Star Ledger Editorial Board
Given the fiscal crisis, New Jersey needs to find a truckload of smart spending cuts. But the Christie administration's plan to limit spending on those with serious mental illnesses could backfire, as the same type of effort has in other states.
For starters, let's understand what's at stake. This change would cut funding to threadbare community mental health centers, which are the last resort for those with mental illness and no money for private treatment.
The change would affect places like CarePlus, in Bergen County, which plasters its phone number across the George Washington Bridge to save would-be jumpers.
Police refer many clients there as well. One recently drove his car into a building and attempted suicide-by-cop during a bout of psychosis. Another ended up fatally shooting his wife in front of their 12-year-old kid, then himself.
These centers treat people who have no place else to go, are who are rendered desperate, and sometimes dangerous, by their illnesses. So there is no room for error.
The change that Christie wants to make is technical, and sounds reasonable on its face. Instead of guaranteeing a regular payment to these centers, the state would pay for each service they provide to patients, a method known as fee-for-service.
The state would save money, in theory, because the centers would receive pay only for the work that they do -- each therapy session, hospital service or psychiatrist session will be reimbursed after it's provided.
The problem is the reimbursements are low to begin with, and hundreds of these centers say they can't absorb the cuts without cutting into bone. They worry the reimbursements won't be enough to cover their overhead costs -- including rent or electric bills, or salaries for psychiatrists whose patients don't always show up.
They warn that the change will force them to cut services, or even close down. And the concern has built to a roar, with hundreds of centers warning the state of a potential crisis. As many as 29 outpatient programs could close, they say, putting 20,000 people at risk of losing treatment.
There is good reason to take that threat seriously. When Michigan made this change between 2014 and 2016, about 10,000 people lost services, according to a group that represents providers there.
Sen. Joe Vitale and Assemblywoman Valerie Vainieri Huttle have proposed legislation that provides independent oversight of this transition, to examine whether the new rates and access to care is adequate. That offers at least some safeguard against disaster. The question is, if the Legislature passes it, will the governor sign it?
This is the kind of spending cut that could backfire if it's not implemented carefully, and tweaked quickly if the need arises. When mental health centers lose capacity, more people end up in emergency rooms, in the criminal justice system or homeless. And that costs us even more.
The human cost will be high, too. Take Deborah Danner, a 66-year-old woman in New York City. She wrote a remarkable essay about living with schizophrenia, in which she worried she would someday spiral out of control and be killed by a police officer.
"What if my medication fails me?" she wrote. "I ask myself, will I know if it does? Will the illness overpower its effectiveness? When? Where?"
Two weeks ago, it did fail her, and she was fatally shot by a cop in her Bronx apartment. If our mental health centers did cut back or close, how many might suffer the same fate in New Jersey?