After multiple attempts in a lower level of care to stop drug abuse, 16-year-old Genesis was referred to New Hope Integrated Behavioral Health Care’s residential program, where she received treatment for substance use, as well as post-traumatic stress disorder. The treatment and supports she received enabled Genesis to manage these illnesses and thrive. She graduated from the program, is continuing outpatient treatment and is currently training to be a Certified Nursing Assistant and security analyst.
Genesis is one of countless examples of successes made possible by the community behavioral health system. Without sustained and increased funding for these services, many individuals will not have the opportunity Genesis had to recover and build a better life. Community behavioral health care is highly effective, yet historically inadequately funded, a situation exacerbated by the COVID-19 pandemic, limiting the system’s capacity for treating and supporting New Jerseyans in need.
For years, the numbers of children, youth and adults contending with depression, anxiety, suicidal ideation, substance misuse and overdoses have been increasing. The tragic statistics of years past have skyrocketed during the pandemic due to social isolation, economic hardship, fear and other impacts, including social and racial injustices. The Centers for Disease Control and Prevention stated in August that the number reporting symptoms of depression quadrupled versus the same time in 2019, and that 40% of adults “reported struggling with mental health or substance use.”
New Jersey’s heroic behavioral health workers enable individuals to work through these difficulties. Their unwavering dedication translates to effectiveness in helping individuals achieve recovery and other personal goals. This work continues despite the risks the behavioral health frontline workers are facing during the pandemic.
Now, more than ever, New Jersey must invest in the long-neglected community-based behavioral health workforce. With them having had no cost-of-living adjustment in over a decade, the state has also failed to provide any funding for the several annual increases in the minimum wage. Recruitment and retention of qualified staff has always been very difficult, given the fact that starting wages in the largely nonprofit community behavioral health system are, on average, $10,000 less than state, private or educational systems, and the gap only grows from there. With the impact of the pandemic on the workforce — many leaving the field for various reasons and recruitment even more difficult for these stressful, demanding jobs — and an exponentially growing need, it is critical for New Jersey to strengthen and expand this workforce.
This is literally a matter of life and death for many of New Jersey’s citizens — they could be your family, friend, neighbor or co-worker, or someone you love.
While many factors have contributed to the current workforce difficulties, the lack of COLAs since January 2008, no funding for minimum wage increases and the transition to a fee-for-service reimbursement system stand out. Many rates in the FFS system are just inadequate to cover the actual costs of care. The FFS rates immediately left providers with an approximate aggregate deficit of $25 million. Until such time that a rate study required in 2017 legislation to investigate the adequacy of rates, as well as the impact of FFS on access to, continuity of and quality of care, is completed and rates adjusted accordingly, funding to fill the $25 million FFS gap must be included in the budget, along with an appropriation to cover the increasing minimum wage providers must pay. These, and other new costs, were never factored into the many already-inadequate FFS rates. Looking forward, to ensure the community behavioral health system that over 500,000 children, youth and adults rely on each year is there when needed, a formula that indexes the rates and contracted services to increasing costs must also be established to maintain the capacity of the system.
Strong, sustainable community-based services are necessary for the state’s fiscal viability and the health and well-being of New Jersey residents. It is time to strengthen the state’s longstanding programs, while newer integrated models of care continue to be developed. The workforce and infrastructure that support these programs need investment if we are to build a better future giving all New Jerseyans the opportunity to live healthy, fulfilling lives — as Genesis is now able to do.
Debra L. Wentz is CEO and president of the New Jersey Association of Mental Health and Addiction Agencies, a statewide trade association representing 153 organizational providers of services for more than 500,000 children and adults with mental illnesses, substance use disorders, intellectual/developmental disabilities and co-occurring disorders.