Mental and behavioral health experts stressed the importance Tuesday of mental and physical health care integration, but the majority said they do not favor a proposed shift within state government agencies to achieve integrative care at this time.
Experts appeared before New Jersey legislators in Trenton to testify on how a plan, proposed by Gov. Chris Christie, to shift mental health and addiction services to the state Department of Health would create probable disruption for providers and clients.
“While we strongly believe integration of behavioral health and substance abuse is important to integrate with physical care, we believe this move is not a viable way of making this happen,” said Barbara Johnston, director of policy and advocacy for the Mental Health Association in New Jersey.
The governor submitted a reorganization plan June 29 that would transfer Division of Mental Health and Addiction services from their current home within the state Department of Human Services to the Health Department, which oversees physical or medical care.
The shift could involve moving millions in state funding, a couple hundred employees and regulation changes between the two departments.
According to a copy of his reorganization plan, Christie said the shift would “remove bureaucratic obstacles to the integration of physical and behavioral health care, and effectively address substance-use disorder as the public health crisis that it is.”
Health Commissioner Cathleen D. Bennett, who was not at the hearing, said in a statement that the reorganization plan aligns with the department's Population Health initiatives and that an integration would better allow the state to treat the "whole person."
The Legislature has 60 days from when the plan was introduced to approve or disapprove.
The majority of speakers at Tuesday’s hearing said they favored more integration but not at a time when community agencies are already undergoing a major transition from a contract-based payment system to a fee-for-service system.
Johnston and others said the timing for reorganization of the mental health division, which oversees community-based mental health and substance-use programs, the state’s four psychiatric hospitals and other behavioral health programs, could hurt agencies already struggling with the payment transition.
Debra Wentz, CEO and president of the New Jersey Association of Mental Health and Addiction Agencies, said on top of that, uncertainty on the impacts of what a federal health care repeal could do to mental health and addiction services in New Jersey is another reason for hesitation.
Assemblywoman Valerie Vainieri Huttle, D-Bergen, asked advocates at the hearing whether the Christie administration consulted community experts and agencies before proposing the reorganization plan, of which multiple advocates said no.
Bennett said some experts and community providers offered their support and assistance for integration during phone calls with health department officials in the last several weeks.
Huttle, along with several other legislators, questioned if reorganization was appropriate given that Christie has less than six months left in his term as governor.
“With the state of health care in limbo at the federal level and a new state administration poised to take over in six months, consciously choosing to inject turmoil into an already chaotic situation seems ill-advised at best and extremely irresponsible at worse,” Huttle said in a statement.
Other speakers were hesitant to separate mental health and addiction services from wrap-around services such as housing, food assistance, employment, Medicaid oversight and others that currently exist within the human services department.
John Jacobi, Seton Hall director of the Center for Health and Pharmaceutical Law and Policy, said years of research and study on integration issues has shown that the fragmentation of health care delivery systems is one of biggest issues legislators have had to face.
Jacobi said regardless if the plan gets passed or not, integration between mental and physical health must happen, which should include a streamlined process where providers can get a single license to provide behavioral, substance and medical treatment.
“I believe, from our research, that behavioral health integration saves lives,” he said. “That reform of New Jersey’s licensure system for outpatient care is necessary, but the process for integration is a long one.”