There’s a pandemic within the COVID-19 pandemic in New Jersey and across the nation, a record increase in fatal overdoses and a growing number of people struggling with mental illness and addiction. As health care providers, we need to approach this crisis with urgency and commit to expanding access to care, better coordinating care and innovating treatment.
Sadly, the Centers for Disease Control and Prevention reported this month that a record 93,000 Americans died of overdose last year, a 30% increase from the prior year. New Jersey lost more than 3,000 people – many in the prime of their lives.
“I have friends who have OD’d and died during COVID,” a Bergen County man now in recovery told a New Jersey reporter at the height of the pandemic. With the isolation and stress of lockdown, “you just have a lot of time to sit and stew. And for people with addictions, your idle hours are the worst,” the man said.
At Hackensack Meridian Health, we are deeply committed to improving care for the 1 in 4 people who suffer from depression, anxiety, addiction and many other mental health issues. These aren’t just statistics: we all have a loved one, a friend, a neighbor or a colleague who is affected. At the core of our strategy is treating behavioral health care like any other major health care service; it is as important as cardiology, oncology, women’s health and other essential care. We need a bold and robust plan in New Jersey and as a nation that must include the following to save lives.
Bob Garrett at the opening of The Retreat at Ramapo in Feburary 2021. – HACKENSACK MERIDIAN HEALTH
First, we must expand access to care to help bring more people into treatment. Less than half of U.S. adults with mental illness received treatment in 2019, according to the National Alliance on Mental Illness. The barriers to treatment are formidable: there’s a real dearth of psychiatrists; even though finding a licensed therapist isn’t as hard, many are out-of-network, and many people just can’t afford to pay privately.
In 2019, Hackensack Meridian Health merged with Carrier Clinic, New Jersey’s most respected behavioral health provider, to radically improve care. Within a year of the merger, we opened the state’s first behavioral health urgent care center in Neptune which has treated thousands of patients. Nearly half of our patients receive treatment for anxiety or a major depressive disorder. Patients can avoid an emergency room that’s overwhelmed with cardiac, stroke or accident patients and receive care in a quiet, more appropriate environment in non-life-threatening cases.
Plus, it’s more affordable. The cost of this care can be 70% less than the cost of an ED visit. For patients, urgent care copays are significantly less than ED copays. The cost of avoidable use of emergency department care in the U.S. is $32 billion annually and upwards of two-thirds of those visits could have been managed in another setting, such as a physician office or urgent care, had the resource been available.
Equally important, we rapidly expanded access to telehealth in the pandemic to connect people with behavioral health experts from their homes. We increased these visits by a record 700% during the pandemic and continue to invest in a major expansion to provide even more of this essential convenient care.
In February, we opened a state-of-the art addiction treatment center, The Retreat at Ramapo Valley in Mahwah. It currently provides outpatient care and will ultimately support a 90-bed inpatient facility. This care is not only cutting edge, it is comprehensive so that all health needs are met in one place.
Second, we must provide more coordinated care. Here’s a quick story about a real New Jersey patient that makes my point.
“Jane’’ is 40 years old and covered by Medicare. She is diagnosed with mental illness, substance use disorder, and other chronic illnesses. In a five-year span, she has visited hospitals in give different health systems 77 times. Jane has been hospitalized nearly 300 days in five years. The total bill for those services? $4.4 million.
We are not helping Jane, nor are we providing cost-effective care. Instead, what if Jane had regular checkups with the same physician who understood her complex condition? What if she went to an urgent care center instead of an emergency department (ED) for treatment? We are providing more coordinated care for patients like Jane in many ways.
We are embedding specialists in many physician offices so patients can conveniently meet with an expert immediately. Our goal is to have services or support available at all primary care sites. This will also provide a more complete medical record for patients so we can provide holistic care.
Additionally, we created a “Behavioral Health Home’’ to help patients with serious and persistent mental illness get the care they need for hypertension, diabetes or other illnesses. This is vital because these patients typically have a decreased life expectancy because they can’t access necessary care.
Third, we need to innovate treatment. For too long, innovation has lagged in the treatment of mental illness and addiction. We are proud to be at the forefront of progress. Multiple studies are underway at Hackensack Meridian Health to use advanced technology to better diagnose and monitor behavioral health patients. This includes studying the use of wearable technology and new apps in inpatient settings and home care that can monitor vitals and may better detect and even prevent relapse. This would help more patients lead stable, more fulfilling lives and at the same time, prevent costly hospital care.
Fourth, let’s not forget our children. Suicide is the second leading cause of death among Americans age 15 to 19, according to the CDC. There’s a shortage of 10,000 psychiatrists in the U.S. and it’s especially heartbreaking for children in need. For the 1 in 3 covered by Medicaid in New Jersey, it can take months to get an appointment.
Our network took the lead in launching a statewide Pediatric Psychiatry Collaborative Program supported by state funding and in partnership with the NJ Chapter of the American Academy of Pediatrics and other health systems. It provides pediatricians with immediate access to a child psychiatrist and is concentrated in hubs that serve the state’s 21 counties. Since its launch six years ago, we have collectively screened more than 250,000 children and teens and referred over 10,000 for treatment.
We have also added child psychiatry fellowships to the expanding psychiatry residency program in our network and I’m proud to report that two members of the first graduating class at the Hackensack Meridian School of Medicine have been accepted for residency training in psychiatry at HMH.
Remember a generation ago, we spoke of cancer in hushed tones, we whispered about the suspected “Big C,” diagnoses were kept secret, and that was that. Our collective will to tackle this disease changed the game: death rates dropped 27% in a generation. Today, 16 million Americans are living with cancer. We need to harness that same spirit that transformed cancer care in America to write a new playbook for mental illness and addiction. Hackensack Meridian Health is all in.
Robert C. Garrett is CEO of Hackensack Meridian Health, New Jersey’s largest and most integrated health network with 17 hospitals and more than 500 patient care locations.
