NJ Public Advocate seeks greater freedom for people held in state psychiatric hospitals awaiting community placements

TRENTON -- The Department of the Public Advocate has asked the Department of Human Services (DHS) to enhance the freedom of people living in state psychiatric hospitals who have been cleared for discharge but are awaiting a community placement.

On July 2, the Department of the Public Advocate, Division of Mental Health Advocacy, submitted comments to the DHS Division of Mental Health Services (DMHS), on the re-adoption of regulations regarding the levels of privilege and freedoms granted to patients who are on Conditional Extension Pending Placement (CEPP) status.

Read Public Advocate's Comments Regarding Patients on CEPP Status

CEPP status means that these individuals are stable and eligible to be released from the hospital, but have no place to go because of a lack of community housing resources. 

There are more than 1,000 CEPP clients in state psychiatric hospitals awaiting placement, many of them for months and years. State law requires that individuals on CEPP status not be subjected to unnecessary restrictions of their liberty within the institution.

The freedom granted to psychiatric patients in state psychiatric hospitals is based on a “level of privilege” system. At Level I, patients are restricted to the ward or building, on Level II they can leave the building only under staff escort, Level III affords patients the ability to walk the campus and buildings without escort while level IV patients can leave the campus for community or home visits without escort.

For many years, in compliance with a New Jersey Supreme Court mandate, patients were presumed to be Level IV upon designation of CEPP status.  However in 2003, the regulation was changed to remove the presumption of Level IV status.  The Public Advocate has argued that being on CEPP status should correlate with greater freedoms because patients on CEPP status are, by definition, “those who pose no or minimal risk of harm…and who may be discharged upon finalization of after care plans” N.JA.C. 10:36-1-8.

The Public Advocate argues that the current DHS/DMHS  guidelines, which define the level of privileging standard  as the “highest level that provides the necessary supervision” is unnecessarily vague and places the burden of justifying higher Level status on the Patient, rather than on the institution.

The effect of the 2003 change resulted in CEPP patients having nearly identical privilege levels to patients who have been involuntarily committed. In a survey of Trenton Psychiatric Hospital, one of four operated by DMHS, of a total of the 85 CEPP clients surveyed, only one was on Level 4, while  42 were on Level 2.

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