The recent high-profile suicides of celebrity chef and travel documentarian Anthony Bourdain and designer Kate Spade underscore how mental illness continues to be a scourge in the U.S., including New Jersey.
The state, however, appears ill-equipped to deal with the problem.
Though New Jersey does have the second-lowest suicide rate in the country, it was still the 11th-leading cause of death in the state in 2017 and more alarmingly the third-leading cause of death among young people ages 10 to 34, according to data from the American Foundation for Suicide Prevention. On average, one person in the state commits suicide every 11 hours.
The suicide rate is not the only metric for mental illness – the state also has been ravaged by substance abuse and other mental illnesses such as depression and anorexia, according to Mental Health America, which compiles statistics on mental illness in the U.S.
Despite these statistics, data from the U.S. Bureau of Labor Statistics show New Jersey has a shortage of mental health specialists – in particular those that accept health insurance – making it more difficult to treat mental diseases. This reality exists even as most of the major health care systems in New Jersey look for ways to incorporate behavioral health into their population health programs, and counties such as Bergen and townships including Englewood are promoting “Stigma-Free” programs to treat psychological disorders.
According to the latest BLS data, the state employed 3,500 behavioral health specialists (including psychologists) and 1,030 psychiatrists as of May 2017. That adds up to just 11.4 psychiatrists per 100,000 residents and 38.9 behavioral health specialists per 100,000 residents, despite the fact that psychiatrists in New Jersey have the second-highest average annual wage in the U.S. at $252,470.
A majority of psychiatrists in the state do not accept health insurance. Those that are out-of-network often charge fees ranging from $300 to $500 per hour out of pocket, though some insurance companies are willing to reimburse patients partially under certain plans. Many of those that are in-network have long wait periods for appointments.
“There is a well-documented national shortage of psychiatrists in the country, but it seems to be even worse in our state of New Jersey,” said Dr. Petros Levounis, chair of the Department of Psychiatry at Rutgers University Medical School, in an email. “Poor reimbursement rates, exhausting bureaucracy, and intensely cumbersome pre-authorization requirements that insurance companies impose on mental health services keep psychiatrists out-of-network.”
The two most prevalent solutions offered by providers are: Insurance companies must do more to provide greater reimbursement to mental health providers and health care systems must underwrite some of the cost of providing behavioral health care as part of their population health programs. That suggests having behavioral health specialists on hand when a patient comes in with a physical ailment caused by a mental health issue, and it also means structuring providers’ salaries in such a way that they would make as much as they would in private practice.
“We need to knock down the barriers,” said Dr. Stephen Brunnquell, president of Englewood Health Physician Network, . “Let’s hire these folks and knock down the insurance barrier. I’m not being critical of my psychiatrist colleagues, but they can’t make a living in-network because these commercial insurers have never treated mental health the way it ought to be treated.”
Englewood HPN recently added a psychiatrist, psychiatric nurse practitioner and six licensed clinical social workers.
“When our board decided to add a psychiatrist to our program, they recognized that they need to underwrite some of the costs of that,” Brunnquell said, adding the psychiatrist is salaried and also is incentivized to see as many patients as possible. “We’re able to provide some of the cost to a psychiatrist that we hired.”
Brunnquell said it is critical to have behavioral health specialists on hand as part of its population health programs as a way to treat patients before suicide becomes the final option.
“More people die in this country by suicide than by motor vehicle accidents,” he said. “If you can get people into therapeutic relationships, the number of suicides in the state go way down. You can save lives doing this.”
Dr. Ramon Solhkhah, chairman of the Jersey Shore University Medical Center’s Department of Psychiatry at Hackensack Meridian Health, hopes HMH’s new medical school, Hackensack Meridian School of Medicine at Seton Hall University, has the potential to produce 10 new psychiatrists per year. The system recently signed a letter of intent with Carrier Clinic to increase its capabilities in mental health care.
“HMH has made an effort to hire as many mental health providers as we can,” Solhkhah said. “But if you’ve got commercial insurance, you actually can’t access mental health care because it’s all self-paid with psychiatrists. It’s the most underserved medical specialty, particularly for children and the elderly. I think that the state has not done a great job of recruiting psychiatrists to come into this state, but we’re also situated between Philadelphia and New York City where a lot of mental health providers choose to practice.”
Dr. Stephanie Coyne, president of the New Jersey Psychological Association, stressed the state could add psychologists by easing the training requirements for them.
“Graduates of doctoral programs in psychology are still required to complete half of the required hours for licensing after graduation even though they often have already completed far in excess of the total number of required hours prior to graduation,” Coyne said.
“Delaying licensing for qualified graduates thereby negatively affects access to mental health care,” she added. “In addition, access is negatively impacted because of the ‘brain drain’ that results when graduates decide to forego licensing in our state and choose instead to get licensed in other nearby states where the total number of their supervised hours enables them to be licensed more quickly.”
Other health care professionals – including Lori Ann Rizzuto, director of behavioral health at Atlantic Health System; Jennifer Velez, executive vice president of behavioral health at RWJBarnabas Health; and executives at Horizon Blue Cross Blue Shield of New Jersey – said that until the number of psychiatrists in the state increases, counselors, psychologists and social workers will have to fill in the gaps.
“While many patients have behavioral health needs that do require medication, it is also important to note that not every behavioral health case calls for medication,” Rizzuto said. “In behavioral health, we work in a treatment team model; clinicians see patients in individual and group therapy services, and, when indicated, refer patients to our employed psychiatrists.”
“Addressing the national shortage in psychiatrists requires creative solutions like AbleTo and Quartet, but Horizon has also responded by building a robust network of trained and licensed providers – psychologists, clinical social workers, addiction specialists, therapists, counselors, and mental health nurse practitioners – who delivered more than half of the in-network behavioral health services to our members last year,” Horizon’s statement said.
Velez acknowledged there is a shortage of psychiatrists, but she noted that RWJBarnabas also has partnered with Quartet Health.
“We’ve contracted with Quartet, and our primary care physicians [can] … refer patients to a mental health provider when they need it,” Velez said. “The other roads you’ll see is the advent of telepsychology. It’s a way people are accessing care generally. The fact that that has become very normal for them is very positive.”