Chicago’s gun violence crisis is also a mental health crisis
Kimberly Greer can't sleep. Almost every night for the better part of four years, she has woken up in the dark. The numbers on her clock flash 3:30 a.m.
Greer rouses at this hour most nights, haunted by the faces of her son, Ricky, her daughter, Ryann, and her nephew, Jordan — three of the hundreds of Chicago's victims of gun violence. One survived. Two did not. But they all come back in the hours she can't sleep.
"I'm traumatized," she says, thinking about the people she's lost.
Her daughter, Ryann, was hit in the head by a bullet in March 2006. An assailant shot and killed her friend as they sat in the front seat of her friend's car. Ryann survived the shooting, but she woke up in a medically induced coma and it took years of rehab at home with help from her mother to regain her motor skills.
Greer's 30-year-old son, Ricky Brown, wasn't as lucky. On March 21, 2012, while leaving for his job at the U.S. post office, Brown was shot multiple times in the chest as he descended the steps of his Englewood home.
"I feel bad for every mother who has lost a child," she said.
Greer's nephew, Jordan "BayBay" Liggins, was 18 when he was fatally shot in the head one morning last June while sitting in a car — also in Englewood.
Every day on her way to work as a drug counselor at St. Bernard's Hospital, Greer drives from her South Side neighborhood past that spot where her nephew was killed.
"I have to suck up my grief. Whatever I'm feeling I gotta suck it up and keep it moving," she said. "Go to work because you can't fall to pieces."
Greer, 58, is one of thousands of people across the South and West Sides of Chicago who experience some form of mental health trauma as a result of gun violence. And as the number of shootings in the city increases, mental health providers are struggling to keep up.
In 2016, there were more than 4,000 shootings and 762 homicides in the city, according to the Chicago Police Department — a nearly 60 percent increase from 2015. It's the highest number of homicides since the 1990s, though recent numbers are still well below the worst years of that decade.
Through the first seven months of 2017, there have been 397 murders, 1,692 shootings, and 2,124 shooting victims in Chicago, according to the police. The number of shootings is down 13 percent compared to this time last year, but there has been one more murder so far compared to 2016, police data show. The overwhelming majority of these incidents took place on the city's South and West Sides, where communities reeling from violent deaths also face anxiety, depression, post-traumatic stress disorder (PTSD) and a host of other mental health conditions, says Brad Stolbach, the clinical director of Healing Hurt People-Chicago, a trauma treatment organization.
"Every time a person gets shot, especially a young person, there are literally hundreds of people who are affected by that shooting," Stolbach said. Those people are "not thought about," he said.
Meanwhile, since 2009, the city has closed six mental health clinics. Between 2009 and 2012, the state cut $113.7 million in funding for mental health services, according to National Alliance on Mental Illness' (NAMI) Chicago branch. And while mental health coverage expanded under the Affordable Care Act, service providers who work with low-income clients still say they are strained.
A 2014 Department of Public Health assessment of Chicago's behavioral health resources indicated an inadequate citywide infrastructure for mental health.
In recent years, city government and health care providers have launched initiatives to train police officers and volunteers in trauma response techniques. Chicago Public Schools also received a $1.35 million federal grant for trauma support, intended for use at the 10 high schools where community violence is most prevalent.
"I am confident we will be in a better place, but it won't happen overnight," Chicago Public Health Commissioner Julie Morita said.
As part of a five-year plan launched in March 2016, the city is training new police officers in crisis intervention when working with residents who have experienced trauma. Chicago also received a $5 million federal grant from the Substance Abuse and Mental Health Services Administration to invest in programs that build trauma resiliency in neighborhoods with high rates of violence. It will be used, in part, to:
- Establish a Chicago ReCAST (Resiliency in Communities After Stress and Trauma) Institute to train staff at city agencies and partner organizations on "how to identify, respond and support recovery from to various forms of trauma."
- Launch a directory of resources that will better connect community organizations and residents to the city's mental health services.
- Expand mental health services through new partnerships with Cook County Health and Hospitals System and the Chicago Department of Family and Support Services.
"We recognize that there is a need in these communities and we're working feverishly to address those needs," Morita said. "There are too few resources for us not to be working together."
But providers and residents still say there isn't enough support to fully address the mental health issues their communities face.
"A kid who never had a chance"
Everyone called Jordan Liggins "BayBay" because he was the baby in the family. Though he was the youngest, he was protective of his mom and older siblings. He was also a jokester who liked swimming and played baseball. When Liggins needed to make money, he drummed on buckets on the streets of downtown Chicago or passed out fliers for local companies.
He was shot twice as a young teen, once in 2011 and again in 2012. On June 13, 2016, the 18-year-old was shot again, in the Englewood neighborhood of Chicago's South Side. This time, it was fatal. They still haven't found his killer.
Police say it was gang related, but Greer disputes that.
"The police think that BayBay was this horrible, awful person," Greer said. "He was a kid who never had a chance."
Neighborhoods that experience the most gun violence have the highest number of hospitalizations for depression, anxiety, self-medication and other behavioral health issues, city data show.
The city is becoming more aware, said Jaleel Abdul-Adil, the co-director of Chicago's Urban Youth Trauma Center. "But I don't think we truly understand the complexity of what it's like to survive on a day-to-day basis in under resourced, historically oppressed and dangerously impoverished communities."
Providing better care
The first step to providing care is actually addressing the problem, health care experts say. That starts with screening for mental illness, which is sometimes overlooked after traumatic experiences, said Inger Burnett-Zeigler, a clinical psychologist in Chicago.
"That can be important not only in the treatment of mental health symptoms, but just in the treatment of the person as a whole when they're getting health care," said Burnett-Zeigler, who is also a professor at Northwestern University's Feinberg School of Medicine.
While not everyone who undergoes a traumatic event will experience PTSD, Burnett-Zeigler says often times a person may have a symptom of PTSD, such as depression or anxiety.
These symptoms and needs are most severe in neighborhoods such as Lawndale on the West Side or Englewood on the South Side, where Kimberly Greer's son and nephew were killed.
Last year, Burnett-Zeigler surveyed women in "disadvantaged urban neighborhoods" in Chicago. More than 50 percent of participants said they experienced a traumatic event, such as gun violence, sexual abuse or domestic violence.
More than 70 percent of those who did experience a traumatic event had some mental health symptom associated with PTSD, according to the survey.
In Chicago's African-American communities, admitting the need for mental health care remains one of the biggest challenges.
"There's a stigma attached to saying that you need mental health counseling," Greer said. Asking for that kind of counseling is seen as a sign of weakness, she added.
The violence in some neighborhoods is so prevalent that residents, especially young men, see it as normal.There's also an overall lack of understanding of mental illness among residents.
In Chicago, there are six hospitals designated as trauma and mental health treatment centers dealing with issues that stem from violence. A seventh is expected to open at the University of Chicago in 2018. There are another 400 locations of clinics and agencies that offer mental health, violence prevention and substance abuse services, according to the city's department of public health.
Alexa James, executive director of NAMI Chicago, said the problem is not the number of facilities across the city. It is that the facilities that do exist are understaffed and lack clinicians and caseworkers with trauma training. And the waitlists are full.
"There's nowhere where you can call and get in tomorrow," she said.
Illinois passed its first full state budget in more than two years earlier this month. But the lengthy impasse left health and social service organizations that rely on state funding unable to hire more staff to keep up with the consequences of the city's growing violence, James told the NewsHour.
During the budget impasse, a third of the city's mental health organizations had to reduce the number of clients they served, according to a March survey by United Way Illinois. A May survey from the Community Behavioral Healthcare Association of Illinois found that the state owes local providers more than $142 million.
The new budget reinstates funding to those organizations, but Illinois has more than $14.6 billion in backlogged bills stemming from the impasse.
One organization hit by the deadlock in Springfield is Healing Hurt People-Chicago, a trauma support organization that trains and employs clinicians and caseworkers, provides counseling for as many as 200 young people and their families each year. With four or five more caseworkers, the organization could take on an additional 100 patients, medical director Kim Joseph said. Joseph said putting together the money to hire more staff is always a challenge, but that the budget impasse made it even more difficult.
"One of the frustrating things for me is to know that we are not sufficiently resourced to provide the kind of service that we would like to," said Joseph, who is also a trauma surgeon at Stroger Hospital.
Faith communities as first responders
Even if a person can find treatment, they cannot always afford it. Certain insurance plans do not cover mental health treatment.
The Mental Health Parity and Addiction Equity Act in 2008 required plans that covered mental health to treat those issues the same way they treat physical health needs. The Affordable Care Act (ACA) also had a provision that required most insurance plans to cover mental health. As a result, Illinois' Medicaid expansion through the ACA increased mental health coverage for thousands of Chicagoans, though there are still some gaps.
State dollars from Medicaid reimburse providers who have contracts with the Department of Healthcare and Family Services for certain — but not all — types of treatment. Psychiatric care is reimbursed, but other, sometimes more appropriate, community-based treatments — such as mentorships, self-soothing programs and housing programs — are not. So agencies have to search for outside funding, a challenge in communities with high levels of trauma, or residents have to pay for such services on their own.
Many trauma victims have said they already struggle to pay rent or a mortgage, making mental health treatment a luxury.
"I don't have a choice to take off [work] and grieve," Greer said. "Because if I stay home and grieve, after a while I'm not going to have a home to grieve at."
The House of Representatives Republicans' bill to replace the ACA, the American Health Care Act, is largely seen as weakening mental health coverage. The legislation passed in the House in June. In July, the Senate voted against a "skinny repeal" bill that would lift mandates that require individuals to purchase insurance and companies to provide it. An earlier bill proposed in the Senate would give states the power to allow insurers to remove "essential benefits," including mental health care, from their coverage. It's an issue that may resurface as the legislation returns to committee.
For many in Chicago, the first step after a traumatic event is not seeking medical help, but reaching out to their faith communities. One new effort, from Bright Star Church in Bronzeville on Chicago's South Side, is trying to fuse those things together. The church's nonprofit organization just launched a program called the Trauma Urban Relief Network, which trains faith leaders to work with social workers and clinical directors to provide post-trauma care.
"Faith leaders are able to bypass the negative mental health stigma and utilize the strength of the community in combination with their own influence to peel back the layers of mental trauma," Bright Star Church assistant pastor Rodney Carter said.
Faith communities across the city are often the first responders to an individual's mental trauma. It was a nurse at Latanda Graves' church who first told her the hyperventilation she experienced after the fatal shooting of her son Joseph in 2015 was a form of post-trauma anxiety.
"They have been the biggest support group," Graves said of her church, Trinity United Church of Christ. "They are still walking with my family."
Learning to live with grief
With each new report of a shooting, Greer said she thinks about other mothers, families and friends across Chicago that face her same sense of loss and the mental health challenges that come with it.
"It will continue to be a loss for them for the rest of their lives," said Susan Johnson, director of Chicago Survivors, an organization that responds to every shooting in the city and works with families in the immediate aftermath providing counseling and support.
"Others around them will want them to return to their normal selves, and they're going to have to find a new normal self," Johnson said.
Part of that healing process involves connecting with other survivors and engaging in community discussion.
For Greer, a network of friends and family provides a sounding board for her; they also pass no judgement. Her group even pooled money together to pay for the burial of her nephew.
Finding a new normal, on the other hand, has proved to be difficult. She says she writes sporadically in a journal, as a sort of therapy. She is working on a master's degree in inner city studies at Northeastern Illinois University, and is writing her thesis on community violence.
She hopes to one day tell the full story of her nephew and others who met a similar fate. But most days, she says, are spent pushing the losses she's endured out of her mind.
"I don't think you ever get through grieving," she said. "You learn to live with it."