Friday, December 1, 2023

Chicago model for mental health care fraught with access barriers

Chicago’s model for providing mental health care is riddled with access barriers, especially for undocumented and uninsured residents, a new analysis by advocates says. will reopen what mental health clinics show to the public.

Those barriers include long wait times, health centers inaccessible by public transit, lack of availability during non-business hours and inability to get to the centers to schedule an appointment. .

The assessment was conducted by the Collaborative for Community Wellness – a group of community organizations and licensed health care clinics that advocate for the reopening of closed city mental health clinics. under former Mayor Rahm Emanuel.

The Chicago Department of Public Health did not review the report in its entirety but responded to some of its top-level findings. In response to questions from WBEZ, a spokesperson said the department, and Mayor Brandon Johnson, “are committed to delivering the best mental health care to all Chicagoans, regardless of insurance status, immigration status or ability to pay.”

The study examined the city’s network of so-called Trauma-Informed Centers of Care, which was created under former Mayor Lori Lightfoot, by calling and surveying providers in the network.

“It’s marketed as a way to give people options to access mental health services,” said Arturo Carrillo, a licensed clinical social worker with a PhD in social work who helps lead in the Collaborative. “And what we’ve seen is that you don’t really give people more options if they’re not necessarily available or if they’re going to be very inconvenient to access.”

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Under the TICC system, the city partners with a large network of non-profit organizations, community groups and clinics that mostly treat low-income and uninsured people. Lightfoot instructed the partners to provide “barrier-free mental health services.” The system also includes five public mental health clinics in the city, which were not examined in the study.

Lightfoot argued that the TICC system would be more effective than reopening public mental health centers, which are underutilized. In 2019, the city treated about 3,600 Chicagoans at five mental health clinics and a smaller number of private providers, according to the city.

A few years ago, as the city partnered with TICC providers, nearly 60,000 Chicagoans received treatment, Lightfoot’s administration reported. Lightfoot allocated $90 million to the city’s mental health budget in 2022 compared to $12 million in 2019.

While CDPH told WBEZ there are 162 unique locations within the TICC network, researchers narrowed their call list down to 65 individual locations — eliminating any that don’t provide service accessible to public, such as school-based services only available to students, or sites with multiple locations but a centralized drinking number.

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In a round of up to three calls to each provider from July to September, the researchers were only able to survey 27 mental health providers. More than 30 locations are completely unreachable by phone, the study said.

“That’s very problematic for us” because it mirrors the experience that community members seeking treatment may face, Carrillo said. Callers must also constantly navigate automated phone systems.

The group used six different barriers to assess access to clinics within the TICC network, including waiting times, fees for services, transit accessibility and more. The researchers found that only five TICC clinics were fully accessible.

More than half reported waiting anywhere between one and seven months for a mental health care appointment. Approximately 15% of those surveyed said they do not serve undocumented residents. And while 81% reported serving the uninsured, only 41% reported offering free service.

In response to those results, a CDPH spokesperson said that “the funding opportunity (from the city) specifically stipulates that patients cannot be excluded for services due to health insurance status, documentation status, or ability to pay.” A spokesperson added that the city “conducts regular course corrections when evidence shows that a provider is not meeting expectations.”

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The CDPH also questioned whether “the volunteer communicated with a staff member who was not aware of these criteria” and added that “we would like to know the identities of these organizations to confirm that the program is operating in accordance with our funding requirements.”

Caitlin O’Grady, who co-chairs CCW’s research arm, said it makes no difference to patients if the person answering the phone doesn’t know the city’s protocols.

“If that information isn’t known to everyone in the organization, and that’s not being communicated — really, it doesn’t matter, right?” O’Grady said.

The study comes because the need for mental health care has increased dramatically since the COVID-19 pandemic — with not enough providers to treat them — and because organizers have an ally in the office. which supports their preferred model of mental health. Johnson campaigned to reopen public mental health clinics and committed his first budget to piloting two new centers in existing CDPH buildings, though those details are few.


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