Only days after former Gov. Jon S. Corzine signed five bills aimed at improving conditions for New Jersey's mentally ill residents, recommendations by Gov. Chris Christie's Transition Team raised concern about future care for patients under state supervision.
Chief among the team's suggestions was that one of the state's five psychiatric hospitals be shut down. The Transition Team report did not recommend which hospital should be closed.
But the Transition Team report mentions the federal Department of Justice's scathing report on conditions at Ancora Psychiatric Hospital in Winslow, Camden County, the state's largest and arguably its most troubled facility.
It mentions the state Department of Human Services' commitment to expanding community housing for the mentally ill in the southern New Jersey area with "an eye towards possibly closing the facility in its entirety."
Human Services spokeswoman Ellen Lovejoy referred questions about the report to the governor's office. A spokesman for Christie could not be reached for comment.
Phil Lubitz, director of advocacy programs for the National Alliance on Mental Illness New Jersey, said closing a psychiatric hospital might not save that much money for the state, because New Jersey receives federal funding to pay for the many indigent psychiatric patients.
Two of the new laws signed by Corzine were at least partially prompted by a series of violent incidents and patient deaths at Ancora. Ancora is the the state's largest hospital for the mentally ill, with about 550 patients.
One new law mandates drug testing for job applicants at state psychiatric hospitals, as well as permitting testing of existing employees who are suspected of substance abuse. A second law requires the Human Services report all deaths and assaults at the five state hospitals.
Three more bills Corzine signed aim at reducing the time mentally ill people must wait for treatment in emergency rooms.
Six patients died at Ancora during a 20-month period in 2007 and 2008, sparking an investigation by the federal Justice Department that resulted in a scathing criticism of the hospital. The Justice Department described Ancora in early 2008 as a dangerous place where patients suffered "serious, frequent and recurrent harm."
The state's Division of Mental Health Services says Ancora is a much different place than it was in January 2008, when the Justice Department's investigators visited the hospital.
Among the improvements state officials have touted are a reduction in the patient population from near 770 to about 550; increased training for staff members; more active treatment for patients and greater interaction with local officials.
But Assemblyman Louis D. Greenwald and Assemblywoman Pamela Lampitt, both D-Camden, said the hospital still has a long way to go.
"We haven't received as many complaints, and there are some things that are slightly improved," Lampitt said. "But the physical locality of the building itself does not lend itself to a lot of dynamic changes."
Ancora, advocates claim, is a relic of an earlier approach to mental illness that saw patients removed from society and warehoused for years in large, sterile institutions.
Greenwald said that Human Services has not moved quickly enough to develop the alternatives that would allow patients to move out of Ancora into smaller facilities or group homes where they could receive better treatment.
"My belief is, our push for this type of legislation has changed the direction (at Ancora)," said Greenwald, one of the primary sponsors of the drug testing and assault reporting bills. "Without this type of vigilance, we could easily slip back."
The need for these new laws show that New Jersey's mental health system is in crisis, some advocates say, with a lack of short-term beds for patients, especially children and the elderly. For former patients released from psychiatric facilities, there are not places to live that provide the support services to help them return to productive lives.
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