Fighting Privatization Is Good for Mental Health

Chicago has not opened a public mental health center in three decades. In 2012, former Mayor Rahm Emanuel closed half of the city’s dozen public clinics. Community groups fiercely opposed the closures and called for their reopening under the banner of the Mental Health Movement.

In 2019, Emanuel’s successor, Mayor Lori Lightfoot, campaigned on reopening the centers, but she ultimately reneged in favor of the private sector, stating: ​“There’s lots of different service providers that frankly did and do a better job.” In reality, many patients fell through the cracks, received worse care or could not access care at all.

Just as bookstores cannot replace libraries, a system of private clinics cannot replace public mental healthcare.

Research by the Collaborative for Community Wellness (CCW), a coalition of more than 70 organizations advocating for accessible mental healthcare, found that, when residents attempted to call private nonprofits for appointments (the same nonprofits directly funded by the Chicago Department of Public Health’s ​“Trauma-Informed Centers of Care” model), 17% did not serve undocumented residents and 25% did not serve uninsured people. Less than half offered free services. Other callers reported barriers to receiving care, including lengthy wait times, confusing phone systems and high costs.

A 2023 report from AFSCME Council 31 found that ​“cost is the single greatest obstacle for individuals who need treatment.” Fewer than half of city-funded private agencies offered no-cost service, while all of Chicago’s public mental health centers are free for city residents.

Previously, the CCW had found such burdens fall starkly upon racial lines, with Black and Latinx communities facing gaps in accessing care at a far higher rate than their white counterparts.

Following the 2020 racial justice uprisings, a coalition of organizing groups across Chicago launched the Treatment Not Trauma campaign to advocate for public mental healthcare and alternatives to police-based emergency response systems. 

Now, Chicago is demonstrating what is possible when neoliberal service delivery models are rejected for the public good. 

Working in the mental health field, I know from personal experience that access is often a barrier to treatment. The need for more accessible care is universal across Chicago.

Beyond the CCW’s reports, research examining differences in working and treatment conditions between public centers and private nonprofits is sparse. It’s important to remember that clinicians’ working conditions are clients’ treatment conditions, and what research does exist looks at the challenges that violence prevention and street outreach workers face — with recommendations for more sustainable funding, higher wages and improved work-life balance. 

In 2021, Kathryn Bocanegra, an assistant professor at the Jane Addams College of Social Work at the University of Illinois, Chicago, was inspired to lead a comprehensive study on working conditions for violence prevention workers in nonprofit settings, driven by her own experiences working at a nonprofit agency. Relying on private agencies is bad not only for patients, but for the dedicated clinicians who work at them. 

Chicago’s nonprofits offer inconsistent to downright nightmarish working conditions, largely because of the lack of unionization and a precarious funding structure — not to mention decades of the mental health profession embracing an anti-union mindset that seeks to separate care workers from the rest of the working class. Private agencies in Chicago pay therapists up to $20,000 less than they would get in equivalent positions in Chicago Department of Public Health (CDPH) clinics (which are covered by an AFSCME union contract), leading to higher staff turnover and disruptions in continuity of care. 

Many of these private nonprofit agencies receive public money to offer free or low-cost counseling services — including, for example, Community Counseling Centers of Chicago, which failed to pay workers on time throughout 2019. It was targeted with a probe into its finances by the Illinois attorney general, which led to the firing of its CEO. 

Another nonprofit community mental health counseling center, Thresholds, engaged in such egregious union-busting behavior that it inspired a 2023 city ordinance that prevents city-funded nonprofits from union busting on the taxpayer’s dime. 

Then there’s Howard Brown Health, where workers won their first union contract in May — after two years of organizing and bargaining, facing down mass layoffs and filing multiple charges of unfair labor practices.

It’s crucial we stand in solidarity with these workers and advocate for their rights, while also demanding the hundreds of millions of public dollars CDPH sinks into the nonprofit system be used to expand care at public CDPH centers, which are already unionized.

Public centers are also more transparent. Contracts, budgets and even emails between management and city leaders are accessible through Freedom of Information Act requests. The same cannot be said for the vast network of nonprofit social service providers, and Chicago’s most vulnerable deserve basic transparency and accountability.

Dedicated community leaders and persistent organizing helped make Chicago’s new expansion of public mental health services a reality. For more than a decade, community leaders have been fighting against the disinvestment in public mental health, such as by occupying the Woodlawn Mental Health Clinic, closed in 2012.

Treatment Not Trauma has led by organizing community conversations across the city and actively encouraging current and former patients, caregivers and workers to speak out. Through such organizing, we are building a mental healthcare system with care — not policing or coercion — at the center.

In 2022, the campaign ran a successful non-binding ballot referendum in Chicago’s 6^th, 20^th and 33^rd Wards, where 93% of voters supported Treatment Not Trauma’s vision for mental healthcare. That vision is beginning to be put into action. 

Organizers with Treatment Not Trauma played a significant role in building support for Johnson’s campaign during the 2023 mayoral race, after he promised to implement key policies. Since, we’ve made major strides as the city has expanded 911 alternative response teams to send social workers (instead of armed police officers) to help in mental health crises. Johnson’s 2024 budget includes $15.9 million earmarked to double nonpolice emergency response.

The recent expansion also includes a dramatic increase, not seen in decades, in hiring clinicians in the CDPH system. Under the previous health commissioner, positions stood vacant; under Johnson appointee Dr. Olusimbo ​“Simbo” Ige, hiring is ongoing, with more than 20 new clinicians brought on to staff the reopened centers.

We also desperately require more street outreach workers, the frontline workers who directly respond to shootings and intervene to prevent violence. The city’s current hiring portal is cumbersome and needs updates to allow workers with the most direct knowledge and understanding of community violence to do the work that can save lives — regardless of education level or conviction record, and with livable salaries and benefits. 

The struggles around inadequate access to mental health services and the dangerous involvement of police in mental health calls is not unique to Chicago. When developing what Chicago’s policy should look like, Treatment Not Trauma leaders, including 33^rd Ward Alderwoman Rossana Rodriguez Sanchez, toured programs in other cities, including Denver and Portland, Ore. Because crises happen everywhere, the focus on police alternatives and investing in public mental health infrastructure can help serve as a model for cities across the country. Philadelphia has its own Treatment Not Trauma campaign working to provide mobile crisis services, and even New York City — which is much larger and does not have a progressive mayor — is working to expand nonpolice responses to some 911 calls. 

There is no better way to fight sadness, anxiety and despair than winning the care we all deserve.