Chicago will be spending what City Hall characterizes as an unprecedented amount of money to support mental health services next year— about $86 million.
But some activists say the fight isn’t over until all the mental health clinics shuttered in 2012 under former Mayor Rahm Emanuel are reopened.
Every budget season the question is asked: Why is the city spending so much money on the Police Department, while public health gets squeezed?
The most recent cycle was no different, as participants in budget forums across the city continued to press Mayor Lori Lighfoot’s budget team on the issue.
For many supporters of the cause, the issue of mental health goes hand-in-hand with violence prevention, addressing the trauma of gun violence and over-policing. Two years of pandemic life have put even more pressure on the city to invest in mental health.
So when Chicago benefited from nearly $2 billion in federal coronavirus relief under the American Rescue Plan (ARP), many activists and progressive aldermen thought the city should be spending it on mental health — specifically, reopening the clinics.
“We need treatment, not trauma, and investment in ARP funds to reopen the closed mental health clinics to provide the follow up care necessary for crisis response,” Elena Gormley, a social worker, said this summer during a press conference with members of the City Council’s Progressive Caucus.
But from day one, Public Health Commissioner Dr. Allison Arwady has made her position clear: The city can invest in mental health without reopening the neighborhood clinics. It was one issue that almost tanked her confirmation hearing at the start of the term of Lightfoot, who appointed her to lead the health department in 2019.
More recently, during a Facebook Live Q&A with the public, Arwady and her deputy for behavioral health Matt Richards explained why opening the clinics isn’t the savior activists make it out to be — while also agreeing that the city has not done all it could be doing to provide support for mental health.
“I don’t think it’s a secret to anybody that we don’t have enough mental health services,” Arwady said. “And we’ve not really had a good system for coordinating among all of the places where people can get mental health services.”
But she stopped short of saying that reopening the clinics is prudent. In fact, she argued it’s counterproductive to addressing the mental health needs of the city’s most vulnerable, who may be better served with continued outreach.
“For me, it’s sort of clinics and — it’s that we are interested in growing and expanding the access to outpatient mental health care,” Arwady said. “But it’s all about lowering barriers for everybody, not just thinking about the people who can make an outpatient appointment.”
Richards said the city has been able to treat 26,000 people under its community-based strategy, one that largely consists of outreach versus an “if you build it, they will come” mentality. By comparison, 3,600 people were treated when Arwady took over the department, he said. Those numbers still represent a fraction of the city’s roughly 2.7 million residents.
When Emanuel shuttered nearly half the city’s clinics in his first budget plan as mayor, bringing the total down to seven, he framed it as a way to save money without impacting the quality of care. According to his 2012 budget plan, CDPH clinics served 29,000 unique patients during 84,000 visits at a cost of $314 per visit.
Emanuel’s team projected community clinics, or federally-qualified health centers, would serve the same patients for less money. In the years that followed, the city’s health department under Emanuel continued to find ways to leverage those partnerships.
A spokesperson for CDPH said reopening the closed clinics would cost the city roughly $15 million a year.
Lightfoot’s nearly $17 billion budget for 2022 — approved by the City Council last week — does make substantial commitments for mental health, including 29 new positions created for behavioral health services and outreach. And all the positions will be funded by city tax dollars, meaning the positions could become permanent well after federal COVID-19 relief dollars run out.
That alone was enough to get several Progressive Caucus members to support the budget.
“It’s the biggest investment that has been made into the mental health clinics in over a decade, and the leaders and the people on the ground that I have been working with understood how meaningful it was,” said Ald. Rossana Rodriguez Sanchez, 33rd Ward, after the budget vote.
Rodriguez Sanchez, a self-identified Democratic Socialist, is one of the freshmen aldermen who campaigned on a platform of reopening the clinics, and she has continued to press the administration on the issue.
She doesn’t agree with Arwady’s position that you can invest in mental health without reopening clinics, calling that an example of “neoliberal policies” pushed by Emanuel that relied on outsourcing social services to agencies and local nonprofits.
“I think every community needs to have a public mental health clinic,” Rodriguez Sanchez said, adding that the fight will continue until those clinics are reopened.
But for now, she’ll take the win.
Claudia Morell is a WBEZ metro reporter. Follow her @claudiamorell.