Op-Ed: Improve Health in NJ by Coordinating Behavioral Treatment, Primary Care

Joan Randell | December 29, 2016 | Opinion, Winter 2016
Gov. Christie’s $100M commitment is a good start toward improving effectiveness of treatment by taking broader approach

Joan Randell
In his State of the State address on January 12, Gov. Chris Christie announced a $100 increase in funding for mental-health and substance-abuse treatment in New Jersey.

We applaud this critical financial commitment – the funding is sorely needed. In addition to the terrible toll behavioral health (mental illness and substance use) disorders take on individuals and families, they are also very costly to society. Individuals with untreated conditions often become involved with the criminal justice system, disproportionately use social services, and significantly add to the costs of healthcare.

A study published earlier this month by Rutgers University showed that while Medicaid patients in the top 1 percent of New Jersey Medicaid spending are extremely diverse in terms of their physical health problems, 86.2 percent had a mental health or substance abuse diagnosis.

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The governor’s speech identified a number of budget initiatives, including raising Medicaid reimbursement for mental-health and substance-abuse providers; converting a prison into a substance-abuse treatment facility, and increasing training for first responders.

We recommend that the administration make one additional – and vital – commitment that would exponentially increase access to, and improve the effectiveness of, behavioral healthcare in our state: integrating primary care and behavioral health services.

Traditionally, behavioral health has been separated from the physical healthcare delivery system. Providers operate in separate facilities, are governed by different regulatory bodies, and are usually reimbursed through separate funding streams. And yet, neuroscientific studies show that psychosocial experiences and stress are intimately linked with physical health. This research, combined with decades of on-the-ground and evidence-based experience on what works, has resulted in a national consensus that providing integrated care treating the whole person is essential.

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We know that when behavioral health conditions like anxiety, depression, insomnia, or substance misuse go untreated, they not only worsen, but exacerbate the effects of other chronic medical conditions, like diabetes or heart disease. The evidence indicates that treating these problems early, and in concert with patients’ physical health, will result in better initial care and fewer subsequent hospitalizations.

New Jersey would benefit from using the primary care delivery system to intervene early to treat patients’ behavioral health conditions. Most individuals prefer to receive services in the primary care setting. They are more likely to disclose unhealthy substance use or mental health issues to a trusted physician. An integrated system reduces the stigma attached to seeking behavioral health treatment, enabling more people to seek out the care they need to get and stay well. Patients appreciate the convenience of integrated care and are more likely to become and stay engaged in treatment. They certainly benefit from reducing the time, hassle, and expense it takes to schedule separate appointments at different locations.

Recent estimates show that only 5 percent of New Jersey residents are receiving the addiction treatment they need. In addition, the Mental Health Association in New Jersey reports average wait times for community-based mental health outpatient services of three to six months in most counties in New Jersey and more than 12 months in some.

When individuals can’t receive behavioral health treatment when they seek it, research and experience show that their conditions are likely to remain untreated.

The governor’s proposed infusion of $100 million for behavioral health services will do a lot — but it will still leave a substantial gap between the demand for treatment and the capacity of the behavioral healthcare system to provide it. Enlisting the primary care system is a key strategy to further narrow the treatment gap.

Furthermore, an integrated behavioral and primary health system that delivers the highest quality care – and gets it to patients early, before problems become severe and chronic – will have powerful downstream effects on society as a whole. Acting before individuals lose their homes and jobs because of their mental health or substance use problems will help prevent these negative personal consequences. This will also avoid substantial societal costs later, such as homelessness, criminal justice involvement, and avoidable hospital use.

The Nicholson Foundation is currently funding pilot programs to integrate behavioral health and primary care services at six clinics across New Jersey. Yet the clinics that are implementing these evidence-based models are facing significant regulatory and reimbursement challenges. We know that many more primary care providers and behavioral health professionals are eager to adopt an integrated model of care, but they are wary of the barriers the early adopters are facing.

Gov. Christie’s substantial public commitment to improving behavioral health services in New Jersey provides an unprecedented opportunity for his administration to champion the broad structural changes that are needed to spur behavioral health and primary care integration. Advancing from our current, bifurcated system of care to an integrated model is one of the best and most cost-effective strategies to improve overall health in New Jersey.

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