Pushback Against Christie Plan to Reorganize Addiction and Mental Health Care
TRENTON — Lawmakers have a little over a month to decide if they want to block Gov. Chris Christie from reorganizing the state government to change how addiction and mental-health services are provided.
Christie surprised lawmakers with the reorganization plan submitted June 29, the height of the state budget showdown that led to a temporary shutdown and the verge of a summer recess that, this being an election year, typically idles most legislative action until early November.
Christie plans to move the Division of Mental Health and Addiction Services from the Department of Human Services to the Department of Health.
The shift would move the four state psychiatric hospitals and community-based behavioral health programs from the Department of Human Services to the Department of Health. Some 200 workers would be affected and around $1 billion in state and federal funds.
Christie says the plan is needed to “effectively address substance use disorder as the public health crisis that it is.”
“Behavioral health problems in general, and opioid addiction in particular, need to be treated as illnesses no different than infectious diseases such as Zika virus or chronic conditions such as hypertension – all are best addressed by preventive measures,” Christie said in the proposal.
“Only through such a public health approach can we overcome the stigma that for too long has characterized efforts to treat addiction as something that must cordoned off from the rest of health care,” he said.
Sen. Richard Codey, D-Essex, a former governor, wanted the Senate and Assembly committees that held a hearing on the proposal Tuesday to formally ask the legislative leaders to convene a session to pass a bill rejecting the changes.
“Why now? It’s absolutely ridiculous to be here when we’re going to have a new governor in just a few months,” Codey said. Hopefully we can very firmly and loudly say, ‘Not now, governor, not now.’”
“We have something like 40-something days left to overturn this, and I kind of hate to say this, but I feel the thing may be wired already, unfortunately,” Codey said.
It’s less time than that, actually. The Legislature can block a reorganization within 60 days of its submission, meaning Aug. 28.
Sen. Robert Gordon, D-Bergen, said nobody doubts the benefits to patients of integrating addiction and mental-health care with physical health care but that the question is changing the Trenton organization charts.
“Why now? We’re about four months from what I’m confident will be a transition process with a committee devoted to organization design of the state government,” Gordon said. “Why should we make these changes now when it might be better to put those decisions off for at least four months, when they may be part of a larger change in organization structure?”
Assemblyman Herb Conaway, D-Burlington, indicated support for the move, saying the state implicitly reinforces a stigma around mental health and addiction by not classifying them as health programs. He said he was “baffled” by sometimes contradictory arguments against it in the nearly three-hour hearing.
“I heard ‘disaster,’ and then I heard the plan ‘may have merit,’” Conaway said. “And yet there’s a rejection out of hand.”
“Why shouldn’t the government, and I think the governor’s trying to, recognize these shifts and respond to them?” Conaway said. “To listen to some of the arguments, it’s going to take forever to make any changes culturally, you’d never do anything. I mean, when would be the time to do anything to take on these challenges that you all admit exist?”
More than a dozen behavioral health advocates testified against the proposed change.
Kimberley Higgs, executive director of the New Jersey Psychiatric Rehabilitation Association, said it could be the right thing to do but hasn’t been fully assessed.
“To presume that DMHAS could easily integrate into the Department of Health, frankly is exceedingly optimistic and blissfully ignorant of the reality in which these systems are operating,” Higgs said.
“Our position is not to not do it,” she said. “Our position is simply let’s not do it at this time.”
Robert Davison, executive director of the Mental Health Association of Essex County, called it a worthy ideal but “irresponsible at best and reckless at worst” not to take more time.
“Leadership requires a sustained effort, not a policy hit and run in the waning days of an administration,” Davison said.
The transition would take years to fully implement. Ray Castro, director of health care policy for New Jersey Policy Perspective, said transitions of administrations are chaotic enough with a change that has life-and-death consequences for patients.
“The governor’s plan represents one of the most radical changes in the organization of state government in a century and deserves much more study than the allotted 60 days,” Castro said.
Seton Hall Law School professor John Jacobi, whose study on the issue for a Nicholson Foundation report provided the impetus for the Christie administration’s plan, said the state needs to integrate physical and behavioral health care and the way providers are licensed.
That requires reorganizing the state government, he said.
“If we were or anyone was coming up with a regulatory system in 2017 to deal with outpatient therapeutic services, we would never develop it the way it’s currently in place,” Jacobi said.