Mayor-elect Brandon Johnson was clear on the campaign trail that he supported reopening the shuttered city-run mental health clinics that closed more than a decade ago. It’s a goal he said “that we have to work towards immediately in this first budget.”

But as he prepares to take the keys to the 5th floor office next week, his new administration says much of their approach has “yet to be determined.”

Johnson’s First Deputy Chief of Staff Cristina Pacione-Zayas recently told WBEZ that the administration’s first task will be to assess Chicago’s landscape of mental health services to see what’s working. Ultimately the administration’s goal is to create “a more comprehensive system of care and structures of care that ultimately are driven by public resources in collaboration with community,” she said.

Just how much that system of care will include city-run clinics or city funds sent to nonprofit and community organizations to provide services, remains to be seen. And the effectiveness of those approaches is up for debate.

Outgoing Mayor Lori Lightfoot had also campaigned on reopening the clinics, but backed away when in office. Instead, she pumped tens of millions of dollars into nonprofit and community-based providers and offered counselors in other public spaces, such as libraries.

• RELATED STORY
• Politics
• Chicago Elections 2023

Mental health and medical deserts: The crisis facing Chicago’s next mayor

read more

The city’s public health department says nearly 74,000 patients were served in 2022 through nonprofit providers and community organizations receiving city funds. Of those patients, 1,782 were served through the city’s five remaining mental health clinics – a downturn from the 2,064 patients seen in 2017, the first year the city operated just five clinics.

Meanwhile, advocates who have long called for reopening the shuttered clinics argue they lack investment from the city, making them difficult to access. An analysis from the Collaborative for Community Wellness shows the wards with the highest rates of 911 calls for behavioral health tend to be concentrated in areas where the city clinics have closed.

Now, as Johnson prepares to be sworn in as mayor, the question remains how he will open more clinics – and whether it will be at the expense of funding for nonprofit clinics and community organizations.

“If there’s a way to do both, that would be ideal,” Marc Atkins, a UIC professor of psychiatry and psychology, said of expanding Lightfoot’s embedded services model and offering city clinics. “If there’s not, that’s when the hard policy choices come up.”

Continuing Lightfoot’s approach

At a mayoral candidate forum in January, Johnson previously said that not only do city mental health centers need to be reopened, but they “do have to be publicly funded, with good union paying jobs and no to privatization.”

But Pacione-Zayas isn’t making any promises.

She said whether the Johnson administration will continue to fund nonprofit providers will be determined through the assessment the new administration is undertaking.

“While we’ve been able to expand capacity by using our nonprofit and social service agencies, we can’t forget that they have been extended, and in many ways, stretched with everything that they’ve been dealing with in terms of the pandemic,” Pacione-Zayas said.

“So while that was in many ways a stopgap measure, we’re going to have to look and assess and see if that is still the appropriate path to take, or if it’s a coupling of both the publicly funded and opening those up again, and then also collaborating with the county to layer the resources together.”

Lightfoot’s administration increased mental health services funding from $12M in 2019 to $89M in 2023, which included investments in the city’s five remaining clinics and providing funding to a network of nonprofit providers, collectively known as the “Trauma-Informed Centers of Care.”

Patients seen at city-run clinics represent just a small fraction of the more than 40,200 patients who received clinical care at 45 providers included in the network in 2022, according to provisional public health department data. That number does not represent the number of times a patient has been seen, as many receive numerous visits, the public health department noted.

That same year, a little over 33,600 patients received clinical services through other city-funded means, like services at homeless shelters, the city’s 311 hotline, crisis response teams and providers who offer team-based community care, according to CDPH data.

Alexa James, the CEO of NAMI Chicago, which works with the city to administer its 311 hotline, said dismissing any of the nonprofit partners who have worked with the city or stripping funds to stand up new city clinics “would be a deep heartbreak.” She said she hopes to see Lightfoot’s investments in mental health care continue.

“I think that stopping that, stalling that or disrupting that would be just as awful as the experience that people had when the clinics were closed,” said James, who is also serving on Johnson’s transition committee on health and human services.

Meanwhile, the city’s remaining clinics all have capacity to see more patients, said public health department spokeswoman Anna Dolezal – even as the city has made investments to double clinic staff and expand services to children. Dolezal declined to cite the maximum capacity of the clinics, noting a number of factors play a role, like the acuity of a patient’s needs. As public health staff have increased, they also now work within the city’s program that sends mental health professionals along with police officers to 911 calls and throughout the city’s mental health safety net system, Dolezal said.

“We are committed to serving as many patients as we can, without compromising care, in the city clinics – but as a health department charged with the health of the whole city, we know that we need to stop thinking of success in terms of hundreds, or even thousands of patients served,” Dolezal said. “We need to create no-barrier systems that serve tens of thousands, or even hundreds of thousands of Chicagoans to start to reach the scale of need.”

The difficulties of reopening the clinics

Ald. Rossana Rodriguez-Sanchez, 33rd Ward, said rebuilding the city’s “defunded” public health infrastructure is “not going to happen in a night, it’s not going to happen in six months, it’s not going to happen in a year.”

But Rodriguez-Sanchez, who also co-chairs Johnson’s transition subcommittee focused on health and human services, said seeing the topic of reopening the clinics become a major theme in the mayor’s race, told her that “whoever wins is going to have to contend with the fact that we have organized enough, we have made enough noise, that this is now a central issue.”

The city’s public health department estimates reopening the shuttered clinics would cost $2-3 million per clinic, with costs driven by personnel and renovating or leasing space, Dolezal said.

Pacione-Zayas floated collaborating with Cook County to offer mental health services, and it’s an area where Johnson said in a WBEZ/Chicago Sun-Times candidate questionnaire that “by working together, I believe we can not only provide better care but do so for $5-10M/yr less.”

Johnson’s transition subcommittee on health and human services also features officials from across local and state government, including Dr. Linda Rae Murray, the Cook County Department of Public Health’s former chief medical officer.

Pacione-Zayas wouldn’t give details about where new city-run clinics would be located, but acknowledged it would include taking stock of community-driven mental health clinics funded by property tax increases that have recently arisen to ensure “what we do is complementary and it strengthens that network.”

Rodriguez-Sanchez said she hopes to see progress under Johnson’s administration on a proposed pilot program that would use several of the city’s existing mental health clinics as walk-in stabilization centers for people in a mental health crisis.

By keeping mental health centers open 24 hours, staff would be available after-hours to receive people experiencing a mental health crisis and help meet basic needs, like a place to take a shower or wash clothes, Rodriguez-Sanchez said.

Police stations or emergency rooms, “are not the places where you want to transfer somebody that doesn’t really have a physical illness, but is just dysregulated or is having a mental health crisis. We saw what happened to Irene Chavez,” Rodriguez-Sanchez said, referring to the 2021 death of Chavez, a military veteran with severe PTSD and alcoholism who hanged herself in a holding cell after pleas for her to be taken to a hospital were ignored, according to a lawsuit her family filed against the city. “We don’t want those things to ever happen again.”

Last year, Rodriguez-Sanchez proposed using millions of dollars within the police department slated for vacant positions to instead be used by the public health department to create three crisis drop-off centers at existing clinics. But her idea was never implemented.

“Of course, the goal is to reopen, the goal is to expand,” Rodriguez-Sanchez said. “I think that there are ways to be able to do that in a way that moves us in that direction and that creates capacity, while we also create new initiatives that can support the work that the mental health centers were doing.”

Ultimately, Pacione-Zayas said the administration wants to ensure it’s not treating mental health issues in a silo and aims to address the “root causes” that could bring people to a point of crisis, in areas like housing, domestic violence and more.

Clinics are just “one tool in the toolbox” said Atkins, who said he already sees Johnson taking a more holistic approach to tackle “upstream issues,” like Johnson’s pitch to double the number of youth the city hires this summer.

“Job skills are a mental health intervention,” said Atkins, who also directs the Community Engagement and Collaboration core for UIC’s Center for Clinical and Translational Science. “Getting kids the skills they need so that they go on a different path is a mental health intervention.”

Still, Angela Ali, a psychologist in private practice on the South Side and a commissioner for the upcoming Bronzeville Expanded Mental Health Center that residents approved via referendum in 2020, said a physical clinic where residents know they can go for adequate service is invaluable to a community.

“What it provides is a reference point, what it provides is an actual resource, what it provides is safety,” Ali said. “If someone is suicidal, they need help and you can’t necessarily just always go and get what you need by going to your nearest emergency room.”

Tessa Weinberg covers Chicago government and politics for WBEZ.