Public Health Comm. Allison Arwady speaks before the City Council budget committee Monday. [City Council Livestream]

The City Council questioned the city’s health department about its mental health crisis response pilot program during a Committee on Budget and Government Operations hearing Monday.

One year into the launch of the Crisis Assistance Response and Engagement (CARE) program, aldermen pressed Public Health Comm. Allison Arwady to expand the services citywide and said the department is too slow in its work to scale up the program. At the same time, Arwady expressed concern over securing more permanent funding sources for when grant funds run out in the future.

The Chicago Department of Public health’s budget is set to see an overall decrease in Mayor Lori Lightfoot’s 2023 proposed spending plan. Though its allocation through the Corporate Fund is set to rise from more than $64 million in 2022 to more than $70.2 million in 2023, the health department’s grant funding is expected to drop down to $875 million in 2023 from more than $961 million this year. 

At the same time the number of full-time equivalent positions is proposed to rise from 864 to 1,105 in 2023, the department’s budget would decrease next year to $963 million, down from more than $1.04 billion in 2022. 

Arwady on Monday touted her department’s plans under the 2023 budget to expand mental and behavioral health care citywide. Fifty-nine community areas are currently providing mental health care through federally qualified health centers and other clinics, but the aim is to increase coverage to all 77 community areas by the end of this year. 

Arwady explained the department will soon expand the CARE pilot program to additional neighborhoods. The CARE pilot program launched in September 2021 and sends two teams consisting of varying combinations of a Crisis Intervention Team-trained police officer, a paramedic and a mental health professional to qualifying mental and behavioral health calls in the pilot areas. Only one of the three teams working under the pilot does not include a police officer. 

Arwady said a second team without police will soon launch. 

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Ald. Rossana Rodriguez-Sanchez (33), who has advocated for years for a mental health response model that does not involve police, told Arwady she believed the rollout was too slow and asked why the teams were reliant on the 911 system.  

“I am very worried about how slow this is going. You're saying it's because it's going through 911. Well, that is not our only option,” Rodriguez-Sanchez said. “But we are not using any other options. The nonprofits are getting money from the state, but the city is not getting money from the state to do this. So can you explain why we haven't explored or gone down this route in order to be able to provide the service?” 

Public health officials and first responders have previously told aldermen that using the 911 system is necessary in order to get an immediate response to the residents in need, which could be crucial the caller requires an ambulance or is posing a threat to public safety.  

“I think the 911 space is the space that is clearly city government responsibility, given that it's already (Chicago Fire Department) or (Chicago Police Department),” Arwady said. “We are trying to figure out … the best place to put City of Chicago resources.” 

During the CARE pilot’s first year, teams responded to 385 calls and conducted 332 follow-up responses. The teams have had zero use of force events and made zero arrests, the program’s dashboard shows. 

During the hearing, Arwady commended Chicago’s response to the COVID-19 pandemic and said the progress on the pandemic is a result of a successful vaccination campaign, along with available treatments and testing efforts. 

“We are in a different phase of the pandemic and I remain incredibly proud of the way the city has responded to COVID,” Arwady said. 

Though Arwady recognized many people are exhausted from the toll of the pandemic, she said the virus is “still with us.”  

“The pandemic has claimed the lives of 7,887 Chicagoans and counting,” Arwady said. “It has become the second leading cause of death in Chicago behind heart disease.” 

Though Arwady said the department’s budget is now about five times what it was before the pandemic, “more than 60 percent of that is COVID-specific federal grant funding, much of which will evaporate over the next two years.” 

Arwady said her department has used COVID grant funding to build a more permanent infrastructure within her department to respond to disease outbreaks more generally, a strategy she said proved incredibly helpful in responding to monkeypox.  

But she said more reliable funding sources are needed. About 86 percent of the department’s budget comes from grant funding, though Arwady said that’s been the case since before the pandemic when about 80 percent of the department’s budget was funded by grants. 

“The cycle of disease-specific time-limited surge funding from Ebola to Zika to COVID does not help us achieve the shared goal of a robust and prepared health system,” Arwady said. 

By next year’s budget hearing, about $50 million worth of large federal grants that came with the pandemic will have expired, Arwady told aldermen.  

"In this country, we do not fund public health at a sustained level,” she said. “We fund after an emergency occurs, and this is a problem that goes far beyond this chamber."