Senate Told Mental Healthcare is still in “Crisis”

Some of the testifiers at Wednesday’s hearing on Mental Health Care in the Virgin Islands.
(Photo by Alvin Burke Jr., Mario Fonseca and Barry Leerdam, Legislature of the Virgin Islands)

Although the subject has been discussed in media for at least two decades and the last two governors have declared mental healthcare emergencies, senators heard Wednesday why the subject is still a “crisis” for residents of the Virgin Islands and is a legacy for politicians.

In March 2019, Gov. Albert Bryan Jr. signed an executive order declaring a mental healthcare emergency in the V.I. due to a shortage of psychiatric physicians and behavioral health providers. In 2016, Gov. Kenneth Mapp also declared a mental health emergency.

More than 20 providers of mental and emotional care were called to testify by the Committee on Health, Hospitals and Human Services with Sen. Ray Fonseca, the chairman. Most of the entities have outreach activities and literature for the public on mental illness, suicide and substance abuse. And some lead support groups. All said they need resources and lack a psychiatrist.

Dr. Nicole Craigwell-Syms, V.I. Health Department assistance commissioner said the Behavioral Health Department continues to apply for grants and hire professional personnel able to live on the wages paid by the government. Currently, DOH has two part-time psychiatrists, 10 case managers, three clinical staff, an opioid project director and several support staff.

Craigwell-Syms said the Eldra Schulterbrandt residence, with its 25 residents, is the responsibility of DOH. Another testifier, Dr. Laura McDonald, suggested some of those residents could be released if there was a psychiatrist to ensure they would not harm themselves or others, have outpatient care and have access to long-acting injectable medications.

“Bringing back just one of the 44 people with serious mental illness being housed off island more than pays for the additional money to put into this position (psychiatrist),” she said.

The department also works with prisoners requiring care. The doctor said it costs Health $14,000 to $15,000 per trip just to transport two patients and officers.

Additionally, DOH pays $500-$600 a day for 48 V.I. residents in off-island facilities. The division also oversees case management and participates in team meetings. As legal guardians, the commissioner approves changes to care plans and medication.

“Often mandated by court orders, these patients require intensive services to address their acute mental health diagnoses, highlighting the increasing demand for specialized care for those facing severe mental health challenges,” the assistant commissioner said.

As a result of Act 8688, sponsored by Sen. Novelle Francis, DOH set up an interdepartmental coordinating committee that communicates with various governmental entities.

Psychiatrist and family physician Laurie McCormick, a part-time resident since the 2017 hurricanes, said the reason there is a mental health crisis in the territory is because there hasn’t been adequate funding for a full-time community psychiatrist for the DOH on St. Thomas. She said there isn’t enough funding because the bill for off-island patients takes most of DOH’s $7 million Mental Health Division budget.

Since the demolition of the behavioral inpatient unit on St. Croix over 10 years ago, there has not been adequate psychiatric treatment nor the funds to send patients to St. Thomas.

McCormick pointed out that there is one psychiatrist on St. Croix who covers the hospital and the Bureau of Corrections but is not available to the public. The two part-timers on St. Thomas cannot take on the St. Croix patients.

Schneider Regional Medical Center’s Chief Executive Officer, Tina Comissiong, said the hospital is required to provide emergency stabilization and inpatient care for people with acute mental health concerns, whether the patient can pay or not. The 8-bed unit usually has six patients. (Gov Juan Luis Hospital is under the same mandate.)

In 2023, there were 107 mental health admissions, and this year, there have been 83. Operating the unit cost SRMC $1.2 million during that time. Additionally, 541 patients were treated in the emergency department for behavioral health issues.

Schneider Regional is also mandated to accept court-ordered patients from the Bureau of Corrections, which adds security and medical care costs to the hospital. The BOC currently owes SRMC $877,000, which she said the Legislature should provide.

“Without sufficient funding, accessible treatment choices, short-term housing options and community-based support services…individuals grappling with mental health challenges often find themselves in a cycle of crises, leading to recurrent hospitalizations,” Comissiong said.

The critical resources called for by testifiers were a residential facility for mental health patients, at least one psychiatrist for each island, a database to search for and apply for grants, and, of course, funding.

Other testifiers included representatives from the Human Services Department, St. Thomas East End Medical Center, Frederiksted Health Care Inc., The Women’s Coalition of St. Croix, Gov. Juan Luis Hospital, the V.I. Bureau of Corrections, The Family Resource Center, Nana Baby Children’s Home, St. Croix Foundation and the Education Department.

Sens. Fonseca, Kenneth Gittens, Marvin Blyden, Diane Capehart, Francis, Marise James, and Milton Potter attended the hearing.