Appropriate care for Americans struggling with mental illness and drug addiction has been hard to find and not well coordinated, and it rarely loops in medical treatment for chronic health conditions like diabetes or high blood pressure.
But a federal pilot project launched in July 2017 in eight states, including New Jersey, seeks to address these shortfalls and close the gaps in coordination. The program seeks to invest some $1.1 billion — the largest commitment in generations, according to advocates — in evidence-based community programs that have already improved access to treatment and care coordination for patients impacted by multiple behavioral health conditions. Wait times have gone down, new treatment options are available, and individuals are getting better care overall.
An increase in Medicaid reimbursements has allowed the seven Garden State groups involved in the program to hire dozens of new staff members, including psychiatrists assigned to each organization — a first for some — expand treatment protocols, and build partnerships with local clinics, hospitals and other healthcare providers. (More than 1,200 staff were added nationwide.) They have also beefed up case management, recovery support and other services like transportation and employment assistance, according to the National Council for Behavioral Health, which advocates for the program.
“It covers things we always wanted to do,” explained Vera Sansone, president and CEO of CPC Behavioral Healthcare, in Monmouth County. “All these things we know we need to do if we want to engage people, and keep them coming, but we couldn’t pay for consistently” in the past, she added, when the funding came “through a variety of grants and programs that were all over, in different silos.”
But despite the initial success, the program is not statewide and could be short-lived. The current pilot program only runs for two years, through June 2019. Sansone and other advocates want to highlight its benefits so that state and federal officials recommit to the effort, providing sustainable funding for the organizations already involved and expanding the concept to more sites and new states. It’s a message that has attracted the attention of some members of New Jersey’s federal delegation.
If federal dollars go away, program will disappear
“It’s an integrated health model and it’s extremely good. The problem is, once the federal dollars go away, it disappears,” noted Carolyn Beauchamp, president and CEO of the Mental Health Association of New Jersey, who has long been an advocate for improving care for individuals with co-occurring diseases, or mental health and substance abuse diagnoses, a situation that impacts half the Garden State patients in the program. “The funding is the trick,” Beauchamp said.
New Jersey has made strides to expand care for behavioral health, including for those with both substance and mental-health disorders. In early 2017, former Gov. Chris Christie launch an effort to add nearly 900 inpatient beds for those with mental health or co-occurring diagnoses, which Gov. Phil Murphy has continued. The Murphy administration has also sought to invest more in community-based services, critical programs run by nonprofits that assist the clear majority of those with mild to moderate, and sometimes more severe, behavioral health challenges.
But advocates said these local programs deserve more support. Studies have show that appropriate treatment is only available to roughly four in 10 Americans with serious mental illness, and one in 10 diagnosed with addiction issues.
The federal program, the Certified Community Behavioral Health Clinics pilot, or CCBHC, seeks to support this community care and improve the odds of obtaining proper treatment. Rooted in a 2014 federal law, the program was crafted by the Substance Abuse and Mental Health Services Administration, which chose New Jersey, New York, Pennsylvania and five other states for the pilot. The agency then selected 67 providers in these states, all experienced with treating co-occurring disorders, to provide key services, like 24-hour crisis response, care coordination and connections to other medical care.
According to the National Council, the federal budget signed into law in March includes $100 million in new funding for the CCBHC program, and President Donald Trump has requested additional support for his fiscal year 2019 budget. U.S. Rep. Leonard Lance, (R-NJ) introduced legislation to extend funding for another year and expand it to another 11 states, co-sponsored by U.S. Reps. Rodney Frelinghuysen (R-NJ) and Bill Pascrell, (D-NJ). U.S. Rep. Frank Pallone, (D-NJ), who visited with CPC staff in mid-July, has also expressed support for the program.
State must act
Advocates said the state also has a role to play in sustaining or expanding the CCBHC program. The state Department of Human Services, which oversees Medicaid, would need to request a federal waiver and commit funds of its own to supplement the federal dollars. While integrated care has been a priority for state health officials under Murphy, the DHS did not respond to a request for comment on the program late last week.
To increase the funding flow, the CCBHC program created more flexibility within the Medicaid program and enables the providers to get reimbursed more, and for a wider range of services. This leads to greater financial stability that has allowed these organizations to expand access to all the patients they serve, not just those who are covered by Medicaid directly, Sansone explained.
“Now we get to take care of these people,” she said, “instead of them getting diverted” to less appropriate facilities, like hospital emergency rooms, which have seen a growing number of psychiatric patients in recent years. Providers have also been able to provide effective crisis intervention, even on weekends, when the state’s existing county-based system is often overloaded, Sansone noted.
According to results shared by the National Council in May, one in three New Jersey providers in the program have been able to treat at least 50 percent more patients as a result of the program. Two out of three have been able to decrease wait times, with most able to provide a first appointment within a week, when weeks or months had been standard in the past.
The additional funding allowed more than 80 percent of the Garden State participating organizations to launch new withdrawal-management programs and a similar number to expand access to medication-assisted treatment, a pharmacological approach now considered the gold standard, and addiction counseling. Two-thirds of the providers here added case management services, half grew their peer-recovery coach programs, and a third added education and employment supports.
The New Jersey program, which also involves Rutgers Behavioral Healthcare and a handful of other nonprofit providers, also enabled all participating organizations to establish or expand relationships with hospitals and inpatient and outpatient detox and treatment programs. More than 80 percent partnered with children’s behavioral health providers or crisis programs, and two-thirds created links with recovery housing initiatives.