Good morning Chairman Vitale and members of the Committee. Thank you for this opportunity to provide my testimony in opposition to S4263. My name is Dr. Brittany Holom-Trundy, and I am a senior policy analyst at New Jersey Policy Perspective (NJPP). NJPP is a non-partisan, non-profit research institution that focuses on policies that can improve the lives of low- and middle-income people, strengthen our state’s economy, and enhance the quality of life in New Jersey.
NJPP strongly opposes the permanent extension of involuntary commitment length, which threatens the health and rights of New Jersey residents. The role of involuntary commitment in treatment for those experiencing mental health crises has long been recognized as complicated and, often, problematic. Research has shown that racism, sexism, and other biases in health treatment settings lead to disparities not only in judgments about people’s pain or illness, but also in diagnoses of psychological disorders.[i] Because involuntary commitment requires medical judgments from healthcare professionals about whether a person is a “danger to self” or “danger to others or property,” emphasizing these situations further as a blunt tool for care without needed data opens doors to increased discrimination.[ii] Studies have shown that patients of color are more likely to be determined to be a “danger” and involuntarily committed than white patients.[iii] Meanwhile, there remains very little research on the medical effectiveness of 72-hour holds, let alone double that amount of time.[iv]
Though involuntary commitment may be necessary as a blunt tool to address an emergency situation, it is certainly not the ideal approach to care, and not one that should be prolonged arbitrarily. Hospitals often do not have the resources necessary to provide the standard of care for patients in involuntary commitment throughout its original 72-hour length; thus, extending the possible length of time simply invites worsening conditions resulting from staff and resource shortages.
The need for extended involuntary commitment remains low, and when it is utilized, it indicates other gaps in care. According to quarterly reports submitted to the Department of Human Services since the initial introduction of this extension, facilities requested extended holds for less than 1-2% of all hospitalizations due to psychiatric crises.[v] This means that these holds were needed for less than 1% of all patients screened for mental health crises, most of whom are discharged without hospitalization.
Such a small number does not indicate a pressing need to permanently suspend patients’ rights to reasonable, humane treatment in the standard timeframe. Instead, if our goal as leaders is to improve care, further decrease the number of cases in need of involuntary commitment, and address challenges within that system, then we must consider the question of why these patients were in need of help and were unable to receive that help within 72 hours (3 days), which should be achievable. In particular, attention to the following would allow for a better, more targeted response:
- Whether and where beds were available at the time of the hold
- Staff shortages at the facility holding the patient
- Reports of refusals to accept patients based on complicating medical conditions, criminal history, insurance status, or other circumstances
- Insurance status of patients held and payments charged
By considering these factors, lawmakers could determine if more psychiatric facilities and beds are needed; if increased staffing at hospitals should be prioritized; if staff need improved training, regulation, or support; or if facilities have financial incentive to keep some patients longer than others. Addressing these root causes of issues would provide better long-term solutions than the band-aid of simply extending involuntary commitment. Leaders could seek to invest state resources into long-term solutions to improve the mental health system so that we can decrease the number of people reporting mental health crises, improve treatment for those experiencing crises, and ensure the best, most efficient use of hospital care settings for both patients and healthcare workers.
New Jersey needs long-term investment in the mental health system, not a self-fulling solution that invites further abuse and ignores the cause in the first place.
We hope that the Committee will agree and hold this bill and consider these concerns today.
Thank you for your time.
End Notes
[i] Hamed, Sarah, Hannah Bradby, Beth Maina Ahlberg, and Suruchi Thapar-Björkert. “Racism in healthcare: a scoping review.” BMC Public Health 22, no. 1 (2022): 988; Zhang, Lanlan, Elizabeth A. Reynolds Losin, Yoni K. Ashar, Leonie Koban, and Tor D. Wager. “Gender biases in estimation of others’ pain.” The Journal of Pain 22, no. 9 (2021): 1048-1059; Garb, Howard N. “Race bias and gender bias in the diagnosis of psychological disorders.” Clinical Psychology Review 90 (2021): 102087.
[ii] Morris, Nathaniel P. “Detention without data: public tracking of civil commitment.” Psychiatric Services 71, no. 7 (2020): 741-744.
[iii] Shea, Timothy, Samuel Dotson, Griffin Tyree, Lucy Ogbu-Nwobodo, Stuart Beck, and Derri Shtasel. “Racial and ethnic inequities in inpatient psychiatric civil commitment.” Psychiatric Services 73, no. 12 (2022): 1322-1329.
[iv] Morris, Nathaniel P. “Reasonable or random: 72-hour limits to psychiatric holds.” Psychiatric Services 72, no. 2 (2021): 210-212.
[v] New Jersey Department of Human Services. Continued Hold Orders. https://nj.gov/humanservices/dmhas/publications/orders/
