Last week, at the New Jersey State House, we released the Children’s Mental Health Mapping Report, the product of 18 months of research, interviews, and monthly meetings with our external advisory group of experts. Joining us were the legislative sponsors of the bill to commission the work, many of our partners in producing the report, and families who shared their stories in the hope of benefiting from an improved mental health system of care for their children and others.
In preparing this report, we conducted interviews and focus groups with over 230 families, providers, hospital staff, school personnel, justice system staff, and others inside the State’s systems. We analyzed state and national data, and documented where the system is working, where it is falling short, and what can be done to fix it.
The mapping report is a resource, not a quick read. But strip away the data and the acronyms and what remains is children who are struggling, and the families and professionals desperately trying to help them. A few things from this report stuck with me.
The first thing is the waiting. Parents wait for everything: on hold, for an appointment, for an assessment, a callback, a diagnosis, an opening. A child may spend seven or eight hours sitting in an emergency department waiting for a mental health evaluation. If a child needs an intensive out-of-home treatment bed, that family may be on a waiting list for months or years. When a child is struggling, delay is the enemy. Their needs do not pause while the system catches up. They grow, and so does the strain on the family trying to manage them.
The second is how few of the right providers there are. Some counties in New Jersey don’t have any child or adolescent psychiatrists; some have only a handful. A directory can list hundreds of names and still leave a family with no one who treats children, takes their insurance, or has an in-person opening in a reasonable time frame.
The third is the children stuck in crisis beds. We found youth clinically ready to leave a hospital but with nowhere appropriate to go, so they stayed for days or weeks in a setting everyone agreed was no longer right for them. Hospitals described themselves as holding environments while other systems searched for a placement that did not exist. A bed occupied by a child ready to move on is a bed unavailable to the child in crisis behind them.
The report makes many findings and recommendations, and we will highlight more of them in the weeks ahead. But two stand out to me as imperative: real enforcement of network adequacy, and the creation of a comprehensive children’s mental health data dashboard.
We already have state laws and contracts defining and requiring network adequacy, requiring access, and mandating that carriers’ provider directories be accurate, current, and independently audited. The problem is the lack of consistent, strong oversight and enforcement of these laws, and accountability for non-compliance.
That is why we are calling upon the State to enforce existing laws and contract requirements. Delay in accessing mental health care harms every child looking for help and allows conditions to grow more complex and expensive to treat, for families and the State. The report outlines additional steps to be taken to drive accountability over access to mental health care. Network adequacy should be measured by whether a child can actually get an appointment in a reasonable time, not by whether providers names are in a directory but they don’t really see adolescents, or not in person, or not at that address, or not in network.
The children’s mental health data dashboard is about giving everyone a shared line of sight into the system. Families, providers, and the State are all trying to navigate this system without a clear picture of it, and the data we do have sits scattered across separate agencies. A single, public dashboard that tracks the full continuum, from the workforce and insurance networks to residential beds, waitlists, and how long children wait once they are clinically ready to move, would let everyone see where access actually breaks down, whether it is improving over time, and where the State should invest resources.
I invite you to read through the report and welcome your thoughts on what jumps out to you as the most actionable and critical next steps we can work on together. The landscape analysis section lays out the system, the findings call out what we saw and heard, the three illustrative care path stories represent the journeys of children we consistently heard about in our research, and the recommendations set forth next steps. We look forward to working with you, our members, and anyone interested in improving the status quo for children in the Garden State.