Could this Chicago program be the answer to insuring the mentally ill?

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Ruthie Anderson spends time with family at her new apartment in Chicago. Credit: NewsHour Weekend

Just outside Chicago’s city limits in Oak Park, Ill., Ruthie Anderson finally has a place that feels like home.

Her sun-filled, one-bedroom apartment is sparely furnished — the walls are mostly blank, and there’s just a table and four chairs outside the kitchen and an easy chair in the living room. But it’s a place where the 59-year-old mother of seven can finally spend time with her ten grandchildren.

“I love them to death, they’re just like my world,” Anderson said. “That’s all I live for now is to see them grow up and make sure they’re all right. I don’t want to see them go through the things that I had to go through.”

The apartment is her first permanent home in years. Anderson spent three decades living on the street, struggling with drug addiction and mental illness, including depression. Today, she’s getting treatment and has a place to live — a beneficiary of a year-long mental health pilot program that experts say could serve as a national model for treating people with mental disorders.

According to the 2012 National Survey on Drug Use and Health, nearly 40 percent of adults with “severe” mental illness, such as schizophrenia or bipolar disorder, received no treatment the year prior. Among adults with any mental illness, the survey said, 60 percent went untreated.

For much of her adult life, Anderson was no different, with the exception of the occasional visits she made to Chicago-area emergency rooms.

She was addicted to heroin and slept in parks and hospital waiting rooms — and at other people’s houses, occasionally in exchange for sex or drugs.

“I was stealing in and out of stores doing everything I could to get high,” Anderson said. It didn’t make a difference what it was, as long as I got that next fix.”

Ruthie Anderson shares her story of a struggle with mental illness and drug addiction with NewsHour Weekend’s Stephen Fee. Video edited by Mori Rothman. 

But in 2013, after she was admitted to the hospital for the 19th time in less than a year and a half, an employee of the Chicago-based mental health non-profit, Thresholds, offered to help her find a place to live and get the care she needed.

“I really didn’t have faith in no one,” Anderson said, “because everyone had lied to me about the things they said they could do for me or help me.”

Anderson said the non-profit group gave her a place to stay, managed her Social Security disability payments, and gave her access to a mental health provider.

“I thank God that I made it,” she said, “Without Thresholds, I really didn’t think I would’ve made it. I really didn’t.”

Normally, providers like Thresholds bill Medicaid for each service provided — the fee-for-service model that typifies insurance providers in the US. In this case, though, Thresholds was given a list of 50 high-risk, high-cost mental health patients receiving Medicaid.

Under the year-long pilot program, a managed care Medicaid organization called IlliniCare gave Thresholds a flat fee for keeping Anderson healthy and out of the hospital — and Thresholds could spend the money any way they saw fit.

“I think everyone across the spectrum and everyone within the medical community, the social service and policy community understands we have to move out of this fee-for-service mindset,” said Harold Pollack, a professor at the University of Chicago and an expert on health care policy. “We don’t quite know how to do it yet, and we’re working on it.”

Over the past 15 years, states have experimented with managed care organizations that contract with state Medicaid programs and avoid the fee-for-service model. The state of Illinois passed a law requiring 50 percent of its Medicaid recipients to move to managed care entities by next year, but managed care entities are still restricted to the types of services they can provide.

As Anderson’s case shows, supportive housing and other services are often a necessary part of treatment for people with serious mental illnesses — but those services are seldom financed by Medicaid or private insurance plans. And with 1.2 million mentally ill Americans expected to join Medicaid under the Affordable Care Act, advocates say supportive services have to be part of the treatment mix.

“One of the ironies in our health care system is that we provide tremendous resources, all things considered, to deal with the things that we consider to be medical problems,” Pollack said. “If someone needs psychiatric care, we will provide that. And then that same person needs a place to live. And suddenly we’re in a much more underfunded and challenged set of systems.”

Illinois is looking to change that. This summer, the state applied for a Medicaid waiver, asking the federal government for permission to use Medicaid dollars to pay for services like housing.

“If you can spend money on social services and keep people out of hospitals, obviously that’s a win-win situation,” said University of Chicago lawyer and mental health policy expert Mark Heyrman. “The federal government spends less money. The state government spends less money. And the person with the serious mental illness is getting services in the community that keep him or her from getting really sick and ending up in the hospital.”

Anderson says she still has her daily struggles. She goes to a methadone clinic six days a week to treat her drug addiction.

“It takes faith,” she said. “It might look gloomy, but sooner or later you will run across somebody that will pick you up and help you.”

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