Allison Arwady, illustrated by Shane Tolentino

The Future of Public Mental Health?

Public Health Commissioner Allison Arwady says she is “confident” the city is heading in the right direction to deliver mental health services

In January, the City Council confirmed Dr. Allison Arwady as Chicago’s new commissioner of public health. Arwady had been the acting commissioner after Dr. Julie Morita resigned from the position in June 2019. Prior to becoming commissioner, Arwady was the Chicago Department of Public Health’s (CDPH) chief medical officer for four years; before that, she worked for the Centers for Disease Control and Prevention as an Epidemic Intelligence Service officer. 

Last October, after Mayor Lori Lightfoot formally nominated Arwady for the position, aldermen in a Human Relations and Health Committee session blocked her confirmation. Members of the City Council’s Progressive Reform Caucus raised concerns over the closures of six public mental health clinics that occurred under the Emanuel administration, noting that Lightfoot had made campaign promises to reopen the clinics, but later backed away from the pledge. Arwady had in the past made statements supporting the closures, and when the objecting aldermen pressed her on the issue, she reiterated her opposition to reopening the clinics, citing the fact that the remaining five public clinics are not operating at full capacity. 

The Weekly discussed city mental health services with Arwady after the full City Council confirmed her appointment. The interview has been edited for length and clarity.

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How will the Chicago Department of Public Health ensure that patients with mental illness know where public clinics are?

Number one is that we have some real money for promotion—everything from anti-stigma campaigns [to] making sure that we’re getting information out broadly about mental health and also about our own clinics. We’ve dedicated hundreds of thousands of dollars to print material and other media ways of raising awareness, but we’re pairing that with new staff whose job will be just to do outreach around and for our CDPH clinics. We have three new positions we’ll be hiring this year. Our goal is to make sure that the CDPH clinics are part of this larger system in Chicago, so we want to think about building new linkages and partnerships between our clinics and other community assets, [and] doing training—for example [in] Mental Health First Aid in the community served by the clinic.

Critics say the clinics are uninviting to patients, and that this issue may contribute to underutilization. Does CDPH have plans to make public clinics more welcoming to patients?

Funding has always been an issue related to mental health broadly. Even where we look historically, some of that reason was because of the major state funding cuts that happened around mental health. So, the fact that the mayor in 2020 more than doubled the mental health funding, really gave us flexibility in terms of what kinds of investments we need to make. One of the really concrete things is physical improvements to our site. We know that we have really dedicated providers and professionals, but [there are] basic things like if our signage is not up to date, if our clinics are not welcoming in terms of creating a good therapeutic environment, [these are] all things [we] can do to make sure people feel comfortable in a setting where they’re going to support their mental health.

Is the inclusion of trauma-informed care new to the CDPH under your leadership?

The violence prevention teams here at CDPH for a number of years have been interested in how to do this better. But I think frankly with the new mayor coming in, there was a lot of interest in how can we turn this concept into reality. For example, here at CDPH we did a trauma-informed physical assessment of all of our clinics. We looked at language and have done trainings internally. At the mayor’s request, starting last summer, we started with partners developing these kinds of trauma-informed trainings that aren’t just for our health department staff, but were available for city employees who were working with youth in the summer. And it’s something we really want to build on this year, so we’re interested in things like not just clinical settings but other settings in which people may have mental health issues—or if not formal mental health issues, difficult experiences in their life [that may need support].

This goes far beyond the clinic. A concrete example where we think about young people [are the] Chicago Public Schools, which are very interested in this and doing work around [trauma]. But we’re also planning to do outreach to coaches and athletic and recreational settings where kids may know those folks and sometimes issues may come up.

I really see this trauma-informed approach as something that is not just for the department. I’m interested in expanding this more broadly and having it be something that we’re talking about far beyond CDPH, across the city and outside of city government to all the settings in which people are trying to help other people.

How will CDPH ensure continuity of care for patients who access public mental health clinics?

One of the problems that we see is that right now there are people getting mental health care primarily through emergency departments. Especially people with more severe forms of mental illness, [they’re] frankly rotating through the emergency department [because] they’re in and out of crisis. That is the opposite of a good continuity of care plan. We’ve been working with partners across the city to make sure we really are building a network of mental health care. Not only are we investing in outpatient clinics, but we’re creating for the first time some violence prevention programming that will really make sure people who are victims of violence—and their families and community members—if there are mental health needs there, we will use the opportunity for outreach. We’re investing for the first time in crisis prevention and response teams to address the issue that people may not have a real care plan. It will be an opportunity to bring mental health treatment out of the clinic and to people with some of the highest needs.

Do you have any plans to work with the various community groups that sprang up to fill the mental health care void that occurred after the 2011 closures?

Absolutely. One of the things that’s most important to understand is that the city-funded clinics play an important role, but [that is] a really small role in terms of numbers. We want to grow that, but even at the peak we were maybe serving five percent of the adults [who were] getting mental health care. So, it’s really worth thinking about really building a network and that’s our goal: coordinating mental health across the system absolutely means working with these community partners. My team has been doing a lot of work over the past year or so, reaching out to community mental health clinics, some of whom are working in the spaces where there were previously CDPH clinics, [and] many of whom are working across the city, and to the other publicly funded mental health sites. Whether that’s our Federally Qualified Health Centers, whether that may be a school-based clinic, there’s a lot of different settings. We really want to make sure that we’re doing a much better job of coordinating all those resources.

Mayor Lightfoot’s 2020 budget allocated an additional $9.3 million to fund new mental health initiatives. How will you ensure accountability in terms of how that money is spent?

The Health Department has a lot of responsibility for accountability when we work with community partners. For example, we receive a lot of federal grant dollars around things like immunization or tuberculosis, and we often are contracting with community partners to ensure that the goals the city made [are met]. And so, we have good systems and processes in place around things like reporting, what kind of data will folks be providing back, things like fiscal oversight, the basics of ensuring that you’re being a good steward of this funding. We will use a lot of those similar mechanisms with this funding. I’m confident that it will be used well.

My hope is that people will be excited about these new investments and really looking forward to seeing improvements. At the end of the day, we’re all interested in improving and getting more people the care they need.

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Jim Daley is the Weekly’s politics editor. He last wrote about holiday baked goods from around the South Side for the 2019 Holiday Issue.

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