeing).

Villareal Sosa said that copies of the report went to the task force and to the Collaborative for Community Wellness, a collective of mental health providers, community organizations, and residents. “The aldermen certainly have used the report,” in particular to leverage opposition to Arwady’s appointment in October 2019, she said. “Unfortunately, as far as I know at this point, the [CDPH] has not used…the report to inform any of their decisions.”

When asked how the recommendations from the 2019 task force report would be implemented by CDPH, Arwady said she “did not have specific pieces in front of me, but we are certainly taking input from a lot of directions; we have been and continue to do so.” She added that the task force was not organized by CDPH, and said questions about it would be best directed to the City Council.

Arwady also said that CDPH conducted “a lot of structured interviews and conversations with folks across Chicago who work in different settings.” She said the department interviewed community organizations and patients who are served by public clinics to identify strengths and gaps in the mental health system. “All of that data was used to help develop” the mayor’s plan to address deficiencies in public mental health, which included a pledge to double spending on mental health (an increase of about $9 million), provide trauma-informed services, and improve outreach.

The CDPH and City Clerk’s office responded to public records requests the Weekly submitted for materials related to the public hearing by saying neither office had any notes, transcripts, or other documents from the meeting. Dr. King submitted a FOIA request to CDPH regarding fifty structured interviews the department conducted with stakeholders between June and October 2019 to develop its mental health framework, and said she was similarly rebuffed, receiving simply a list of stakeholders but none of their answers.

“I think a lot more could be done in terms of really acknowledging some of the findings of the report,” Villareal Sosa said. “I would like to see more inclusion of this [community] perspective by the CDPH in terms of their decision-making around services. I think it could be used in a wider, more intentional way.”

Patrick Brosnan, the executive director of the Brighton Park Neighborhood Council, one of several community groups that has advocated for expanding public mental health access, said he thinks the 2019 task force was not “really invested in” by the CDPH or taken as seriously as it should have been. “That’s too bad, because I think that there’s a lot of good people, including people who used the public clinics, whose opinion should be taken into consideration when we’re making decisions about funding and quality.”

“I hope that the new task force is not just going to be filled with people who are just going to be providing some sort of intellectual or community currency to the existing plans without actually critically examining the system that we have in place and looking at the gaps,” Brosnan said. “And I hope there’s people on the task force who believe in the public system, and not just people who believe that privatization is the way to go.”

The Future of Public Mental Health?

City Public Health Commissioner Allison Arwady says she is “confident” the city is heading in the right direction to deliver mental health services

BY JIM DALEY I n January, the City Council confirmed Dr. Allison Arwady as Chicago’s new commissioner of public health. Arwady had been the acting commissioner after Dr. Julie Morita resigned from the position in June 2019. Prior to becoming commissioner, Arwady was the Chicago Department of Public Health’s (CDPH) chief medical officer for four years; before that, she worked for the Centers for Disease Control and Prevention as an Epidemic Intelligence Service officer.

Last October, after Mayor Lori Lightfoot formally nominated Arwady for the position, aldermen in a Human Relations and Health Committee session blocked her confirmation. Members of the City Council’s Progressive Reform Caucus raised concerns over the closures of six public mental health clinics that occurred under the Emanuel administration, noting that Lightfoot had made campaign promises to reopen the clinics, but later backed away from the pledge. Arwady had in the past made statements supporting the closures, and when the objecting aldermen pressed her on the issue, she reiterated her opposition to reopening the clinics, citing the fact that the remaining five public clinics are not operating at full capacity.

The Weekly discussed city mental health services with Arwady after the full City Council confirmed her appointment. The interview has been edited for length and clarity. How will the Chicago Department of Public Health ensure that patients with mental illness know where public clinics are? Number one is that we have some real money for promotion—everything from anti-stigma campaigns [to] making sure that we’re getting information out broadly about mental health and also about our own clinics. We’ve dedicated hundreds of thousands of dollars to print material and other media ways of raising awareness, but we’re pairing that with new staff whose job will be just to do outreach around and for our CDPH clinics. We have three new positions we’ll be hiring this year. Our goal is to make sure that the CDPH clinics are part of this larger system in Chicago, so we want to think about building new linkages and

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partnerships between our clinics and other community assets, [and] doing training— for example [in] Mental Health First Aid in the community served by the clinic.

Critics say the clinics are uninviting to patients, and that this issue may contribute to underutilization. Does CDPH have plans to make public clinics more welcoming to patients?

Funding has always been an issue related to mental health broadly. Even where we look historically, some of that reason was because of the major state funding cuts that happened around mental health. So, the fact that the mayor in 2020 more than doubled the mental health funding, really gave us flexibility in terms of what kinds of investments we need to make. One of the really concrete things is physical improvements to our site. We know that we have really dedicated providers and professionals, but [there are] basic things like if our signage is not up to date, if our clinics are not welcoming in terms of creating a good therapeutic environment, [these are] all things [we] can do to make sure people feel comfortable in a setting where they’re going to support their mental health.

SHANE TOLENTINO

The violence prevention teams here at CDPH for a number of years have been interested in how to do this better. But I think frankly with the new mayor coming in, there was a lot of interest in how can we turn this concept into reality. For example, here at CDPH we did a trauma-informed physical assessment of all of our clinics. We looked at language and have done trainings internally. At the mayor’s request, starting last summer, we started with partners developing these kinds of trauma-informed trainings that aren’t just for our health department staff, but were available for city employees who were working with youth in the summer. And it’s something we really want to build on this year, so we’re interested in things like not just clinical settings but other settings in which people may have mental health issues—or if not formal mental health issues, difficult experiences in their life [that may need support].

This goes far beyond the clinic. A concrete example where we think about young people [are the] Chicago Public Schools, which are very interested in this and doing work around [trauma]. But we’re also planning to do outreach to coaches and athletic and recreational settings where kids may know those folks and sometimes issues may come up.

I really see this trauma-informed approach as something that is not just for the department. I’m interested in expanding this more broadly and having it be something that we’re talking about far beyond CDPH, across the city and outside of city government to all the settings in which people are trying to help other people.

How will CDPH ensure continuity of care for patients who access public mental health clinics?

One of the problems that we see is that right now there are people getting mental health care primarily through emergency departments. Especially people with more severe forms of mental illness, [they’re] frankly rotating through the emergency department [because] they’re in and out of crisis. That is the opposite of a good continuity of care plan. We’ve been working with partners across the city to make sure we really are building a network of mental health care. Not only are we investing in outpatient clinics, but we’re creating for the first time some violence prevention programming that will really make sure people who are victims of violence—and their families and community members— if there are mental health needs there, we will use the opportunity for outreach. We’re investing for the first time in crisis prevention and response teams to address the issue that people may not have a real care plan. It will be an opportunity to bring mental health treatment out of the clinic and to people with some of the highest needs.

Do you have any plans to work with the various community groups that sprang up to fill the mental health care void that occurred after the 2011 closures? across the city, and to the other publicly funded mental health sites. Whether that’s our Federally Qualified Health Centers, whether that may be a school-based clinic, there’s a lot of different settings. We really want to make sure that we’re doing a much better job of coordinating all those resources. Mayor Lightfoot’s 2020 budget allocated an additional $9.3 million to fund new mental health initiatives. How will you ensure accountability in terms of how that money is spent?

The Health Department has a lot of responsibility for accountability when we work with community partners. For example, we receive a lot of federal grant dollars around things like immunization or tuberculosis, and we often are contracting with community partners to ensure that the goals the city made [are met]. And so, we have good systems and processes in place around things like reporting, what kind of data will folks be providing back, things like fiscal oversight, the basics of ensuring that you're being a good steward of this funding. We will use a lot of those similar mechanisms with this funding. I'm confident that it will be used well.

My hope is that people will be excited about these new investments and really looking forward to seeing improvements. At the end of the day, we’re all interested in improving and getting more people the care they need.

Jim Daley is the Weekly’s politics editor. He last wrote about holiday baked goods from around the South Side for the 2019 Holiday Issue. ¬

Absolutely. One of the things that’s most important to understand is that the cityfunded clinics play an important role, but [that is] a really small role in terms of numbers. We want to grow that, but even at the peak we were maybe serving five percent of the adults [who were] getting mental health care. So, it’s really worth thinking about really building a network and that’s our goal: coordinating mental health across the system absolutely means working with these community partners. My team has been doing a lot of work over the past year or so, reaching out to community mental health clinics, some of whom are working in the spaces where there were previously CDPH clinics, [and] many of whom are working