Executive Summary: Report on the June 13, 2019 Public Hearing on the Public Mental Health Service

Expansion Resolution

Background: In January 2019, the Chicago City Council passed a resolution on Public Mental Health Service
Expansion, with 48 of the 50 aldermen signed on as co-sponsors. The resolution affirmed the critical role of city
mental health clinics run by the Chicago Department of Public Health (CDPH) and called for an independent
study to investigate where new clinic services were most needed.

Dr. Leticia Villarreal Sosa of Dominican University School of Social Work and College of Applied Social Sciences
was tapped by former Health Committee Chairman George Cardenas to help moderate the community public
hearing called for in the resolution and synthesize the emergent themes from public hearing testimony with city
budget data and previous research on community mental health needs.

Pursuant to the resolution, a hearing was held at Malcolm X College on June 13, 2019. Attendees came from
neighborhoods across the city—30 of Chicago’s 77 community areas—and contributed input via testimony and
survey. Demographically, survey respondents were 57% Latinx, 27% Black, 8% White and 1.9% Asian.

Key findings include:

• The city of Chicago has seen a pattern of disinvestment in publicly funded mental health services, as
evidenced through reduced spending and clinic closures While the city of Chicago had a network of 19
public mental health centers in the 1970’s, this number has consistently decreased. As of 2004, seven of
the 19 clinics had closed. With the passage of Chicago’s 2012 city budget, the CIty closed six more clinics
and subsequently privatized another. Over the past decade the amount of City Corporate Fund dollars
allocated to mental health salaries declined by 74%.

• Structural barriers, not stigma, are the main impediments to mental health care in Chicago.
Commonly-cited barriers included cost (20%) and not knowing where to find care (20%). Only 5% of
those who said they needed but had not received mental health care cited stigma as the main reason.

• CDPH clinics have unique attributes that set them apart from private sector providers. Nonprofit
mental health providers, including Federally Qualified Heath Centers, play important roles in Chicago’s
mental health system, but unlike CDPH clinics, many charge copays, have long waiting lists and limit the
number of therapy sessions. Among the 253 private agencies CDPH identified as mental health
providers, only 59% (150) of these providers could be successfully reached via phone after a minimum of
two outreach attempts. Of the providers who were successfully contacted, only 15% (19) reported that
they offer free services and 30% (34) reported having a wait for services.

• Geographic disparities in the number of mental heath therapists is a major barrier to mental health
care. For example, the zip code 60602, in the affluent center of the city, yielded the highest ratio in
Chicago, with more than 324 licensed clinicians per 1,000 individuals. In contrast, zip codes
corresponding to low-income community areas on Chicago’s west, southwest, and south sides
consistently yielded fewer than 0.1 licensed clinician per 1,000 residents.
 • Community residents indicated the need for access to psychotherapy and services that address
complex traumas. Testimony provided by hearing attendees offered valuable insights to complement
quantitative data. Testimonials stressed the need for the type of long-term, holistic and culturally
responsive mental health treatment public clinics provide, and community residents offered suggestions
based upon their experiences for expanding treatment to meet a wider range of psychosocial needs and
create greater opportunities for social support.

• Policies at the federal level make public safety net clinics an even more critical part of the mental
health landscape. New “public charge” rules for DHS and DOJ expand the range of public benefits
considered in determining whether an immigrant is disqualified for consideration to include publicly-
funded health insurance. Changes to ACA policy at the federal level may also limit access to health
insurance. These policies create an even greater need for free care for the uninsured.

Recommendations:

• Increase funding and investment in public mental health services. Public mental health clinics are an
important safety net that can provide the space and resources needed to promote healing from trauma
and address mental health needs, particularly for vulnerable and low-income communities.

• Target expansion of public mental health services in underserved community areas, including south,
west, and southwest side communities. Investment must be targeted to community areas with the
greatest unmet need.

• Increase access and investment in psychotherapy as a crucial form of mental health service delivery.
The mental health field has seen a trend towards a psychopharmacological treatment approach, and a
decrease in use of psychotherapy, partially due to an increasing shift of the cost to consumers. The
social support offered by individual therapy for both the respondents in the survey and as offered in the
testimony is a vital form of support in coping with trauma and isolation.

• Greater diversification of funding. In order to preserve and expand accessible mental health services in
the city of Chicago, it is imperative for the City of Chicago to dedicate a greater share of its own revenue
towards mental health services, and not over rely on potentially unstable federal or state grants.

• Increase access to trauma-informed services. Service cost and organizational capacity among private,
providers pose barriers to long-term participation in services that promote healing from trauma.

• Consider ways to create holistic, culturally responsive, and empowering mental health services. In
addition to expanding access, building the capacity for culturally appropriate care and expanding the
diversity of clinical staff should be a focus for improving public mental health services.