June 18, 2008 — More staffing, more in-patient beds, more patient follow-up and oversight of medication would make a dent in homelessness and improve the lives of the mentally ill, advocates argued Wednesday at a press conference in the Disability Rights Center of the Virgin Islands on St. Croix.
"We all get together and whine, but what are some concrete solutions?" asked Amelia Headley Lamont, the center's executive director.
Many of the territory's homeless could lead productive lives with better care if they had easier access to treatment and medication, said Judy Bain, the program director of Rainbow House in Frederiksted, a 10-room short-term shelter for homeless men. But the territory's systems for helping the homeless and mentally ill have broken down in recent years, Bain said, letting more patients fall through the cracks and become homeless needlessly.
"Unlike many years ago, when a person is brought into the emergency room with an acute mental-illness crisis, they must meet strict guidelines to receive ongoing care," she said. "What happens to persons taken off the street who do not meet those criteria? They go back out, don't take their medicine and are soon back where they were."
With many patients being rejected for treatment, police who pick up mentally ill persons in the midst of an acute crisis often take them straight to jail, rather than "waste time" taking them to the hospital, Bain said.
Staffing problems make proper care difficult, too.
"There is one psychiatric nurse trying to oversee every patient," Bain said. "The system is poorly, poorly staffed. We badly need to look at this. … We need to have psychiatrists and nurses who will work closely with residents and staff; mental-health workers who function as case managers, occupational therapists" and other staff.
Money is needed, as well.
"We need to position ourselves more effectively to pursue funding opportunities from a wide variety of sources that will support the recovery model of treatment and ongoing public education," Bain said. "Of course, that means being aware of grants that are coming out and writing grant applications each time."
Eliminating the federal cap on Medicaid payments to the Virgin Islands would help a lot, Bain and Lamont agreed. On the mainland, Medicaid payments are an entitlement and paid out according to the level of need. In the Virgin Islands, there is a cap on the total amount of Medicaid money available. That cap, coupled with the relatively high levels of poverty and need in the territory, means there is much less money per patient here than stateside.
But increasing spending is not the sole answer, they say. The first step to a revitalized mental health-care system would be to reestablish acute treatment and community treatment under one umbrella, so all parts of the system talk to one another, Bain said. Right now, acute care is done in the territory's two hospitals, but once a patient is discharged, there is little in the way of a system to follow up and ensure patients are okay and continuing to take medications, she said.
It's important to educate the public, health-care workers and patients themselves, to help remove the stigma attached to mental illness.
"The stigma is often a cause of persons not going for help," Bain said. And if they receive help, they are sometimes barred from training and other job help because of the stigma attached to mental illness, she said.
While the problems are large, solutions are possible, Lamont believes.
"We are a small community," she said. "So I have to believe we can make a difference and solve these problems."
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