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Early Intervention Could Help Psychiatric Patients Steer Clear of the ER

A crowded, noisy emergency room is not the right environment for people having a mental-health crisis, experts argue

poor people waiting room

New Jersey lawmakers are seeking to significantly expand initial screening programs for mental illness in an effort to divert patients in crisis from hospital emergency rooms into more appropriate community-based treatment.

In recent years, hospital officials have seen a growing number of patients with psychiatric problems flocking to their emergency departments when they are unable to find affordable care elsewhere. This results in less effective patient care and higher healthcare costs overall, experts note.

On Monday, an Assembly panel was the first legislative body to approve measures to beef up early intervention services (EIS) for individuals with mental illness and ensure each of New Jersey’s 21 counties have locally based programs — effectively doubling the number of sites currently operating. The proposals, introduced in January and crafted with significant input from hospital officials and mental health providers, are designed to better identify patients that need help and connect them with local mental health programs before they end up in the emergency room.

“We heard concerns time and time again relating to crisis services throughout the state,” said Assemblyman Gary Schaer (D-Bergen), who led a series of roundtable discussions on the topic over the past year, a process that drew praise from several participants. “Early intervention and support is paramount when it comes to behavioral health care.  With these bills, we will be taking commonsense steps to improve and modernize our services, benefiting patients and their families.”

Steady growth in demand

Demand for community mental health services has grown steadily as New Jersey and other states have continued to close psychiatric institutions and shift patients into less-restrictive community housing and treatment programs. But these local providers are also facing funding cuts, labor shortages, and other challenges that have made it hard for them to care for all those in need.

As a result, more patients end up in the hospital seeking help. A report released last fall by the New Jersey Hospital Association found that half of the increase in ER patients between 2014 and 2015 involved individuals in psychiatric crisis.

Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies — which worked closely with Schaer on the bills — submitted testimony to the Assembly Human Services Committee Monday that noted emergency room staff “are overwhelmed and unable to offer appropriate, specialized care that patients in psychiatric distress need in a timely manner. These patients are then negatively affected by the long waits they have in tumultuous waiting rooms.”

Currently, the Division of Mental Health and Addiction Services, within the state Department of Human Services, contracts with 10 organizations that provide early-intervention mental health screenings for adults in 11 counties: Atlantic, Bergen, Camden, Cumberland, Essex, Hudson, Middlesex, Mercer, Monmouth, Morris, and Ocean. These programs are designed to quickly connect patients with short-term, recovery-oriented treatment that can help get them stabilized within a month; some are run by hospitals, others by nonprofit providers.

Early-intervention success

Early-intervention programs and screening centers “have been extremely successful in diverting individuals from both EDs and hospitalizations. Every county in New Jersey should benefit from these extremely effective services,” Wentz noted.

One proposal, (A-4468), sponsored by Schaer and Assemblywomen Valerie Vainieri Huttle, (D-Bergen) and Shavonda Sumter (D-Passaic), would require the DHS to expand early-intervention programs so that one existed in each county. Programs would be required to operate 14 hours a day, seven days a week. Under the bill, the state would also need to work with county officials to publicize the program and collect data on participation.

While screening programs alone can’t keep patients healthy, they can make it a lot easier for these individuals to connect with the help they need, agreed Mary Ditri, director of professional practice with the New Jersey Hospital Association, which also contributed to the development of the bills. “If they don’t have access to screening, it’s just one more reason forcing their hand to go to that next step, that safety-net provider” such as the emergency room, Ditri said.

Another bill, (A-4469), sponsored by the three lawmakers and Assemblywoman Pamela Lampitt, (D-Camden), would make it easier for existing screening services to expand their regional work. The measure would allow the DHS to accept applications from these providers to add additional programs or open satellite services at a separate location to enhance outreach and early intervention. It also urges the department to collect data and issue annual reports on the impact of such expansions.

Expanding critical services

Mary Abrams, the senior health policy analyst with NJAMHAA, who took part in the stakeholder meetings, said the opportunity to expand is important to screening agencies, most of which are members of the association. Expanding this “critical service” of early screening and intervention “could have some high impact,” she said. “It’s good for consumers and it’s good for providers.”

Both measures, which saw strong support from the committee on Monday, will now head to the full Assembly for further consideration; Senate versions of these bills are still pending. The bills do not include any cost estimates.

The Human Services Committee also approved on Monday legislation (A-4523) to make it easier for patients to receive basic behavioral-health services at the same place they receive primary-care treatment. The proposal would reduce licensing restrictions for primary-care providers that want to deliver mental health and substance-abuse services, a change experts have said will lead to more comprehensive care.

Providers have praised this bill — which passed the Senate in February under the leadership of Senate Health Committee Chairman Joseph Vitale (D-Middlesex) — but note that it only addresses one part of the problem. Additional reforms are still needed to ensure that behavioral health providers who serve patients with some of the most severe mental illnesses also have the freedom to add primary-care options at their facilities, they note.

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