Officials from the Christie administration will be called to explain the benefits of a controversial plan the New Jersey governor outlined to shift addiction and mental health services to a different department during a legislative hearing scheduled for later this month.
The July 25 session of the Senate Health, Human Services and Senior Citizens Committee and the Assembly Human Services Committee could also help lawmakers determine if they want to take formal action to block the move.
Gov. Chris Christie submitted the surprise reorganization plan to the Legislature Thursday, June 29, on the eve of a five-day budget struggle that closed state government and kept lawmakers in Trenton wrestling over a compromise. If they want to stop the shift, lawmakers have 60 days to pass a resolution in both houses opposing the plan.
The governor’s proposal is designed to better integrate behavioral health and physical health services — an approach widely recommended by experts — and improve government efficiency by moving the Division of Mental Health and Addiction Services from its current home in the Department of Human Services into the Department of Health.
DMHAS, which runs the state’s four psychiatric hospitals, and community-based addiction and mental health services among other programs, has some 4,321 employees (including hospital staff) and a $1.16 billion budget — all of which would be transferred to DOH. Christie framed the shift as another step in his ongoing effort to improve the state’s addiction services and address what he has framed as a public health emergency of opiate abuse.
Plan raises concerns
But the reorganization plan quickly sparked concerns for some healthcare providers and patient advocates, worried that it could hamper the delivery of services, and lawmakers who said such a major change deserves greater public scrutiny.
“The governor may be ready for the beach, but we are still paying attention,” said Assemblywoman Valerie Vainieri Huttle (D-Bergen), chair of the Assembly Human Services committee and an early critic of the plan. “He has put into motion a major system change and it seems like he was hoping we wouldn’t take notice. This plan has to be vetted.”
Seton Hall professor John Jacobi was encouraged by the governor’s proposal, however. Jacobi and his colleagues published a report in March 2016 that identified bureaucratic and systemic hurdles that prevent New Jersey from better integrating behavioral and physical care, and he has been working with key staff at both the health and human services departments ever since; Christie frequently cited the study in his proposal.
“This is a real opportunity for New Jersey,” Jacobi said earlier this week. “There’s no easy way to do this,” he added, “but there is a deep commitment in both agencies to get this right.”
Not the first reorganization
This is not the first time the state has reorganized how it provides health and welfare programs as part of an evolving process to improve service delivery and accountability. In 2006, the New Jersey Department of Children and Families was founded, creating a cabinet level agency to handle responsibilities once held by the Division of Youth and Family Services, within DHS. A few years earlier, addiction services were moved from DOH to DHS, where they were eventually aligned with mental health under DMHAS.
Jacobi said it is not uncommon for public agencies to have structures and protocols that are out of touch with the practical reality of the sector they oversee, but making major systems changes is challenging on many levels. He said he has been encouraged by the commitment he has seen from staff at DOH and DHS seeking to overcome the barriers identified in the 2016 report.
“I think that it is extremely important to remember that however the first order of change occurs,” Jacobi said, “that this is only the beginning of the process.”
“No matter where you start,” he added, “the hard work is making sure there is follow-through so the regulations are patient-centered and make sense for providers.”
Among other things, Jacobi found that a split system of licensing has made it difficult for many providers to offer mental health, addiction, and physical health treatments at one site. Under the current setup, DOH licenses and oversees hospitals, clinics, and other physical health practices, while DHS is responsible for mental health and addiction providers.
There is a growing body of research that shows individuals with serious mental illness often suffer chronic health conditions or other medical issues that don’t receive proper care; as a result, they die an average 25 years earlier. In other cases, patients seeking physical care may not be diagnosed or treated for behavioral health problems. Better integrating the two aspects of healthcare makes it easier to provide more holistic and effective care to all, experts agree.
The state has taken some steps to address this already. The DOH issued a rule in early 2016 that eased some of the licensing restrictions, but it didn’t solve the problems for all providers. Legislation to further integrate services, allowing clinical providers to share space with behavioral providers who treat mild or moderate conditions, was signed by Christie on Thursday. But shifting DMHAS would go even further.
Sen. Joe Vitale (D-Middlesex), the chair of the Senate health committee — and sponsor, with Vainieri Huttle and others, of the measure Christie signed Thursday to improve integration — said the July 25 hearing will help lawmakers determine if this step is necessary.
“We want to hear from the administration on this and why they think it is a good idea,” he said. In addition to representatives from DHS and DOH, the 11 a.m. session will include testimony from advocates and stakeholders, including patients, he said.