The Fight for Mental Health Services in Chicago

By Anne-Marie Cusac. Published by The Progressive 4/27/2015. Reposted with permission.

Diana Bryant loves to dance. In a few days, she will sway and bop at a big celebration she helped raise money for and plan along with twenty-four other clients and volunteers at Chicago’s North River Mental Health Center. But dancing is something she’s done all her life.

“In my apartment, alone, I would dance until I was exhausted so the voices in my head that sounded like my dad would go away,” Bryant says. The music and movement could give her mind a break when the self talk came “just like my dad—his voice, his comments, which were always very cruel.”

Bryant, now in her late sixties, describes an alcoholic father who probably had mental illness. “You could walk in the house with your shoes untied and it would cause major problems,” she says. “He was violent and reactive to every little thing. That was his illness.”

His words stayed with her. “You’re no good,” her mind would say. “How stupid can you be?”

The dancing tired her body until she dropped from exhaustion, which brought relief. “If you’re too tired, you can’t think,” she says.

Then one day, Bryant broke her ankle. Her bone recovered, but the strategy she’d once used to make the voices go away was unavailable. The bad ankle had stopped her dancing.

Three months after her fall, Bryant returned to work. “I was sitting at my desk and I felt like the room was starting to close in on me. I could not breathe,” she says. She phoned a psychiatrist she’d seen for depression, and learned that he had died. She grabbed her purse, told her boss she was leaving, and walked out. She took the El home, but can’t remember the rest. Her landlord found her.

“I was in their house, in their chair, balled up into a little ball, and I scared them half to death,” she says. “I wasn’t making any sense.” Bryant ended up in the psychiatric unit at Chicago’s Swedish Covenant Hospital for three weeks. She says her boss called and fired her while she was there.

But Bryant tells the story of this breakdown with gratitude. Swedish Covenant Hospital referred her to the North River Mental Health Center, a public clinic that serves impoverished people with serious mental health disorders. It was there that she received a diagnosis of depression and post-traumatic stress disorder.

“A lot of people think that post-traumatic stress disorder is just for people in the military,” she says. “It’s not. You can get it when you’ve been an abused child. You can get it when you’re in situations that you cannot get out of. It’s usually a very cruel situation.”

Diana Bryant’s story shows how mental illness can strike anyone, and how crucial it is to get accessible and affordable care. Mental health care cuts at the state and city level have been devastating, but the story of North River shows that people do value mental health care and that they can work together to protect and even create it. But cuts remain a threat, as the shortage of psychiatrists and the uncertain future of the North River clinic show.

In 1991, the city of Chicago had nineteen public mental health clinics. By 2012, there were twelve left. That year, Chicago city officials closed six more, a controversial move that helped drive this year’s grassroots effort to unseat Mayor Rahm Emanuel.

Of the six centers that remain, North River is the only one serving the city’s vast North Side. The efforts of devoted activists (made up of both mental health consumers and members of the community) have kept North River open. But the consumers fear it could be the next to close.

Reductions in Chicago mental health services are a microcosm of a national issue. Cuts to public mental health over the past several decades crowd our jails, making them repositories for people with mental illness.

“Currently, the largest mental health hospital in Illinois is not even a hospital—it’s Cook County Jail, which I oversee as sheriff,” wrote Cook County Sheriff Tom Dart in an op-ed last July for the Chicago Tribune. “My office’s conservative estimate is that one-third of the 10,000 inmates in custody suffer from serious mental illnesses.”

Between 2009 and 2012, Illinois slashed mental health funding by nearly 32 percent. The decline reflects a nationwide trend, which advocates call a national crisis.

In February, Illinois Governor Bruce Rauner released a budget that would cut $82 million more from mental health services.

Bucking this trend is the Coalition to Save Our Mental Health Centers, an advocacy group formed in 1991 when Chicago first placed the North River Mental Health Center on a closure list. The storefront office is on a street of small businesses—the Hawaii Flower Shop (a “for rent” sign in the window), a dentist, a barber, and farther down the block, Bub’s Carry Outs, and the Happy Kids Polski Przedszkole (Polish Preschool).

In the face of extensive cuts, the coalition has managed to save the North River Mental Health Center, so far, despite repeated attempts to close it. And that’s not all. The Kedzie Center, a new mental health clinic serving people with less serious disorders than those treated at North River, marks the first expansion of mental health services funded by public dollars in Chicago in two decades.

But the Kedzie Center, on Chicago’s Northwest Side, is noteworthy for other reasons, too. Constituents voted to raise their own taxes to build it.

The Chicago example shows how even property owners of modest means can contribute to public health via a small levy (about $15 on a property with an assessed value of $200,000). The first year of this tax raised more than $500,000. Those funds made possible the nonprofit Kedzie Center, which opened October 29, 2014, offering free and low-cost counseling to residents of several North Side neighborhoods. The activists hope to take their model to other parts of Chicago.

Bryant helped make it happen. She’s fought to protect and expand mental health services in her community for more than eight years. Her emotional investment in the new Kedzie Center is palpable, even though she isn’t a patient there.

“It’s so clean,” she says. “A nice new building. A lot of times we get what we call the leftovers.” But she calls the Kedzie Center “beautiful,” and says she knows why—”because we’re the ones that did it.”

In a referendum in 2012, nearly 74 percent of North River voters chose to raise their taxes to fund mental health services.

“I wanted to kiss my neighbors,” Bryant says. “You know what they were saying about that? ‘Of course I’m going to vote for it. It’s a no-brainer.’ ”

Chicago mental health workers once went into schools, senior centers, and homes to offer counseling. Those services were discontinued in the waves of cutbacks. The new Kedzie Center is building an outreach program for children. Says Bryant, “That’s very dear to my heart because I was one of those children.”

Bryant lives two bus rides from the coalition office. Her neighborhood has big trees, two-flats, small houses, a few larger buildings. The fences are mostly chain link with swing gates.

Bryant rents the second floor of a large house. She babysat her landlords’ children when they were young, and has been with the family since. “We’ve got about thirty-five years together,” she says.

The day after the North River holiday party, Bryant is at home, decorating for Christmas; she and her landlords will spend Christmas Eve together. She has nine tubs of ornaments. In the bathroom, an electric flame flickers from a glassy wreath. There are pictures of Santa and Jesus on the walls. A tree stands near a portrait of Benjamin Franklin, whom she admires so much she named her cat after him (“He was a very stubborn brat,” she says).

Bryant admits she might be compensating with the ornaments “because we had very little when I was a kid at Christmas.” She loves the holiday. “It’s pleasant. It’s hopeful.”

Pill bottles are arrayed across the top of her television: buspirone, fluoxetine, omeprazole. The omeprazole is for her stomach. The other two, for depression and anxiety, were prescribed by a North River psychiatrist who retired in July. The clinic has been without a psychiatrist ever since. By mid-December the city has not yet informed Bryant and others who depend on the North River Mental Health Center if a new psychiatrist is coming. Bryant is “starting to run out of meds,” she says. “But not yet.”

The departure of the center’s only psychiatrist prompted an outcry even before her retirement. The North River Consumer Council, an advocacy group comprised of mental health consumers, began writing letters last summer to the commissioner of the city’s Department of Public Health.

The letters warned about the loss of services to vulnerable people. The department responded that it was having trouble hiring a psychiatrist because of a nationwide shortage, and that it planned to bring in a temp. The activists protested, saying the lack of a psychiatrist “has left our consumers in an alarmed and panicked state, exacerbating our mental health symptoms. Consumers have no one to turn to for medical treatment. Our consumers are suffering from untreated symptoms and we are trying to prevent hospitalizations or worse.”

In January, the center hired temporary psychiatrists who work two days, half the time of the previous psychiatrist. The patients say the wait times are longer, and it’s hard to get a psychiatric evaluation.

Bryant is concerned. Trusting a doctor who is temporary is difficult, she says. “Rejection—that’s what you feel when they keep passing you from doctor to doctor.” And she says it’s especially difficult to feel fear after hoping a treatment will work.

“Trust is everything with treating mental illness,” Bryant says. “We don’t have any, and there are damn good reasons why we don’t.”

Diana Bryant’s experience of regained purpose shows how important public mental health services can be to people with low incomes and serious disorders. In December, shortly after the holiday party she helped organize, I tag along with her as she goes Christmas shopping. She is dressed in layers and the striped hat with earflaps her landlady crocheted.

Giving requires effort. Bryant has no savings. That evaporated during the two years she waited to qualify for disability. She works six hours a week typing, filing, and mailing fundraising flyers for the Coalition to Save Our Mental Health Centers. That pays her cellphone bill. Bryant’s landlady bought the phone for her, and Bryant pays her back, bit by bit. “I just add it to my rent.”

Bryant’s $700 monthly rent includes utilities. “For my neighborhood, that’s good,” she says. There are other costs: insurance to supplement Medicare, Internet, groceries, and (because of her two bad ankles) sometimes a charge of $5.50 for grocery delivery. “I don’t have a lot of money left over to save, but at least I have something,” she says.

The few dollars a week she is able to save go into a box labeled “Christmas” in the room she and her landlady painted a shade of aqua, a stark contrast to the black wall she had painted in her bedroom as a young woman. When the money in the box gets to be $25, it goes into a special account. This year it totaled about $300.

“I just have a few people, special people, that I buy for,” Bryant says. What she doesn’t use for gifts goes back to the bank. But this has happened only a few times.

She travels by bus and on foot, her ankles fighting her, she said, because they resent the dancing she did at the party. She shops first at Target, where she purchased the DVD of Guardians of the Galaxy for her landlord. She asked him what he wanted. “I just like the smile on peoples’ faces, even if they know what they’re getting,” she tells me.

At the Dollar Store, Bryant puts together a homemaking gift basket for her landlady’s grandson. She surveys the products, collects a few, puts them back. She later goes to a different store, Jewel, to buy the goods: detergent pods, dryer sheets, bleach. It comes to $16.96. She will also give the young people some money, she says.

Bryant bags the purchases herself, tying the plastic loops in a knot. Under the clanging Salvation Army bells, she heads home, another walk on rocky ankles, another bus.

“I’m sixty-seven,” Bryant says. “I really didn’t start to live my life till I was probably fifty-two.”

Fifty-two was when she broke her ankle. Life starting means her eyes are on the reality before her.

Her angry father is gone. She has finally learned that, too. “When you grow up like that, you ask, ‘Why, why, why? Why did my father do this?’ ” she says. “That kind of question will drive you nuts. You can never stop asking yourself that because there is no answer to that question. And it doesn’t serve any purpose. If anything, it keeps you sick.”

But there have been costs. Bryant has lost long-term friends. She had a boyfriend for about ten years “but we never made it work past just dating.” She puts the onus on herself. “I had too many issues, too many problems,” she says. “I was too hard to live with. I was depressive, anxious. You try living with someone like that. It isn’t fun.”

Things are better for Bryant now. She is no longer “that person.” She is glad for it, glad to be in a position to help others. Characteristically, she ties her past to empathy. “Think of all the people out there who’ve been searching,” she says. “That would be me if I’d never found North River.”

Anne-Marie Cusac published a related story, “Why One Community Voted to Tax Itself,” for In These Times.