New Jersey officials have launched a six-week outreach effort to help frontline staff, providers, and members of the public understand the potential benefits and timeline of the state’s controversial plan to shift addiction and mental health services to a new department.
Leaders at the state Department of Health, which will take the reins at the massive Division of Mental Health and Addiction Services, and the Department of Human Services, which currently runs these programs, held a trio of conference calls last Thursday to discuss the changes with some 500 stakeholders.
Officials are also working to schedule “town-hall” discussions in all 21 counties; dates for all but four have been confirmed, starting with a Thursday morning session in Burlington County. Details on these two-hour public meetings, with links to registration information, are available online.
The outreach effort is just one aspect of a massive reorganization that will transfer the division — which runs the state’s four psychiatric hospitals and oversees an extensive system of community-based programs operated largely by nonprofit contractors — from the DHS to the DOH.
Gov. Chris Christie announced his plan in late June, as lawmakers gathered in Trenton for last-minute budget negotiations, and gave them 60 days to block the change, which he framed as an important next step in his ongoing quest to improve addiction services in a state facing an opioid crisis.
The massive shift has sparked concerns for some advocates and lawmakers who oversee health and human services programs, who fear it could result in chaos at critical programs for some of the state’s most vulnerable residents. But state officials insist it provides an opportunity for widespread improvements.
“The reorganization will provide increased efficiency, coordination and integration of mental health and addiction prevention and treatment services within the Department of Health,” Donna Leusner, the department’s communications director, explained.
During the stakeholder calls last week, Leusner said DOH Commissioner Cathleen D. Bennett and DHMAS director Valerie Milke stressed that the reform seeks to improve healthcare services for all state residents, help providers to treat the “whole person” in a single setting, and better address substance use disorders.
‘Continuity of care’
“Commissioner (Bennett) explained that continuity of care is our priority, along with ensuring no interruption in payments to providers. The Commissioner also noted that DMHAS staff and expertise are moving to DOH so providers/stakeholders/advocates will have the same points of contact,” Leusner said.
Meetings will also be scheduled at the psychiatric hospitals to answer questions from staff, patients, and family members, officials said. (The state operates Trenton Psychiatric Hospital, Ancora Psychiatric Hospital, and Greystone Psychiatric Hospital, as well as Anne Klein Forensic Hospital, which cares for those referred by the court system.)
People who cannot attend one of these sessions are invited to email questions and feedback to officials at the DOH using the following address: firstname.lastname@example.org.
The DOH has already created a new logo for the program and has crafted a social media hashtag, #njintegratedhealth. Still to be determined is which of the division’s 4,300-plus employees will be relocated and where in the DOH they will be housed, among other challenges. The division’s $1.16 billion budget will also shift with the programs, oversight, and staff.
But Kimberly Higgs, a social worker and executive director of the New Jersey Psychiatric Rehabilitation Association, which represents small community providers, said the briefing call she joined last week was fairly light on details.
“The County meetings are a good first step in engaging stakeholders, and NJPRA is hopeful that any timeline of activities, objectives, and deliverables will include a robust engagement of stakeholders that extends beyond the provider community to include persons served by DMHAS, families, housing, and other care providers who are well acquainted with the wide-ranging scope of community-based mental health and addictions services,” she said.
Christie’s plan draws on a March 2016 report from Seton Hall Professor John Jacobi, who identified how bureaucratic and systemic hurdles had made it difficult for many healthcare providers to obtain the state licensing and certification they needed to be able to address both behavioral and physical health for their patients. Experts agree that integrating mental health and addiction services with other medical care results in better outcomes, and Jacobi has been working with leaders in both departments to help smooth the path for change.
But while they support better integration, advocates for the mentally ill and the providers who serve them have raised many concerns about the shift, which they have suggested could create a chaotic situation at a time when some provider groups are struggling to adjust to a major reform with how the state pays for their services.
Some also worried the move would create new bifurcations, making it more difficult for DMHAS programs to coordinate with other divisions within DHS that handle Medicaid and disability programs, for example. Others, including Higgs, are concerned that DOH — which licenses and regulates healthcare facilities and oversees a suite of population health programs — doesn’t have the background and experience to manage behavioral health services.
Blocking the reorganization
Advocates aired these concerns during a joint legislative hearing in late July, led by Sen. Joe Vitale (D-Middlesex), the longtime chair of the Senate health and human services committee, and Assemblywoman Valerie Vainieri Huttle (D-Bergen), who oversees the Assembly human services panel. A few days later, the full Assembly voted to block the DMHAS move.
Vitale convinced Sen. President Steve Sweeney (D-Gloucester) to schedule a Senate session to vote on a similar measure, before it was too late to block Christie’s proposal. But efforts to call members back to Trenton in late August failed, forcing them to cancel the session and allowing the DMHAS move to proceed according to Christie’s plan.
While he applauded the goals involved, Vitale said the governor’s plan was the “wrong way to go about it” and called it the “wrong policy for the state” — especially since most of the changes will take place under a new governor, after Christie leaves office in January. Vitale said that DOH is “ill equipped” to oversee the DMHAS programs and is already overburdened with its current level of responsibilities, like hospital inspections.
“The governor had eight years to act on this and to decide two months before the election of a new governor to make such a drastic change is just poor policy. It’s irresponsible,” Vitale said, noting that while lawmakers could not act in time to block the transition, “we will closely monitor the process and will work with the next administration on reversing it if necessary.”