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Speech by Ellie Dumerauf, Rayo Fall Friendraiser, 10/22/23

Part of the vision behind Rayo is to redefine what it means to be a Community Mental Health Center. We currently have two separate systems of mental healthcare: the Community Mental Health Center (or CMHC) for those with medicaid or without insurance, and the Private Practice for the privately insured. This doesn’t work for many reasons, but I’ll try to be brief.

Most importantly, as long as a system remains segregated it will remain unequal. Community mental health centers have a very different feel to them than the Private Practice. For one, they are typically very big. They must be in order to survive the constant turnover. Despite their size, the need for services exceeds their capacity, meaning waitlists are long and at the end of them clients have little choice in their provider.

Another source of inequity at the CMHC is the inconsistency in treatment. There are many ways to unpack this, but reasons for treatment inconsistency can be summarized by an unsustainable pay structure and a rigid divide between two systems. When the tension a clinician feels between their values and their income meets its breaking point, clients lose their therapist. When a client gets a job and suddenly has private insurance, they lose their therapist. On the flip side, when clients of a private practice lose insurance, they also often lose their therapist.

There are very few private practices in the Chicago area that attempt to counteract this by accepting Medicaid, and those that do typically only accept one or two Medicaid plans. This means that they remain inaccessible to many.

I want to be clear that Rayo has no intention of operating as a private practice that accepts one or two Medicaid plans. We intend to become a Community Mental Health Center; meaning we plan to accept every Medicaid plan out there and are committed to offering sliding scale services to those without insurance. We will prioritize accessibility of care to this population by requiring all clinicians carry a minimum caseload of clients on Medicaid or who need a sliding scale. We are committed to providing support beyond therapy including community support, case management, and social resources.

However, by working with clients across the socioeconomic spectrum we dismantle the divide in our mental healthcare system and embrace what it means to be a community in the full sense of the word. Ideally, we create a Community Mental Health Center devoid of rigidity, a model that is sustainable to staff, and an agency truly able to meet the needs of those that rely on it.

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