Oversight of community-based behavioral health services is back where it belongs, according to New Jersey officials, and the restructured system is working better to support local providers and ensure patients in state psychiatric hospitals are getting the treatment and other services they need.
That was the message delivered yesterday by Department of Human Services Commissioner Carole Johnson and Department of Health Commissioner Dr. Shereef Elnahal, who testified together before the Assembly Human Services Committee on the latest restructuring of the Division of Mental Health and Addiction Services. DMHAS, one of state government’s largest divisions, was moved last year under former Gov. Chris Christie from one department to the other, but switched back under Gov. Phil Murphy starting this summer.
Among other things, Johnson said the changes made under Murphy, which were finalized on October 1, allow the state to be more effective in combatting the opioid epidemic, capitalizing on federal funding, and assisting those who are discharged from psychiatric hospitals to secure housing and treatment in the community.
The shift has also enabled officials at the DOH to advance regulatory changes that should soon provide for more integrated physical and behavioral healthcare, Elnahal said, an issue of particular interest to Assemblywoman Joann Downey (D-Ocean), the committee chair. The move has also supported the DOH’s effort to improve operations at the state’s four psychiatric hospitals, he said.
And through the changes, staff members at the two departments have forged an effective working relationship, Elnahal added, making connections that are especially important for the many patients suffering from multiple medical, mental health and substance-abuse conditions. “The patients have always had an integrated set of problems. We are trying to build an integrated system to try and meet those needs,” he told the committee.
System had been in turmoil
Both commissioners made clear that aspects of the behavioral health system were in turmoil when Gov. Phil Murphy’s team took over, but they did not mention former Gov. Chris Christie by name. Elnahal said he learned his first day on the job that one of the psychiatric hospitals was in danger of losing its national accreditation; Johnson described previous oversight changes that led to disruption in critical technology services and other disruptions in operations.
In the heat of his last budget with Democratic legislative leaders, Christie, a Republican, announced his plan to move DMHAS from Human Services to the health department. The goal was to better integrate services for mental health and substance-use disorders with medical care, which is overseen by the DOH. While there was general support for the concept, lawmakers and providers balked at the last-minute nature of the switch, which was carried out in the final months of Christie’s eight years as governor.
Murphy, who took office in mid-January, was urged by policy experts and the mental health provider committee to revisit Christie’s decision. In June he announced the policy would be largely reversed: most of DMHAS would return to the DHS, which would oversee the vast network of nonprofit providers the state contracts with to ensure there is community-based care. However, DOH would retain control over the state psychiatric hospitals and the licensing functions, which state officials hope to better integrate in the months to come so that patients have easier access to a full panorama of care.
Trying to minimize disruptions
“All of our efforts were focused on achieving as seamless a transition as possible because our service recipients should be our primary focus, not rearranging organizational charts,” Johnson told the committee. She stressed that the Murphy administration took time to carefully plan the return move, engage staff and community providers in the process, and take steps to minimize operational disruptions, including tying the shift to the end of the fiscal quarter to avoid payroll or funding hiccups.
“We are heartened by the enthusiasm of the community for the Division’s return to DHS, and department staff was excited to welcome our colleagues back home,” she added, praising the staff, assistant commissioner Valerie Mielke, and the providers for their patience with the process.
DMHAS has a $1.16 billion budget and employs more than 4,300 people — some of whom were shifted fairly suddenly during the Christie reform, Johnson noted. Its work benefits tens of thousands of residents, including some of the most vulnerable patients, who seek care in community settings, and some 1,400 seriously ill individuals in the psychiatric hospitals.
Both commissioners agreed their departments would benefit from better data systems, something Murphy has also prioritized. Johnson said it is hard to get a jump on the opioid epidemic when much of the data on treatment and drug-related deaths is months or years old.
Still using paper charts
Elnahal lamented the fact that the psychiatric hospitals still rely on paper patient charts, something that hinders clinical care and easy integration with community providers; he said he is working with Treasury Department officials to find a way to help fund what he conceded would be a costly, complicated shift to electronic health records.
Community providers are also struggling to adjust to a payment reform the state instituted in recent years, Johnson noted, a process that has left some organizations with multi-million dollar holes in their annual budgets. The department is seeking ways to support these critical services, she said, and pledged to continue meeting with these providers as their work evolves.
Murphy’s DMHAS move also coincided with the findings of a consultant’s report on the state psychiatric hospitals, commissioned by the Christie administration and released by Elnahal in September. The 18-month plan calls for a major overhaul, with investments in physical improvements, technology, workforce capacity and training, and better integration with community services for those discharged from inpatient care.
Elnahal told the Assembly panel improvements have already been made, including the addition of 90 staff at one site, policy changes to reduce seclusion, and operational reforms to improve safety. They have also increased staff training significantly, but it will take time to build a truly integrated system able to meet the complex needs of the hospital patients, he added.
“So, challenges remain. Nothing gets fixed in a year that has been decades in the making,” Elnahal said, adding, “Part of our reforms include transforming the culture of the hospitals to foster a patient-centered, therapeutic setting rather than a custodial environment.”