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Controversial DMHAS Move Now Well Underway

Provider groups ‘cautiously optimistic’ about massive integration of behavioral and physical healthcare

moving truck

Three weeks after the switch became official, state leaders have held public meetings in all 21 New Jersey counties and have begun to move hundreds of employees into new quarters as part of a massive government reorganization of behavioral health services.

Office moves will continue through early November and meetings at three of the state’s four psychiatric hospitals have been scheduled for later this month to allow staff, residents, and their family members to ask questions about what is a major evolution of state oversight.

The changes are part of a controversial plan to shift the Division of Mental Health and Addiction Services from its former home in the Department of Human Services to the Department of Health, proposed by Gov. Chris Christie in late June, as lawmakers were focused on a last-minute struggle to balance the state’s budget.

The reorganization is designed to better align physical healthcare with behavioral health services — something many experts agree is important to improving patient outcomes — and create a more efficient and effective state system. The governor’s order was informed by a 2016 study of New Jersey’s system by Seton Hall professor John Jacobi that identified a number of bureaucratic and cultural hurdles to better integration.

Bad timing

But despite widespread support for these goals, some mental health advocates and provider groups balked at the proposal, which they said was introduced with little input from caregivers and ill-timed, given that Christie’s second term in office expires in January. Democratic lawmakers also expressed concern about the plan and held hearings on the issue during the summer, but they were unable to rally support in time to vote to stop its implementation.

Some worries remain, including fears that the departure of DOH Commissioner Cathleen Bennett — a key supporter of the plan who is leaving government to lead the New Jersey Hospital Association later this year — will endanger the process. But a growing number of behavioral health groups expressed cautious optimism about the evolution.

“We have long supported integrated care,” said Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies, an alliance of some 160 providers that treats 50,000 children and adults throughout the state. “We believe people need to be treated holistically.”

Chronic conditions

Many individuals with mental illnesses or substance-use disorders suffer from chronic physical conditions, like diabetes and hypertension, she said, and patients receiving medical care often don’t get diagnosed or treated for behavioral health concerns. One result of this disparity is that people with significant mental illnesses die an average of 25 years earlier than those without these diagnoses, in part because they don’t to get adequate care.

“There’s still a lot to be figured out” with the state transition, Wentz continued, and the timing unfortunately coincides with a major reform in how the state pays community providers for their work. (The state is moving from a system of monthly contracts with these providers to a fee-for-service model in which they are paid for specific treatments.)

“As with any system change, some concerns remain,” she said, “but hopefully this will lead to better treatment for everybody.”

DMHAS, which operates the state psychiatric hospitals and oversees hundreds of community-based programs, is among the state’s largest divisions, with more than 4,300 employees — including hospital staff — and a $1.16 billion budget.

The division officially joined DOH on October 1 and a new website for its programs, which includes links to regularly updated lists of frequently asked questions, was launched the following day. There is also a coordinated social media campaign with the hashtag #NJIntegratedHealth.

Moving days

While staff at the hospitals will remain in place, hundreds of DMHAS workers in Trenton will be moved to one of two DOH offices in the capital city in shifts that will continue through the first week of November, officials said. In early October, the health department published a special edition of its Health Matters newsletter devoted to the reorganization and designed to introduce stakeholders to DOH operations.

“Integrated physical and behavioral health is a national best practice,” acting DHS Commissioner Elizabeth Connolly said in the newsletter. “DHS made great strides in advancing this goal in philosophy, policy, and practice. The Division’s transfer to the Department of Health will take it to another level in inclusion.”

Donna Leusner, communications director for the DOH, stressed that Bennett will continue to oversee the process until she leaves in November. Since DMHAS is being transferred as a whole, the department will also inherit the expertise and leadership skills of Valerie Mielke, the former DHS assistant commissioner who runs the division, and her team, Leusner added.

“The Department of Health leadership, including DMHAS's senior staff, are all committed to the reorganization and will continue to work with stakeholders to integrate care,” Leusner said.

Over the past six weeks this process has involved town-hall-style forums in each county, which drew more than 400 people, according to the DOH. Bennett and Connolly also held a trio of conference calls with some 500 stakeholders; these calls were joined by Dennis Gonzalez, the acting regional director for the federal Health and Human Services Department, which works with behavioral health programs nationwide, who “supported the reorganization and supported the need for integration,” the state noted.

Psychiatrist Anthony DiFabio, board president of NJAMHAA and head of Robins’ Nest, a five-decade old treatment provider in the southern half of the state, called the reorganization a “remarkable opportunity” for the public and private sectors to work together. He and others said Garden State caregivers have already made significant strides in better coordinating care, and the shift gives them a chance to build on that momentum, while continuing to support community providers and their work.

“There is no question that we will all face challenges as we work together creating a truly integrated system of care, but all know it’s the right move, as integrated care will both improve the quality of life as well as the lifespan for those we serve, who deserve nothing less,” DiFabio wrote in the DOH newsletter.

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