Association for Public Policy Analysis & Management

Background: Community residents living on Chicago’s southwest side are disproportionately impacted by poverty, unemployment and underemployment, housing challenges, under-resourced schools, and limited social service infrastructure. Chicago’s mental health infrastructure has been eroded over the past several years. However, city officials, including the Chicago Department of Public Health (CDPH), have argued there are sufficient services available. We, a coalition of community-based organizations, examined structural factors impacting mental health service access. Consideration was given to understanding spatial allocation of providers relative to neighborhood need.

Methods:

Using community-based participatory methodologies, we systematically assessed Chicago’s mental health infrastructure in three phases:

• Documenting: We surveyed 2,859 predominantly Latino (91%) adults across ten southwest side communities to explore their mental health needs and barriers to accessing services. Post-hoc weights were used to mirror community demographics. Findings were shared with community stakeholders through nine individual interviews and eight community forums. An iterative, grounded process was used to code stakeholder feedback which provided further context to findings.
• Investigating: We mapped the density of private providers (N = 3,199) across the city, overlaying neighborhood socioeconomic status.
• Questioning: In response to the CDPH’s releasing a list of 253 mental health providers in the city, we systematically surveyed all organizations listed to gauge accessibility. For organizations that responded, a brief survey was administered to determine services offered, wait list length, number and language skills of clinicians, and cost structures.

Results:

Documenting: Weighted survey findings indicated a high level of mental health need among survey respondents, with 43% reporting depression, 37% reporting anxiety, and 30% reporting trauma-related symptoms. A clear majority (72%) indicated willingness to seek professional support. The top four access barriers were structural: cost (49%), being unsure where to go (31%), services not being near (28%), and insufficient health insurance (27%). Social barriers such as stigma (12%) were least prevalent. Feedback from community stakeholders mirrored these results.

Investigating: As opposed to affluent areas, 17 low-income zip codes had fewer than one private provider per 10,000 residents. Regression analysis showed zip codes’ median income significantly predicted higher provider rates (p<.01).

Questioning: We connected with just 59% of providers listed by CDPH (n = 150), pointing to the challenges associated with navigating the mental health system and connecting with needed services. Only 15% (n = 19) of surveyed providers offered free mental health services. Moreover, only one-third of federally qualified health centers (n =9), seen by CDPH as safety net providers for uninsured, underinsured, and undocumented individuals provided affordable options (sliding scales fees <$20).

Implications:

Structural barriers were the primary impediments to accessing mental health services. In contrast to the narrative from city officials, we identified that services are not evenly distributed across the city. Public health systems need to address the mismatch between spatial allocation of services and neighborhood need. Findings have been used by coalition members who successfully advocated city government to create a mental health task force which is charged with making recommendations on improving the mental health infrastructure of the city.