How Joe Masciandaro built a mental health care powerhouse

Masciandaro spent decades advancing behavioral health care in NJ
Lilo H. Stainton, Health Care Writer, njspotlightnews.org | June 6, 2023

Joe Masciandaro pictured recently, and (right) as a young immigrant in his ROTC uniform: Masciandaro originally envisioned a life in the Army, a career that aligned with his enthusiasm for his new country.

When Joe Masciandaro, the founder and longtime leader of CarePlus New Jersey, got a letter from a woman in Cameroon who needed help getting rural residents to a nearby mental health program, he turned to a network of behavioral health leaders in America and New Jersey-based foundations and civic organizations, including the Rotary Club of Paramus, where he was a member. Together they raised $45,000, which they wired to a Rotary Club chapter they had connected with in the west-central African nation, and that group bought a bus that could transport people to the clinic for care.

“To me she seemed genuine. She seemed honest,” Masciandaro recalled years later, noting that colleagues warned him it was likely a scam. “And I did the same thing in India and Shri Lanka with water wells,” he added, describing projects he helped fund to improve the daily lives of people in far-away lands.

Masciandaro retired last year after 45 years as the president and CEO of CarePlus, a nonprofit based in Paramus that provides behavioral health services, medical care and a host of social services through some four dozen facilities in northern New Jersey. But his impact stretches far beyond the nonprofit’s 20,000-plus annual clients, according to colleagues and leaders in the field, who call him a “pioneer,” “mentor,” “strategist,” “visionary” and “Renaissance man” when describing Masciandaro, an Elizabeth resident. On June 6 he will be presented with the Courage Award by the CarePlus Foundation, an entity he helped found years ago to support the broader mission, the latest in a long line of honors.

A father of six children ranging in age from 28 to 50, Masciandaro said he enjoys a rich life full of family, travel to his native Italy, and zealous bike rides with a diverse and dedicated crew of older men. When his parents were too old to live alone, he moved them into his Elizabeth home, recreating their New York City apartment in his living room. He grows bushels of tomatoes and cans them in the backyard every August with the help of friends and neighbors. He loves to cook, routinely feeding his family after work, offering dinner for 10 at fundraisers and whipping up an asparagus frittata for a visiting reporter.

‘It’s always about the client’

At CarePlus, Masciandaro grew the organization’s portfolio to include programs for both adults and children and expanded from its Bergen County base to provide care throughout the region. He was an early adopter of engaging families in clients’ care, colleagues said, and pioneered efforts to provide both behavioral health and medical care at the same location. Masciandaro led the pushback when Gov. Chris Christie’s administration changed how it paid behavioral health programs — something many feared would bankrupt the state’s patchwork system of community-based care. And he oversaw the transformation of a long-struggling psychiatric hospital in Paramus, now called New Bridge Medical Center.

“Joe has left such a strong footprint on behavioral health here in the state of New Jersey. He’s not one out there to toot his own horn, to be front and center,” said Valerie Mielke, an assistant commissioner with the New Jersey Department of Human Services who oversees the community-based behavioral health organizations that provide psychiatric and addiction treatment to more than 70,000 residents each year. Her job as industry regulator sometimes put her at odds with Masciandaro and other behavioral health organizations.

“But he works very diligently, very quietly behind the scenes to make change,” Mielke said. “And he understands how systems change and that sometimes you have to look at the long game.”

While Masciandaro’s understanding of federal funding requirements, state regulatory structure and the historical evolution of mental health care in this country help him as a leader, those who know him said his primary focus has always been helping those in need. “He was one who never shied away from stepping outside the box to identify an issue, or a need, and he would find a way to meet that need for families and clients,” Mielke said. “Joe sets the tone and it’s all about the people they serve,” she said. “It’s always about the client. And that’s not usually the case.”

Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies — an advocacy group that includes Care Plus — said Masciandaro also believes in the power of quality treatment. “He always put the individual first. And he was always recovery-oriented,” she said. “Few could match his leadership in creating innovative, empowering services. Few could match his genuine commitment to helping mental health consumers recover.”

A dream derailed

Despite dedicating his career to behavioral health, Masciandaro didn’t start out with a passion to help people experiencing psychiatric distress. His mother intended him to be a priest, but after seminary school in Pennsauken, which Masciandaro says included a memorable sermon on the evils of women, he eventually left and set a new course of his own. “I thought, ‘I’m going to take my chances’,” Masciandaro said. “I’m very fine with accepting my mortality. And also alright not knowing what’s on the other side. It’s cool with me. I don’t have to make up a story to make myself feel better.”

Masciandaro envisioned a life in the Army, a career that aligned with his enthusiasm for his new country. “For me, it was a very conscious decision. I wanted to be an American,” he said. Born Giuseppe in Gioia del Colle — near the city of Bari, at the heel of Italy’s boot — he was dubbed Joe upon arrival in New York in 1958. His brother, Orazio, was renamed Oscar. “Once I became Joe, I fully bought into the whole culture and expectations,” Masciandaro said. “I was very gung-ho.”

‘Joe has left such a strong footprint on behavioral health here in the state of New Jersey.’ — Valerie Mielke, assistant commissioner, New Jersey Department of Human Services

This dream derailed when an ophthalmologist at Walter Reed Medical Center discovered a potential vision problem that prevented him from serving. Masciandaro recalls feeling dejected as he passed a waiting room full of young men desperate for any excuse to avoid the draft. His politics shifted significantly over time, however, shaped by public events like the National Guard shootings at Kent State University in 1970 and personal experience like watching a nurse he worked with stare helplessly at the nightly TV news to see if the scrolling list of deceased soldiers in the Vietnam War included her boyfriend.

From Italy to Queens

When Masciandaro arrived in the United States with his mom and brother they joined his dad, a barber, who had come over eight years earlier, following in the steps of his stonemason father. At first the family lived in Astoria in Queens, where neighborhood kids called him a “wop,” an insult he misunderstood for the Italian word for “daring” until his cousins set him straight. Eventually the family moved into an upscale apartment building on the Upper West Side, above the 12-seat barber shop his father ran. “My father hated the Beatles,” Masciandaro said, chuckling. “He said they ruined his business. Before the Beatles, everybody used to get their hair cut every two weeks.”

Masciandaro made his way to St. Bonaventure University, in far western New York state, where he studied psychology and met his first wife, Valerie, before graduating in 1966. His mother connected him with a summer job at the Manhattan Psychiatric Center, a massive psychiatric hospital on Wards Island in the East River, which then treated more than 5,000 residential patients in wards stacked 17 stories high. His first posting in the geriatric ward proved dull, so Masciandaro said he got himself transferred to an acute adult ward and was soon put in charge of tracking down patients who had left the facility on their own, without a formal discharge.

Many of the center’s residents were no longer considered dangerous to themselves or others, Masciandaro said, but those whose families could not take them would remain in “lodging” at the psychiatric hospital, even though treatment was limited largely to group therapy. “The only philosophy was the AA philosophy, basically complete abstinence. And that didn’t seem to work,” he said. “There was no addiction medicine, per se. Those were crazy times. The whole idea was, you brought these people in, you let them sober up — there were no medications, none, even though they were in a psych hospital.”

‘I think the big difference between 1963 and 2023 is there was no hope for a cure. There was no belief that anyone would get better. Now you can get better.’ — Joe Masciandaro

Masciandaro’s time at Manhattan Psych — in the late 1960s and early 1970s — coincided with a seismic shift in the behavioral health field. President John F. Kennedy’s Community Mental Health Act of 1963 had forced the country to rethink how mental health and addiction treatment were provided, shifting services from large state-run hospitals to smaller, nonprofit groups that could treat people while they lived at home. A limited number of inpatient beds would be kept for patients who were deemed criminally insane or a danger to themselves or others, some of whom would eventually be released. (Wards island now has inpatient beds for about 400 people at two separate complexes, half of whom are sent there by the court.)

Tug of war

While resources for inpatient treatment declined steeply, the country has yet to fully invest in the community system, Masciandaro and others note, resulting in a patchwork of poorly funded nonprofit providers that struggle to provide sustainable care. “There’s always been a tug of war about where that money should be dedicated,” Masciandaro said.

Changes to pharmaceuticals over the decades have largely benefited patient care, however, experts agree. “I think the big difference between 1963 and 2023 is there was no hope for a cure. There was no belief that anyone would get better,” Masciandaro said. “Now you can get better,” he said, pointing to the emergence of flawed but revolutionary antipsychotic drugs like clozapine to treat some serious mental health diagnoses and eventually antidepressants like Prozac, for far less severe cases. “We can interrupt the progress of this disease” of mental illness, he said.

At Manhattan Psych, Masciandaro went on to lead research on methadone, working with young men who were addicted to heroin. Eventually he ran a unit for people with alcoholism who were homeless, many who also suffered from psychiatric problems. He received a master’s degree in clinical psychology from St. John’s University in Queens. And working with colleagues, Masciandaro successfully sued the state of New York when a civil service change threatened their job security.

He’s very good at seeing what gets in the way of people getting what they need and finding better resources, or figuring out the system, or where the problems are.’ — Carolyn Beauchamp, president and CEO, Mental Health Association of New Jersey

“That’s when my career changed. That’s when I went from being kind of a clinical person to being more of a community organizer,” Masciandaro said. “I saw the limitations in dealing with you one on one as a patient, (which) can only go so far. But looking at the larger community, looking at the system (that) was really what I thought the more relevant, the more powerful, the more effective means” to improving people’s lives, he said. “And this kind of changed me.”

In 1977, Masciandaro was ready for a change. He had received calls about a bankrupt community health clinic in Paramus and was interested. “The idea of having a direct line between my thoughts, my plans, and getting it done was very attractive to me,” he said. The new job would also introduce him to his second wife, Maria, a psychologist who worked there at the time.

Early struggles

Originally known as Mid-Bergen Community Mental Health Center, Masciandaro eventually renamed the organization CarePlus, based on the tagline, “care, plus mental health care.” After struggling to close an initial budget gap, he set about building what has since become four separate corporate entities. The nonprofit “mothership,” as he calls it, oversees the treatment services, a foundation supports community education and other entities provide workforce skills development and a therapeutic day school, which opened in 2018. “People need to have complete care. It isn’t just the mental health,” Masciandaro said. “They have to have a decent place to live. They need a job.”

Carolyn Beauchamp, president and CEO of the Mental Health Association of New Jersey, a statewide advocacy organization, said Masciandaro has successfully implemented this vision through CarePlus. “I think Joseph is the kind of professional who sees the problem that keeps people from getting what they need, in terms of behavioral health, and he finds ways to solve them through his empire — and I don’t mean the word empire in a bad way,” she said. “He’s very good at seeing what gets in the way of people getting what they need and finding better resources, or figuring out the system, or where the problems are.”

‘We course-corrected some things that otherwise we wouldn’t have, because of his advocacy.’ — Valerie Mielke, NJ Department of Human Services

Masciandaro’s leadership also impacted CarePlus colleagues, said attorney Brigitte Johnson, who started there in 1998 and was appointed president and CEO after Masciandaro’s departure. “I credit our growth to Joe allowing and being open to taking risks, when other agencies were more risk averse,” she said. “It’s a matter of having the foresight to let us venture out of our confines of what we thought mental health was,” she added, as well as expanding the organization’s presence in Essex and other counties.

“You can’t fault an entity for always pivoting,” Johnson added. CarePlus has grown from about 150 employees to more than 500 since 1998, she said, and its budget has expanded from about $15 million to $56 million. “We want to provide quality care in the lives of the people that we serve. And when you seek to serve the whole person, you can’t help but grow.”

Lobbying lawmakers

Masciandaro is widely admired in his field, but concedes he has at least one lasting enemy, due to fallout over the creation of New Bridge Medical Center, formerly known as Bergen Regional Medical Center, in Paramus. And he has regularly challenged government officials in his quests for funding or regulatory reform. When the state sought to do away with a system of monthly fixed payments, replacing it with fee-for-service reimbursements, Masciandaro was a steady presence in Trenton, lobbying lawmakers to step in with additional funding and frequently quoted by the media.

“I don’t fault him for that,” said Mielke, the official charged with implementing change. “I appreciated his advocacy,” she said, “because through that, things evolve and change. We course-corrected some things that otherwise we wouldn’t have, because of his advocacy.”

While the state has slow-walked regulatory reform designed to make it easier for behavioral health care facilities to also offer basic primary care, Masciandaro secured a grant and met with state officials to find a more immediate fix. The rules required separate facilities for each program, but Masciandaro said CarePlus obtained three waivers — permitting it to offer just one bathroom, a single janitor’s closet and one file cabinet for both behavioral and medical charts — but engineered separate entrances, enabling it to provide both services under the law. “It’s nonsense, total nonsense,” he said.

This type of integrated care will save lives, behavioral health advocates say, since people with severe mental illness tend to die decades earlier than they otherwise would, largely because of untreated medical conditions. “When we’re fussing about integrated care, we’re putting pressure on the Department of Health (which regulates health care facilities) and we’re trying to make something happen, he’s already done it,” Beauchamp said. “He understands there’s a need. And he has the energy and persistence and the daring to just make things happen. Which is fabulous.”

Regardless of these accomplishments, friends like Wentz of the New Jersey Association of Mental Health and Addiction Agencies also highlight Masciandaro’s humble nature. He and Maria live in the same house in Elizabeth, with a pampered pup named Percy, surrounded by photographs of their extended family. In the cooler months, Masciandaro’s road bike is set on rollers so he can ride while watching the news, and Maria works remotely from a bedroom upstairs.

“What really captures Joe, when you first meet him, it’s just “Hi, I’m Joe” — very accessible, down to earth,” said Wentz, who was hired by a team that includes Masciandaro, who became her mentor. “He’s just such an amazing, caring person.”