Early intervention helps keep people with mental illnesses out of overcrowded ERs, which are not prepared to assist them

A legislative proposal to effectively double the reach of New Jersey’s county-based mental-health screening system is one step closer to reality, an advance advocates hailed as necessary to help the state better address — and possibly reduce — a growing behavioral health crisis.

But the Democratic-sponsored measure, which would cost more than $10 million annually, still faces two significant hurdles: a final vote in the state Senate, which is scheduled to meet only a handful of times before the end of the legislative session, and the signature of Gov. Chris Christie, a Republican whose second term ends in mid-January.

(All bills not adopted by then would need to be reintroduced and begin the process again in the 2018-2019 legislative session and presented to Gov.-elect Phil Murphy.)

Prompt identification

On Monday — the first-time legislators met since early July — the Senate budget committee approved a bill to expand the adult mental health early-intervention system to all 21 counties. Although they are open to any residents, currently only 11 counties operate these services, which are designed to more effectively identify individuals with mental health needs early on and promptly connect them with appropriate treatment.

Introduced in January, the proposal (A-4468) was developed by Assembly Budget Chairman Gary Schaer (D-Bergen) and his colleagues, following a series of roundtables he convened with mental health providers, consumers, and other stakeholders. A companion measure (A-4469), which also advanced Monday, requires state health officials to work with providers who are seeking to expand services.

“We heard concerns time and time again relating to crisis services throughout the state,” Schaer said. “Early intervention and support is paramount when it comes to behavioral healthcare. With these bills, we will be taking commonsense steps to improve and modernize our services, benefiting patients and their families.”

ER uptick

The bill also reflects concerns raised by the New Jersey Hospital Association, which tracked a significant uptick in emergency room use in recent years, half of which involved patients with psychiatric symptoms. Experts said this reflects a growing problem nationwide, as those in need overwhelm existing treatment capacity and flood hospital ERs ill-equipped to provide proper care.

The proposal also reflects an increasing awareness of how government entities can better engage and assist individuals experiencing mental health crises. The Mental Health Association of New Jersey offers public training in mental health “first aid”; its work in Gloucester County to incorporate mental illness intervention training among law enforcement has been used as a model for other police departments in the state.

The Senate version of the bill, sponsored by Senate health committee chairman Joe Vitale (D-Middlesex) and Sen. Fred Madden Jr. (D-Gloucester) passed the Senate health committee in May. The Assembly bill — also sponsored by chair of the Assembly Human Services Committee Valerie Vainieri Huttle (D-Bergen), Shavonda Sumter (D-Bergen), Nick Chiaravalloti (D-Hudson), and Pamela Lampitt (D-Camden) — cleared several committees in the spring and sailed through the full Assembly in June with near unanimous support.

“Early intervention programs are designed to do just that – intervene before a patient reaches a crisis point, thereby providing stabilization,” Vainieri Huttle said. “These services are critical in preventing the recurrence of a crisis and reducing the overutilization of hospital emergency departments. Coupling this with increased screening services will have a dramatic impact on behavioral healthcare in New Jersey.”

Sumter said delays in diagnoses often hamper efforts to provide effective care. “Expanding early intervention services and boosting screening services, will significantly improve access to treatment when it’s most effective: early,” she said.

Avoiding other injuries

In addition, connecting individuals with treatment can help them avoid other injuries or conditions that can be triggered or exacerbated by anxiety.

“If left untreated, mental illness can lead people who may be suffering in silence to engage in self-destructive behaviors that also affect their physical health,” Chiaravalloti noted. “By expanding EISS programs and other services, New Jersey can take a more comprehensive approach to healthcare and enable more of our residents to access effective, professional treatment as soon as possible.”

The proposal would require the county operations to be open at least 14 hours a day, seven days a week, beginning 13 months after the law is signed. It calls for providing individuals over age 21 “rapid access to short-term, recovery-oriented crisis intervention and crisis stabilization” for up to a month. This treatment can include therapy, medication, case management, and more, provided by hospitals, clinics or other community providers.

The bill would also require state officials to help coordinate the system, spread the word about the services, track and monitor its use over time, and make recommendations for improvement. Health officials would also need to report to the legislature regularly.

Mental health EIS services are now based in the following counties: Atlantic, Bergen, Camden, Cumberland, Essex, Hudson, Middlesex, Mercer, Monmouth, Morris, and Ocean. “Our current services do an outstanding job, but we know we can always make them better. We need to do more,” Schaer said. “In the end, these bills will lead to better services and, more importantly, better lives.”

New Jersey also operates a separate state-run EIS system to identify learning and developmental disabilities among children and connect them with county and local treatment and other services.