Grading the States 2006: New Jersey - Narrative
A governor who cares can make a huge difference.
In November 2004, New Jersey Senate Majority Leader Richard Codey became the Acting Governor of New Jersey upon the resignation of Governor James McGreevey. On his very first day in office, Governor Codey began his day with breakfast at the state's largest psychiatric hospital. Later that day, he signed his first executive order, creating a taskforce on mental health. He promised that improving services for people with mental illnesses would be one of his top priorities while in office.
During his 13 months in office, Governor Codey proved true to his word. Despite inheriting a $4 billion dollar budget deficit when he assumed office, the FY 2006 Budget approved by the New Jersey legislature contained an increase of $40 million in mental health funding for a variety of important mental health initiatives, including jail diversion, supported employment, community short-term inpatient treatment facilities, case management for individuals re-entering the community from corrections, and mental health workforce expansion. Perhaps the most important accomplishment of all, in terms of long-term impact, was the enactment of a law dedicating $200 million for a Special Needs Housing Trust Fund to create 10,000 new units of supportive housing units for people with mental illnesses and special needs.
At a time when many states are cutting mental health services, these accomplishments are remarkable - a true tribute to the determination of Governor Codey to invest new resources into services that work for people with serious mental illnesses.
This is not to say that all is rosy with New Jersey's mental health system. The Division of Mental Health Services (SMHA) has direct responsibility for operating the state's five public psychiatric hospitals. Several of these hospitals are seriously overcrowded, and services that might enable some patients to function in less restrictive settings are not available. According to the Governor's Task Force on Mental Health, "almost 50 percent (1,000 people) of New Jersey's state hospital patients are clinically ready for discharge but housing and support services are not available for these patients."
All five of New Jersey's state psychiatric hospitals are overcrowded, placing great strains both on patients and staff. Moreover, Greystone Park, the largest hospital in the state, is old and decaying. Plans have been developed to replace the current hospital with a new, state-of-the-art facility with fewer patients while maintaining the same number of staff to improve quality of care. While this seems like a hopeful plan in concept, whether it succeeds depends upon the development of appropriate services and supports in community-based settings for those deemed no longer to require inpatient care. Is the state prepared to reinvest money saved by reducing the census of its state hospitals into community-based services and supports on a dollar-for-dollar basis?
The Division's plan to increase community-based services and ultimately decrease the numbers of individuals served in hospitals includes increased use of evidence-based practices (EBPs), such as Assertive Community Treatment (ACT), integrated case management services for individuals discharged from state or county hospitals, and the use of psychiatric units in general hospitals for individuals requiring acute inpatient care. The SMHA has taken strides in recent years to increase the availability of certain evidence-based practices. Thirty-one ACT teams currently operate in all of New Jersey's 21 counties, an impressive number on its face, but nevertheless not enough to serve all who could benefit from ACT in the densely populated Garden State. More ACT programs are needed.
A cooperative agreement exists between the SMHA and the Division of Vocational Rehabilitation to collaborate on financing supported employment services. Currently, SMHA funds help support consumer participation in 22 supported employment programs throughout the state, one in each county except for Mercer county, where there are two such programs. Here too, significant expansions are needed in the availability of supported employment programs. Fewer than 1,000 people with serious mental illnesses currently receive this vital employment support in New Jersey.
The state has lagged significantly in implementing integrated dual diagnosis treatment (IDDT) programs for the large numbers of consumers who suffer from co-occurring mental illnesses and substance abuse disorders. Citing problems with meeting specific staffing requirements, the SMHA acknowledges that only one such program exists at the present time. While funding requirements may be burdensome, IDDT has proven effective in facilitating recovery. In the long run, investing in the development of IDDT programs will decrease more costly expenditures associated with hospitalizations or incarcerations.
On a positive note, New Jersey should be applauded for its decision to provide wrap-around coverage of medications for individuals dually eligible for Medicaid and Medicare who would otherwise be required to satisfy co-pay requirements under the new Medicare Part D program. And New Jersey has, in recent years, significantly improved mental health treatment for prison inmates with serious mental illnesses, implementing an open medication formulary in prisons and contracting with the University of Medicine and Dentistry of New Jersey to provide prison mental health services. The challenge for the state is to work with counties to expand these promising practices into jail settings.
New Jersey has taken unique steps to ensure a culturally competent workforce, including enacting legislation that requires medical schools to teach these principles andphysicians to attend cultural competence training before renewing state medical licenses. Additionally, the DMHS has solidified its commitment to cultural competence through the development of an Office of Multicultural Services (OMS) within the Department. The OMS oversees a variety of activities, including: liaisons with state hospitals to evaluate the needs of multicultural clients and communicate those needs to hospital CEOs; the Multicultural Services Advisory Committee, composed of providers, consumers, families, and academicians; provision of multicultural grants to minority communities; and a Technical Assistance Center at the state's University of Medicine and Dentistry that provides training in cultural competency and other DMHS priority areas.
As Governor Codey leaves office and returns to his role as Senate President, he can look back with pride at significant advances that have occurred in public sectormental health services during his watch. However, these advances are just a start. New Jersey has a long way to go to develop a truly comprehensive system of services andsupports for people with serious mental illnesses. Efforts must continue to develop housing and implement evidence-based practices, while maintaining adequate numbers of inpatient beds for those who need them. Hopefully, the momentum generated under Governor Codey will continue under new Governor Jon Corzine.
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