New Jersey has exceeded the goals outlined in a 2009 court settlement that required state officials to expand local programs for adults with mental illness and do more to transfer those who no longer needed the support of state hospitals into less-restrictive lifestyles in community facilities.
Disability advocates, their attorneys, and officials with the New Jersey Department of Human Services, which oversees these state programs, announced earlier this month that New Jersey has added 1,436 beds in supportive programs over the past six years, exceeding the 1,065 threshold in the settlement. The state also succeeded in resettling more than 2,000 patients, including nearly 300 individuals who had been cleared for discharge from state facilities, but remained institutionalized for months while an appropriate spot was located.
The shift has helped New Jersey reduce the number of patients in state psychiatric hospitals by one-third over 10 years; the three public facilities now operating cared for around 2,100 patients in 2016. A fourth facility is limited to patients who are committed by the court system; two others closed in recent years, part of a nationwide shift from institutional treatment to community-based programs.
“The state is providing a greater array of these resources, which helps to prevent unnecessary hospitalization and to assist consumers to attain and sustain recovery with as little disruption as possible to their work and home lives. We’re incredibly proud of these advances and the positive impact it has for consumers,” said Elizabeth Connolly, DHS acting commissioner.
But despite these gains, acute-care hospitals and county psychiatric facilities have reported an increase in the number of mental-health emergencies they are treating and too many of these patients remain longer than needed, given a lack of appropriate community options. Community based providers have said they are struggling to maintain services as costs escalate and government-funding programs evolve.
Advocates with Disability Rights New Jersey, which joined with the Bazelon Center for Mental Health to challenge the state’s resettlement plan in 2005, praised the results and the improvements it has brought to people’s lives. The lawsuit was triggered by concerns over the state’s implementation of the “Olmstead decision,” a 1999 federal Supreme Court ruling that required states to serve disabled individuals in the “least-restrictive” environment possible.
Connolly and Joseph Young, the executive director of DRNJ, said the state would continue to build upon these advances. In a draft plan for the next three years, state officials predict they will add another 220 beds in the current fiscal year and will continue to add community space to meet demand as funding permits. Other goals call for further reducing the median length of stay at state institutions and limiting the number of patients who are held after their discharge is approved, until housing options can be secured.
“As a result of the settlement, the state put in place new practices and shifted resources to avoid needlessly hospitalizing individuals with serious mental illness and to ensure that such individuals have the chance to live in the most integrated setting,” explained Bazelon’s director of Policy and Legal Advocacy, Jennifer Mathis.
Gov. Chris Christie included nearly $117 million in state and federal funding in the DHS budget proposal for fiscal year 2018, which starts in July; this is a more than $5 million increase over what was budgeted in the current year. Other resources come from housing programs within the Department of Community Affairs.
But some mental health providers insist that overall funding for community programs is down, a problem exacerbated by the state’s plan to shift from a system of annual contracts to a fee-for-service model that pays for each specific treatment. Advocates have lobbied lawmakers to slow this reform, warning the changes will leave them unable to care for those they do now, let alone take on new patients. (Christie included an extra $127 million in state and federal dollars to help implement this change in fiscal 2017 and fiscal 2018, but advocates said overall funding continues to decline.)
With community services stretched, some psychiatric hospitals still end up holding patients longer than clinically necessary, providers said. The problem is particularly acute at county-run facilities that are not covered by the DRNJ settlement, which applies only to state hospitals. (New Jersey has six county psychiatric facilities, plus dozens of private and hospital-based psych emergency programs.)
“We want people to live in the community,” said Tom Rosimelia, the vice president of behavioral health services at Bergen Regional Medical Center, a county-owned facility with some 300 mental-health beds, at a briefing for state lawmakers last fall. “But what we have is people boarding in the hospital because they have no place to go.”
Hospitals have also reported a growing number of mental health emergencies and found that these patients are often languishing for days, until staff can connect them with a more appropriate treatment site. Nearly half of the more than 200,000 additional patients treated in recent years at emergency rooms in Garden State hospitals were suffering from psychiatric issues, according to a study released last fall.
But state officials said the fee-for-service transition, along with other reforms designed to better plan hospital discharges and improve communication with local providers, will only enhance the success of New Jersey’s deinstitutionalization efforts in the years to come. Officials working on the Olmstead transition will continue to meet with advocates on a quarterly basis to assess their progress and next steps, officials said.
“These initiatives are milestones of some of the most critical system enhancements the mental health delivery system has seen in nearly a generation,” DHS said.