Mayor Lightfoot is trying to rejuvenate Chicago’s mental health care system. But is it enough?

Saint Anthony Hospital
Saint Anthony Hospital, which serves Chicago’s Southwest Side, has a yearlong waitlist for mental health services. A 2018 report found that the area has only 0.17 clinicians per 1,000 residents. (Maura Turcotte/MEDILL)

By Maura Turcotte
Medill Reports

It began with a 15-year-old boy shooting a 7-year-old girl on Halloween. Then, over the course of a month, seven more residents of Chicago’s Little Village were hit by gunfire. One incident proved fatal — a 32-year-old nurse walking home from his shift, shot by an unknown assailant.

The string of shootings that plagued the Southwest Side community in November caused a local advocacy group, Enlace Chicago, and its violence prevention program to shift into overdrive.

With two street-based counselors, two school-based counselors and a couple of interns, Enlace Chicago delivered as much mental health support as it could muster to the neighborhood’s youth through workshops, talk therapy and more. But with the Little Village population nearing 75,000, with at least a third being teenagers or younger, the organization found itself stretched thin.

“It’s been a really difficult time,” said Alicia Martinez, violence prevention program manager for Enlace. She explained that the nonprofit has been helping students process the violence and making sure they feel safe.

Despite the organization’s limitations, the mental health care resources Enlace does offer, Martinez said, are critical for a part of Chicago’s Southwest Side that sees few accessible services. For many residents, Enlace’s team members are their first encounter with counseling.

“There’s not a lot of places that have services readily available,” Martinez said. “Oftentimes, they are put onto lists or they have to go outside of the community to receive the services, which is an additional barrier.”

Little Village is not alone in needing mental health resources, according to a 2018 report by the Collaborative for Community Wellness, a coalition of health professionals and local organizations. The group declared a “mental health crisis” across Chicago’s Southwest Side, a region that includes Little Village and extends nearly 10 miles south to Marquette Park and the Chicago Lawn neighborhood.

Huge disparities in care exist. Only 63 licensed clinicians, or doctors in direct contact with patients, serve the entire Southwest Side — 17 clinicians per 100,000 residents, according to the study. In comparison, the Near North Side, a more affluent neighborhood in the city, has 381 clinicians, or 445 clinicians per 100,000 residents, a ratio 26 times higher.

In total, nearly 178,000 people had unmet mental health needs throughout Chicago in 2018, the city’s Department of Public Health reported.

To address those gaps in care, Mayor Lori Lightfoot announced the Framework for Mental Health Equity with her new city budget in late October. The proposal came with nearly $10 million in new funding for the city’s mental health budget.

While the complete details have not yet been revealed, the mayor’s press office said that the money will be directed to 20 public and nonprofit health centers, mobile crisis prevention and response teams, and an improved health helpline.

“Access has been lacking in too many communities, particularly those on our south and west sides,” Lightfoot said in a statement. “That’s why this framework prioritizes communities that have suffered from disinvestment.”

There has long been a need for quality mental health services in Chicago, especially in communities such as Little Village that see high rates of poverty, violence and aggressive policing.

Saint Anthony Hospital, a care facility with several locations on the Southwest Side, found in a 2018 community health needs assessment that almost 40% of local respondents reported symptoms of chronic depression. About 20% of adults ages 18 to 39 in the area reported a time when they were unable to get needed mental health services in the past year.

While the Southwest Side doesn’t see the highest rates of shootings in Chicago, trauma from gun violence, and violence in general, still infuses many of the communities. In 2016, the University of Chicago Crime Lab reported 41 homicides in Back of the Yards, 14 in Gage Park and 18 in Little Village.

Moreover, some mental health issues stem from the immigrant status of many of the communities, explained Arturo Carrillo, program manager for Saint Anthony Hospital’s Community Wellness Program. Foreign-born residents in Southwest Side neighborhoods, such as Archer Heights, Brighton Park and Gage Park, account for nearly half the population, according to U.S. Census estimates.

“We see, of course, what it means for people to not be able to travel back to their home country and, you know, deal with the loss of family members, experiences of trauma during the migration and prior to migration,” Carrillo said. “So, really, there’s an added layer we’re working with.”

The city’s mental health care system, however, was thrown even more into flux in 2012 when then-Mayor Rahm Emanuel shut down six of the city’s 12 clinics. A seventh clinic was privatized in 2016.

Those original 12 city mental health clinics served about 5,200 people. In June 2019, Chicago’s Department of Public Health estimated 2,800 people receive care at the city’s five remaining clinics.

Within the Southwest Side, the Back of the Yards clinic was one of the six closed. Carrillo recalled seeing an influx of people suddenly in need of care as a result. But there was little monitoring and guidance as to how those patients would continue their care elsewhere.

Carrillo said he attributes the city clinic closures in 2012 to furthering the disparity of mental health care in Chicago.

“We have a yearlong waitlist. It’s not stigma or people’s lack of desire to access services. It’s the, you know, the inaccessibility of services that are free or highly affordable,” he said.

At Saint Anthony Hospital, Carrillo and his team of about 30 had in 2018 about 1,000 patients admitted for immediate mental health treatment. Additionally, through the team’s case management and outreach work, the program manager estimated the team works with nearly 1,000 patients a year.

To help meet that demand for services, Carrillo and the Collaborative for Community Wellness have recommended that the Back of the Yards clinic be reopened. However, Lightfoot’s new framework does not include a proposal to reopen any of the closed sites.

“Nonprofit providers like ourselves do all that we can, and you know the hospital has a very clear mission to serve the underserved,” Carrillo said. “But it’s not enough, and the public sector and the city do have a responsibility.”

The Sinai Health System, which addresses mental health needs at its Mount Sinai Hospital, Holy Cross Hospital and Crisis Stabilization Unit locations on the Southwest Side, similarly has waitlists. While the system averages about 100 to 150 patient encounters per day, patients often wait three to four weeks to see a psychiatrist, said Dr. Paul Berkowitz, chairman of psychiatry and behavioral health at Sinai Health System.

Offering such mental health services is critical in an area depleted of hospital resources, Berkowitz said.

“From Holy Cross Hospital, in any direction, it’s several miles before you get to another hospital,” Berkowitz said. “And as we all know, in Chicago that couple miles is a big deal.”

As a result, the chairman said he welcomes more money being dedicated to mental health in the city.

“We know that even with our expansion, we’re not getting to all the patients that need services,” he said. “And so, I look forward to partnering up even more with the city.”

Back at the nonprofit Enlace Chicago in Little Village, the organization’s work has grown less chaotic as the neighborhood calms down after the November shootings, said Martinez, Enlace’s violence prevention program manager.

“I think we’re kind of past that stage of heightened awareness,” she added.

Still, Martinez said she has not seen enough funding for care intended for youth at risk of either becoming victims or perpetuators of violence. She added she would like to see some of the money within the mayor’s new framework offer more preventative services.

“We’re seeing a lot with our youth that they are experiencing complex trauma. So, it’s not just one thing, it’s several things that are compounded,” Martinez said. “For example, they might they might have a parent who’s undocumented, and there’s an anxiety of them getting deported. And they might have been exposed to community violence, and there might be also domestic violence — so there’s several factors that are contributing to their presenting issue, and that’s why they come to us.”

Enlace does not operate entirely by itself. Counselors try to refer people in need of more mental health care services to a traditional facility, such as Mount Sinai. Moreover, through its Violence Prevention Collaborative, Enlace meets with more than 20 local organizations, including social service agencies, churches and the local chamber of commerce, to coordinate services. Together, the collaborative also develops initiatives, such as programs aimed at deescalating situations, that connect the area’s mental health needs with issues such as domestic violence and street crime.

But even with all the partnerships, Martinez said, Enlace’s team of four youth counselors can only accomplish so much.

“We get the interns just to support that work we do. But then, it’s not enough,” Martinez said. “We’re at capacity.”

Photo at top: Saint Anthony Hospital, which serves Chicago’s Southwest Side, has a yearlong waitlist for mental health services. A 2018 report found that the area has only 0.17 clinicians per 1,000 residents. (Maura Turcotte/MEDILL)