Accessing Services for Minors and Adults with a Mental Illness
Services for adults with a mental illness are provided through the Division of Mental Health and Addiction Services who provide services for individuals who are over the age of 21, and their families (DMHAS). Prior to age 21, minors in need of services are provided through the Children’s System of Care, https://www.state.nj.us/dcf/about/divisions/dcsc/.
What is Mental Illness and What Help Exists to Address it?
New Jersey defines “mental illness” as “a current, substantial disturbance of thought, mood, perception or orientation which significantly impairs judgment, capacity to control behavior or capacity to recognize reality”. “Mental illness” in New Jersey is not limited to “psychosis” or “active psychosis,” but includes all conditions that result in the severity of impairment described above. Mental illness does not include by definition in New Jersey simple alcohol intoxication, a temporary reaction to drugs, or what our state calls “organic brain syndrome or developmental disability”, unless the disability results in the severity of impairment described in our statute(s).
“Mental illness” means a current substantial disturbance of thought, mood, perception, or orientation which significantly impairs judgment, behavior, or capacity to recognize reality but does not include simple alcohol intoxication, transitory reaction to drug ingestion, organic brain syndrome, or development disability.
“Mental impairment” means impairment in cognitive, neurological, sensory, or cerebral functioning resulting from other than mental illness.
“Neurological Impairment (NI)” means a severe disorder of the central nervous system.
Just because someone has a mental illness doesn’t mean they necessarily need to be admitted for inpatient or outpatient treatment. There must be more. Mental illness requires a belief in the imminent “danger” or “dangerous” when placement and treatment is being considered for an individual.
The Division of Mental Health operates New Jersey’s state psychiatric hospitals. It is here where in-patient treatment is provided to people with major psychiatric illnesses. There are five hospitals, including Greystone, Trenton State, Ancora, Garrett Gagedorn, and Ann Klein. If a family member or person of significance in your life has been involuntarily committed, they likely have been committed to one of these five institutions, or one of several smaller institutions run by the State of New Jersey. Placement to one of these hospitals is called a “civil commitment”. There are six other smaller hospitals, namely Bergen Regional, Buttonwood, Camden County Health Services, Essex County, Runnells, and Meadowview. Each of these six institutions are voluntary psychiatric facilities. If you don’t believe your loved one has voluntarily committed himself/herself, and suspect an inappropriate involuntary civil commitment, or you believe they may be treated with inappropriate medication, call Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at email@example.com to schedule a confidential appointment to discuss what can be done.
If someone close to you has been committed or is presently being treated at a community hospital who is planning to transfer him or her to a state psychiatric hospital, we can also help. A person has a legal right to be placed in the least restrictive environment appropriate to his or her condition.
If you are a caregiver, guardian or power of attorney for a loved one with a mental illness, make an appointment to speak with Fredrick P. Niemann, Esq. as soon as possible to discuss your options for ensuring they receive the best possible care in the least restrictive environment. If you are a caregiver exhausted by your responsibilities, respite relief may be available to you. Let Hanlon Niemann & Wright assist you with your respite options.
Watch my video on Families with Minor Children Who Have Special Needs and Disabilities
Watch my video on Drug Addiction and Mental Illness
How Does New Jersey Determine if Someone Needs “Treatment”?
To determine if someone needs inpatient or outpatient treatment provided by our state, reliance upon doctors and psychologists in screening centers are the first line to examine the person, and determine if they are a danger to themselves, to property or to others.
How Does New Jersey Determine Who is Dangerous to Himself or Herself?
In New Jersey, someone is “dangerous to themselves” if, because “of mental illness the person has threatened or attempted suicide or serious bodily harm”, or has behaved in a way that “indicate[s] that the person is unable to satisfy his need for nourishment, essential medical care or shelter, so that it is probable that substantial bodily injury, serious physical harm or death will result within the reasonably foreseeable future”. If your family member is safe when they are with you, and he or she is not a danger to others, then they are exempted from this definition. To determine if your loved one is not a danger to him or herself, the state says we must “take into account the person’s history, recent behavior and any recent act, threat or serious psychiatric deterioration.”
How Does New Jersey Determine if Someone is Dangerous to Others?
In New Jersey, someone is “dangerous to others” if, because of their illness, “there is a substantial likelihood that the person will inflict serious bodily harm upon another person” in the reasonably foreseeable future, taking into account “a person’s history, recent behavior and any recent act, threat or serious psychiatric deterioration.”
How Does New Jersey Determine if Someone is Dangerous to Property?
New Jersey uses the same test as it does to determine if someone is dangerous to others: is there a “substantial likelihood” that the person will “cause serious property damage in the reasonably foreseeable future”, taking into account “a person’s history, recent behavior and any recent act, threat or serious psychiatric deterioration.”
How Will a Person be Treated if They are a Danger to Self or Others?
What happens if the answer to any of those three questions is yes? Treatment is an option. Treatment may be inpatient or outpatient, voluntary or involuntary. Sometimes a person may get assistance instead of treatment because in New Jersey, everyone has the right to be treated in the least restrictive environment.
New Jersey residents may be eligible for different kinds of programs, treatment or assistance. To determine what is appropriate, the first step is screening.
Screening means the process our state uses to determine of a person is mentally ill and/or dangerous. This usually takes place at one of the “screening centers” where crisis stabilization can occur.
Supportive employment means employment with an employer who understands their employee has a disability. It is a competitive work environment for someone whose severe disability requires them to have intensive, extended support in order to perform their job functions.
Residential services and supportive housing are exactly what they sound like: residential placements for individuals with a mental illness, who may not be able to live safely on their own.
Programs in Assertive Community Treatment (“PACT”) is integrated rehabilitation, treatment and support services for people living in the community with a serious mental illness. Services may include prescription management, education, career counseling, job seeking skills training, or other kinds of ongoing support. Services may vary by county and provider.
Voluntary Commitment is treatment provided on a voluntary basis at a hospital, at a short-term care facility, a psychiatric facility or a special psychiatric hospital, either in an inpatient or outpatient setting. Voluntary means the person understands they are a danger to themselves, to others or to property, and agrees to be admitted to a short-term care facility for stabilization and treatment.
Involuntary Commitment is when an individual whose mental illness “causes the person to be dangerous to self, or dangerous to others or property” and “is unwilling to accept appropriate treatment voluntarily after it has been offered“. Involuntary commitment can be in a hospital, at a short-term care facility, a psychiatric facility or a special psychiatric hospital. It is important to understand that Involuntary Commitments must be reviewed, and approved, by a Superior Court Judge sitting in each county.
Crisis Stabilization means screening, sometimes followed by admission to a hospital, short term treatment, and monitoring followed by discharge back into the community, discharge into an outpatient program, or transfer into an involuntary commitment. Most crisis stabilization occurs in a short-term admission to a hospital, through an emergency room or a screening center. Once your family member has been screened, they will be transferred to a facility which can provide short term care. A list of those facilities is available at https://www.state.nj.us/humanservices/dmhas/resources/services/treatment/mental_health/STCFs.pdf
Please watch my video on Power of Attorney to Protect Someone From Mental Illness, Abuse or Addiction
Legal Documents That Help Individuals Helping Others with Mental Illness
The Benefits of an Advance Directive for Mental Health
An Advance Directive for Mental Health, or a Psychiatric Advance Directive, is a document that you can use to direct your health care providers about what kinds of mental health treatment a person will or will not be allowed to provide if a psychotic episode occurs. This legal document “speaks” for a person if they become ill and incapable of making decisions. These documents are private – no one must know about it or its contents unless the signator wants to. A properly drafted Advance Directive for Mental Health enables an attorney to speak with and advocate for him or her if they are hospitalized involuntarily and will enable the person to exercise as much control as possible over treatment. For more information about Advance Directives for Mental Health, contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at firstname.lastname@example.org to make an appointment with to draft an advance directive for mental health to take back control over your treatment.
The Importance of a Durable Power of Attorney
A Power of Attorney is a powerful and important document that allows a person to appoint another person to be his/her legal advocate and representative. If a person with the disability is (in general) of sound mind, it is imperative they sign a Power of Attorney naming the person they choose as their agent. The POA is revocable at any time that the person with the disability chooses, but we can use the POA to gain physical access to a confined person if they are institutionalized and in a psychiatric hospital.
To learn more about a Power of Attorney, please visit our dedicated Power of Attorney web page which explains in thorough detail how a Power of Attorney can benefit you and a person who is relying upon your efforts. Click here: https://www.hnwlaw.com/elder-law/durable-power-of-attorney/
Understanding the Civil Commitment Process
Civil Commitments usually begin when a person is hospitalized or presents to a screening center. If the hospital’s medical staff determines your family member is a danger to himself/herself or to others, or to property, the staff can begin civil commitment proceedings. These proceedings take place in the hospital. They usually start when a suspected ill person says they want to leave. That starts a clock, where the hospital must get a court order for a temporary involuntary commitment. How long the hospital has to get this order depends on whether a person has consented to treatment previously or not, but regardless, it is short, 72 hours or less.
The hospital has to have a psychiatrist sign off on the screening, has to have a second psychiatrist sign off on the state’s screening certificate, and has to request a temporary commitment to get a court order to keep a person confined beyond that time.
Once someone is “temporarily committed”, they have the right to have another hearing, before a Superior Court Judge, no longer than 20 days after the initial commitment occurs. Until then, the commitment will continue until the Judge agrees the person is no longer a danger, whereupon they will be put on what is known as “CEEP” status, and a social worker will begin looking for an appropriate out-placement for him or her.
So, What Does CEEP Mean?
The term “CEEP” means a “conditional extension pending placement”. Translated, it means the hospital thinks your family member can leave, but the social worker has not yet identified whether your family member can or should come home, transition to a residential placement setting, or be referred to an outpatient setting.
If someone important to you has been civilly committed, call to make an immediate appointment with or Fredrick P. Niemann, Esq., to protect his or her rights.
Accessing Services for Minors and Adults with Mental Illness
Not all disabilities are physical. Individuals with a mental illness are entitled to services from the State of New Jersey through the Division of Mental Health and Addiction Services.
For both minors and adults, the first step to securing services for them is getting them Medicaid. If the mental illness was diagnosed before the age of 22, then we can assist you with SSI and Medicaid based upon a parent’s work history. If the diagnosis was not made until after age 22, and the person has a work history, our focus becomes getting the person qualified under social security disability. Getting SSI or SSDI eligibility can be a difficult and time-consuming process but the end results are almost always well worth it.
Identifying Your Priorities
For many, the most important thing for the family is securing a safe place for their loved one to live after they are gone. To secure housing, we almost always need Medicaid first, and NJ Family Care can be a good place to start if a person has not previously qualified for access to Medicaid.
Services range from family counseling “Acute Care Family Support” (educating family members about the housing and personal services process) to mental health and substance abuse treatment programs, homelessness prevention, integrated case management, “Intensive Outpatient Treatment Support Services”, the “Program of Assertive Community Treatment”, to voluntary and involuntary commitments.
New Jersey Wants to Help Disabled Persons Get on Their Feet
It is important that the family connect with the Division of Vocational Rehabilitation Services (DVRS) to investigate possible work-related opportunities. There are supportive employers in the state that can be networked.
It is important for a family to understand that individuals with mental illness cannot usually access services from DDD. This is because most individuals with mental illness do not have an intellectual disability as defined under Federal and State law.
Social Security Disability Insurance Benefits & Supplemental Security Income
Some people living with a mental health condition find that there are periods of time when working becomes too difficult, and they can no longer sustain employment. Fortunately, there are two national programs run by the Social Security Administration (SSA) that provide monthly income and health insurance for people unable to work. Here is some information on both programs:
Social Security Disability Insurance Benefits (SSDI)
To qualify for SSDI, you must have an impairment that prevents you from working for at least 12 months and you must have worked and paid into the Social Security program (payroll taxes or FICA) for at least five of the last ten years.
In 2014, the average SSDI monthly benefit was $1,165. However, the amount you receive is directly related to the amount of FICA taxes you have already paid into the FICA system over your working years.
Supplemental Security Income (SSI)
SSI has two programs, one for adults and one for children (up to age 18).
Children: To quality for SSI benefits, children must have an impairment that has lasted or is expected to last for at least 12 months and that causes “marked and severe functional limitations.” The child’s family must have very low income and resources. When the child turns 18, SSA will make a determination regarding whether or not he or she is eligible for SSI adult benefits.
Adults: To qualify for SSI benefits, you must have an impairment that prevents you from working on a regular and sustained basis. In addition, you must have very low income, resources and assets; to be exact, you cannot have more than $2,000 in assets. Spousal rules are in place as well; if you are married, your spouse must also have very low income, resources and assets. A couple may not have more than $3,000 in assets.
In 2015, the federal payment was $733/month for an individual and $1,100/month for a couple. However, the amount depends on several factors, including your living arrangements.
Disability Claims Process
Most Social Security applications are processed through a local SSA office. An attorney with disability claims experience or a Social Security claims representative can help you prepare your application and file it for you. Payment for disability representation is limited by law—no more than 25% of any retroactive SSI or SSDI payments you receive when you are awarded disability, but no more than $6,000—whichever is the lesser amount. Many professionals will agree to only get paid if you win your case.
SSA has detailed information on how disabilities are evaluated, so make sure to read the SSA criteria for your condition. Go to Disability Evaluation Under Social Security. If your condition is not listed, or if you don’t meet all the criteria, try looking at the standards for qualification under other disabilities. Because SSA does not use the same diagnostic system as medical professionals, you might qualify for benefits under a condition other than that which you have been medically diagnosed with.
Typically, it will take three to five months to get a decision on your application. If approved, the SSA will begin paying benefits immediately. Both SSI and SSDI applicants may receive back pay or retroactive benefits based on when the claim was filed, and the date established as the onset of your disability.
Appealing Your Denied Claim
The majority of claims are denied, and most people file an appeal. You may file an appeal and have a hearing before an administrative judge. Many people whose applications were denied are often awarded benefits by these judges. You might wish to consult a Social Security disability benefits attorney or other professional to guide you through the complex hearings and appeals process. It usually takes about 22 months from the time you apply for benefits until you get a hearing.
SSA has important information about appealing decisions on your disability claim or the amount of your payment at Understanding the SSI Appeals Process and SSA Disability Appeal.
Residential Placement for Person with Mental Illness
Getting a “good” residential placement takes a long time. Think multiple years. So, the earlier you start the process the better. You need to see us as soon as possible.
Having read all or a portion of this site, you likely have questions. At Hanlon Niemann & Wright, we are here to answer those questions and to help you. If we can be of assistance, please reach out to Fredrick P. Niemann, Esq., toll-free at (855) 376-5291 or you can email him at email@example.com. He is very easy to talk to and all discussions are strictly confidential.
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