Gov. Chris Christie’s commitment to expand inpatient treatment options for those with mental health and addiction issues would address what experts consider a persistent barrier to effective care for patients in New Jersey: limited capacity at residential facilities.
But it will be nearly a year or more before patients have access to any of the nearly 900 new psychiatric treatment beds Christie promised on Tuesday the state would help provide. And while Christie said it was the first time the state had called for such an expansion in nearly 20 years, it appears the state Department of Health was prepared to do so last year but canceled the effort when officials determined there was not a “present need.”
During a visit Tuesday to Renaissance House, an addiction treatment facility in Newark, Christie announced the DOH would immediately launch the regulatory process to add to the state’s bed count. According to a notice posted Wednesday by the DOH, the law requires that hospitals or other acute care providers have 90 days from the time of the announcement to submit an application to expand or create new space and treatment programs. The application deadline is now May 1, the DOH said, and the review process is likely to stretch through October, after which any construction could begin.
Additional beds ‘long overdue’
Advocates for addiction treatment and their supporters in the Legislature have praised the governor’s push for additional beds, although some called it “long overdue” given New Jersey’s growing epidemic of opiate and heroin abuse. “I’m gratified to see that the administration is finally addressing this issue,” said Assembly Budget Committee Chairman Gary Schaer.
Schaer (D-Bergen), who sponsored a bill to track open psychiatric beds in real time, noted the capacity crunch has been a problem that providers have raised for several years; the bill has passed the Assembly but awaits a Senate hearing. Sen. Joe Vitale (D-Middlesex) has also tried to address the issue with legislation that would eliminate the cumbersome approval process for existing providers seeing to expand.
The state now licenses 2,343 psychiatric beds in hospitals or other acute-care facilities — which treat patients for mental illness or “co-diagnoses” of mental health and substance abuse issues — and nearly 3,000 more in community-based organizations focused on addiction.
Thousands turned away from inpatient treatment centers
In 2015, some 28,000 residents received inpatient treatment in New Jersey, while thousands more were turned away. Another 1,600 lost their lives — a 22 percent increase over 2014. Roughly half of those diagnosed with a substance use issue also suffer from mental illness, and vice versa, experts said. The 864 beds Christie requested would be available to those with mental illness or both mental illness and drug issues.
“We know we need to increase treatment beds across the state,” Christie said Tuesday, thanking DOH Commissioner Cathleen Bennett, who joined him, for all her hard work on the issue. He said mental health and addiction issues “are so often paired together but often are not treated together the way they should. These beds will help to do that.”
The governor has focused almost exclusively on addiction issues recently, declaring it a public health crisis and outlining plans to provide long-term insurance coverage for treatment and limit certain prescription supplies during his State of the State address last month. While many advocates have supported his passion for the subject, experts have also questioned how his proposals can be implemented and what impact they are likely to have. And some legislators worried aloud Monday, during a hearing on legislation to codify these priorities, how these key reforms can succeed without additional beds.
Schaer, others questioned DOH decision in 2015 to cancel call for additional beds
Even with Christie’s call for greater capacity, some wondered why the state didn’t act sooner. Schaer’s office released a copy of the letter he, along with Assembly Speaker Vincent Prieto and a dozen colleagues, sent to Bennett in the summer of 2015, questioning the department’s decision to cancel the call for additional beds earlier that year. At the time, the DOH suggested that the practice was to issue calls every few years as part of a regular schedule and that the next such “Certificate of Need” call would go out in February 2017.
DOH officials declined to comment on the existence of a schedule for issuing CN calls, but said the commissioner has flagged Christie’s recent request as a priority. “Recognizing that Governor Christie declared opioid abuse a public health emergency in New Jersey, Commissioner Bennett will do everything possible to move the process forward,” spokeswoman Donna Leusner said.
“The state’s hospitals are on the front line of caring for people who overdose and who are brought into their emergency departments. It is in the best interests of state residents with addiction disease and others, who may be at risk, that the state and hospitals partner together in a way that can effectively expand treatment options and locations,” Leusner said. “The Department of Health’s Certificate of Need call provides a pathway for the hospitals and other providers to make those beds available to those who need them,” she added.
Last year the New Jersey Hospital Association released a report that found emergency department visits had increased by more than 117,000 between 2014 and 2015, and nearly half of these cases involved patients with mental health or substance use disorders.
According to the DOH posting, once applications are deemed complete — most likely by the end of the summer — the department will review the files and pass them on to the State Health Planning Board; the board will then make recommendations to the commissioner — estimated to occur in October — and she will issue a final decision on the requests by providers to create new capacity.
The state is looking to direct the new beds to counties that are now underserved. Based on population figures and current availability of psychiatric beds, that means Middlesex is targeted to get 186 new beds, Ocean 129 and Morris 99. Other space is allocated to Atlantic, Cape May, Cumberland, Gloucester, Hudson, Hunterdon, Monmouth, Passaic, Salem, Sussex and Warren counties.
Providers who wish to apply to add or create beds can apply to fill all the spots in their local county, or a portion of those, as well as beds allocated to adjacent counties. Five percent of these must be reserved for Medicaid patients and another five percent for those without any insurance. The DOH said it will give special consideration to applicants that offer a regional approach to addressing co-occurring disorders, those that are willing to work in more than one county, and those that offer innovative treatments.