New Jersey Institute Provides Model for States to Advance Behavioral Healthcare

As the end of 2023 approaches, our field is still confronted by a very serious workforce crisis. This crisis is multidimensional—too few behavioral health workers, too few people entering the field, burnout among current staff, and exceptionally low reimbursement rates. The effects of this crisis are extremely far reaching. Today, we can only serve about 1 in 4 people who have behavioral health conditions. At the same time, opioid overdose death and suicide rates remain extremely high.

National efforts are being undertaken through the Department of Health and Human Services (HHS), the Health Resources and Services Administration (HRSA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) to confront this workforce crisis. HRSA education programs have been expanded to train additional professional and paraprofessional personnel, including peer supporters. And SAMHSA has developed technical assistance and training modules to address staff burnout. Further, much of the national advocacy by the behavioral health community seeks to increase reimbursement for clinical and related services.

For the most part, these national efforts operate with a longer-term horizon. Yet, rarely do we look at developments at the state level that might serve as models for shorter-term interventions with more immediate results. This commentary will describe one such model.

First, a little background. For 70 years, the New Jersey Association of Mental Health and Addiction Agencies—fondly known as NJAMHAA—has provided outstanding training, technical assistance, policy development, and advocacy for member mental health, substance use, and intellectual and developmental disability providers.

In the year 2000, NJAMHAA created the New Jersey Mental Health Institute. The primary purpose of the Institute is to undertake special projects that will advance the quality and outcome of services provided by NJAMHAA members. Funding for the Institute’s activities comes from both governmental and private philanthropic sources.

Throughout its history, the Institute has always undertaken important projects. Major examples include the following:

• Between 2001 and 2012, it undertook a series of key initiatives to improve access and quality of behavioral health services for Hispanic individuals in New Jersey, including the development of new evidence-based practices now recognized by the World Health Organization (WHO).
• Between 2001 and 2006, it collaborated with the University of Medicine and Dentistry of New Jersey (now part of Rutgers University) to provide behavioral healthcare training for many New Jersey children’s system of care providers.
• Between 2005 and 2019, it supported relief projects for behavioral health services in Sri Lanka.
• From 2014 and 2017, it provided training on evidence-based practices for New Jersey military veterans and their families.

As the behavioral health workforce crisis became more severe in New Jersey, the Institute launched the Leadership Academy for Behavioral Healthcare Providers in October 2022. This special project sought to expand human resource capacity for mental health, substance use disorder, intellectual and developmental disabilities treatment and support services, as well as other social service organizations. Career development opportunities were fostered for emerging leaders in clinical and supervisory positions. Participants were encouraged to build their skills for future leadership roles, as well as to contribute to their organizations’ long-term sustainability and quality of services provided. The program was operated on a 12-month cycle, and each participant met monthly with a mentor and with a coach.

The first cohort of 7 participants was completed in August 2023. At the same time, a new cohort almost triple in size was initiated. This new cohort not only includes participants in clinical and supervisory roles, but also individuals in human resource and administrative roles, as well as clinical supervisors and direct service providers. Original, nationally renowned mentors and coaches were retained, and new ones were added.

“Career development training is a key step in addressing our current workforce crisis,” said Debra Wentz, PhD, executive director of both NJAMHAA and the Institute. “Not only are participants more willing to continue with their current employer, but they also are able to identify a future career path in behavioral health for themselves.”

In addition, the Institute recently developed plans for creating a Center of Excellence on Social Determinants of Health. Because the social determinants account for 80% to 90% of a person’s health status, it is critical to intervene to address determinants that cause trauma and adverse health and behavioral health outcomes.

The proposed center will provide education and training for behavioral healthcare providers regarding strategies to access services that address these determinants for clinical populations, as well as mental health and substance use services accessible to local providers that offer services that address the social determinants of health. This training also will emphasize the importance of advancing health equity. The goal is to reduce the prevalence of chronic disease and to reduce the incidents of healthcare inequity. The Institute currently is seeking funding to implement this new center.

“As we go forward, the notion that there can be no good healthcare without good behavioral healthcare must be expanded to include social care,” Dr Wentz noted. “Only in this way will we be able to reduce burden on our providers by addressing the social determinants of health where many behavioral health conditions originate.”

The New Jersey Mental Health Institute represents a particularly important model for the future. Once developed by the Institute, trainings, practices, and tools can be applied immediately by the members of NJAMHAA to improve the quality and outcome of behavioral healthcare for NJ residents. These products also can be made available to residents of other states and even internationally. The exceedingly long delay between development and application can be reduced dramatically. Clearly, we need much more innovation of this type to address our current workforce crisis.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.