Following a large number of clinic closures and record budget cuts, the state of mental health in Chicago has made national headlines over the past year. In 2012, Mayor Rahm Emanuel closed half the city's mental health clinics, and budget cuts at the state level coupled with often high deductibles found on the Affordable Care Act insurance exchange have left many in the city's LGBT community struggling to access professional care and turning increasingly to alternative means of support.
"The system is overwhelmed," said Robert Kazel, the president of a local chapter of the Depression and Bipolar Support Alliance ( or DBSA ) that meets weekly at the Center on Halsted. His is one of only a handful of DBSA chapters nationally which focus on the LGBT community. It recently celebrated its tenth anniversary, and has grown exponentially since then, something Kazel puts down in part to the dwindling mental health resources available to the community. "We have some people who are really desperate to find help but haven't been able to."
Kazel attributes this to several factors, from the clinic closures and budget cuts to insurance deductibles and the lack of mental health professionals in private practice. He says many have been unable to find help "either because they can't afford a therapist or doctor" or they've been placed on waiting lists by clinics and outpatient departments.
It's a concern shared by Kelly Ducheny, the director of behavioral health at Howard Brown Health. "We'd always love for there to be more resources," she said. Recent years have seen services "significantly contracted," she said. "There are always more folks requesting care than we can immediately provide. We get really concerned. I don't want people to have to wait."
Over the past year-and-a-half, Howard Brown has shifted its model-of-care to an incidence-based model, focusing on episodic and goal-oriented care. Each episode of care entails 24 visits with a therapist, at which point patients who desire additional care are referred out to services which can offer more prolonged care. "After a period of time, folks can return to us for another episode," she said.
Ducheny stressed that the change was not prompted by any budget cuts or clinic closures, but rather seen as a way to better serve patients, and one which most patients have found beneficial. "A far majority of clients are finding this model helps them focus in on the piece of work they want to do in that episode and the episodes are running easily six to nine months."
Nicole ( a pseudonym ), who has been attending the DBSA group at the Center for around three years, found that the new model was not a fit for her, though. While she feels "their medical staff is top-notch," she is concerned that Howard Brown—like other providers—"is so backlogged when it comes to therapy." Nicole, a trans woman, believes Howard Brown is "one of the few places that's actually well-versed in trans therapy" and that the episodic care has really limited their ability to help her long-term.
Nicole used to be on Medicaid, but lost it because she made too much money when she began collecting disability insurance due to her depression. She found private coverage on the insurance exchange, but selected an HMO by mistake. "I couldn't find a therapist in my HMO," she said. She's recently switched to a PPO, but said, "The closest therapist in my PPO is about 569 miles away." Even if a therapist was closer, her deductible of $4,000 makes accessing care costly.
"Just in terms of resources, it's very hard to find a psychiatrist," said Marji Leslie, another DBSA member who attends meetings at the Center and has served in various capacities, including on the national board of directors. Leslie considers herself "lucky" to have found her therapist 20 years ago, but adds that "Many people really can't find a psychiatrist in general because they don't take insurance anymore." The pool becomes even more limited when looking for an LGBT-friendly mental health professional.
It's a problem Kazel frequently sees. Many therapists, he said, "are not receptive to receiving a lot of forms of insurance as payment." From his research—Kazel is also a journalist who has covered the insurance industry—those in private practice who do accept insurance are unlikely to accept Medicare or Medicaid.
Ducheny is also concerned that "there are fewer places who accept sliding scales and uninsured folks who can't pay standard fees." But she said there are also "a lot of resources to help people access Medicaid or ACA plans" that could suit them. Howard Brown itself has devoted staff to helping people navigate the insurance exchange and enrollment process. "We can certainly talk to them about the different kinds of things different plans offer and help them investigate what's going to be the right match for them."
For people who can't find affordable insurance or treatment, or who wish to enhance their care, DBSA is a great option, Ducheny added. "We regularly refer clients to DBSA," she said. "I think that getting support in a group of people who have some personal experience with some of the things that are very impactful in your life can be a compelling home."
It's a sentiment echoed by Leslie. Finding the LGBT DBSA group "really felt like I was coming home," she said. "It is a safe place especially to talk about not just personal issues but the way that society impacts on being gay or trans."
The shared experiences of being both LGBT and living with mental health issues also keeps Nicole coming back. Without a regular therapist, Nicole relies heavily on the peer support she receives from friends, but also the group. She originally attended a DBSA group geared towards veterans, but it wasn't a good fit for her. Finding the LGBT group, where "we have a lot of shared experiences," has been very beneficial, she said. "DBSA has been great for me."
"I think people feel most comfortable talking to people, in general, who share their life experiences," Kazel said. "It's kind of a double closet that a lot of people with mood disorders and who are LGBT live in. Sometimes they're in or out of one closet. Sometimes they're in or out of the other closet," he said. "This is a place where people can come and speak completely freely and not have to worry about any closets."
The DBSA LGBT group meets every Saturday, 11 a.m.-12:30 p.m., at the Center on Halsted, 3656 N Halsted St. Visit www.dbsa-glbt-chicago.com/ or call 872-216-3272 for more information .
