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Mayor Brandon Johnson’s mental health plan in Chicago starts small but carries big political implications

Chicago Tribune - 12/4/2023

At roughly 0.1% of the city’s recently passed $16.77 billion budget, the initial cost of Mayor Brandon Johnson’s effort to begin reopening Chicago’s city-run mental health clinics is minuscule.

But the political ramifications are potentially huge.

Johnson rode into office on a progressive wave powered by unions and activists who have long advocated that Chicago should return to having 19 city-run clinics, as it did in the 1980s, instead of just five.

The mayor’s answer in his first budget was far from a full response. While he cautioned supporters that reopening the clinics would take time, his budget called for restoring only two clinics and placing them in yet-to-be-determined locations.

Still, by including $5.2 million to expand mental health services and $15.9 million to double staffing for the city’s team of behavioral health professionals who respond to mental health and substance abuse crises, Johnson is trying to show he isn’t dropping the ball on the issue while preaching patience and signaling a more robust response is yet to come.

Those behind the “Treatment Not Trauma” campaign would have a right to be skeptical. Mayors Richard M. Daley and Rahm Emanuel both closed mental-health clinics, and Mayor Lori Lightfoot backed away from a campaign promise to reopen the city-run facilities, arguing instead that funding third-party clinics was a more effective use of resources.

Johnson himself in September cautioned that while he is committed to reopening mental health clinics, “how many we can reopen within the first four years — to be perfectly frank with you all — that’s still to be determined.”

“There are real budgetary dynamics that we have to address, and I’m committed to doing that,” he said.

But, so far, the Treatment Not Trauma advocates have applauded Johnson’s moves, while at the same time saying they expect more to be done down the road.

“This is very much a down payment toward getting Chicago to a better place,” said Arturo Carrillo a social worker who directs violence prevention and health initiatives for the Brighton Park Neighborhood Council, part of the broad Treatment Not Trauma coalition. “We count it as a win, but not an overall win.”

In addition to wanting to reopen as many as 14, and possibly more, of the centers closed by Daley and Emanuel, those behind the movement also hope the centers grow far beyond offering just clinical services to also become bases for expanded nonpolice emergency response teams and a corps of new community care workers.

The sweeping plan — featuring clinical services at the reopened sites; a “community care worker corps” centered around trained nonprofessionals working in neighborhoods to administer basic services to prevent crises; and first-responder teams and crisis call lines to support nonpolice response for emergency calls with mental health components — is an answer activists found for lofty questions.

“What does public care infrastructure look like and how does it serve? What do we need?” said Cheryl Miller, public health organizer for Southside Together Organizing for Power, or STOP, and another coalition member.

‘Build the plane while we’re flying it’

The Treatment Not Trauma coalition’s plans to get clinics reopened and boost mental health care across the city are rooted in the backlash Emanuel faced when he moved to close six of the 12 city-run clinics in operation at the start of his first term, a decision unanimously approved by the City Council.

Protests to keep the clinics open, supported by public unions whose members faced losing their jobs, resulted in City Hall melees and the arrests of dozens of demonstrators who barricaded themselves inside one Woodlawn clinic.

None of it was ultimately successful.

The coalition briefly found hope in Lightfoot’s upstart 2019 campaign when she said “of course” the clinics should be reopened and she pledged to spend $25 million to do so while also investing more in the city’s mental health infrastructure. But that hope faded after Lightfoot took office and she decided it made more sense to fund private and nonprofit clinics already operating in low-income areas.

Johnson’s campaign again revived the coalition’s aspirations when the former Chicago Teachers Union organizer used Treatment Not Trauma as a chief piece of his platform. After Johnson took office in May, the promises got a boost in September when the City Council passed an ordinance introduced by Ald. Rossana Rodriguez, 33rd, to establish a working group to examine implementation.

The working group, which isn’t expected to come back with recommendations until May, gives Johnson more time before he must make larger decisions about mental health issues and, in the meantime, allows him the opportunity to promote the smaller goal of reopening the two clinics.

“We are at the very beginning,” said S. Mayumi “Umi” Grigsby, Johnson’s chief of policy. “We want to build the plane while we’re flying it.”

Grigsby said the location of the two clinics likely won’t be determined until after the working group releases its report in May. She also declined to say how many new mental health workers might be hired or clinics reopened in coming years.

Regardless, the Johnson administration is in “lockstep” with the activist coalition on the “major priority,” she said, describing the effort as a way to add well-paying jobs and improve safety by addressing the root causes of violence.

“The specific goal is to just ensure that we are being expansive,” Grigsby said.

Members of the coalition told the Tribune they view the proposed investments as a strong start.

“This is a first step, a good faith investment in the larger project toward Treatment Not Trauma” said Kennedy Bartley, executive director of United Working Families, a progressive political organization that strongly backs Johnson. “That would see the reopening of many more mental centers.”

Bartley said she hopes the first two centers reopen in 2024. A report put out by the coalition calls for the city to operate 19 centers by the end of Johnson’s first term.

But the challenges the city will face in opening up the first two clinics and possibly expanding far beyond them were quickly highlighted during an October budget hearing between aldermen and officials with the Department of Public Health.

CDPH officials told aldermen nearly half the department’s budgeted positions were unfilled and the officials were unable to say how much money is being spent by different city departments on mental health care.

“I understand that we have a lot of challenges when it comes to hiring,” Rodriguez said. “It always takes us so long to be able to hire staff.”

Department officials also said the department was targeting early-career therapists to staff the centers.

“It feels like we’re having a very specific and acute challenge with hiring mental health clinicians,” added Ald. Daniel La Spata, 1st. “We got to dig a little deeper here to understand what’s the holdup.”

‘We are in crisis’

As the department struggles with staffing, Diane Adams, a longtime client who has witnessed firsthand how the city-funded clinics have dwindled, is facing another hurdle. Her therapist for years retired and was replaced two months later by another therapist, who is now out on maternity leave, she said.

Adams once took two buses to get to a clinic on 79th Street in Auburn Gresham. When that location closed, she followed her therapist to the city’s Englewood site, a move that added a train ride to her journey.

The long trip is a small price for therapy Adams says has made her a “very strong woman.” She began using the city clinics in 1997 after her son DeAndre Adams, 18, was shot and killed at a gas station. Facing depression, bouts of anger and a drug addiction, she tried to take her own life a year after his death.

If you saw Adams then, you wouldn’t recognize her now, she said.

“I had no feelings, no emotions, nothing,” Adams said.

The psychosocial rehab she received has taught her again how to be part of a community, be accountable and set goals, she said. More broadly, she said, it inspired her and taught her how to do things for herself, including owning an apartment and controlling her own money.

“I pay my bills, and I know how to take care of myself and my responsibilities,” said Adams, who is a member of STOP. “I’m the woman that I should have been a long time ago.”

Adams said she’s sure she’d be worse off without city-run clinics. She thinks other providers are more focused on money, rely too heavily on prescriptions and are less accountable than the city’s centers.

“The therapists with the city, they’re more compassionate and understanding,” she said.

Many activists claim public centers are a better option than the private, nonprofit clinics that serve many Chicagoans because the city clinics have more oversight, focus on outcomes over cost and have a more substantial community connection. Still, the emerging overhaul isn’t without critics.

In her term as mayor, Lightfoot argued funding third-party clinics was a better use of money as she expanded the CDPH’s mental health budget from $12 million to $89 million. Johnson’s administration is spending $43.1 million on city-run clinics, but did not provide an amount for total spending on mental health in 2024.

Last January, the Lightfoot administration said the CDPH’s five clinics served 1,782 in 2022, while the city-funded mental health care served 60,000 people.

“A singular reliance on city delivered services would never effectively scale services to the number of people that need them,” a CDPH spokesperson said at the time.

In October, Johnson said he didn’t know if the conversation surrounding reopening clinics should be about “whether or not is it cost-effective and how many.”

“If we serve one, if we serve 100,000, we have to serve more than who we served. And that’s what I made a commitment to doing,” he said.

Chicago’s nonprofit clinics are already seeing long waitlists and intense acuity, said Alexa James, CEO of the Chicago chapter of the National Alliance on Mental Health.

“I’ve never seen anything like this,” James said. “We need more and more and more. And what we also need is to make sure that there aren’t interruptions in services.”

James, who served on Lightfoot’s Health & Human Services transition committee, said it’s unclear if the city’s efforts to reopen public clinics will take city funding away from nonprofits like NAMI Chicago in the near future.

Johnson seems to view the health department less as a convener and funder, and more as a provider, she said. While she supports the idea of opening more mental health clinics in Chicago, she is not convinced doing so through the city’s health department is the fastest, most efficient way to provide more service.

“We are in crisis. There has to be a continuum of care built,” she said. “We can’t politicize this mental health crisis.”

The reopening effort has drawn strong support from the American Federation of State County and Municipal Employees. The union, a major Johnson supporter in his mayoral campaign, lost dozens of positions for members when clinics closed.

Some of the private clinics underpay workers and don’t employ enough people, hurting care, Bartley said. Union representation at the centers would lead to living-wage salaries and oversight on staffing levels, she said.

“The government should be investing in good public jobs. The government should be investing in access to good public mental health care,” Bartley said.

When asked about how AFSCME’s support of the administration affects the effort to reopen clinics, Grigsby said the goal is creating jobs for more than just AFSCME’s members.

“If one of the byproducts of building a public health infrastructure and building a bench of community health workers is that there are people who have access to good paying jobs and jobs that are fulfilling, then I think we would have accomplished our goal,” she said.

Chicago Tribune’s Alice Yin contributed.

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