Chicago’s model for providing mental health care is riddled with access barriers, particularly for undocumented and uninsured residents, a new assessment by advocates who want to reopen the city’s public mental health clinics shows.
Those barriers include long wait times, health centers that are unreachable by public transit, a lack of availability during nonbusiness hours and inability to reach centers to schedule an appointment.
The assessment was conducted by the Collaborative for Community Wellness — a group of community organizations and licensed health care clinicians that has been advocating for the reopening of the city’s mental health clinics shuttered under former Mayor Rahm Emanuel.
The Chicago Department of Public Health has not reviewed the report in full but responded to some of its top-level findings. In response to questions from WBEZ, a spokesperson said the health 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 assessed 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.
“This was sold as a way of providing people choices to access mental health services,” said Arturo Carrillo, a licensed clinical social worker with a Ph.D. in social work who helps lead the collaborative. “And what we’re seeing is that you’re not actually giving people more choices if they’re not necessarily available, or if they’re going to be very, very inconvenient to access.”
Under the trauma-informed care centers system, the city partners with a large network of nonprofit organizations, community groups and clinics that mostly treat low-income and uninsured people. Lightfoot mandated those partners provide “no-barrier mental health services.” The system also includes the city’s five public mental health clinics, which were not evaluated in the study.
Lightfoot argued the care centers system was more effective than reopening public mental health centers, which have been underused. In 2019, the city treated about 3,600 Chicagoans at its five mental health clinics and a small number of private providers, according to the city.
A few years later, as the city partnered with trauma-informed care center providers, about 60,000 Chicagoans received treatment, Lightfoot’s administration reported. Lightfoot allocated about $90 million to the city’s mental health budget in 2022 compared to about $12 million in 2019.
While the city’s health departmen told WBEZ there are 162 unique locations within its care centers network, researchers narrowed their call list to 65 individual locations — eliminating any that did not provide publicly accessible services, such as school-based services only available to students, or sites that had multiple locations but one centralized intake number.
In a round of up to three calls to each provider from July to September, researchers were only able to survey 27 mental health providers. More than 30 locations were completely unreachable by telephone, the study said.
“That’s really problematic for us” because it mirrors the experience distressed community members seeking treatment could face, Carrillo said. Callers also had to frequently navigate automated phone systems.
The group used six barriers to assess access at clinics within the care centers network, including wait times, fees for services, transit accessibility and more. Researchers found just five clinics were completely accessible.
More than half reported there was a wait of anywhere frm one to seven months for a mental health care appointment. About 15% of those surveyed say they don’t serve undocumented residents. And while 81% reported serving uninsured people, only 41% reported offering free services.
In response to those results, a health department spokesperson said, “The funding opportunity [from the city] specifically stipulates that patients cannot be turned away for services due to health insurance status, documentation status or ability to pay.”
A spokesperson added the city “conducts regular course correction when evidence indicates that a provider is not adhering to the expectations.”
The health department also questioned whether “the volunteer spoke to a staff member that is unaware of these criteria” and added it would “want to know the identities of these organizations in order to confirm that the program is operating in accordance with our funding requirements.”
Caitlin O’Grady, who co-chairs the research arm of the Collaborative for Community Wellness, said it doesn’t make a difference for patients if the person answering the phone is unaware of city protocols.
“If that information is not known by everybody at the organization, and that’s not communicated — honestly, it doesn’t matter, right?” O’Grady said.
The study comes as the need for mental health care has grown significantly since the COVID-19 pandemic — without enough providers to treat them — and as organizers have an ally in office who supports their preferred mental health model. Johnson campaigned on reopening public mental health clinics and committed in his first budget to piloting two new centers in existing health department buildings, though details are sparse.
Mariah Woelfel covers Chicago city government and politics at WBEZ.
