‘Falling through the cracks’

Mental health clinic protest

Photo by William Camargo

Members of the Mental Health Movement, a coalition led by Southside Together Organizing for Power, gathered outside Mayor Rahm Emanuel’s office on March 10 to protest the city’s closure of six mental health clinics in 2012 and to demand more services.

The Chicago Department of Public Health closed half of its 12 mental health clinics in 2012, generating a major outcry. The closures have continued to be the subject of vocal protests held at City Hall and a prominent issue in general, including in the 2015 mayoral race.

Clients, advocates and AFSCME Council 31, the union that represents clinic staff, allege that hundreds of clients have “fallen through the cracks” after the closures. The health department said clients were referred to the remaining public clinics or other mental health providers at private or county facilities.

Interactive map of closed clinics

Click for an interactive map of Chicago’ s public mental health clinics, 2011-2014

Data obtained from the Chicago Department of Public Health through Freedom of Information Act requests show that at the time of the closures there were 2,798 clients in the city’s public mental health clinics. Of those, 429 were referred to external providers, and 2,362 went to the remaining public clinics. Of the 429 clients, 63 later returned to the public clinic system. The total client caseload at the public clinics has dropped every year since, and by September 2014 there were a total of 998 clients receiving services in the clinics.

The health department noted that there was a significant jump between the number of clients receiving services at the public mental health clinics in January 2012 (2,071) — before the six closures — and the number of clients receiving services during or immediately afterward (2,798).

“When identifying clients to assist during transition, we included those who were provided services for 12 months prior to the transition,” the FOIA response said. “This was to ensure we connected directly with every client who may have been impacted by the transition. Additionally, the 2011 numbers may include clients who had not been in service at CDPH clinics for some time and may not represent active clients as defined today. In 2012 updates were made to client reporting processes, ensuring more reliable numbers regarding active clients were available both immediately prior to the transition and since.”

The department declined to provide a breakdown of how many clients were referred to different external providers, citing privacy concerns under the Health Insurance Portability and Accountability Act (HIPAA). The department provided a list of about 50 providers where clients were referred. The list includes hospitals, nursing homes, neighborhood clinics and non-profit organizations. However the provider names were incomplete and lacked addresses or contact information. That information was not provided upon follow-up requests.

The city tracked clients sent to external providers for two months after the clinic closures. The department has not kept further records about those clients. An FOIA response stated “we do not track former clients after linkage to an external provider is complete.”
Nor has the city tracked the people who left the city system between the closures and September 2014, a total of 1,365 people.

The health department declined to specify where clients from closed clinics were referred, citing HIPAA. In interviews, multiple clients of the closed clinic in Woodlawn, the site of a high-profile protest and occupation, said they were referred to the Englewood and Greater Grand clinics. The Englewood clinic shows a significant increase in client caseloads in January 2013, following the closures. But by January 2014 caseloads at both Englewood and Greater Grand had dropped significantly.

In response to Freedom of Information Act requests, the Chicago Department of Public Health also provided data on staffing levels at each clinic since 2011.

In January 2012 before the closures, there were 97 total staff members at the clinics. As of January 2015 there were 47 total staffers.

The number of clinical therapists overall fell from 49 in 2012 to 24 in January. The number of psychologists has remained constant at six.

While the number of total staff equates roughly to the drop in total caseloads, the drop in number of psychiatrists in the system has been precipitous. In response to a FOIA request, the department noted there were 14 psychiatrists filling 11 full-time-equivalent positions in 2006.

At the time of the closures, there were eight psychiatrists filling 5.5 full-time-equivalent (FTE) positions. Today there are two psychiatrists filling 1.5 FTE positions, plus a temporary psychiatrist working half-time.

The department notes that they have budgeted for six FTE psychiatrists, but have been unable to fill the positions.

“The national shortage of psychiatrists has led to historic vacancies in CDPH,” the department said in its FOIA response. “As a point of information, in October 2014, the City increased the hourly wage of the psychiatry title in an effort to recruit and retain psychiatrists for the CDPH mental health centers.”

Spokesman Brian Richardson declined requests for interviews about the transition process during the closures and about the CDPH’s plans going forward, but provided a statement:

“The Chicago Department of Public Health is dedicated to ensuring access to quality mental health services for all residents. We do this by both providing direct services to uninsured residents at our clinics and by making targeted investments to strengthen the overall mental health system, focusing on Chicago’s most vulnerable populations.”

This story was produced as part of the Social Justice News Nexus, an initiative at Northwestern University’s Medill School of Journalism that brings together reporters, community watchdogs and journalism students to cover issues that affect Chicago. Learn more at sjnnchicago.org. The Social Justice News Nexus is supported by the Robert R. McCormick Foundation.