Mayor-elect Lori Lightfoot ran for office on a pledge to improve mental healthcare in Chicago. The goal is laudable and critical. The question is how to achieve it.
During the mayoral campaign, candidates were asked repeatedly whether they supported reopening six city-run mental health clinics that were closed in 2012, as if that were self-evidently the best way to improve care. This, in our opinion, is the wrong question.
We are mental health advocates with earned expertise. Our aim is to improve access to appropriate, effective treatment services in Chicago for those living with mental health and substance use disorders. And we oppose reopening the city-run mental health clinics.
Fundamentally, the model is outdated. The best evidence has turned against publicly-run clinics that provide mental health services exclusively. The best practice today is to provide coordinated and integrated health care. Individuals should be able to receive an array of necessary services and see multiple providers — whether a family physician, therapist, substance use counselor or case manager — within the same network.
Health care should be fragmented as little as possible so individuals can connect to the services they need when they need them.
Clinics that are not integrated with other services worsen the stigma associated with mental illness. They segregate individuals in separate facilities rather than bringing them into a system that treats the entire person. We should be building a system of health care that recognizes that the brain is part of the body. All illness is illness.
For serious mental illnesses, the best practice is often community-based care, where trained social workers go to the patients instead of the reverse. Those who live with serious mental illnesses typically have compounding challenges, including access to transportation, child care, housing, inflexible work schedules and fear of discrimination.
Community-based, integrated care results in better access and adherence to treatment as well as overall better health outcomes.
Reopening the six public mental health clinics would be a step backward in mental health care. It would be like bringing back a 1970s station wagon, a car model that made sense decades ago but can’t match what’s available and needed today. Evidenced-based models of care have evolved in our city to meet the needs of individuals.
So how should Chicago live up to its responsibility to improve the mental health system? The new mayor and City Council should dramatically scale up the evidence-based models that make for healthier families and communities.
These models already are working well in Chicago and across the country. Thousands upon thousands of Chicagoans receive community-based mental health services from nonprofit organizations. Moreover, Chicago has about 65 federally qualified health centers serving some 600,000 low-income residents in an integrated way.
Enhancing and expanding mental health care through integrated models would serve far more Chicagoans than reviving the six city-run clinics that, in the year before closure, served 2,800 individuals — many of whom now have insurance due to the Affordable Care Act and can receive services in other settings.
The city also should invest more in tracking and better understanding Chicago’s mental health needs, which are always a moving target. And it should coordinate the complex set of players in the mental health system — from providers to jails to emergency rooms to first responders — to connect those with mental health and substance use disorders to needed services in the most efficient, effective, and dignified way.
We need the city to build bridges between islands, not build more islands.
Embracing these strategies rather than the outdated clinic model does not deny the importance of mental health, but affirms it. Policymakers must resist the temptation to embrace the simple slogan of “reopen the clinics” and instead take a careful look at evidence-based approaches that do the most good for the people who need it.