Nearly one-third of people admitted to a New Jersey hospital last year sought treatment for a mental illness, an addiction, or a medical condition exacerbated by a psychiatric condition, according to mental health advocates and hospital executives.
TRENTON -- Nearly one-third of people admitted to a New Jersey hospital last year sought treatment for a mental illness, an addiction, or a medical condition exacerbated by a psychiatric condition, according to mental health advocates and hospital executives. These patients likely waited at least three days in the emergency room before a hospital found the room to admit them.
But given the option to begin a process last winter that would have solicited offers from hospitals to open more beds for psychiatric patients, the Christie administration declined to do so. Officials postponed the next review to 2017, according to a notice on the state Health Department's website.
Calling the decision "unconscionable" and "disconnected from reality," Assemblyman Gary Schaer (D-Passaic) and 14 other Democratic lawmakers, including Assembly Speaker Vincent Prieto (D-Hudson), are now seeking an explanation as to why the state cancelled "a call. . . for comprehensive rehabilitation beds and services."
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They sent a letter to acting Health Commissioner Cathleen Bennett on July 30 asking for her to reconsider the decision, and went public with it this week after getting no response, Schaer said.
Bennett's spokeswoman Dawn Thomas said on Tuesday the commissioner was reviewing the letter and declined to comment.
Nicole Brossoie, spokeswoman for the Department of Human Services, the state's mental health agency, said the state cancelled the call for more beds partly because hospitals and other treatment providers had failed to open 13 new beds they had won approval for in 2008. Nine of those beds were supposed to be provided by Princeton House Behavioral Health, and the remaining four by Newton Memorial Hospital, which has since been taken over by Atlantic Health System based in Morristown.
"We continue to follow up with the 2008...awardees who have not yet (opened) their beds to determine how to move forward," Brossoie said.
Schaer noted that over the past several months, lawmakers have hosted three roundtable sessions that featured discussions about "behavioral and mental health, one of them being our state's inpatient psychiatric delivery system.
"Throughout these discussions, behavioral and other healthcare professionals continuously raised the need for increased bed capacity," Schaer said. "It seems to me on the face of it the decision makes no logical sense, given the need based on what virtually everyone at those sessions said - the presidents and CEOs of their respective institution. One would expect logically to see the department taking a leadership role to answer those concerns. Canceling the call is a total disconnect from the reality."
According to the health department's website, "The Department has reviewed statewide need for new or expanded comprehensive rehabilitation beds and services and determined that need has declined due to national policy changes that have influenced admission rates for comprehensive rehabilitation beds and services."
The department's decision "confused" members of the New Jersey Hospital Association, said Mary Ditri, the association's director for professional practice.
"The volume of patients coming in and out of the hospital for mental health care and substance abuse care continues to grow, regardless of age, regardless of gender, of location," said Ditri, who attended the discussions with hospital executives and led by Schaer.
In 2014, roughly 839,000 people came to acute-care hospitals with an underlying mental health or substance abuse problem, Ditri said. Of those people, 534,000 came to the emergency room and were never admitted. These patients represented nearly 18 percent of all emergency room visits, up from 12 percent in 2008.
Hospitals admitted the remaining 305,000 people, which represented 31 percent of all patients admitted last year, Ditri said. She said did not have complete admission data to compare the rate of growth over time.
Added to that is the level of complexity of cases, Ditri said. One example is the spike in the number of people diagnosed with a mental illness and a developmental disability.
Rita O'Grady of Union Township said emergency rooms have become a second home for her 23-year-old son, Tyler Loftus, who is diagnosed with autism and a mental illness. From January 2014 to January 2015, he spent 99 days outside of his group home, most often in emergency rooms waiting to be admitted to Trinitas Regional Medical Center, the only specialized unit in the state for people who are dually diagnosed with a mental illness and a developmental disability.
He ends up in the ER because group home employees are instructed to call 911 when he exhibits aggressive behavior and makes violent threats, O'Grady said.
"He has gone to Trinitas probably seven or eight times and waited up to 10 days to get in there," O'Grady said. "He's had to sit on a cot in a hallway exposed to infectious disease. They inject them continually with drugs to chemically restrain him to keep him calm."
"The population who is disabled is on Medicaid and the reimbursement is very low. These are not money-generating units in a hospital," O'Grady said. "Mandates need to be created that designates a hospital unit (for disabled people with mental illness) in every county."
The trend in mental health care for 30 years has been "diversion" from hospitals, said Robert Davison, executive director for the Mental Health Association of Essex County. Some people don't need inpatient care, or don't need it for long, Davison said. But he also sees how the high cost of treatment is driving the decisions to eliminate or decline to open more short-term and long-term psychiatric beds.
Acute care hospitals charge about $800 a day, he said.
"Our experience in Essex County is very difficult to get someone hospitalized and the decisions are more often financially driven than clinically driven," Davison said.
Davison said he didn't know why state officials declined to seek more hospital beds. "My opinion is they don't want to pay for it" through Medicaid.
Once admitted, the hospitals push for a short stay, he added. When he joined the Essex County nonprofit in 1999, the average stay was 23.5 days. Last year, it was 5.6 days.
The Christie administration's decision to close Hagedorn Psychiatric Hospital in Lebanon Township in 2012, taking with it roughly 285 beds, "was absurd, and did harm," Davison said. "The system should be redesigned to give people the treatment they need."
Schaer said the legislature will explore what role it can play expand the availability of patient care. He sponsored a bill that would create an electronic central registry of psychiatric beds, so hospitals would know in real time what is available.
Schaer acknowledged: "The (health) department has very significant control here."
The letter was signed by Prieto, Majority Leader Lou Greenwald (D-Camden), Health and Senior Citizens Committee Chairman Herb Conaway (D-Burlington), Human Services Committee Chairwoman Valerie Vainieri Huttle (D-Bergen), Financial Institutions and Insurance Committee Chairmman Craig Coughlin (D-Middlesex), Women and Children Committee Chairwoman Pamela Lampitt (D-Monmouth) and Assembly members Nancy Pinkin (D-Middlesex), Daniel Benson (D-Mercer), Shavonda Sumter and Benjie Wimberly (both D-Passaic), Gabriella Mosquera (D-Gloucester), Joseph Lagana and Timothy Eustace (both D-Bergen), and Cleopatra Tucker (D-Essex).
Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.
