Mental health dominates city budget discussion

*This article is courtesy of the Social Justice News Nexus where it first appeared.
Chuy Campuzano an advocate with the Mental Health Movement in Chicago. (Flickr/Mario Garcia-Baeza)

Chuy Campuzano is an advocate with the Mental Health Movement in Chicago. Photo taken on April 30, 2012. (Flickr/Mario Garcia-Baeza)

Ebola readiness was the marquee topic at the Department of Public Health hearing on the proposed Chicago budget at City Hall on October 28. But the topic that drew the most attention from Aldermen, and likely from those in attendance too, was the city’s budget and plans for mental health care.

Aldermen grilled department commissioner Bechara Choucair about the proposed budget numbers as relates to the city’s public mental health clinics, and asked often-repeated questions about the impacts of closing six of 12 clinics in 2012.

Choucair reported that the public clinics are serving about the same number of people they served before the closings – between 2,100 and 2,400. And, he said, thousands more Chicagoans are getting mental health services thanks to “targeted investments” in partnership with private providers.

This includes a $1.5 million investment with eight agencies to offer more psychiatric services; a $4 million investment with the Illinois Children’s Healthcare Foundation to provide mental health services to children on the South and West sides; and a $4.1 million federal grant for integrating substance and mental health care that the department said has served 4,500 people since 2012. The city is also working with four social services agencies to help students deal with the impacts of violence and trauma.

Activists with the Mental Health Movement and the AFSCME labor union have said the city numbers are misleading because the public clinic caseload was much higher in the year before the closings; by the time of the closing the city had “closed” cases that they maintain represent people still needing services. There were 2,798 clients who had an appointment at the clinics in the year before the closures, according to the city.

Aldermen also asked Choucair why the city has not enrolled in managed care networks that would enable the public clinics to receive Medicaid reimbursement. An ordinance that would pave the way for such enrollment has been drafted but not introduced in City Council. Choucair said city officials are in “active discussions” about enrolling in managed care networks.

But he stressed that the six clinics are intended for the uninsured, and those with insurance or Medicaid coverage are encouraged to look for private providers. He said existing clients at the clinics are allowed to remain even if they have acquired Medicaid coverage, and new clients with Medicaid who want to go to the clinics will be considered on a case by case basis but advised to go elsewhere.

Choucair noted that 167,000 Chicagoans gained new Medicaid coverage under Medicaid expansion, many of those people with mental health needs who are now covered for mental health treatment.

Choucair and Aldermen discussed the shortage of psychiatrists within the city mental health system. There are currently four psychiatrists serving about 2,400 patients across the six clinics, and one of them is retiring. Their hours are relatively limited, with two working only on Fridays. The city’s goal is to have six full-time psychiatrists, Choucair said, and the city is actively recruiting but hampered by a nationwide shortage of psychiatrists. The city recently increased the salary being offered to $96 an hour from $87, for an annual salary of about $174,000, in hopes of being more competitive with the private sector.

Aldermen also asked about the city’s pilot program to improve police interactions with mentally ill residents. Aldermen and groups including ONE Northside have called for expansion of the Crisis Intervention Team (CIT) program, which trains officers to identify and deal with mentally ill people. Advocates and some officers say there is a backlog of officers wanting to take the training but not being scheduled. They say the funds are available through a federal program. Meanwhile Choucair explained the city’s investment of $100,000 in a pilot program wherein a mental health professional from the South Side-based group HRDI will be on call 24 hours a day to respond when police call with a mental health crisis in three specific police districts (the 2nd, 3rd and 7th).

Alderman Scott Waguespack expressed reservations about how the city is addressing the police issue. “They don’t have time for someone on call to show up,” said Waguespack. “The timeline is very short at a time when you need to figure out what’s going on with that patient.”

Health deputy commissioner Joe Hollendoner said that police are likely to send mentally ill people to a hospital or local detention facility, preferably a hospital, and the HRDI staffer will meet them there.

Choucair said that, “Internally I feel good about where we are, except for the psychiatrists” shortage. And he said the city’s investment with private programs and the Medicaid expansion mean that the city’s mental health care situation today is much better than it was three years ago.

Aldermen asked the department for more numbers to consider before they vote November 5 on the proposed 2015 budget, which includes $9.5 million and a total of 69 full-time staff positions at the mental health clinics. Among other things, Aldermen asked for a breakdown of how $500,000 diverted from the closed clinics to private federally qualified health centers each year has been spent, how an increase in private contracts in the department in general has played out, and how a “realignment” of management positions works.

The attention devoted to mental health during Tuesday’s hearing – while issues including diabetes, smoking and petroleum coke pollution got more fleeting attention – shows just how serious Chicagoans and Aldermen consider the issue to be. Alderman Brendan Reilly made that clear when he said that even with budgets tight, the city should consider spending more on mental health, specifically to make sure to fill psychiatrist vacancies.

“This Council would support increasing the budget for those positions,” he said. “To serve our absolutely most vulnerable citizens.”