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Jani Actman/MEDILL

Mental health advocates stand in line to speak at a town hall meeting held by the Mental Health Movement, an advocacy group.

Mentally ill face new stresses as system changes

by Jani Actman
Mar 13, 2014


Jani Actman/MEDILL

Mental health advocate Debbie Delgado speaks about the lack of access to mental health care at a town hall meeting .

For about a year, Gail Davis had regular visits with a therapist at Beverly Morgan Park Mental Health Clinic. The Washington Heights resident had long suffered from severe depression, a condition that had gone largely untreated.

“We had a connection,” said Davis, 52, of her therapist, whom she began seeing in 2012. “We had a network that was my adopted family.”

But last April, Davis enrolled in CountyCare, Cook County’s early version of Medicaid expansion under the Affordable Care Act. Three months later, Davis’ therapist revealed that her new coverage meant she could no longer be treated at the clinic, since the city is not part of the network.

She was shocked.

“I already had a relationship with my therapist,” said Davis, who had been uninsured for years. “I didn’t want to start with someone brand new.”

According to the Mental Health Movement, an activist group that fiercely opposed the city’s shutdown of half of its mental health clinics in April 2012, Davis’ situation is common. The group held a town hall meeting in McKinley Park last month to shed light on what they say is the latest blow to this vulnerable population.

“People form bonds and for people with mental health problems – more than anyone else – trust is always an issue,” said N’Dana Carter, a movement spokeswoman and mental health client. “If that therapist is helping you, and then you have to leave and wait four to six months to see someone else, you start over again.”

In 2011, Illinois enacted a law requiring half of all Medicaid patients to be in managed care by 2015. The state also in 2013 opted to expand its Medicaid coverage under the nation’s sweeping health care law. CountyCare, launched in January 2013 with special permission from the federal government, is currently the largest effort to enroll county residents in the public program. The county reported that, as of mid-February, applications had been initiated for about 141,000 of 250,000 eligible individuals.

Despite the law, Chicago has not joined a managed care network. This is a concern for advocates who say those with serious mental health conditions, such as schizophrenia, depression and bipolar disorder, are being turned away from the city’s clinics.

On its website, the Chicago Department of Public Health states that the city’s mental health clinics will continue to focus on serving the uninsured. Department spokesman Brian Richardson declined a request for comment.

But in a written statement, Richardson told Progress Illinois, a political news site sponsored by the SEIU Illinois State Council, that “staff have been instructed that any current client who wishes to remain at a CDPH clinic after learning of these additional benefits may do so.”

“If a new client with insurance requests their mental health care still be provided at a CDPH clinic after being counseled on other options, we will work with them,” he stated.

However, a veteran city therapist, who requested anonymity, said that’s not the case.

“We are basically telling anybody who has CountyCare, ‘Sorry we can’t take care of you,’” the therapist said. “Anybody here who gets on CountyCare, we’re transitioning them to a CountyCare provider.”

Davis continued to see her therapist until she was able to make an appointment with a psychiatrist at Oak Forest Mental Health Hospital. But it was more than seven months until she met with the new provider, and she said she suffered without access to care.

“If they’re saying people can no longer see their therapists then they need to literally make sure they get connected to another provider,” said Mark Heyrman, chairman of public policy at Mental Health America of Illinois and a mental health law professor at the University of Chicago. “They can’t just say, ‘This is a place you could go. That’s okay if you have a toothache – it’s not okay if you have schizophrenia.”

Heyrman said the city’s duty to ensure access to mental health care extends not just to its current clients, but to the tens of thousands of potential clients who are presumed to sign up for Medicaid under the Affordable Care Act.

Under the new Medicaid eligibility requirements, which took effect Jan. 1, 2014, state residents aged 19 to 64 who earn below 138 percent of the federal poverty line, or $16,105 annually, will qualify. Previously, childless adults with mental conditions were eligible only if their incomes exceeded 100 percent of the federal poverty line and they were deemed disabled.

Mental health patients enrolled in CountyCare can seek services from the county or community-based services. But some are skeptical that these providers will be able to effectively handle the influx of new Medicaid patients, especially in underserved areas on the South and West sides.

“We have a shortage of psychiatrists. We have a shortage of social workers,” said Joel Johnson, president of the South Side’s Human Resources Development Institute, which offers mental health and substance abuse services. “Quite frankly, we have a shortage of professionals who want to deal with the lower socioeconomic population.”

According to Johnson, this scarcity stems from historically low and delayed state Medicaid reimbursements and deep budget cuts. Between 2009 and 2012, Illinois slashed its mental health budget by 32 percent, to $403 million from $590 million, reported the National Alliance on Mental Illness. The Counseling Center of Lakeview in Chicago closed in 2012, citing a lack of state funding.

The Affordable Care Act will partially alleviate the budgetary concern by providing a new revenue stream that could be used to bolster health care services. Under the law, the federal government will pay Medicaid providers for services until 2017, with the state contribution climbing to 10 percent by 2020.

Still, advocates are worried. They insist that city mental health clinics are necessary to fill the gaps that private providers may not be able to handle.

In 2012, the city shuttered six of its 12 mental health clinics, citing a need to cut costs and increase efficiency. Last September, Cook County Sheriff Tom Dart took the city to task when he announced that there were at least 2,500 inmates with severe mental issues housed in the county jail.

Carter, of the Mental Health Movement, and others are convinced that Chicago’s failure to join CountyCare is an attempt to eventually privatize mental health services. The group believes the city would get a needed revenue boost if it joined a managed care network, since taxpayers foot the bill for the uninsured.

“What will happen is the only people who will be qualified to go to the mental health clinics will be people who are undocumented,” she said. “Most citizens will qualify for the Affordable Care Act, and we know the clinics will close because there are not enough people who are undocumented.”

Logan Square resident Debbie Delgado, who is uninsured, felt the impact of the clinic closures firsthand. In 2006, one of her sons was murdered and her other son has since been diagnosed with depression and post-traumatic stress disorder. She attempted suicide twice in the past few years.

“It’s hard to have a teenager at home that you cannot help,” she said at the town hall meeting. “It was so hard to deal with this because I’m losing my family.”

Delgado had received grief counseling at the Northwest Mental Health Center until it closed in April, and visiting another city clinic means traveling for over an hour, she said.

“We need these clinics back open, and we need it fast,” she said. “You’re killing our community – this is not just the black community, this is Latino, this is whites."