The Senate Health, Hospitals and Human Services Committee on Thursday reviewed the territory’s mental and behavioral health system, hearing testimony on staffing shortages, facility delays and gaps in services.
Assistant Health Commissioner Nicole Craigwell-Syms warned that mental illness is a “significant and growing public health concern” in the territory, citing rising rates of depression, anxiety, substance use disorders and serious mental health conditions. She said the challenges are driven by economic stress, trauma, social isolation and limited access to care, while chronic workforce shortages, geographic barriers and resource constraints make it difficult to meet demand.
“If we are serious about improving behavioral health outcomes in the Virgin Islands, we must equally be serious about building the system required to support them,” Craigwell-Syms told lawmakers. “Effective behavioral health care cannot exist without the necessary infrastructure, sustainable funding, adequate workforce, and coordinated services.”
Residents who require hospital-level psychiatric care are often treated at off-island facilities, and many have limited continuity of care once they return home. Craigwell-Syms said the territory lacks a permanent supportive housing system for people with serious mental illness who are discharged from inpatient or residential treatment programs. As a result, some residents face housing instability, repeated psychiatric crises, frequent emergency room visits and increased interactions with law enforcement.
While the Health Department has expanded outpatient services, case management, school-based programs, telehealth and mobile outreach efforts, officials said those programs continue to operate within a system that lacks key long-term treatment and housing resources.
Lawmakers spent considerable time questioning the status of two facilities viewed as central to the territory’s plans for expanded behavioral health and long-term care services: the proposed behavioral health campus at Estate Anna’s Hope on St. Croix and the Eldra Schulterbrandt Residential Facility on St. Thomas.
Craigwell-Syms testified that planning work for Anna’s Hope envisions a comprehensive behavioral health campus with crisis stabilization services, a secure forensic unit and supportive housing. However, engineering assessments found that existing structures on the site could not be renovated to modern standards, and the full project carries an estimated cost of about $240 million.
Officials said that the price tag has forced the department to treat the master plan as a long-term goal and instead pursue a phased approach focused on smaller, more affordable projects, including a concept for modular or tiny-home units to provide supportive housing while officials seek funding for larger facilities
“Our goal is to build what we can and keep building as we receive funding,” Craigwell-Syms said, explaining that tiny-home style units would serve as transitional housing while the department looks for funding for larger facilities.
Senators also questioned the status of the Eldra Schulterbrandt Residential Facility on St. Thomas, where officials said a shortage of nurses and ongoing renovations have limited occupancy in the existing 32-bed facility to about 20 residents. A newer building damaged during the 2017 hurricanes remains tied up in a dispute with FEMA over whether it should be repaired or rebuilt, limiting the territory’s ability to expand capacity for long-term care residents.
Several senators questioned the status of settlement funds previously allocated by law for behavioral health initiatives, including money tied to the Jeffrey Epstein-related settlement. Sen. Novelle E Francis said he had sponsored or cosponsored multiple pieces of legislation related to behavioral health funding and expressed concern that the funds had not yet reached the Department of Health.
Sen. Alma Francis Heyliger said health officials should not have to “beg” for funding that has already been approved by the Legislature and warned that delays in releasing the money undermine public trust and limit access to care. Citing concerns that settlement dollars tied to the Epstein case have been used for purposes beyond what lawmakers intended, she argued that the Legislature shares responsibility if it does not intervene. “If we, as a legislature, ain’t going to stand up and stop the craziness, we are partially at fault,” Heyliger said
The testimony described a behavioral health system in which outpatient and community services are expanding, but significant gaps remain in infrastructure, inpatient care and supportive housing, while senators said they will continue seeking clearer accounting of past appropriations and will continue monitoring long-delayed facilities and programs.
