As the Democrat-controlled Illinois legislature and Republican Gov. Bruce Rauner gear up to tackle the state’s fiscal problems, including a multi-billion budget deficit, mental health advocates are warning against further cuts to community-based services.
“Community mental health services have been cut to the core, and we’re seeing a lot of the fallout,” said Heather O’Donnell, vice president of public policy and advocacy for Chicago-based Thresholds, a recovery service provider for people with mental illness in Illinois.
Among other issues, O’Donnell noted that the Cook County Jail has about 2,000 inmates with some form of mental illness. And 22,000 people with mental illness in the state are living in nursing homes even though they “don’t need that level of care.” These people, she explained, would likely be homeless if they were not living in such facilities due to the lack of housing and other supports for them to live independently.
“We just need to make sure that we preserve every dollar, because we don’t have anything else in the community mental health system that we can cut without costing the state far more than the cuts,” O’Donnell stressed.
Between fiscal year 2009 and 2011, state funding for community mental health services was slashed by $113 million, O’Donnell said. During that three-year period,Thresholds and other care providers had to cut programs and reduce services, she added. Meanwhile, psychiatric emergency room visits increased 19 percent during that time period, costing the state and hospitals $131 million, O’Donnell pointed out.
Since fiscal year 2011, state mental health funding has increased. However, O’Donnell said the additional funding has gone almost “exclusively to deinstitutionalize people under legal consent decrees, lawsuits that the state settled.”
“So there has been no new funding to actually put in place an adequate mental health system. The state absolutely has to invest in mental health services,” she stressed. “We are hoping that the new Rauner administration will recognize that we’re spending money in the wrong places already in mental health, and it’s costing taxpayer dollars. We need to invest in treatment services. And we need to raise sufficient revenues to pay for these services.”
O’Donnell spoke to Progress Illinois after a Wednesday evening panel discussion on the state of mental health services in Chicago and Illinois, hosted by the Community Media Workshop. In addition to O’Donnell, panelists at the event included Mark Heyrman, board member at Mental Health America of Illinois and a clinical professor of law at the University of Chicago Law School, and Dr. Nneka Jones, first assistant executive director of the Cook County Department of Corrections who oversees the Cook County Jail’s mental health strategy.
At the panel discussion, held at Columbia College Chicago, O’Donnell said Medicaid expansion in Illinois as part of the federal Affordable Care Act is good news for people with mental illness, many of whom were previously ineligible for Medicaid coverage.
“The Medicaid expansion will enable literally hundreds of thousands of people in Illinois who have a mental illness, serious or not, to access care, so that it is a huge opportunity,” she stressed.
That being said, O’Donnell noted that the state needs to address its Medicaid reimbursement system.
“The challenge in Illinois is that because the mental health services that are publicly funded through Medicaid are so terribly underfunded, Medicaid reimbursement rates do not cover the full cost,” she explained. “These reimbursement rates literally hamstring mental health providers to be able to expand capacity to reach new people. So that still presents very serious challenges to reaching new people.”
Meanwhile, the Cook County jail system began a Medicaid enrollment process last year for detainees, most of whom were uninsured before 2014, Jones said.
“At last count two months ago, we were around 6,000 people who have been enrolled,” she told the crowd. “Which is wonderful news, right? Except in the city of Chicago.”
In 2012, six of Chicago’s 12 mental health clinics shut down as part of a city strategy to modernize and enhance mental health services, with a focus on serving the uninsured.
“The unfortunate piece to that is that now with those six clinics that are still open, if you have insurance, including Medicaid, they do not want to treat you at those clinics,” Jones explained. “So they are now telling those individuals that you need to see a private physician who will see you with Medicaid.”
The clinic closings and the focus on uninsured clients at the city’s existing facilities have created “more obstacles” for people with mental illness who have been discharged from the jail and need services, Jones said.
“While we’ve done a great job with expanding the number of people that have access to care, we also have to have compatible services in the community so that we don’t have to send someone from the West Side of Chicago to the North Side so they can see a physician,” she said.
The six mental health clinics that closed were located in the city’s Auburn-Gresham, Back of the Yards, Logan Square, Morgan Park, Rogers Park and Woodlawn neighborhoods. The Chicago City Council unanimously passed Mayor Rahm Emanuel’s budget in November of 2011 that authorized the clinic closings.
Heyrman said the issue of “mental health deserts” in the city where services are hard to find and people are forced to travel long distances to seek care is a “serious problem.”
“My criticism of the city over the closing of the six clinics is not so much that they closed six clinics. It’s that the city has never figured out what its health care and … mental health priorities should be,” he said. “In my view, a public health department should be responsible for ensuring that the citizenry in its geographic area are getting appropriate health care. That doesn’t mean you have to provide any health care, but they have to figure out how to make sure that health care is delivered to people.”