Six city-run mental health clinics face declining revenue and unfilled vacancies, and have been using contractors to fill psychiatry positions for more than a year, according to Chicago Department of Public Health (CDPH) documents and a recent Office of the Inspector General (OIG) report. A new ordinance from Ald. Jason Ervin (28) immediately calls for new contracts so clinics can take on more patients, take “whatever steps are necessary” to fill vacancies, and expand neighborhood outreach.The ordinance has 29 cosponsors.

Jo Patton, Director of Special Projects at AFSCME Council 31, consulted with Ald. Ervin on the ordinance and says vacant psychiatry positions at city clinics have long been a concern, but worries without some aggressive recruiting from CDPH, clinics might be forced into a “vicious circle.”

“If you don’t have enough psych hours, you can’t take in new patients, then the client base shrinks and the rationale for keeping those centers going also is diminished,” she told Aldertrack.

Ervin’s ordinance says the number of care hours at city clinics has been cut in half over the past two years. That drop can partly be attributed by Mayor Rahm Emanuel’smove, and City Council’s unanimous approval, to shutter six of the city’s 12 mental health clinics in April of 2012.

Five of the six remaining clinics are scattered throughout the South and West Sides, one is on the Northwest Side.

Just one full-time psychiatrist serves at those six clinics, Public Health Commissioner Dr. Julie Morita told aldermen this past fall at the department’s budget hearing. Other psychiatry positions, she said, are being filled by contractors. Those contractors are budgeted for 2,185 hours in 2016. Those temps have been there longer than a year, according to a recent OIG report, which violates the city’s Contractor Policy. Patton says AFSCME started becoming concerned when the clinics were down to four full-time psychiatrists.

CDPH says they’ve made progress on finding another full-time psychiatrist, and filling other vacancies. The department also points to spending on targeted mental health programs for victims of sexual assault and family members of homicide victims.

Matt Smith, from CDPH’s Media Affairs, says there are 58 full-time positions across CDPH’s clinics. As of this summer, 27 of those positions are therapists, between 3 and 6 therapists at each site. Some therapists see as many as 40 patients a month.

Morita has blamed a national shortage in psychiatrists for the lag time in finding permanent psychiatry staff. During budget hearings, Ald. Leslie Hairston (5), who is co-sponsoring Ervin’s ordinance, countered that the city couldn’t attract candidates because of low starting salaries. In an effort to make those positions more attractive, Morita said that Chicago had recently won federal designation as a Health Shortage Service Area. The designation allows applicants with outstanding medical school loans to be repaid by the federal government in exchange for working in underserved areas.

But Ervin’s ordinance also says that while CDPH is understaffed, it is also turning away revenue by failing to join managed care networks and not seeking reimbursement for Medicaid recipients.

CDPH says their clinics do mostly focus on uninsured patients, and have faced declining revenue. “We continue to provide services to clients regardless of their insurance status or ability to pay,” CDPH’s Smith says. In 2015, CDPH was allocated $9.5 million for mental health services, most of which went to direct services at those clinics.

By contrast, the Cook County Health and Hospitals System (CCHHS) has started to bounce back from precarious financial footing in part by setting up its own managed care system, CountyCare, a Medicaid program through the Affordable Care Act. CCHHS currently gets a 100% per member per month (PMPM) federal match payment for each member enrolled in CountyCare. Revenues from the program have helped the County cut down its tax allocation to CCHHS by tens of millions this fiscal year.

Smith tells Aldertrack the Department has “retained a consultant to facilitate new contracts with insurance companies, including managed care entities.”

Patton says the contract with that consultant includes a two year window, which she says is too long to get into straightforward agreements with local insurers like Blue Cross Blue Shield, Aetna, and Illini Health. With the recent focus on policing and mental health in the wake of Quintonio Legrier’s death at the hands of Chicago police, Patton thinks the political will might be enough “for the mayor to put a little bit of money into mental health instead of [policing].”