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Legislators Press Christie Administration on Need for More Psychiatric Beds

Democrats want answers on reversal of state call for services after hearing from hospitals, behavioral-health providers

Assemblymen Gary S. Schaer (D-Bergen and Passaic).

Democratic legislators want to know why the state Department of Health cancelled a request last winter for applications to expand the number of beds available for psychiatric patients.

The lawmakers’ call for answers about the cancellation is driven by concerns of behavioral-health providers and hospital officials who say emergency departments are under a great deal of pressure to find beds for psychiatric patients. State officials said that they’ve received the request and are reviewing it.

The issue is related to the broader topic of whether patients in need of behavioral-health services have adequate access to inpatient care. This varies widely across the state depending on the specific capacity of local psychiatric facilities and hospitals, according to industry representatives. That’s why legislators would like to see hospitals have the opportunity to make a case for expanding the number of beds and other psychiatric services.

It’s difficult to assess whether New Jersey has enough psychiatric beds statewide, at least compared with other states. For example, although New Jersey’s 21.9 psychiatric beds per 100,000 residents in 2010 were only 44 percent of the number advocated by the Arlington, Va.,-based nonprofit Treatment Advocacy Center, the state ranked ninth nationally in per-capita psychiatric beds.

“What is critically disturbing is that we have New Jerseyans with behavioral issues who have need of hospitalization at times and that need is simply not being answered or being answered poorly,” said Assemblyman Gary Schaer (D-Bergen and Passaic).

A coalition of seven senior Assembly members including Schaer sent a letter to Acting Health Commissioner Cathleen Bennett on July 30 asking why the state cancelled a call for applications for certificates of need for psychiatric beds. Certificates of need, also known as “CNs,” are documents that request healthcare services. For example, the state will issue a certificate of need for maternity care if it finds that there’s a shortage in a certain area. The CN process also is used to determine whether hospitals should add or close departments or facilities.

Two months after sending the letter, the legislators are expressing frustration that they haven’t heard back from the Department of Health. Although the state’s original reason for cancelling the call for applications was that “there is no indication of present need for additional beds and services for this population,” they don’t necessarily agree. Legislators point to statements from behavioral healthcare providers that a shortage of beds can lead to wait times of three to 10 days, during which patients must remain in hospital emergency departments.

The letter was based on conversations that legislators had with hospital and behavioral health executives during three roundtable discussions hosted by the New Jersey Hospital Association this year, focused on behavioral health needs. They were held at St. Joseph’s Regional Medical Center in Paterson, Riverview Medical Center in Red Bank, and Kennedy University Hospital – Cherry Hill.

“This issue seems to be at the top of everyone’s lists,” Schaer said of the discussions. “You’ve got a critical situation affecting a number of New Jerseyans, some of whom are looking at anywhere from three to 10 days in an emergency room, which is extraordinarily disruptive to them and extraordinarily disruptive to everyone else.”

Russ Micoli, vice president of ambulatory services for Kennedy Health System, said the legislators’ focus on the issue “really has highlighted an opportunity for looking at better ways to treat our patients.”

“More beds is certainly part of that big picture,” Micoli said, adding that the need for beds can differ for each community -- some may need more substance-abuse beds, while others need beds for children or seniors.

The discussion is taking place against the backdrop of New Jersey closing the Hagedorn psychiatric hospital and replacing the original Greystone Park hospital with a smaller facility, part of a national shift toward outpatient treatment. Currently, there are roughly 3 percent of the psychiatric beds per capita as in 1950, the historic peak.

“Part of the reality is that that has resulted in a larger burden, if you will, being placed on the community mental health system,” Micoli said of the Hagedorn and Greystone closures, adding that there will always be some patients who are a threat to themselves or others if they aren’t treated in an inpatient setting. “We need the right beds in the right places -- we have a population that is seriously, persistently mentally ill.”

Mary Ditri, NJHA director of professional practice, emphasized that the availability of psychiatric beds is just one of a multitude of issues related to access to behavioral healthcare.

She added that “we appreciate the fact that the Assembly is engaged in the issue.”

“The underlying theme is really understanding where the bed need lies,” she said. “It’s difficult to say in total there is a shortage of beds or to say there isn’t a shortage of beds … it’s really specific to the community.”

It’s not unusual for the state to cancel a call for applications for certificates of need. For example, just this winter, the Department of Health also cancelled CN calls related to adult and pediatric rehabilitation beds and services; intermediate and intensive-care bassinets for newborns; and pediatric and specialized long-term beds and services.

State officials said in cancelling the call that the Department of Health, consulting with the Division of Mental Health and Addiction Services of the Department of Health and Human Services, has monitored the need for new and expanded psychiatric beds and services, and determined there is no indication of present need.

Schaer said legislators have drafted legislation, yet to be introduced, that would call on the state to create a daily registry of available psychiatric beds, so that providers will know what is available. He added that “it doesn’t really solve” the overall problems of shortages.

The CN calls are made on a regular schedule every two years. The next call is scheduled for January 2017, but the legislators said in their letter that they’d like to see Bennett move that date up.

In addition to Schaer, the other legislators who signed the letter are Assembly Speaker Vincent Prieto (D-Hudson), Assemblyman Louis D. Greenwald (D-Camden), Assemblyman Herb Conaway Jr. (D-Burlington), Assemblywoman Valerie Vainieri Huttle (D-Bergen), Assemblyman Craig J. Coughlin (D-Middlesex), and Assemblywoman Pamela R. Lampitt (D-Camden).

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