Breakdown

Claire Hungerford

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The communal dining room and kitchen at Northwest Mental Health Center has long been a fixture of programming at the clinic. Rosa Torres, who has worked as a clinical therapist at Northwest for 21 years, recalls how busy the kitchen used to be. Many of the clinic’s Psychosocial Rehabilitation and Support (PSR) programs were conducted here, where patients received instruction in meal planning and food preparation. But in recent years the kitchen has been used less and less, since funding for the meals has long since disappeared. Now Torres and her remaining colleagues, who have to wear many hats in their work as therapists and administrators, take turns providing money out-of-pocket for groceries.

Those in Torres’s field use PSR to refer to many of the programs that serve as material and emotional support infrastructure for adults suffering from mental illness—whether chronic or acute. Included in the health center’s PSR offerings are the various group therapy sessions held by clinicians, such as the Spanish-speaking women’s group that Ana Navarro has coordinated for over a decade.

The announcement of Chicago’s 2012 fiscal budget last October sealed the fate of mental health care across Chicago. The city’s outlined plan is to consolidate the clinics–transferring, for example, responsibility for the entire Back of the Yard’s patient population to the Southwest Side’s Greater Lawn Public Health Center. In the context of the prolonged and dramatic decline in mental health resources in Illinois, the measures will prove another painful blow to an already broken system, suffering from a lack of funding and legislative protection, which used to provide some insulation for Illinois’s mentally ill against homelessness and unemployment.

Northwest, which is located in Logan Square, will be merging with the South Side’s Lawndale clinic. Five other clinics will close their doors: Rogers Park, Woodlawn, Auburn Gresham, Beverly-Morgan Park, and Back of the Yards. Chicago will soon be serving upwards of 5,100 patients with a mere six operational clinics–a third as many as were open at the start of Richard M. Daley’s tenure. Since 2009 funding has seen a 36 percent reduction, a cumulative loss of $33.5 million.

The current mental health system has its origin in the Community Mental Health Services Act of 1963 (CMHA), signed into law by President Kennedy. CMHA called for the closure of state hospitals, while providing funding for mental health care at a local level through federal grants. With federal support, community health centers were able to serve as effective primary care providers for the mentally ill. This legislation was part of a national shift–both in public opinion and the field of healthcare–away from health policy that saw inpatient and institutionalized care as the best method of treating mental illness.

Over the past half-century, federal allocations have been starved and legislation distorted into what Mark Heyrman, a professor of law at the University of Chicago who specializes in mental health advocacy, calls “a variety of un-funded, uncoordinated services.” The central deficiency in many respects is a severe lack of human and financial resources, a fact hardly disputable when compared to the Illinois of yesteryear. According to Heyrman, there were 35,000 beds in Illinois available to patients in both outpatient and institutional facilities 60 years ago. Today there are 1,300.

Heyrman believes that successful mental health programs exist–they just haven’t been implemented on a large enough scale in Illinois. One such program is the Assertive Community Treatment, or ACT model. Under this system, patients are provided  “the multidisciplinary, round-the-clock staffing of a psychiatric unit, but within the comfort of their own home and community.” According to the National Alliance on Mental Illness, ACT recognizes that “individuals with the most severe mental illnesses are typically not served well by the traditional outpatient model, with various services that the patient must navigate on their own.” Throughout Illinois, ACT is almost nowhere to be found, since it is simply too costly for health providers to offer. Heyrman notes that the number of ACT teams in the state “has declined precipitously as providers have increasingly had to secure funding [outside of their budgets] in order to afford it.”

The consequences of this dearth of resources are perhaps nowhere quite so visible as in city hospitals. Urgent care facilities are increasingly saddled with the severely ill–those who struggle with cyclical but nonetheless debilitating symptoms–and the newly unemployed or homeless. The latter’s need for mental health services would ideally be mitigated by the network of support–as simple as food and cots–that Torres and other long-time clinicians know to be very effective in the treatment and prevention of mental illness.

As the mental health clinics close, these preventative resources–and their benefits–will be in jeopardy. Torres is still shaking her head over the proposal:, “It doesn’t make sense any which way. From a [fiscal] perspective it doesn’t make sense, because of the increased cost of hospitalizations, incarcerations…If people aren’t stable they’re going to lose their jobs, their houses…You’re denying very basic rights.”

For patients, clinicians, and activists alike, the expected drop in quality of care is an unending source of disappointment and frustration. But the defunding is, distressingly, not simply a matter of money drying up. To make matters worse, some say the loss of state dollars is due to gross financial mismanagement.

In February 2008, Illinois’s Department of Human Services was notified of a transition from a state system to a computerized bill payment system provided by a subcontracted tech company, CERNER Corporation. The system was revealed to be largely nonfunctional, as shown in documents obtained through the Freedom of Information Act according to the Coalition to Save Our Mental Health Centers. In the months after its implementation, an overwhelming 95 percent of bills submitted to the state government by the new software were rejected on grounds of missing data.

Because the claims couldn’t be processed, the state’s Division of Mental Health elected to withhold the funding necessary to cover the operational costs of clinics like the soon-to-be terminated Woodlawn Mental Health Center. A spokesman for the Department of Human Services, Tom Green, stated that the decision to cut funding on the order of $1.2 million was based solely on the city’s inability to provide billing data.

Michael Snedeker, who has worked for the Coalition to Save Our Mental Health Centers since 2008, recounts an incident that could be an omen of what’s to come: when the roof of the Rogers Park Clinic partially collapsed last year, its patients were temporarily directed to the nearest operational mental health center, North River, where they remained under the care of Rogers Park staff. Roughly half of those patients never sought treatment at the stopgap location.

Snedeker regards this figure as a generous estimation of the number of patients who will make it through the transition. For many of the nearly 2,600 current clients whose local clinics will be shuttered, the forced relocation is more than a logistical inconvenience. A longer commute for patients means a hike in the cost of treatment–especially for those who have been unable to secure coverage and who have long relied on the unflagging generosity of therapists like Torres and Navarro.

“We took it as a betrayal,” Torres says of the budget. “They’re annihilating health, period. Not just the clinics. And especially for Ana [Navarro]–she’s been here 27 years, she’s from this community, born and raised, people from her church come here. So it’s also a betrayal of the community, not just of the clients but of their families too.”

Other patients face the possibility of arriving at a new facility where there are no therapists who speak their language. Meanwhile, relationships that have been built over years are likely to end. As Navarro explains, “We’re merging with Lawndale, but that doesn’t necessarily mean Rosa and I will be going to Lawndale.” The city’s transition team hasn’t yet told them when their clinic will close or where they’ll be reassigned, she says.

Torres is most distressed by the uncertain fate of her clients: “We’re staff–we’re used to being tossed around like foster children. But the clients? It’s very humiliating for them…they just want to send ten of them here, move ten over there. And will it be today, or tomorrow, or a week from today?”

Patients’ prospects for dependable treatment will remain bleak as the slated closures take effect, possibly as soon as mid February or March, according to a Greater Lawn clinician. Torres states that just under 40 therapists will be terminated, a figure that does not include the psychiatrists and other clinic staff who will be laid off.

“In terms of the physical size of Chicago alone, six centers is pretty pathetic,” Snedeker says. “And as to the claim that services will be improved, I just don’t see how that’s possible with the reduction in staff that’s taking place.” He foresees a grim landscape of meager mental healthcare resources, which he likens to the food deserts that also plague expanses of the South Side. “Conceivably very soon,” he portends, “in these neighborhoods where resources have been so depleted, a near-absence of care could definitely come about, and I think to a very sobering effect.”