Thanks to the Affordable Care Act’s expansion of Medicaid, many more Chicagoans will have access to mental health care in the near future. But ironically, the increased availability of health insurance could starve Chicago’s six remaining public mental health clinics of resources — and cause havoc for the city residents who depend on them.
In addition to serving those without insurance, the clinics have long provided care to locals with insurance who could have gone elsewhere, but saw the facilities as their most accessible and supportive option.
Over the past year, however, city officials reportedly started directing people with existing insurance to private or county mental health providers instead. And as formerly uninsured Chicagoans get new coverage from the Affordable Care Act, some say they, too, are being discouraged from attending the city clinics. While they theoretically could get care elsewhere, mental health advocates say that in reality, many are likely to fall through the cracks rather than moving to a provider they don’t trust.
Members of the grassroots coalition Mental Health Movement say that starting in 2013, public clinic staff members began pressuring uninsured clients to enroll in CountyCare, part of the state’s expanded Medicaid program. In turn, the clients say they’ve been told that once they have CountyCare or other insurance coverage, they will no longer be able to receive care at the public clinics.
A March 14 memo, obtained by In These Times and sent from Chicago Department of Public Health deputy commissioner Edie Bamberger, says that people with insurance and mental health needs “will be educated” about the “benefits of accessing integrated health care services through their insurance network,” which would not include the city clinics. If the client wants to attend a city clinic, the memo directs, public health staff should consult the clinic director; such requests will be considered on a case-by-case basis. People already attending a city clinic will be allowed to continue attending the clinic once they get insured, it continues, but the clinic director “must be made aware of this request.”
In other words, insured people who are already clients won’t be expressly prohibited from attending the city clinics, but staff are supposed to make an effort to divert them to other providers. And new insured clients won’t be expressly prohibited from the public clinics, but their attendance will have to be specifically approved. Previously, the DPH had a more strident ban on insured people obtaining services from the clinics; the shift in policy apparently came after the department faced a wave of criticism.
On April 2, aldermen who are part of the Chicago City Council’s Progressive Caucus will introduce a resolution calling for public hearings before the Council’s Health and Environmental Protection Committee on the state of mental health care in the city. At a press conference at City Hall on March 27, Aldermen Robert Fioretti and Scott Waguespack explained that the issue of whether and to what extent the public clinics will accept clients with insurance would be a central talking point at those hearings.
Chicago resident and Mental Health Movement member Horace Howard, who attended the press conference, says he has been receiving services from the public Greater Grand Boulevard clinic on the South Side since the Woodlawn clinic closed in 2012; he was part of the high-profile occupation at Woodlawn in April of that year. He claims that after several months going to Greater Grand, he still hasn’t been able to get an appointment with a doctor. (Clients at the public clinics typically meet with therapists on a regular basis and have less frequent meetings with psychiatrists.) But Howard still feels at home at the public clinics and doesn’t want to switch to another provider.
“We’re being kicked out because of managed care,” says Howard, 56, sporting a T-shirt bearing a portrait of Helen Morley, the Mental Health Movement member who died in 2012 of heart complications after famously telling Mayor Rahm Emanuel, “If you close my clinic, I will die.” Howard says the city should reopen the Woodlawn clinic “in memorial to Helen.”
Mental Health Movement member Ronald “Cowboy” Jackson says he knows several former clients of public clinics who were told since obtaining CountyCare coverage that they should go to the county hospital in Chicago instead. But people have had trouble getting appointments at the over-crowded county system, Jackson says; as a consequence, they have grown frustrated and stopped trying to get care.
Alderman Fioretti argues the changes to the system are only making it harder for Chicagoans in need. “They’re creating confusion out there,” he says. “For years, people have been going to these clinics. Now they’re being told they can’t … it’s adding more confusion, more disorientation for people in need of care.”
Because the Chicago Department of Public Health has so far not joined a healthcare provider network, including CountyCare, the public mental health clinics cannot be reimbursed under Medicaid as the state switches to managed care in coming weeks, meaning their funding will be put in danger. Just why the city hasn’t joined a network yet, however, remains unclear. (The department did not respond to an interview request for this story.) The March 14 memo claims that the department is encouraging insured people to go elsewhere because it “remains focused on preserving our limited capacity to serve uninsured residents with more limited options.”
A fact sheet handed out at the press conference rebuts that statement, though. It reads:
Turning away people with insurance means turning away money — revenue that could help strengthen the city clinics for everybody. Turning away that revenue will lower the number of people at the city clinics, lower the funding coming into them and likely end up causing more of them to close.
Mental health and labor advocates — including AFSCME, the union representing public clinic staff — fear that city officials are trying to divert insured clients from the remaining clinics because they ultimately want to close them. They suspect that reducing the client population and the number of employees at the clinics is a way to lay the groundwork for shuttering them altogether.
“Once you have no one going to the clinic because they don’t accept insurance, then you can justify closing it because you have an empty building,” says N’Dana Carter, a leader of the Mental Health Movement.
Fioretti said that in closing and sidelining the clinics, Chicago’s leaders “throw our hands up and say we’re not going to do this service anymore.”
He and other aldermen have apologized for voting in 2011 for Mayor Emanuel’s 2012 budget, which closed six of the city’s 12 mental health clinics. “We made a big mistake,” he says.
Though Emanuel initially claimed the clinic’s closures would lead to an estimated $2.3 million in savings, Fioretti and his fellow progressive aldermen argue that this number “failed to account for the additional costs of increased emergency room visits, hospitalizations, police interventions and incarcerations.”
Alderman Waguespack says he has been disappointed by the city’s misplaced spending priorities. “You look at an $8 billion budget, and we can’t find $2.3 million?” he scoffs. “The city says we’re going to take away the safety net for such a small [savings]?”
Jackson, meanwhile, points to the mid-March standoff along Lake Shore Drive as an example of how unaddressed mental health crises can cause widespread trauma and cost taxpayers millions down the line. In that incident, a man with a history of mental illness who was suspected of killing his wife engaged police in an eight-hour showdown, closing off the major city thoroughfare along with nearby businesses.
“There’s a real effect on families and communities and schools” when people lack mental health care, Jackson says.
At a March 31 seminar on incarceration called “The $2 Billion Question” sponsored by the Chicago Community Trust and other groups, various speakers agreed that unavailable resources can have an enormously detrimental impact on individuals and their networks. They described, for instance, how a lack of mental health care can lead to the imprisonment of people who really need treatment, not punishment.
“We have a growing mentally ill population, both at the county and state level, that we’re struggling with how to deal with,” says Cook County Sheriff’s senior advisor Cara Smith.
At the seminar, she gave one example of the type of situations that land people with mental health issues in jail: A man grabbed a set of sheets or towels from a North Side Walgreens, walked out the door and told the clerk to “charge it.”
“$29.99 was the value of the item that he did not successfully steal,” Smith recounts. “And he was with us [in jail] for quite a long time … He had a very significant criminal history, mostly committing crimes of what I would call ‘survival’ — criminal trespassing, retail theft — things to get shelter.”
“Because of the lack of services in the community, I can sit here and say many people are better off in the jail when they have severe mental illness because they’re getting care,” Smith continues. “Which is an awful thing to have to say.”
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