N.J. Governor Begins Term By Naming MH Task Force

Richard Codey (D) saw an opportunity and seized it when he became acting governor of New Jersey.

He had been a determined and effective advocate for mental health services during his long tenure in the state's Senate (see story on page 21).

After James McGreevey (D) resigned last November, Codey became acting governor while retaining his position as president of the New Jersey Senate.

His first official action was to sign an executive order establishing the Governor's Task Force on Mental Health. Codey charged the task force with conducting a comprehensive review of the state's mental health system and making recommendations to him and the legislature concerning legislative, regulatory, and administrative changes needed to improve delivery and access to mental health services in the state.

Task force member Linda Gochfeld, M.D., told Psychiatric News,“ It's incredibly important and heartening to all of us to have mental health a major priority for the state government.”

Gochfeld is medical director of SERV Behavioral Health Systems Inc., a multicounty program that provides housing and supportive services for people with mental illness and developmental disabilities. She is also a past president and chair of the Public Psychiatry Committee of the New Jersey Psychiatric Association (NJPA).

Other appointments to the 11-member task force also reflected Codey's interest in community-based services and consumer empowerment.

He selected Robert Davison, executive director of the Mental Health Association of Essex County, to chair the task force. Davison is responsible for the day-to-day operation of a large community mental health center.

The co-chair of the task force was George Brice, a consumer who experienced multiple hospitalizations and now serves as team leader for Collaborative Support Programs of New Jersey.

The group had to move quickly to meet Codey's deadline of March 31 to submit its report. They held public meetings throughout the state and solicited comments via a Web site.

Gochfeld chaired the Treatment, Wellness, and Recovery Committee, which played a central role in articulating the vision of the overall report and developing recommendations.

She said that New Jersey exhibits considerable strengths upon which it can build to develop an effective mental health system, including a history of consumer involvement initiated by the Division of Mental Health Services. Consumers, psychiatrists, and mental health professionals agreed on the need for collaboration in future efforts to improve services.

Among the problems in the public system are the restriction of mental health services to “high-risk” populations and long waits for services for those in nonpriority groups. Many services cannot be accessed until a patient deteriorates and ends up in a hospital.

Public hospitals are overcrowded, as are the screening centers that provide access to the hospitals. “Consumers find that it is `hospital or nothing,' with no follow-up services if they are sent home,” according to the report of the Treatment, Wellness, and Recovery Committee.

Access problems are exacerbated by the fact that New Jersey has the lowest reimbursement rate for outpatient psychiatric treatment for Medicaid in the country, so few or no private physicians accept Medicaid patients. Medicaid does not fund consumer-run clubhouse programs, resulting in erosion in recovery-oriented services.

Supportive and affordable housing is scarce, resulting in prolonged hospital stays or discharges to situations that do not promote recovery.

The task force report highlighted the importance of values articulated by the committee. The vision statement opens by saying that the mental health system will be “[d]riven by individuals who use mental health services and their families and focused on promoting wellness and recovery.”

When Codey accepted the report, he said, “By implementing these recommendations, we will move from the current `take your meds, go to a program' approach to treatment to an approach that supports long-term recovery and wellness.”

In March he submitted a budget to the state legislature with funding requests for mental health services that reflect the task force's recommendations (see box above).

Among the key requests were $10 million for staff expansion at mental health screening centers, which serve as the gateway to services, and $2.5 million for an expansion of the number of state-funded work hours for psychiatrists and advanced practice nurses who prescribe psychotropic medication. An important element in the effort to expand community-based services will be the creation of a $200 million Housing Trust Fund.

The most contentious issue for the task force was involuntary outpatient commitment (IOC). IOC, according to the report, is the means by which a court may enter an order requiring a person with serious mental illness to submit to outpatient treatment. IOC, which “commits” a person to outpatient care, is not permitted under current state law. Codey asked for recommendations on the issue, which had been debated in the state legislature.

Gochfeld said consumer groups made strong arguments against IOC on the grounds of civil rights, and the Treatment Advocacy Center, a national organization, argued for it on the grounds of safety. The NJPA submitted a statement supporting the concept of IOC.

A divided task force voted in favor of IOC legislation with three conditions. Primary among these was the idea that no IOC program should be created “unless and until the availability of appropriate community treatment reaches a safe and adequate level.” The same“ dangerousness” standard must be used for inpatient and outpatient commitment in an effort to restrict the procedure to the most seriously ill patients. There must be independent evaluation of the implementation of any IOC program.

Codey identified mental health services for children as a priority. The report repeats a claim by the New Jersey Juvenile Justice Commission:“ The juvenile justice system [has become] the default system for youth who fall through the cracks with mental health and behavioral problems.”

The task force also recommended creating the position of special assistant commissioner of mental health services, reporting to the commissioner of human services.

New Jersey will apply for a Mental Health Transformation State Incentive Grant from the Substance Abuse and Mental Health Services Administration to enable work toward implementation of the recommendations.

The final report of the task force and other information are posted at<www.state.nj.us/mentalhealth/>.▪