In March, a 54-year-old woman went to the emergency department at Hackensack Meridian Mountainside Medical Center in Montclair. She was suffering symptoms of psychosis.
She was given medication which sedated her, she said, and when she “came to” in the hospital, she had bruises on her arms from being held in restraints. Hospital personnel, against the woman’s will, decided to hold her there and prevent her from being released. It was the second time in her life that she had been involuntarily committed for psychosis. Twenty-three years before, the woman explained, she was hospitalized at St. Mary’s General Hospital in Passaic, and held there against her will.
“If the experience is good, or somewhat good, it encourages people to get better. I’ve not seen that,” the woman, who lives in Essex County and spoke with NJ Spotlight News on the condition of anonymity, said of her involuntary commitment in March 2023. While on the psychiatric unit at the hospital in Montclair, the woman was not informed why she was there, she said, and saw a psychiatrist every day for about five minutes. She said she also saw a social worker “a couple of times,” who was in contact with her brother.
“I didn’t have a phone, so I didn’t have access to very much. I was discharged to the doctor that I do have in community, so there really was no plan created for additional support,” she said. “I was given a packet on my exit. But I say to myself, if I were someone without an apartment, or without supports, I don’t think I would have made it.”
Shortage of beds
Gov. Phil Murphy signed a law earlier this month that doubles the length of time people can be held in hospitals and emergency departments without their consent. The measure is needed “to address an emergent crisis facing New Jersey’s mental health care infrastructure,” Murphy said in a statement announcing the bill signing. Murphy added that “a shortage of beds has hampered the ability of health care professionals to treat those with mental illness in the most suitable, least restrictive environment.”
Lawmakers pushed the bill in June, moving it quickly along with hundreds of other bills during marathon votes to pass a state budget.
Bobby Brier discusses concerns with the new law on involuntary commitments
Many who spoke out against the bill urged Murphy not to sign it, or at least send it back to lawmakers for changes. These included people who themselves had been held against their will in hospitals for treatment.
While the new law ‘is not the final step,’ it is an ‘important step forward’ in helping doctors and other health care professionals address the issue, said Luke Margolis of Atlantic Health System.
“The point that we and many others in the civil rights and mental health community were making is that we don’t clearly know what the scope of this issue is and that it’s important for us to be able to understand that before we come up with any policy solutions,” said Ami Kachalia, a campaign strategist at the American Civil Liberties Union of New Jersey. The organization was one of more than 45 mental health, disability rights, civil rights and racial justice organizations that co-signed a letter earlier this summer urging Murphy to veto the bill.
Health care organizations in the state say “critical resources” are needed to provide mental health services and often involuntary commitment, but they remain in short supply. These resources include available beds at short-term care facilities, psychiatric facilities and special psychiatric hospitals, according to Luke Margolis, director of corporate communications at Atlantic Health System.
‘Not the final step’
The new law will provide hospitals with more time to locate a bed, while ensuring appropriate checks and balances are in place to guarantee both the safety of the patient and public, and the patient’s civil liberties, according to Margolis. While the new law “is not the final step,” it is an “important step forward” in helping doctors and other health care professionals address “this challenging issue,” Margolis said.
When people with mental health conditions need to be seen at a hospital and are unwilling to agree to a voluntary admission, some form of involuntary hospitalization should be available if they are likely to harm themselves or cause harm to others, according to the American Psychiatric Association.
People who are held in a hospital against their will are entitled to representation by a lawyer and a “prompt” hearing before a judge, according to the association. Additionally, the involuntary commitment process should include an exam by two or more physicians, preferably psychiatrists. Transportation during an involuntary commitment process must be provided by people who are medically trained and “in the least restrictive manner appropriate,” avoiding the use of restraints and “physically coercive measures” whenever possible, according to the association.
‘The law sunsets in two years and so it gives everyone involved … time to build out more capacity and get to the root of the placement issue.’ — Sen. Joseph Vitale (D-Middlesex)
The new law allows hospitals and emergency departments to involuntarily detain a person for up to six days, if the medical teams obtain a temporary court order to do so. Before this, the maximum length of time a person could be kept legally without consent was three days.
“It makes sense to give hospitals an extra day or two to find the appropriate placement for someone who is a danger to themselves or others,” said Sen. Joseph Vitale (D-Middlesex), a primary sponsor of the bill. “And releasing them sooner would only put them in danger, someone else in danger potentially, or have conflict with law enforcement.”
What patients say, what hospitals say
Everyone cares deeply about someone with a significant mental illness or episode and wants to make sure they are in the right place, Vitale said. In the meantime, a hospital setting is the “next best thing” to another inpatient setting that may not be available, which is why they are waiting for placement in the hospital, he added. “The law sunsets in two years and so it gives everyone involved … time to build out more capacity and get to the root of the placement issue,” he said.
Credit: (Paul Brennan from Pixabay)But for people who have been involuntarily committed, like the 54-year-old woman from Essex County, anxiety about the new law remains.
“My biggest concern is that there’s no treatment plan that goes along with what’s being stated at this time,” she said.
‘I think that just leaving this bill and saying, ‘OK, now we’re going to demand that people spend double the time in the hospital,’ that’s not good enough. We need more. We need to invest in … community-based resources, invest in private practices…’ — Dr. Adeola Sonaike, Baker Street Behavioral Health
And for other people who have experienced an involuntary commitment, it can be “incredibly traumatizing,” said Courtney Haslett of Cumberland County. In late 2019, Haslett said she was on an inpatient psychiatric unit at Princeton House Behavioral Health and received electroconvulsive therapy to treat suicidal ideation. She wound up back at the same hospital about a week later, she said. “And they basically said, ‘There’s nothing we can do for you, so we’re going to commit you involuntarily.’” She spent the next two months at a new hospital, Hampton Behavioral Health Center in Westhampton, with “basically no assistance,” she said.
“I’m extremely concerned that people will be less likely to come to the hospital knowing that there’s a possibility they could stay in for six days against their will,” Haslett said. “And I’m also concerned that people will get worse during that time because not all hospitals offer treatment while they’re in that crisis pod,” she said. “And that they could get significantly worse or just lie their way out and not get the help that they actually need.”
A spokesperson for Penn Medicine said New Jersey’s mental health screening law “governs our practice,” and that the hospital would not be able to discuss a specific patient’s care.
“Penn Medicine Princeton House Behavioral Health is dedicated to providing exceptional, compassionate care that enhances the health and wellness of our patients and the community. All interactions with patients are rooted in that commitment,” the spokesperson said in a statement to NJ Spotlight News. “The decision to involuntarily admit an individual to a psychiatric facility is always undertaken with great care.”
A spokeswoman for Hackensack Meridian Mountainside Medical Center, Chiara Marababol, also declined to discuss the specifics of an individual patient’s care.
“The safety and welfare of our patients is our priority. We provide high-quality individualized care for each patient in a safe environment. Due to federal privacy laws, we cannot comment on individual patients,” she said.
Hampton Behavioral Health Center did not respond to a request for comment.
How it’s supposed to work
Under the new law, a hospital cannot detain a person for longer than 72 hours from the time that a psychiatrist screens them, or issues a “screening certificate,” unless the hospital or emergency department gets a temporary court order that allows it to hold the person for up to 72 additional hours. The New Jersey Office of the Public Defender will be notified of the application and required to represent the person in court.
The law requires each hospital and emergency department to submit a quarterly report to the state Department of Human Services that includes the number of applications submitted to the court for a temporary order to hold a person beyond 72 hours, the number of such temporary court orders granted, and whether the person kept for longer than three days has a “criminal history,” a co-occurring substance use disorder or a co-occurring intellectual or developmental disability.
“Under previous law, despite diligent efforts by crisis teams at acute care hospitals, many times a bed simply could not be located. That left hospitals with an impossible choice: violate the previous statute requiring a transfer to a facility within 72 hours, or release a patient — documented by multiple psychiatrists and health professionals to be a danger to themselves or others — into the community,” said Margolis of Atlantic Health System. “That was not a solution for patients, communities or the hospitals dedicated to their care.”
But some legislators, including Assemblywoman Aura Dunn (R-Morris), said they were surprised Murphy, who had the authority to kick it back to lawmakers for changes with a conditional veto, signed the bill into law because of the “alarms” heard from “various stakeholders.”
“There are safety issues. We know that we’re faced with a crisis. In many ways, I think it should be seen as a humanitarian outlook here to take more time and to find suitable placement, but the reality is we’re facing this because we don’t have enough providers. We don’t have enough beds. We don’t have enough appropriate facilities,” she said. “And we didn’t really address that through this legislation. This is — I don’t know even know if you can call this a short-term fix — this is a Band-Aid.”
Dr. Adeola Sonaike of Baker Street Behavioral Health in Franklin Lakes, and other mental health professionals, say that the bill is “a step in the right direction,” but there’s a lot more that needs to be done to truly have a system that supports people when they’re in crisis.
“I think that just leaving this bill and saying, ‘OK, now we’re going to demand that people spend double the time in the hospital,’ that’s not good enough,” Sonaike said. “We need more. We need to invest in … community-based resources, invest in private practices, that are going to be able to be there to provide care so that the hospital staff and the administrators are not scrambling to find a referring provider so that that provider can … continue the provision of care for the individual who has been committed.”
As for the woman in Essex County, she said solutions can be found by showing compassion for people who are experiencing a mental health crisis and involving people who have gone through crisis evaluation in the search for better processes.
“There’s an engagement factor that I think peer support specialists are masters of, regardless of how many encounters an individual has in the mental health field as a practitioner,” she said. “There is a very special bond … I call it a language that people can speak to one another who have gone through and come through (these experiences),” she said.
