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Breaking the cycle

For three decades, the city has failed to cope with the loss of mental health clinics. The pandemic revealed the wounds of this disinvestment.

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KIKI LECHUGA-DUPONT
  • Kiki Lechuga-Dupont

Gardening keeps Milton Sewell grounded. The 56-year-old North Park resident embraced the isolation brought on by the pandemic by leaning on his hobby. Throughout the spring and summer, he'd scout backyards belonging to friends and church members, converting bare, patchy spots into small fruit and vegetable gardens.

The days between planting seedlings and harvesting can seem long and tedious. Overwatering, garden pests, or even the slightest change in weather can throw the plants off course. But Sewell lives for these moments. He enjoys lugging his tools around, shuffling back and forth between yards, working hours in the sun. To him gardening is more than just tracing the circle of life. It's about rebirth. Once the gardening season ends, all that's left is the foundation of new beginnings.

"Life rejuvenated over and over," Sewell told me. "I love to see that." These thoughts on death and resurrection, however, first stemmed from a much darker place.

In his 20s, Sewell was diagnosed with stage 4 Hodgkin's lymphoma, a cancer of the lymphatic system, which helps the immune system fight infections. He spent the summer of 1988 cooped up at the University of Chicago Medical Center, recovering from a bone marrow transplant and pushing through rounds of chemotherapy. The treatments were tough on his body, and Sewell felt trapped inside the hospital. Cancer had already robbed him of his future: he was unable to have children of his own someday.

"I was always in constant fear that I would come out of remission," he recalled. Sewell talked about being physically exhausted and mentally drained, until he reached a breaking point: "I just cannot go back to another hospital. I just can't do it anymore. I just feel like I don't want to live anymore."

He said he confided in his doctor during a checkup, but he didn't expect that sharing those emotions would jolt him into another traumatic experience. "They comfortably led me down the hall," Sewell remembered. "Got on the elevator, down the steps, and then I went to the room and all of a sudden the door closed, and I heard the automatic locks. Click, click. I'm like, whoa, what is this?"

It would take years before Sewell could confront being ushered to a psychiatric ward room for further evaluation. Those memories were coiled inside his web of grief. He grew comfortable being alone, often ending relationships before anyone got too close. He turned to drinking and drugs to deal with his depression, hoping to free himself from some of his most painful experiences. Alcohol and marijuana made him forget and made him happy. But his moments of relief turned into an addiction cycle. Sewell tried therapy, but aside from the high costs, he realized he wasn't ready to talk about the trauma of his past.

"I didn't have any way to get rid of it," he said. "I just didn't have any way to deal with it."

Two years ago, Sewell was "a total mess." He had just lost his mother and his brother. He also lost his job and then his apartment. Sewell knew he needed something more than prayers and 12-step programs to survive. A fellow parishioner from Grace Evangelical Covenant referred him to the Kedzie Center, a mental health center just a couple blocks away from the church.

Sewell began going to therapy twice a week. His therapist spoke to him like a friend, and for the first time in a long time he felt hopeful. "They just have a way of leading me down the path," he said. "They don't go directly and tell me what to do or think, but they do have a way of asking certain probing, therapeutic questions to get me to see what's behind any statement, ideology, or way of being that I have that I'm not seeing."

Since 2014, the Kedzie Center has offered free mental health services to residents like Sewell from Chicago's Irving Park and surrounding north-side neighborhoods. The center on North Kedzie was the first neighborhood tax-funded mental health clinic created by the Coalition to Save Our Mental Health Centers, which formed in 1991 to fight the city's closures of public mental health centers. In 2011, the coalition championed the Community Expanded Mental Health Services Act, a state law allowing communities to vote on a binding referendum and establish mental health programs by increasing taxes. Today there are four neighborhood tax-funded mental health clinics across Chicago. More may be on the way.

Last November, Bronzeville became the first neighborhood on the south side to increase property taxes to fund free mental health services. The south side famously lost four public mental health clinics nine years ago when Mayor Rahm Emanuel closed half of the city's 12 clinics to save roughly $3 million in the annual budget. Critics warn that neighborhood-funded public mental health centers are only a piecemeal solution to the mounting crisis. Black communities are a reflection of citywide divestment, and the absence of safe spaces such as those clinics leaves residents vulnerable.

On the ballot, residents vote on a 0.025 percent property tax increase, which translates to about $4 per $1,000 paid in annual property taxes. Nearly 88 percent of Bronzeville voters signed off on a $16 to $24 increase to support an expanded mental health program to serve the south side. The coalition had opened two different sites since 2012, in Irving Park and East Garfield Park, and they wanted to build on the south side, said Robert Gannett, executive director at the Institute for Community Empowerment, the coalition's partner organization.

"Bronzeville was an area that we have worked with people on a variety of issues, and people said that mental health is essential," Gannett explained. "It was important, from our point of view, to get started on the south side also. Eventually, the hope is that every community in Chicago will have a new [community-funded] mental health center." This fall the coalition expects to open another mental health center, which will serve residents in Logan Square, Avondale, and Hermosa.

The fight to sustain resources, which have already been cut to their "bare bones," isn't new, said Roderick Wilson, executive director of the Bronzeville-based Lugenia Burns Hope Center. A new mental health clinic in Bronzeville comes when residents were on the verge of losing another resource: In February, Mercy Hospital, one of Chicago's oldest hospitals, filed for bankruptcy, and was briefly slated to close by the end of May.

"When you look at the Black community, we've always had this disinvestment in education. We always had double-digit unemployment, disinvestment in quality housing, inequities in criminal justice," said Wilson. "There's always inequities in health care and what COVID has done is just let us see how inequitable it is."

Under the Expanded Mental Health Services Act, the coalition's centers must have a governing commission consisting of community residents, clients, and clinicians who tailor services based on resident need. That might include hiring bilingual staff or offering childcare and youth programs, in addition to counseling.

"How do you treat, how do you care for, how do you help save the conditions of those who are vulnerable?" Wilson asked. "That's how you determine a world-class society. And that's what we don't do in America. We don't do that in Chicago, on the south side, in the Black community. So, we have to make it happen for ourselves."

Sewell was 12 years old when he was attacked at knifepoint and raped near his home in Bronzeville. He remembered that the attacker, who lured him into a vacant alley with candy, threatened to kill him and his family if he told anyone. Decades passed, and Sewell kept quiet, his secret blooming into alcoholism, drug use, and depression.

"I had to live with that. Any time the thoughts would come to my head, I would shake my head and try to shake them out—I still do that today," he said. Unsure of where to turn for help, Sewell kept to himself. Twelve-step programs led him to learn about mental health, but even then, he didn't know how to start therapy and thought treatment programs were exclusive to hospitals.

There are currently three public mental health centers on the south side. Sewell isn't aware that one of them is located in his old neighborhood. The Greater Grand/Mid-South Mental Health Center is on East 43rd and South Cottage Grove, inside the Dr. Martin Luther King Community Service Center. Its services are hidden in a brick building, surrounded by a few apartments, churches, and restaurants. "A lot of people are not even familiar that it exists there," Gannett said. "If you go by, it's not as if there's lots of publicity about the mental health center on signs."

The King Center is known for city services, including housing, job training, and food pantries. "I never knew that they offered those [mental health] services," Sewell said. "If I did, it would have changed my life."

Amandilo Cuzan has lived in and out of Bronzeville for the last several decades, before finally settling in his childhood neighborhood in 2000. Cuzan, now 64 and the chairman of the Bronzeville Alliance's communication committee, said he has visited the King Center dozens of times, but never knew about the public mental health programs. "When Emanuel closed those mental health facilities, I was deeply upset and stressed by that, because I know how many people need those kinds of services," said Cuzan. "Fragile as they are, I mean, that was not even adequate, what was already in place. But then to go and close those facilities was just criminal in my mind."

Cuzan sought therapy after he was diagnosed with throat cancer in 2017. Though his disease was treatable, he had plans to move to Minnesota and become the primary caregiver for his ex-wife, who was herself battling breast cancer. Overwhelmed by the stress and pressure to care for his family and himself, his anxiety became unbearable.

Cuzan received cancer treatment at the University of Chicago Medical Center and was referred to therapy at Friend Health on South Cottage Grove Avenue in Hyde Park, a six-minute drive from the King Center. While he found talk therapy helpful, because of scheduling conflicts and a high turnover, he had three different therapists at Friend Health.

"I probably would have stayed in therapy longer or pursued it even now, you know, if it was a little bit more of a convenient process," he said. "It is very challenging to open yourself up and be vulnerable like that. And, then you've got to deal with all of this."

In a city that has closed or privatized over a dozen public mental health centers since the 1990s, the coalition's community-focused model is not dependent on the tumultuous budget process. Gannett, who has stood with activists since the 1990s, said the coalition's centers were created to "fill gaps" made by the city's consistent decision to shutter public mental health centers.

These places serve as another resource, not a replacement, for the city's public mental health clinics, said Matt Ginsberg-Jaeckle, a longtime organizer for the Mental Health Movement campaign. Ginsberg-Jaeckle called the coalition's efforts a "stopgap measure" and said the solution is to create "robust public investment where the government takes responsibility for providing high-quality services to those most in need everywhere."

The call for a radical new investment in sustaining a widespread and accessible mental health care system in Chicago isn't new. It has, however, been rejuvenated amid a nationwide outcry to defund, abolish, and dismantle police departments.

After a summer of unrest sparked by the deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery, Chicago activists campaigned to "Defund CPD" and urged elected officials to reallocate the Chicago Police Department's nearly two-billion-dollar budget instead into community services, including mental health programs and affordable housing. (Local proponents of police abolition say police funding takes up a bloated part of Chicago's operating budget, some 40 percent in 2021.) Combined with the impact of the COVID-19 pandemic, the rise of suicides amongst Black Chicagoans, and the city's historic budget deficit, the fight to fund the public sector continues, shining a light on the mental health funding system that has been broken for decades.

"We have a public commitment to make sure that those services are available to those who may not be able to access them in the private sector," Ginsberg-Jaeckle said. "And we know who the private sector tends to leave out the most—they tend to leave out communities of color, particularly the Black community in Chicago."

When Joyce Zick first started at North River Mental Health Center in North Park more than 30 years ago, she worked alongside 15 therapists and ample administrative employees. Back then, the city had 19 public mental health centers. A 1978 map from the Chicago Department of Public Health showed that 11 of these centers were located on the south side, while the rest were scattered around the city's far north and west sides. A bright-eyed young clinician, Zick's only mission was to help people. She helped manage a day treatment program and worked with individuals with mental illnesses who were preparing to transition home after being hospitalized. Even now, she can recite the advice she received from a former supervisor about working in the public sector.

"'Don't let it spoil you,'" she said. "I didn't know what she meant at the time, and I didn't care. My commitment was, as always, to the clients."

City-run clinics like North Center are mandated to serve all individuals, particularly those who are uninsured, undocumented, and low-income. Dani Adams, a member of the Collaborative for Community Wellness, said privately operated mental health centers, and even nonprofits, can turn people away based on their inability to pay or the severity of their illness.

To understand how these city-run clinics are funded, you first have to understand why community mental health centers were created in the first place. In 1963, President John F. Kennedy signed the Community Mental Health Act, radicalizing how mental health services were delivered. He sought to move away from the "cold mercy" of state psychiatric hospitals and replace them with the "open warmth" of community-based mental health centers. The goal was to build up to 2,500 centers across the nation using federal grants, to provide people with mental illnesses and learning disabilities with inpatient and outpatient care, emergency services, and mental health education.

While the act proved key to the deinstitutionalization of state psychiatric centers, it was also flawed. Matt Spitzmueller, an assistant professor at Syracuse University, said only about 700 community mental health centers were built. In 2003, psychiatrist Sally Satel wrote in the New York Times that the centers "could not handle the huge numbers of fragile patients who had been released after spending months or years in the large institutions," and "there were not enough psychiatrists and health workers willing to roll up their sleeves and take on these tough cases." The centers were understaffed and under-resourced.

Medicaid and Medicare emerged at the same time the act was established. Medicaid is the nation's largest funder of mental health services. "Today's state mental health agencies rarely have direct responsibility for patient care, instead contracting services out to a variety of private entities, both for-profit and nonprofit, privately and publicly operated," wrote Adams for South Side Weekly.

President Jimmy Carter carried Kennedy's vision in 1980 by funding more community centers and creating the first presidential commission on mental health. But that all changed when Ronald Reagan was elected. Reagan signed the Omnibus Budget Reconciliation Act in 1981, repealing Carter's efforts to support community mental health centers. That meant funding for mental health services competed with other public needs such as housing and food banks, which were typically prioritized. The shift in federal fiscal spending put cities and states more at risk to piece together the funds for their mental health services, making them "vulnerable to neoliberal political whims," wrote Adams. That led to annual budget cuts, including hiring freezes, trimming administration costs, and reducing services.

In the 1990s, Mayor Richard M. Daley closed seven of the city's 19 public clinics, and Zick noticed the North River center's staff size shrinking, leaving her and her coworkers to pick up other duties. Periodic training in social work, an added bonus to the state-mandated continuing education courses required for most license holders, was cut.

But, what hurt Zick most was how she often scrapped for money to keep the day treatment program going. Strapped for funds, the center opened a thrift store to help alleviate other expenses. "I operated as much as I could within the confines of the city," she said. "They want you to do the job without the money." Zick remembered the city's push to find "community partners," a buzzword that paved over the lack of commitment toward funding its public mental health centers. "There was never a commitment."

In 1990, the Chicago Addiction Treatment Center, one of the city's many public health facilities, was closed and contracts were given to two private firms, according to a 1991 Tribune story. It was one of the first substantial moves toward the privatization of mental health services. Daley told the Tribune that the private firms would be able to serve more people and provide better treatment at a lower cost. The treatment center initially saw 1,445 patients a year for $4.2 million, and under those contracts, it could see roughly 200 more clients for $3.8 million.

Representative Danny K. Davis, a Cook County Commissioner, spoke out against Daley. Davis believed it was "an admission of failure to manage government effectively," and funding city mental health services should be treated as an investment, not a cost-saving measure. Thirty years later, his opinion hasn't changed. Neither has the city's pattern of privatization. "There are some things that demand and require public interest," Davis told me. "Our mental health needs is one of those areas that require and demand public intervention, public perception, and public service."

Davis's concerns about privatizing public health programs resurfaced in 2012, as activists protested the closure of six city-run mental health facilities. Illinois had already slashed a whopping $114 million from its state budget to support mental health services, and Daley had blamed the state for shuttering four south side mental health clinics.

For many public health advocates, dwindling citywide mental health resources meant one thing: people won't get the help they need. In East Garfield Park, where Davis's district office is located, he called pockets of California, Fifth, and Madison avenues that were littered with vacant lots "no man's land." "We could really stand to have a mental health center on every corner," he said.

In 2019, the coalition celebrated the opening of the Encompassing Center that serves residents in Garfield Park, North Lawndale, and the greater west side. Davis said the minimal property tax increase was worth the benefits of the coalition's neighborhood tax-funded model. "I know we're talking about a low-income community, and I know we're talking about people who don't have much to spare. And I know we're talking about what some folks would call socialistic tendencies," he said. "But, we are also talking about democracy. We're talking about engagement. We're talking about involvement."

But the solution here seems to be a ripple effect, born out of a seemingly broken system. To Davis, it doesn't matter who the mayor is, "the systems have become the systems."

In 2012, the American Federation of State, County and Municipal Employees (AFSCME) Council 31 partnered with Southside Together Organizing Power to stop Mayor Emanuel from closing half a dozen public mental health facilities. Located on the south and west sides, those centers saw over 5,300 residents, most of whom were Black and Brown.

Emanuel viewed the clinic closures as a way to save an estimated $3 million in the city budget—a "pitiful" effort to save "just pennies," Jo Patton, a former director of special projects at AFSCME, said. Nearly half of the patients served were forced to find resources elsewhere fast as the Chicago Department of Public Health (CDPH) looked to shut down five facilities within a two-month span (one of the centers, the Roseland Neighborhood Health Center, was privatized). "Those people ended up really falling through the cracks."

Patton said privatization removes the city from its responsibility to provide access to health care for its people. Nonprofits, she said, are still held accountable by the foundations that support them and must bring in enough clients to keep their doors open, "and that can frequently mean making business decisions."

Following the six closures, CDPH sought to lay off 30 employees and cut additional vacant positions, while the remaining clinics saw a huge spike in clients, AFSCME Council 31 reported. In 2018, the Collaborative for Community Wellness reported that there was at least one licensed clinician available per 1,000 residents in the south, southwest, and west sides. And, since 2012, the city has allocated only $817,730 of its corporate funds to mental health salaries and positions, compared to its $3.6 million budget in years prior.

"The need is always greater than the capacity, and given that need, there's a responsibility for the city to step up and make sure it's met," Patton said. "If you don't want to get complaints, if you don't want to deal with the hassle, if you don't want to pay a decent wage for doing it, then you walk away. You pull a Rahm Emanuel and just wash your hands of it altogether."

During Mayor Lori Lightfoot's campaign, she promised to reopen the clinics Emanuel closed. None of these shuttered clinics have reopened. Since taking office, Lightfoot has instead poured millions of dollars into the five remaining facilities by allocating funds for renovations, creating telehealth services, and hiring more staff such as psychiatric nurse practitioners and community outreach coordinators, said Matthew Richards, deputy commissioner of behavioral health at CDPH.

This year, Lightfoot announced several initiatives to expand the city's mental health services, one of which awarded $8 million in grant funds to help 32 organizations, 20 of which are on the south and west sides, develop their trauma-informed programs. The effort is part of Lightfoot's Framework for Mental Health Equity, a joint plan with CDPH to rebuild Chicago's mental health system. While many believed in allocating funds to those community partners, they thought the city, once again, missed the point: it's long overdue for sustainable investment in public mental health centers.

"If that funding goes away, what is to say that private providers will have the capacity to continue offering services?" asked Caitlin O'Grady, an evaluation manager at the Brighton Park Neighborhood Council. "If that money is going to hiring staff, what's to say that nonprofit providers are going to have those funds to be able to continue hiring staff, after that funding goes away?"

Last year, Lightfoot proposed using $1 million to launch two alternative co-responder models to answer mental health crisis calls. One of the pilot programs would allow police officers to partner with mental health professionals and paramedics and crisis-intervention officers when responding to 911 calls. The other program involves a "solo-responder model" that does not include law enforcement, championed by Alderwoman Rossana Rodriguez Sanchez and supported by organizers who demanded that Lightfoot defund the police in the 2020 budget.

Jalen Kobayashi, an activist and organizer of GoodKids MadCity Englewood, opposes the co-responder model. The 20-year-old is skeptical of its effectiveness, because the mere presence of policemen is already triggering for Black and Brown people. Marginalized communities need "an on-site therapist on every corner, because on every corner there's heroin being sold. On every corner, there is a time when a bullet went into the sidewalk."

Aside from counseling sessions, Kobayashi suggested people, particularly teens and young adults, should have access to other forms of therapy such as arts therapy or sports therapy. But they said public mental health services aren't the only resources that need financial support. People must have access to housing, employment, and education.

"Kids need space. In the hood, in Bronzeville, realistically, you got school and you got a YMCA and that's about it," said Kobayashi. "You don't got Evanston-like patios and gazebos and all that type of shit. You don't have that. You have the bare minimum on purpose. Therefore, we're working with the bare minimum, with even less than that."

Patton said these pilot programs were steps in the right direction but she called them "Band-Aids," covering up a "fragmented" mental health system. "The biggest problem is just an unwillingness to make the argument that a good investment of public dollars is an investment in health services and mental health services, and we just have not had that kind of leadership," Patton explained. "How to provide the services is pretty straightforward, but having the political vision and the will to push it, seems to me, to be what's lacking."

"The struggle must go on," Davis said. "That advocacy must go on, and we keep making baby steps in terms of progress. You can't stop. You've got to keep trying."

This winter, Sewell shifted his focus away from his garden. Like many people, the pandemic has given him time to be with himself and learn more about himself. He bought a fish tank, something that had been on his wish list for a while. He's a rock collector, and often asks friends to bring him back stones from their trips. Scattered all over the bottom of the fish tank, these rocks make up his pet fish Thug's home.

Sewell laughed as he told me the story behind the name. He bought ten goldfish and Thug, who happens to be just slightly bigger than the rest, killed the other nine. He said Thug reminded him of his younger self, "just butting heads with people and running them out of my life. You know, I just killed all the relationships."

For Sewell, therapy has been a godsend, a way to finally move forward and take the next step in his life. "Unprocessed trauma will damage you for life," he said. "It really will, and unless the trauma is processed and the damage is talked about, it's going to be like running in mud. It really is. It's living life running in mud."   v

City Bureau supported the reporting of this story.

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