Not Enough Beds
MSNBC explains the worrying reality: As a matter of routine, people across the United State are denied access to mental health facilities because of a lack of beds.
On a nationwide level, hospitals have institutionalized fewer patients for mental health treatment, which, combined with the ever-present threat (and occasional reality) of budget cuts, means that the number of psychiatric beds available has been on a slow decline. This is the result of a decades-long trend of moving away from state-funded psychiatric wards and toward community-based, privatized, outpatient care models. Notwithstanding the logic behind the shift, critics have claimed that not enough has been done to fill in the resultant void. The American Hospital Association reports that over half of the counties in the United States do not have practicing psychiatrists, psychologists, or social workers. The AHA further discovered that only 27 percent of community hospitals have organized, inpatient psychiatric units.
Out in the countryside, the situation is even more dire. Patients living in rural areas have to travel long distances to get help, and emergency services cannot easily get to patients who live far away from highways and urban infrastructure.
Only 27% of community hospitals have organized, inpatient psychiatric units.
A big reason for scaling back hospital beds during that time period was because of the 2008 recession. When Chris Christie launched his presidential campaign in June 2015, CNN reported that unlike its neighbors, New Jersey was yet to shrug off the economic ruin of the recession and recover the jobs it lost.
Christie took office as governor of New Jersey in January 2010, and in an attempt to jumpstart his state’s flagging economy, he cut government spending for social programs. The goal was to avoid raising taxes, but his $32.9 billion budget plan unveiled in 2013 had no provisions for expanding a program that would give judges the authority to legally send severely mentally ill patients to treatment, despite a spokesman saying Governor Christie was completely committed to the program. Many people in the New Jersey were surprised that Christie allocated nothing to expand the outpatient commitment program, despite marking $12.8 million for other treatment and housing programs for those with mental health needs.
Insufficient Funding and Insufficient Beds
The National Council on Alcoholism and Drug Dependence attributed the treatment shortfall in New Jersey to insufficient funding and insufficient beds. This comes at a time when the abuse of heroin and prescription painkillers is at record highs. From 2008 to 2013, the number of behavioral health concerns (as a result of substance abuse) that have led to emergency room visits has doubled, and hundreds of people have died as a result of overdoses.
Middle class Families Bear the Biggest Cost
The federal government has mobilized, with the Affordable Care Act making substance abuse treatment available to more low-income and middle class people. Regulations require insurance companies to give care for substance abuse and mental health the same level of coverage that surgical and medical health concerns receive.
A Gridlocked System
The system, says NorthJersey.com, is broken, and it makes the tough situation of addiction even worse. But there are positive signs: Many treatment programs work, and a number of addicts are now sober. Bergen County public service officials try and secure beds for those in need. Recognizing the scope of the problem, state officials are coming together to combat the opioid epidemic.
There are reasons for cautious optimism; however, families are fighting an uphill battle. Fewer New Jersey hospitals offer detox treatment that people struggling with addiction need to start their recovery. Bergen Regional Medical Center’s 54 beds are almost always occupied, and the hospital sees as many as 18 new patients every day. Between 2007 and 2012, New Jersey emergency rooms experienced an 80 percent increase in the number of behavioral health cases, with substance abuse as a “major contributor” to that figure, according to the New Jersey Hospital Association.
The coordinator of the Bergen County Office of Alcohol and Drug Dependency lamented that parents have to resort to driving for hours, going from one treatment center to another, desperately trying to find one that can take their child.
The Politics of Substance Abuse Treatment
Chris Christie won plaudits for expanding New Jersey’s drug court program, which puts qualifying drug offenders through treatment, not prison. It’s a system praised by politicians and drug advocates, but it also sends increasing numbers of people to mandatory care programs, which in turn puts a heavier burden on treatment centers that receive public funding. There is speculation that the 102 state treatment facilities in New Jersey may be at a bursting point.
There is speculation that the 102 state treatment facilities in New Jersey may be at a bursting point.
A large part of the problem stems from the sensitive and delicate nature of addiction. Substance abuse and mental health are still poorly understood, with many in the public and private sector believing that addiction is a moral failing, not a medical concern. Issues of treatment are often mishandled by politicians and legislatures who are more concerned with the political implications of wading into the subject (such as the overlap between mental health and gun violence, a topic Christie addressed as part of his presidential campaign, or the cross-section between addiction and race).
Moving People out of Treatment Too Soon
Like Winning the Lottery
NJ.com writes than when a client gets one of the few thousand licensed substance abuse treatment beds (whether for a short-term or long-term inpatient stay), that client has won the “addicts’ lottery.” For tens of thousands of other people, it may be easier to win the national lottery. A 2013 report by the Substance Abuse and Mental Health Services Administration found that only 25 percent out of 179,000 people in New Jersey who were dependent on (or otherwise abused) illegal drugs received treatment.
… Only 25 percent out of 179,000 people in New Jersey who were dependent on (or otherwise abused) illegal drugs received treatment.
The director of admissions at a New Jersey-based treatment facility called the situation “woeful”; at his own facility, the waiting list for a bed has more than 300 names on it. What is widely considered the failure of local and state officials to keep up with the demand for treatment services had led to a situation where New Jersey can only treat a bare minimum of its residents who need mental health and substance abuse help.
Instead, patients and their families are put on hold for days or weeks until a bed opens up. But when struggling with a drug addiction, sometimes even a matter of days is too long to wait.
The last time New Jersey conducted an evaluation of its substance abuse and mental health treatment needs was in 2010. At the time, more than 31,000 people who needed access to treatment (approximately 37 percent of the total demand) could not get any help.
A professor and clinical social worker in addiction at Rutgers University tells NJ.com that navigating the insurance landscape for treatment is a “nightmare,” especially more so for people who don’t have insurance. Of the people who did receive substance abuse treatment in New Jersey in 2013, more than 60 percent did not.
But even though there have been some encouraging responses to provide relief to New Jersey’s substance abuse and mental health treatment infrastructure, the goalposts keep getting moved. In January 2015, after a consultation with the New Jersey Department of Human Services, the Department of Health came to the decision that there were enough beds and services for psychiatric treatment to address the needs of the state. The DOH cancelled a previously issued call for applications from healthcare facilities, which would officially request services and resources that such facilities would need to operate (which would be the DOH’s task to regulate).
Without the applications, the hospitals and treatment centers would receive no additional assets to ease the burden of tens of thousands of people in desperate need of treatment. The move has prompted numbers of lawmakers across the state to ask why the Department of Health felt the need to tighten its belt. A spokesman for the DOH told the Courier-Post that the department would send a response to legislators.
Heroin Withdrawal and Denying Coverage
Through all the bureaucratic and legal wrangling, there still remains the human cost of the opioid epidemic and a paralyzed infrastructure. Business Insider writes of a young man from Blackwood, New Jersey, who was repeatedly rejected by treatment facilities because his insurance company refused to cover the expenses. In June 2010, the 26-year-old man went to an emergency room, but doctors turned him away, saying that since heroin withdrawal isn’t life-threatening, he could not be admitted. He was put on an IV to clean out his system, and then sent home.
It took a lie – his sister saying that her brother was withdrawing from alcohol – that finally got the young man into treatment. Unlike heroin withdrawal, alcohol withdrawal can cause deadly seizures. The deception triggered the right red flags for an emergency admission, but treatment lasted only 17 days, at which point the funding from Camden County ran out. Three months later, the man was dead.
Heroin withdrawal is a traumatic and painful experience, but it is not directly deadly. For that reason, most insurance companies will not cover inpatient heroin detox or rehabilitation, saying that the treatment is not medically necessary (suggesting that inpatient care would be excessive), or that the client needs to relapse after outpatient rehab, in order to qualify for inpatient treatment.
As mentioned above, insurance companies favor home-based rehab, as this requires them to cover less expenses. Such a preference entails setting dangerous and impossible hoops for clients to jump through, like requiring a relapse before accepting an inpatient treatment claim.
A spokeswoman for America’s Health Insurance Plans (the national trade association that represents the health insurance industry) defended the reasoning, telling the Associated Press that the system exists because of “evidence-based standards of care” that have three criteria:
The Fight with the Insurance Industry
Similarly, the story of a man who eventually qualified for Medicaid (because treatment costs bankrupted his family), but was denied inpatient treatment coverage by the Medicaid-managed care company, Fidelis, illustrates the quagmire that clients and their families find themselves in, when substance abuse/mental health and the insurance industries collide.
In the legal process of the suit filed against the company by the man’s mother, Fidelis’s guidelines regarding “medical necessity” showed that the woman’s son met the criteria: risk of severe withdrawal, substantial risk of physical harm, etc. However, since the man was not suicidal, homicidal, or showing signs of psychosis, mania, or delusions, the law found in favor of Fidelis.
The company’s chief medical officer issued a statement that explained his organization’s decisions about substance abuse treatment are based on standards of care set out by state and national governments. “Denial of a specific level of care,” he wrote, “does not mean that no treatment is necessary.”
 “Chris Christie on Drugs.” (December 2015). On The Issues. Accessed March 21, 2016.
 “Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs, and Outcomes.” (January 2012). American Hospital Association. Accessed March 22, 2016.
 “Chris Christie’s Problem: New Jersey’s Economy Isn’t Doing Well.” (June 2015). CNN. Accessed March 22, 2016.
 “Gov. Christie’s Budget Contains No New Money to Expand Controversial Mental Health Program.” (February 2013). NJ.com. Accessed March 22, 2016.
 “N.J. Addicts Suffer from Shortage of Drug Treatment Facilities.” (November 2013). NorthJersey.com. Accessed March 22, 2016.
 “Dying for Help: Treatment Options Don’t Meet Demand of Growing N.J. Heroin and Opiate Epidemic.” (July 2014). NJ.com. Accessed March 23, 2016.
 “Lawmakers: New Jersey Needs More Psych Beds.” (September 2015). Courier-Post. Accessed March 23, 2016.
 “Here’s Why It’s So Difficult for Heroin Addicts to Get Treatment.” (April 2014). Business Insider. Accessed March 23, 2016.