Holes in the Safety Net | Neighborhood News | Chicago Reader

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Holes in the Safety Net

A mental health clinic closes abruptly: is it because managed care doesn't care?


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By Ben Joravsky

For 15 years Spectrum dispensed innovative therapy and counseling to thousands of patients, many from the south side.

But this month the mental health clinic--located in the Weathers Y. Sykes Health Center on King Drive--closed with little warning, explanation, or provision for alternative services. It was another victim--patients and staffers say--of the madness of managed care. "There's a serious flaw in a system that allows Spectrum to go out of business when it's so desperately needed," says "Sally," a 40-something south-sider who was a Spectrum patient for most of the 1990s. "There's something tragically wrong. Demand for care goes up but the supply goes down."

Sally found her way to Spectrum in 1992, when the clinic was fairly well established. In its early days, finances didn't seem to be a problem. It was founded by Michael Reese Hospital, and many of the patients were city, county, and Board of Education employees covered by the Reese health plan. "We offered acute outpatient care," says "Red," a former employee who asks not to be identified. "We tried to do whatever we needed to, to keep them from losing their jobs or winding up being hospitalized."

In Sally's case, that meant almost daily visits. "I was falling apart," she says. "I was working 12 to 14 hours a day overseeing the staff and budget of a small business, my parents were struggling with serious illnesses, and I was dealing with a lot of painful memories of domestic violence and family alcoholism. I began to self-mutilate myself and to threaten to hurt myself. I cut myself. My roommate took me to the emergency room and they told me they didn't have any beds in the psych ward--no room at the inn, so to speak. The doctor's main question was whether I could keep myself alive long enough until tomorrow, when I could go to an outpatient place called Spectrum. That's the first I ever heard of it."

The next day she began her treatment, overseen by the clinic's staff of therapists, social workers, and psychiatrists, who offered medication, group therapy, and counseling. "They offered a solid team approach that can go on for several years," says Beverly Hamilton Robinson, a therapist who has worked with Spectrum's staffers. "It's probably one of the best team approaches we had in the era of managed care."

For Sally, that included assistance from social workers who helped her keep track of the daily details of existence. "I was really out of it, sometimes I slept for days," she says. "They helped me in so many ways." Over the years they helped her deal with employers, landlords, relatives, doctors, and hospitals. "I called them day and night, whenever I needed them. The things they did--I can't possibly remember them all. It was little things, like calling cabs when I had to get somewhere. And big things. In the middle of it all I had to have a hysterectomy. I wasn't ready for it--I couldn't deal with the idea that I couldn't have a family. They got the doctors to postpone surgery until I was ready. My OB-gyny said, 'Your psychiatrist's going to drive me nuts'--that's how often he intervened."

In 1997 she bottomed out. "I tried to kill myself. I took an overdose of pills and waited for them to work. But after an hour they still hadn't worked. It was bizarre what happened next. I got hungry. I went to [a restaurant]. And I passed out."

She wound up spending six months in a nursing home in Kankakee. "I was so low and so down, but something clicked. When everything's lost you have to let go." In the last two years she's resumed her life in Chicago. She has her own apartment and works part-time. She says she might even write a book about her ordeal. "The folks at Spectrum saved my life. They were the safety net that caught me when I was falling. I felt I was floating at the bottom of an ocean, and they were always there. They took my calls when I was hysterical. There was never one instance where they said, 'Hey, I talked to you yesterday. Get a grip.' It's funny. I wasn't being treated by Spectrum when I finally got it together. But they got me to that point. They helped keep me alive. They were a rock for me."

Sally didn't know that her rock was sinking. In its last seven years it passed from one manager to another. "We went from different managed care systems," says Red, "from Reese to Humana to Advocate to York Behavioral Health." Each transition brought a new set of guidelines having to do with cutting costs. "There were gradual cutbacks," says Red. "It was pressure to cut costs. I think we did a good job of keeping it from our patients."

In August York announced that the clinic would close October 1. "It had nothing to do with the service we were providing or the need," says Red. "It was explained that they could no longer afford to keep Spectrum open because they had lost contracts to provide health care with various employers. It was very sad. People were crying. Old patients came back and said, 'I heard you were closing. How can that be?'"

A spokesman for Advocate did not respond for comment. One former Spectrum employee who still works for York says former patients will be referred to other clinics or providers. "If they call we will walk them through the system until they get the help they need," says the employee, who asked not to be identified. "We will help patients empower themselves."

The employee continues, "Spectrum was great, but things come and end and something else gets developed. The reason managed care came into being was because of the abuses in the system. I think wherever there's money, there's abuse. We have to look at managed care, but it doesn't mean it's a bad thing. It's an easy target. There were a lot of good people who spent a lot of sleepless nights before we let people go. We're not monsters. I'd love to see people do a good article on the health system, as bad as it is. I know people who are getting good care. You can't have so many people who are using managed care without some success stories. Yes, you should write the shit stuff. But once a month, write a good story about health care."

Others say the system needs radical change. "In the age of managed care we're seeing a steady decline in mental health care," says Allan Scholom, a psychologist with a private practice. "It used to be that about 7 to 8 percent of expenditures in health care were for mental health. Now it's down to about 3 percent."

Scholom says fewer people are receiving mental health care because fewer policies cover it. Patients either pay out of pocket or go without. "The idea behind insurance has changed with managed care," says Scholom, who's also chairman of the Illinois Coaltion of Mental Health Professionals and Consumers, an advocacy group. "It's no longer pooled risk. Instead it's what they call 'capitation.' Basically, that means that the incentives are not to provide care. The 'provider'--to use their term--gets a certain amount of money to serve a certain amount of patients and no more. Capitation shifts the risks to the practitioner. That makes you more of an adversary to your patient. It's harder and harder for a provider to provide service. You have to justify everything. The managed care people will say only four visits. Well, maybe the patient needs more than that. You find yourself on the phone fighting with the insurance company."

In some policies, managed care companies set lifetime limits on mental health care, activists protest. "With a lifetime limit you may use up all your care while you're still very much alive and in need of more care," says Sydney Bild, a retired physician who chairs the health committee of Metro Seniors in Action, a senior-citizen group that advocates a single-payer system.

Sally doubts that Spectrum's former patients will be able to find their way. "Mental health care is so stigmatized as it is. It's very difficult to get someone just to seek help. I can't imagine finding assistance without Spectrum. You know how it is when you call a doctor's office. Sometimes you get that recorded message--push one if you want this, or two if you want that. Or you have to tell a stranger why you need a therapist. How can someone like I was fight their way through that without help?"

Some former Spectrum staffers agree. "I don't know what's going to happen to a lot of these people," says Red. "We had one guy who was severely ill and we got him on psychotic medication. He's working. But he had to come in once every two weeks to have his medication adjusted. What are people like him supposed to do now? Are they going to walk into a doctor's office and say, 'Hi, I'm psychotic. I need antipsychotic medicine'?

"I know a lot of people can't relate to the seriously ill who suffer from serious depression. They say, 'Oh, they're just crazy.' But what about the average person who goes through tragedy? Everyone does at some time in their life. Some handle it better than others. I know of one woman whose child died unexpectedly at the age of ten. The woman could barely function--she thought God was punishing her. She hid in her home. She was totally stressed with anxiety and grief. In two months we got her back to work and to the point where she was thinking of adopting a new child. The point is that depression is one of the most treatable of illnesses. But you have to treat it. You can't pretend it doesn't exist."

Art accompanying story in printed newspaper (not available in this archive): photo/Robert Drea.

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