A new report suggests that the city of Chicago has not fully kept track of some of its patients amid the closing of mental health clinics.
The study released this week by the AFSCME Council 31 public employees union and the Mental Health Movement coalition finds that on March 1 the city counted 3,282 patients using Chicago Department of Public Health, or CDPH, mental health services.
By July 24, following the April closing of six the city's 12 CDPH mental health clinics, the number of patients dropped to 2,798.
That 2,798 figure includes 429 patients who were transferred to a private provider. It also accounts for instances where a therapist might close a case or a patient opts to leave the city system of care.
The difference between the March and July number of patients indicates that 484 patients “disappeared” between March, shortly after patients were notified in a letter of the clinics closing, and July, shortly before the city boasted (PDF) of a successful clinic consolidation transition.
Patients at the six clinics that closed were supposed to transfer to one of the remaining clinics or receive assistance in finding a community care provider.
“Our concern is that the city did not have appropriate follow-up [with the mental health patients],” says Jo Patton, director of special projects at AFSCME Council 31.
Messages left with the Chicago Department of Public Health were not returned.
Patton says that AFSCME and the Mental Health Movement asked the health department this July about the change in patient numbers. “We were told these numbers fluctuate,” Patton says. “Why that would be is beyond me.”
The report comes after city council hearings on Mayor Rahm Emanuel’s proposed 2013 budget.
According to Emanuel’s budget overview (PDF), the clinic consolidation allowed a “focus on the city’s most vulnerable, uninsured population.” To that end, the city has concentrated therapy services on uninsured patients while moving insured patients to community providers.
Bechara Choucair, commissioner of CDPH, testified before city council last week that the closings, “Enabled CPDH to provide improved services by having each of our six remaining centers better staffed.”
This is a dubious argument.
It is literally true that the six remaining clinics have more staff per clinic than when there were twelve such facilities.
But the overall mental health system is not currently better staffed. In fact, the city let go of 19 of its 41 licensed mental health therapists, according to AFSCME. That would mean that there are 22, not 41, total therapists available to see clinic clients.
The report contends that this leads to much longer wait times for clients to see both therapists, and get possible psychiatric care. It also means therapists are carrying caseloads of more than 100 clients, according to the study.
As PI has reported, the city believes that the clinic closings are part of a strategy to modernize and enhance mental health services.
The Emanuel administration and clinic closing foes, though, keep talking past each other, as the city council has not deemed mental health services worthy of much debate.
Last November, the council passed 50-0 a budget that greenlighted the clinic closings. The council has not held a hearing before or since that vote examining mental health care.
“The City Council should hold a hearing that broadly looks at what mental health services are needed,” Patton argues.