A MESSAGE FROM FREEHOLDER BLANQUITA B. VALENTI
It is my sincere pleasure to share with you a copy of the 2007
Middlesex County Mental Health Plan. The Middlesex County Board
of Chosen Freeholders support many services that enhance the quality
of life for our residents. For many years the Board has funded a mental
health continuum of care, with flexible services tailored to consumers,
families, and special populations, ranging from women with post partum
depression to isolated older adults, along with coordination of the
local mental health response to disaster or traumatic community incidents.
The 2007 Middlesex County Mental Health Plan serves as
a guide for the delivery of mental health services to residents of Middlesex
County. The Plan identifies needs and barriers that exist within
the mental health continuum of care and also highlights important resources
that are available. The Plan provides recommendations for improving
the service delivery system, reducing stigma, ensuring cultural competence
and promoting the principles of wellness and recovery.
It is a great privilege to serve the people of Middlesex County as
the Freeholder Liaison to the Department of Human Services and I hope
you will find the 2007 Middlesex County Mental Health Plan
helpful. If you desire any further information or would like additional
copies of the Plan, please call the Middlesex County Department
of Human Services (732) 745-3280 or e-mail: lori.dillon@co.middlesex.nj.us.
Sincerely,
Blanquita B. Valenti
Freeholder
Dedication
The 2007 Middlesex County Mental Health Plan
is dedicated to all consumers and families, who have for too long suffered
the unfounded stigma of mental illness. We salute your courage and resilience.
We pledge to support your transition to wellness and look forward to
partnering with you throughout all phases of the recovery process. We
welcome your voice and presence.
THE 2007 MIDDLESEX COUNTY
MENTAL HEALTH PLAN
|
BOARD OF CHOSEN FREEHOLDERS
David B. Crabiel, Freeholder Director
Stephen J. Dalina, Deputy Director
Blanquita B. Valenti, Chairperson, Committee of Human Services
Camille Fernicola
H. James Polos
John Pulomena
Christopher Rafano
Mental Health Planning Committee
Nadine Bennett
Margaret Giovanni
Stephen Jakubowycz
Vicki Larsen
Lisa Murray
Deborah Richman
Laurie Sneider
Karen Wapner
Tammy Wilson
|
Mental Health Board
Abner Garcia, Chair
Dr. Caren Marks, MD, Vice Chair
Laurie Clancy
Patricia Gaffi
Stephen Jakubowycz
Bobbie Locke
Deborah Richman
Shivani Nath
Sheree Neese-Todd
Beth Szapucki
PAC Liaisons
Nadine Bennett, Co-Chair
John O'Neill, Co-Chair
Leslie Stivale, Vice Chair
|
David B. Crabiel, Freeholder Director
Blanquita B. Valenti, Freeholder
Chairperson, Committee of Human Services
Thomas M. Seilheimer, Executive Director
Department of Human Services
Division of Behavioral Health &
Children's Services
Lori Dillon, Mental Health Administrator
Penny Grande, Program Development
Specialist
Kristen Gilmore, Program Development
Specialist
Table of Contents
I. Introduction
A. Purpose and Overview
B. Authority
C. Planning Process
D. Guiding Principles
E. Evidenced Based Practices
II. Needs Assessment
A. Overview of Middlesex County
B. Confidential Survey / Focus Groups
C. Interpretation of the Data
III. Areas for Special Consideration
A. Cultural Competence
B. Co-Occurring Mental Health & Substance Use Disorders
C. Dually Diagnosed / Mental Illness / Developmental Disability
D. Individuals in the Criminal Justice System
E. The Homeless
F. Aging Out Youth
G. Post Partum Depression
IV. Recommendations
V. Middlesex County Continuum of Care
Middlesex County Funded Mental Health Services
State Funded Mental Health Services
Resource Inventory
VI. Appendices
A. Middlesex County Table of Organization
B. Middlesex County Mental Health Community Partners
Mental Health Board
Mental Health Professional Advisory Committee
Middlesex County Department of Human Services
Middlesex County Division of Behavioral Health &
Children's Services
Middlesex County Mental Health Planning Committee
The Moving Forward Self Help Center
Raritan Bay Mental Health Center
C. Other Committees / Task Forces
The Acute Care Systems Review Committee
Co-Occurring Task Force
The Council for Children's Services / CIACC
The Commission on Child Abuse & Missing Children
Fire Watch Advisory Committee
References
I. INTRODUCTION
A.
Purpose and Overview
As reported by the National
Institute for Mental Health (2006), mental illnesses are among the
most prevalent health concerns in America today. While mental illness
can be devastating, research has demonstrated that individuals affected
by mental illness can achieve wellness and recovery. As a result of
a growing body of research in the recovery field, many consumers, family
members, providers and policy makers have been imbued with a new sense
of hope.
2006 was a historic year
for our mental health community. The legacy of the Governor’s Task
Force on Mental Health, combined with the emergence of best practice,
evidence based models and a strong consumer voice that expects a recovery
oriented system promoting wellness, have all put New Jersey at the forefront
of a national movement.
At the county level, planning
for services that support recovery is essential. The 2007 Middlesex
County Mental Health Plan will serve as a guide for the delivery
of mental health services to residents of Middlesex County. The Plan
identifies needs and barriers that exist within the mental health continuum
of care, and also highlights important resources that are available.
The unique challenges faced by individuals with co-occurring disorders,
the homeless mentally ill and young people aging into the adult system
are also considered. Finally, the Plan provides recommendations
for improving the service delivery system, reducing stigma, ensuring
cultural competence and promoting the principles of wellness and recovery.
B.
Authority
The New Jersey Community
Mental Health Services Act of 1957 contributed to the expansion of public
funding and other resources supporting community mental health services
and mandates the establishment of a Mental Health Board and Mental Health
Professional Advisory Committee (PAC) in each county. The NJ Division
of Mental Health Services Regulations (N.J.A.C. 10:37) stipulate
that County Mental Health Boards develop a Plan for mental health
services, to serve as a basis for future funding and program development.
Shortly after the enactment of the Community Mental
Health Services Act, the Middlesex County Board of Chosen Freeholders
adopted a resolution appointing the first Middlesex County Mental Health
Board. The Department of Human Services, Division of Behavioral Health
& Children’s Services is the unit of county government designated
to support the Board and to plan for mental health services in Middlesex
County.
C.
Planning Process
The Middlesex County Department
of Human Services, in partnership with the Mental Health Board and the
Professional Advisory Committee (PAC), coordinated the development of
the Plan and established a Planning Committee. The Mental Health
Planning Committee, comprised of representatives of the Board, the PAC,
consumers and family members, developed the outline and timelines for
the Plan and oversaw its progress.
Countywide participation
in the planning process was solicited through confidential surveys and
a series of focus groups. The 2007 Middlesex County Mental Health
Plan will be presented to the Middlesex County Mental Health Board
and PAC for their review, comment, and approval, prior to submission
of the plan to the County Board of Chosen Freeholders. The Middlesex
County Board of Chosen Freeholders is responsible for final approval
of the Plan.
D.
Guiding Principles
The following principles provide a context for the 2007 Middlesex
County Mental Health Plan:
We value a mental health
service delivery system that:
v
Is consumer focused
v
Offers the wellness & recovery model throughout the
continuum of care
v
Supports consumers in their transition to wellness
v Looks
holistically at the overall needs of the individual and empowers persons
in recovery to make purposeful choices that lead to a more satisfying
and healthy lifestyle
v
Is community based
v
Prioritizes recovery awareness, prevention, cultural competency
& de-stigmatization
v
Includes psycho-educationally based family services as
an essential element in mental health services
Consumer/Family/Provider/Mental
Health Community Involvement
It is
our expectation that input from individuals and families affected by
mental illness and their advocates will be included in all phases of
administration, planning, decision making, implementation, and monitoring
of the overall mental health system. We fully support and value a strong
consumer presence and voice.
We are
committed to improving the quality of life for residents of Middlesex
County through a comprehensive, inclusive, integrated, community based
system of mental health services & supports accessible to all residents
of the county.
Cultural
competence is a vital part of service delivery. Mental health services
should be flexible and responsive to the diverse population of Middlesex
County, with access to bilingual / bicultural care available to people
of all backgrounds.
Our mental
health system must embrace evidence based and best practices that promote
wellness throughout the continuum of care, and should be driven by outcome
measures and consumer satisfaction.
E.
What are Evidence Based Practices?
Evidence
based practices are mental health services that have established positive
outcomes in multiple research studies. Over the past 15 years, researchers
have gathered extensive data to support the effectiveness of several
psychosocial and pharmacological treatments. The Robert Wood Johnson
Foundation convened a consensus panel of researchers, clinicians, administrators,
consumers and family advocates to review the research and to determine
which practices demonstrated a strong evidence base. Six practices were
identified as demonstrating a strong evidence base:
¨
Illness management & recovery skills
¨
Family psycho-education
¨
Programs of assertive community treatment (PACT)
¨
Integrated dual disorders treatment (IDDT / substance
abuse and mental illness)
¨
Supported employment
¨
Standardized pharmacological treatment
Additional
evidence based practices are currently being identified and will be
promoted as the research evolves. Some promising practices being researched
include peer support programming, supported housing, trauma services
and treatment for individuals with borderline personality disorder (SAMHSA,
2006.) For more information on evidenced based practices, go to http://www.samhsa.gov.)
II.
NEEDS ASSESSMENT
A. Overview of
Middlesex County
Middlesex County is one of the fastest growing and most multicultural
counties in the nation. According to the 2000 Census, Middlesex County
residents speak 90 distinct languages. As of 2004, languages other
than English are spoken at home in 39.1% of Middlesex County households
and 29.4% of people living in the county were born outside of the United
States (American Community Survey, US Census.) In light of this data,
it is essential that program development be sensitive to the needs
of diverse populations and that programs are linguistically
appropriate and culturally relevant to underserved minority groups within
the community.
Middlesex County, New Jersey
|
Language other than English spoken at home:
|
33.4%
|
|
Spanish:
|
12.2%
|
|
Other Indo-European
languages:
|
12.1%
|
|
Asian and Pacific
Island languages:
|
6.9%
|
Source: US
Census Bureau, Census 2000
Middlesex County, New Jersey
|
|
Number
|
Percent
|
|
|
750,162
|
|
|
Native
|
568,401
|
75.8
|
|
Foreign Born
|
181,761
|
24.2
|
|
Region of Birth of Foreign Born:
|
|
Europe
|
34,136
|
18.8
|
|
Asia
|
82,374
|
45.3
|
|
Africa
|
10,256
|
5.6
|
|
Oceania
|
256
|
0.1
|
|
Latin America
|
53,276
|
29.3
|
|
Northern America
|
1,463
|
0.8
|
Source: US
Census Bureau, Census 2000
Middlesex County, New Jersey,
2000
|
RACE
|
Number
|
Percent
|
|
One race
|
730,665
|
97.4
|
|
White
|
513,298
|
68.4
|
|
Black or African American
|
68,467
|
9.1
|
|
American Indian and
Alaska Nativ e
|
1,521
|
0.2
|
|
Asian
|
104,212
|
13.9
|
|
Asian Indian
|
54,880
|
7.3
|
|
Chinese
|
21,999
|
2.9
|
|
Filipino
|
12,397
|
1.7
|
|
Japanese
|
778
|
0.1
|
|
Korean
|
5,988
|
0.8
|
|
Vietnamese
|
2,149
|
0.3
|
|
Other Asian1
|
6,021
|
0.8
|
|
Native Hawaiian and
other Pacific Islander
|
300
|
-
|
|
Native Hawaiian
|
48
|
-
|
|
Guamanian or Chamorro
|
62
|
-
|
|
Samoan
|
46
|
-
|
|
Other Pacific Islander2
|
144
|
-
|
|
Some other race
|
42,867
|
5.7
|
|
|
19,497
|
2.6
|
1 Other Asian
alone, or two or more Asian categories
2 Other Pacific Islander alone, or two or more Native Hawaiian and Other
Pacific Islander categories
Source: US Census Bureau, Census 2000
Middlesex County, New Jersey,
2000
|
HISPANIC OR LATINO AND RACE
|
Number
|
Percent
|
|
Total population
|
750,162
|
100
|
|
|
101,940
|
13.6
|
|
Mexican
|
14,262
|
1.9
|
|
Puerto Rican
|
34,676
|
4.6
|
|
Cuban
|
4,524
|
0.6
|
|
Other Hispanic or Latino
|
48,478
|
6.5
|
|
Not Hispanic or Latino
|
648,222
|
86.4
|
|
White alone
|
464,537
|
6.9
|
Source: US
Census Bureau, Census 2000
The following statistics illustrate utilization
of mental health services by Middlesex County residents, as well as
the ongoing, serious overcrowding at Trenton Psychiatric Hospital.
FY 2005 Middlesex County Clients Served by Program
Element
|
PROGRAM ELEMENT
|
Mental Health Consumers
|
Co-occurring Consumers
|
TOTAL
|
|
ICMS
|
829
|
397
|
1226
|
|
Youth Case Management
|
322
|
63
|
385
|
|
Designated Screening
|
458
|
229
|
687
|
|
Emergency Services
|
3844
|
1589
|
5433
|
|
Children's Mobile Outreach
|
42
|
12
|
54
|
|
Inpatient
|
1328
|
254
|
1582
|
|
Liaison Services
|
45
|
79
|
124
|
|
Outpatient
|
34582
|
8284
|
42866
|
|
Partial Care
|
1736
|
374
|
2110
|
|
Residential
|
329
|
192
|
521
|
|
Systems Advocacy
|
351
|
22
|
373
|
|
Other
|
826
|
218
|
1044
|
|
Miscellaneous
|
269
|
6
|
275
|
|
Total
|
44961
|
11719
|
56680
|
Source: NJ
Department of Human Services, USTF
Middlesex County, New Jersey
|
Psychiatric Hospital
|
Number
|
|
Trenton Psychiatric Hospital: Total Admissions
SY 2006
|
337
|
Source: Middlesex
County Systems Review Committee
Middlesex County, New Jersey
|
Substance Abuse Admissions: Total Admissions
CY 2005
|
3,328
|
|
Primary
drug:
Alcohol: 880 (26.4%)
Cocaine: 380 (11.4%)
Heroin & Opiates: 1,427 (42.9%)
Marijuana: 488 (14.7%)
Other & Unknown: 153 (4.6%)
|
Source: NJ
Division of Addiction Services
B.
Confidential Survey / Focus Groups
Qualitative and quantitative
data were collected from various sources to assess service needs. A
confidential survey was distributed to a broad range of
consumers, family members and professionals within the Middlesex County
mental health community in order to gain diverse perspectives. The survey
contained an open ended question, which asked respondents to describe
barriers, gaps, and strengths affecting the mental health system.
County staff facilitated
a series of focus groups in natural settings to gather
additional qualitative data. A focus group conducted at a local consumer
operated self-help center gave invaluable voice to consumers who shared
their perspectives on the strengths and challenges within the mental
health system of care.
A focus group held at a
NAMI New Jersey meeting provided rich information from family members.
A focus group with the Middlesex County Systems Review Committee allowed
providers within the acute care system to discuss their perspective.
A final focus group held at a Comprehensive Emergency Assistance System
(CEAS) Committee meeting gathered information from consumers and providers
working with those at risk of homelessness.
Open ended questions were utilized to frame the discussions. These
questions included:
¨
What are the most serious issues faced by individuals
affected by mental illness in Middlesex County?
¨
Please identify challenges or barriers
with regard mental health services and access to care.
¨
What are the strengths within the Middlesex
County mental health system?
¨
Looking ahead, can you offer any other recommendations
for addressing the identified challenges / barriers to care?
C.
Interpretation of the Data
Over 150 responses were
collected through the survey and focus group process for data analysis.
Several recurring themes emerged. This section provides an overview
of the following identified concerns: stigma; wellness and recovery;
housing; family support; barriers to employment; transportation and
staffing.
Additional areas for consideration
affecting special populations (co-occurring, aging out, the homeless,
and more) are presented in the next section.
Stigma
Stigma and the discrimination
associated with mental illness were identified by many respondents as
persistent challenges. A number of consumer and family members surveyed
emphasized stigma as a major issue affecting the mental health system.
One respondent stated:
“People think all mentally ill people are dangerous…There
is a stigma that mentally ill people are not very intelligent…”
According to the U.S.
Surgeon General’s Report on Mental Health, stigmatization of people
with mental illness has persisted throughout history. Manifestations
of stigma include: bias, stereotyping, fear, anger and avoidance (www.stopstigma.samhsa.gov,
September, 2006.) Detrimental affects of stigma for the consumer include:
delays in diagnosis, isolation, loss of housing and vocational opportunities,
low self-esteem, hopelessness, and suicide in severe cases. “Stigma
deprives people of their dignity and interferes with their full participation
in society (ibid.)” As a mental health community, it is our responsibility
to stop institutional stigma and to educate the public about mental
illness, wellness and recovery.
The Governor’s Task Force
on Mental Health Final Report (2005) noted that addressing
stigma is fundamental in order to improve the mental health system.
Much like racism, stigma against mental illness is insidious. Increasing
public awareness through education, media campaigns and outreach will
reduce stigma by promoting a better understanding of mental illness
and sensitivity to the challenges faced by those affected.
When asked if she could
change one thing in the mental health system, one family member stated:
“I would like the public to be more aware of the
issues that those with mental illness have to deal with, as well as
their successes.”
Wellness and Recovery
Surveyed respondents identified
the recent shift to the wellness and recovery philosophy as a major
strength in the mental health system. Earlier this year, the NJ Division
of Mental Health Services issued a Wellness and Recovery Transformation
Statement. The purpose of the Statement is to inform the
mental health community of the state and county mandate for evidence
based, recovery oriented services that promote wellness.
As defined by SAMHSA, “mental
health recovery is a journey of healing and transformation enabling
a person with a mental illness to live a meaningful life in a community
of his or her choice, while striving to achieve his or her full potential.”
Key components of recovery include:
·
Individualized and Person-Centered
·
Self-Direction
·
Hope
·
Responsibility
·
Empowerment
·
Respect
·
Peer Support
·
Strengths-Based
·
Non-Linear
·
Holistic
(SAMHSA, 2006, http://www.samhsa.gov/Pubs/MHC/MHC_NCrecovery.htm
)
Wellness, as defined by the National Wellness Institute
(2006), is “an active process through which people become aware of,
and make choices towards, a more successful existence.” The NWI proposes
the following tenets of wellness:
·
Wellness is a conscious, self-directed and evolving process
of achieving full potential
·
Wellness is a multi-dimensional and holistic, encompassing
lifestyle, mental and spiritual well-being, and the environment
·
Wellness is positive and affirming
(National Wellness Institute,
2006, http://www.nationalwellness.org/index.php
)
Wellness includes physical,
emotional, intellectual, social, environmental, occupational, leisure
and spiritual dimensions, and incorporates disease prevention and health
promotion strategies.
The long overdue shift to a recovery orientation challenges all of us.
Our responsibilities in government, as providers, consumers and family
members will evolve as our system embraces evidence based and promising
practices that promote wellness throughout the continuum of care.
Housing
New Jersey ranks among the
top 5 costliest states in the nation (National Low Income Housing
Coalition, Out of Reach, 2005). The lack of affordable housing
was frequently cited by survey respondents as a significant barrier
faced by individuals with mental illness in Middlesex County, where
the Fair Market Rate for renting a two-bedroom apartment is $1,187.
Mental health consumers need a full range
of housing options to meet their needs and to provide them with choices.
The lack of housing with support services complicates discharge
from the psychiatric hospital and contributes to unnecessary overcrowding
there.
The Governor’s Task Force on Mental Health
Final Report (2005) recognized the need to secure permanent, affordable
housing as a crucial step toward recovery for individuals with mental
illness and established a Special Needs
Housing Trust Fund. This $200 million trust fund, administered by
the New Jersey Housing and Mortgage Finance Agency and supported by
bonds issued by the state's Economic Development Authority, promises
to create 10,000 housing opportunities over the next 10 years. In
addition to the expansion of affordable housing stock, support services,
including: case management, career counseling, representative payee
arrangements, rental assistance and transportation services must also
be developed.
Family Support
The importance of family
support services was another priority identified. According to the
New Jersey Association of Mental Health Agencies (NJAMHA), one
in every five families is affected by mental illness. With over 50%
of adult mental health consumers living with family members, many respondents
noted that support for family caregivers is essential.
Research in best practices
has shown that family members can often be the best resource for people
in recovery from mental illness. When
families are informed and provided with support, services, and hope,
they are better able to support their loved ones.
Many respondents described positive experiences with family support
groups, NAMI NJ, and the Integrated Family Support Services (IFSS.)
Respite beds were recommended
to give families some time apart, when needed. An expanded “family
to family” mentor program for the acute care system was recommended
for families experiencing serious mental illness for the first time.
Barriers to Employment
Employment is a critical
issue for mental health consumers in their recovery. In addition to
gaining financial resources and independence, employment offers consumers
a sense of purpose and accomplishment which can have a dramatic affect
on their overall sense of self, often leading to a reduction in symptoms
and hospitalization.
Historically, many barriers
to employment have existed for consumers which have prevented many from
pursuing their educational or career goals. Survey respondents confirmed
that obstacles to employment continue to persist. When asked what change
he would recommend within the mental health system, one consumer respondent
stated:
“Living arrangements
and job placement assistance should be considered immediately so that
you’re not floundering around for years seeking intervention.”
Today,
we know that employment contributes to recovery. As consumers transition
into work, they will likely need assistance along the way to reach their
employment goals. This may include: support in determining job interests
and preferences; navigating the effect work may have on entitlement
benefits such as SSI/SSDI; and exploring disclosure concerns.
As
a mental health system, it is incumbent upon us to support consumers
as they prepare to return to work, and to provide the necessary supports
for them to become and remain gainfully employed. Programs which offer
free training and employment related supports for consumers and technical
assistance to providers include:
·
Consumer Connections – a statewide program of the
Mental Health Association in NJ. Consumer Connections provides
training leading to certification, support and job placement services
to their consumer graduates. For more information, please call 973/571-4100
ext. 120.
·
Integrated Employment Institute (IEI) – a program
of UMDNJ School of Health Related Programs, Department of Psychiatric
Rehabilitation. The IEI strives to expand employment opportunities
for consumers by offering training and technical assistance. For more
information, call 800/593-2434.
The
Governor’s Task Force on Mental Health Final Report (2005) recommended
the expansion of funding for all supported employment services. Locally,
it is recommended that the Middlesex County Employment Consortium, which
promotes employment opportunities for individuals with psychiatric illnesses
and seeks to remove barriers to their employment, continue to be supported.
Expanding educational opportunities and creating career development
training for young people who are aging into the adult system of care
is also strongly recommended.
On
a final note, as we move towards a recovery oriented mental health system,
the employment goals of the individuals we serve must become a paramount
part of the treatment and support process.
Transportation
Unfortunately, in mental
health service planning, transportation does not always receive the
consideration it merits, and rising fuel and insurance costs have only
compounded the problem. Survey respondents reported many concerns related
to transportation, including the need for transportation to and from
employment and for medical appointments.
“The lack
of accessible transportation is a serious barrier for individuals with
mental illness who are trying to work towards wellness and recovery.”
Respondents’ recommendations
included free or reduced fares for consumers and expanded bus routes
and shuttle services.
Staff Issues
Many provider respondents
reported the challenge of retaining qualified staff as significant and
ongoing. The deadly combination of low salaries and high caseloads
contributes to staff turnover, and directly affects consumers by decreasing
the continuity and quality of care. Another gap in service that is
closely tied into this problem is the availability of Advanced Practice
Nurses (APN), who not only can prescribe and monitor psychotropic medication,
but also can provide more extended care. Finally, a shortage of psychiatrists
was also reported, perhaps due to outdated, unrealistic Medicaid reimbursement
rates.
As noted by the New Jersey
Association of Mental Health Agencies (NJAMHA), Medicaid reimbursement
rates were established almost 30 years ago and have remained largely
stagnant in most service elements. Recommendations include state support
for annualized cost of living adjustments (COLA), and an immediate increase
of Medicaid rates for mental health services.
Other Issues
Many respondents described myriad difficulties
with community placement and hospital discharge, due to the lack of
housing, or entitlements, medications, and follow-up appointments not
being in place. Recommendations include a pilot, at Trenton Psychiatric
Hospital, of a Community Assessment Tool, developed by the Middlesex
County PAC and approved the Middlesex County Mental Health Board,
to assist hospital social workers, case managers and consumers at discharge.
Other issues reported by
several respondents included the shortage of bilingual services; the
lack of specialized services for children aging into the adult system;
individuals with co-occurring mental illness and substance abuse; mental
illness and developmental disability; individuals involved in the criminal
justice system; sex offenders and the homeless. A lack of socialization
and recreational opportunities for special populations, especially young
people, was also reported. Areas for special consideration affecting
these populations are presented in the next section.
A Long & Winding Road
Untreated mental illness costs New Jersey
$4 billion a year, with increased hospitalizations, incarcerations,
homelessness and disability (New Jersey Association of Mental
Health Agencies. Perhaps even more significant is the terrible cost
in human suffering. Funding to support mental health services
is a sound investment that benefits all of us.
The Governor’s Task Force
Final Report was subtitled the Long & Winding Road. While
it is true that the road to recovery may be long, with certain basic
supports in place – services, housing, employment, transportation –
it is sure to be shorter, and a little less winding.
III. Areas
for Special Consideration
A. Cultural
Competence
One issue related to culture,
race, and ethnicity is that of unequal access to mental health services.
While mental illness affects people of all cultures, minorities are
least likely to access mental health services, less likely to receive
needed care, and often receive poorer quality of care (US
Department of Health & Human Services, Office of Minority Health,
2006).
African Americans, Asians,
Latinos and other minorities with mental illness are among the most
underserved communities in the state. Many institutional barriers preventing
these communities from seeking mental health services have been identified.
In particular, the absence of culturally appropriate services, with
few bilingual/bicultural screeners, doctors, therapists, nurses or psychologists
is of great concern.
Cultural competence is an
approach grounded in the assumption that services are most effective
when they are provided within the most relevant cultural, gender sensitive
and age appropriate context for the people being served (SAMHSA, 2003.)
Culturally competent mental health care can build trust and improve
access by acknowledging the diverse attitudes, beliefs, and behaviors
of all consumers.
The Hispanic Directors Association of New Jersey
(HDANJ) recently collaborated with the New Jersey Mental Health
Institute to develop a set of recommendations to further cultural
competence within the mental health system, including:
·
Public education and media campaigns to heighten awareness,
acceptance and understanding of mental illness within the Latino and
other minority communities;
·
The collection of better data on services provided to
minorities;
·
Development of mandatory mental health training programs
for law enforcement officials, which address cultural diversity and
race relations, to ensure minorities are appropriately referred to treatment;
·
Assurance that minorities are appointed to all state and
county Mental Health Boards, in reflection of population demographics;
·
Assurance that at least one bilingual/bicultural mental
health screener is on call at each designated screening center;
·
Building on the Student Loan Forgiveness Initiative
enacted by Acting Governor Codey, establishment of a scholarship program
for minority students interested in pursuing mental health careers;
·
Encourage recovering minority consumers to explore peer
support and other mental health career possibilities (adapted with
permission from HDANJ.)
B.
Co-occurring Mental Health & Substance Use Disorders
Co-occurring disorders,
previously termed MICA, refer to a condition in which a person has co-occurring
psychiatric and substance use disorders. According
to a report published in the Journal of the American Medical Association
(JAMA), roughly 50 percent of individuals with mental illness are
affected by substance abuse, yet only a small percentage actually receive
treatment to address both disorders.
Co-occurring disorders are complex, as the illnesses often interact
and exacerbate one another. People with mental illness may self medicate
with alcohol or other drugs, developing tolerance and dependence. This
is of particular concern for young people aging out of the children’s
system of care, who may be vulnerable to substance abuse.
Research in best practice has indicated that the most effective services
for people with co-occurring disorders provide integrated treatment.
Integrated treatment considers the biological, cognitive, affective
and interpersonal aspects of the individual, including, if indicated,
the need for psychotropic medication (Ziedonis, 2004.) This holistic
model combines substance abuse and mental health interventions that
treat both disorders concurrently.
Guidelines for Best Practices in the Treatment of Co-occurring
Disorders were recently developed by the NJ Division of Mental Health
Services. In addition, statewide training efforts have focused on the
introductions and implementation of 2 treatment practices: Integrated
Dual Disorders Treatment (IDDT) and Illness Management &
Recovery (IMR.)
In support of system level
integration and collaboration, the Middlesex County Co-occurring
Task Force has requested that the state restore funding for training
from both the NJ Division of Mental Health Services and the NJ Division
of Addiction Services (DAS) to enhance the skills of Middlesex County
providers working with this population. If this funding were restored,
the Task Force would be able to offer training on IDDT and IMR
to further integrated treatment at the local level.
Another issue affecting
this population is the potential loss of benefit eligibility for individuals
with co-occurring disorders, who have been convicted of a drug related
crime. Within the federal welfare reform legislation, one component
prohibits any person convicted of a drug offense from eligibility for
federally funded benefits including food stamps and public housing assistance.
While New Jersey passed legislation opting out of the strict federal
welfare ban and allowing Work First New Jersey benefits and food
stamps to those who complete a residential treatment program, many individuals
with a co-occurring diagnosis do not have access to integrated treatment
and - unable to successfully complete traditional treatment programs
- lose needed benefits.
Providing
appropriate, integrated services has long range benefits for both the
consumer and the community. By assisting co-occurring consumers to engage
in appropriate treatment, obtain housing, employment, and develop better
coping skills, other issues frequent
