Documenting the Mental Health Crisis in Chicago: Assessing Accessibility and Affordability of Mental Health Services for Low-Income Individuals of Color through a Structural Lens

Background: Community residents living in the city of Chicago’s southwest side are disproportionately impacted by poverty, unemployment and underemployment, housing challenges, under-resourced schools, and limited social service infrastructure. Furthermore, the social systems with which they interact perpetuate conditions of hardship by limiting access to the resources needed to improve their daily lives. Within Chicago’s current service landscape, multiple barriers exist to accessing affordable mental health services. We, a coalition of local organizations on Chicago’s southwest side, examined structural factors which impact mental health service access in Chicago. Consideration was given to understanding spatial allocation of providers and neighborhood need.

Methods:

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

• We surveyed 2,859 predominantly Latino (91%) adults across 10 communities to explore their mental health needs and barriers to accessing services. The findings were shared with community stakeholders through nine individual interviews and eight community forums. Their feedback was analyzed to provide further context to the findings.
• We mapped the density of private providers (N = 3,199) across the city, overlaying neighborhood socioeconomic status.
• In response to the Chicago Department of Public Health releasing a list of 253 mental health providers in the city, we systematically surveyed all organizations listed to gauge accessibility. At least two attempts at contact were made. 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:

Phase 1: Survey findings indicated a high level of mental health need, with 49% of respondents reporting depression, 36% reporting anxiety, and 34% reporting acculturative stress. Four in five indicated willingness to seek professional support. The top three access barriers were structural: cost (57%), being unsure where to go (38%), and insufficient health insurance (38%). Social barriers such as stigma were least prevalent. Feedback from community stakeholders mirrored these results.

Phase 2: Private providers were unevenly distributed. In 17 low-income zip codes, there was 1 private provider or less per 10,000 residents. By contrast, five affluent zip codes had more than 1 provider for every 100 residents.

Phase 3: We successfully contacted 59% of providers (n = 150), pointing to the challenges associated with navigating the mental health system and connecting with needed services. Waiting lists were common, with 31% having waiting lists of at least three months. Only 15% (n = 19) of surveyed providers offered free mental health services. Moreover, half of federally qualified health centers did not provide affordable options for uninsured residents.

Implications:

Structural barriers, including cost and services not being located in high-need neighborhoods, were the primary barriers to mental health service access. 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 to successfully advocate the city government to reevaluate their social service investment with the creation of a mental health task force.