The [Wednesday] Papers
"Mayor Rahm Emanuel's mental health care policies went on trial at City Hall Tuesday, with critics saying many patients ended up homeless, jailed or dead after the mayor closed half of the city's clinics, while city officials maintained that care for the mentally ill actually has been expanded," the Tribune reports.
Well, those are certainly two diametrically opposed views. And one of them basically calls the mayor a murderer. Is there any evidence to support either side? Let's read on.
"[City health commissioner Bechara] Choucair said that after half of the city's 12 clinics were closed in April 2012, every patient was offered services at the remaining clinics or at other health care facilities funded by the state and federal government. Through those facilities, and the federal Affordable Care Act, thousands more Chicago residents are receiving mental health care, he said."
Okay, that doesn't add up. Every patient may have been offered services at the remaining clinics, or elsewhere, but surely not every patient took up that offer - for a number of reasons that have been detailed over the years, including geography. Second, adding in additional coverage due to the ACA is cheating - especially because coverage doesn't mean affordable coverage and affordable coverage doesn't mean access to local clinics, half of which have been shut down.
"[Rahm] Emanuel, at an unrelated appearance before the hearing, said the city's approach 'expanded coverage to more people, and more importantly than just more people, expanded also new benefits like psychiatric care that never existed because the old system did not loosen up the resources.'"
Right. Closing half the city's clinics expanded coverage. Then why not close all of the clinics and expand coverage even more?!
"N'Dana Carter, a patient who for years has been the face of the Mental Health Movement coalition, said the city is ignoring people who fell through the cracks because of the closures and is undercounting the number of people treated at city clinics before half of them were closed.
"When you see the rising crime, when you see the people going to hospitals that didn't go very often, you look at Cook County Jail, these are all a result of choices that were made, decisions that were made without consideration of the people most affected," Carter said.
Is that right? Let's check in with the jail folks.
There ya go.
"It took months for many patients to get treatment after the transition, Carter said, while others just weren't able to get to clinics that were farther from their homes, and many got reduced attention in the end. 'People that were not in and out of the mental wards now are,' she said.
"Carter and other advocates note that city officials said more than 5,000 people were being treated at the clinics as the closures were contemplated in late 2011.
"The city now says that there were 2,798 patients in the clinics at the time half were closed. Choucair told the Tribune that many of the patients on the original list were no longer 'active,' and that all of active patients either remained with the six surviving clinics or were referred to another provider."
It's certainly possible that not everybody on the rolls were active - proof, please! - but providing all patients with a referral is not the same as providing all patients with actual care.
"Dr. Nneka Jones, who heads up mental health services at the Cook County Jail, has described the jail as the largest mental health facility in the state if not the country. [Editor: As has Dart, repeatedly in national media.] She said the numbers of mentally ill detainees has grown about threefold to 2,800 in the past four years.
"Many of the crimes run the gamut, but we can say that about a third of them fall under the terms of what we call crimes of survival: retail theft, possession of drugs, prostitution," she said. Those folks would be better served at less cost in the mental health system rather than the criminal justice system, she said.
The Sun-Times account, by Fran Spielman, was a little more forceful.
"Mayor Rahm Emanuel's two-year-old plan to close six of the city's 12 mental health clinics came under withering attack Tuesday, with advocates accusing the mayor of throwing Chicago's most vulnerable residents to the wolves.
"Cut off from familiar therapists and forced to travel longer for treatment, thousands of patients fell through the cracks, sometimes tearful mental health advocates claimed.
"Some desolved [sic] into depression or returned to past addictions. Others were arrested, turning Cook County Jail into, what Sheriff Tom Dart has called the 'largest mental health hospital' where patients are 'criminalized' instead of being given the care they desperately need."
"N'Dana Carter, a spokeswoman for the Mental Health Movement, branded Health Commissioner Dr. Bechara Choucair a 'liar' for claiming that the city is providing more mental health care with six clinics than it ever did with twelve."
How? Did the city reinvest resources from the closed clinics into those remaining open? Did they then do outreach to attract even more patients? It seems so unlikely . . .
"Smoke and mirrors is fine for the circus, but this is not a circus," Carter said. "This is human lives . . . When they closed the clinics, a lot of people had nowhere to go. We're talking about a few hundred initially that rolled into thousands . . . We don't know where a lot of them have gone."
True, Dr. Choucair? Or can you provide us with (an anonymized) list showing otherwise?
"At an unrelated news conference that preceded Tuesday's hearing, Emanuel stuck to his well-worn script: The clinic consolidation that saved the city $2 million has worked for both the city and its mental health patients.
"Because of the reforms, we have more clinics with more visits.
You see, in Rahm's universe, six clinics is more than 12.
"We've expanded coverage to more people and, more importantly than just more people, expanded also new benefits like psychiatric care that never existed because the old system did not loosen up the resources."
This seems like a claim that can be vetted. To the assignment desk!
"[Ald. Bob] Fioretti cited the city's claimed savings of $2 million and said those government resources had not been saved, but were spent elsewhere," DNAinfo Chicago reports.
"We are spending the dollars," testified Heather O'Donnell, vice president of Thresholds, a mental health agency. "We are spending the money at the jail and in homeless shelters" and in other social services. "We are spending the money in the wrong places, and we are chasing our tail."
For some reason I believe O'Donnell more than the city.
"Choucair testified before the Health Committee that of the almost 2,800 people being treated at the clinics before the six closings, more than 400 had been shifted under stable condition to nonprofit community mental-health providers. Choucair said the city was still treating up to 2,150 people at the six remaining clinics."
Well, even in the unlikely event that those numbers are true, 2,550 is less than 2,800.
"He added that additional care was being provided under the health expansions called for by the federal Affordable Care Act and pointed to additional city services on HIV and substance abuse."
Now, to be fair, if the city has expanded HIV and substance abuse services and that takes care of a certain number of those previously getting those services at a mental health clinic, that might make sense. Sort of.
"The hearing was scheduled to run until from 1 to 4 p.m., and Carter accused Ald. George Cardenas (12th), chairman of the committee, of running a 'filibuster' to fill time, after Cardenas and Ald. Joe Moreno (1st) had previously accused Fioretti of monopolizing time.
"I want people to be educated," Cardenas said. "I want people to get the proper help."
It's called a "hearing" for a reason, George; you're supposed to listen, not talk. But I'm sure you were just doing what the mayor's office ordered you to do.
"Carter said [Cardenas] had 'stacked the deck' with medical professionals as witnesses and not actual clinic clients."
Nothing wrong with medical professionals testifying - as long as they are relevant and not on the tab. Of course, "activists" were scheduled to testify later in the five-hour meeting. Wear them - and the media - down.
"A Woodlawn activist who has called for a trauma center on the South Side, [Veronica] Morris-Moore said, 'I had to scream and shout in order to sit down at this table.' She called it 'idiotic' to expect the entire city to be served by six clinics, adding that Choucair's figures were 'a bald-faced lie' and that 5,000 were being served by the 12 clinics when half were closed."
"The closed clinics were in Rogers Park, Logan Square, Woodlawn, Auburn Gresham, Morgan Park and Back of the Yards."
Chella H vs. Angel Olsen
The Beachwood Tip Line: Icy.
Posted on August 20, 2014
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