This is the third of a five-part “Undercurrents” series examining the subject of mental illness in the Virgin Islands – its scope, its effect, and how it is and how it is not being addressed.
If, as all the experts say, only a fraction of the people from the Virgin Islands who are seriously mentally ill are housed in treatment facilities, where do all the rest go?
The answer is nowhere – until their condition becomes untenable. Then they may very well end up in jail.
As the mental health coordinator for the Bureau of Corrections on St. Thomas, Ruth Warren is the person trying to hold the lid on at the Alva A. Swan Correctional facility in SubBase and the Alexander A. Farrelly Criminal Justice Complex in downtown Charlotte Amalie. The Justice Complex is used primarily for detainees awaiting the disposition of their cases, and Swan for prisoners serving relatively short sentences, generally less than two years.
“You can’t just make the jail the mental health facility, and that’s what’s happening now,” Warren said.
The territory has only one long term residential facility for the mentally ill, the Eldra Shulterbrandt facility. Right now, as it is undergoing renovations, it houses just 32 people. Some seriously ill patients are sent to facilities stateside, but the cost is prohibitive, and besides it’s not a viable option for many.
At the time of a Source interview, the percentage of inmates with disorders was staggering. Of the 103 prisoners then at the island’s two short-term facilities, Warren said she was treating 48 of them for mental health problems and/or substance abuse. However, she added that a more usual number would be about 35. That would still work out to about a third.
Warren said currently there also are about 50 St. Thomas prisoners in facilities outside of the territory, but she could not say how many of those have mental disorders or substance abuse problems.
At the Golden Grove Adult Correctional Facility on St. Croix, which houses inmates facing longer sentences, there were 25 mentally ill patients in mid-November, according to Juel Anderson, BOC public information officer. That included both detainees and people who have been sentenced. Additionally, eight inmates with mental health problems are in facilities stateside, one in Virginia and seven at Sylmar Rehabilitation in California.
The Golden Grove total population is currently 469, including 109 prisoners who are currently serving terms stateside. That means the percentage of mentally ill prisoners for St. Croix is lower than for St. Thomas.
Warden Basil Richards said he does not know the reason for the apparent disparity, but concurred it could be partly because of the nature of the offenses. Many of the mentally ill inmates and detainees have been arrested for relatively minor crimes that don’t warrant the longer terms of inmates housed at Golden Grove.
At the jail on St. Thomas, BOC has contracted with two psychologists to work with the prisoners once a week, on Wednesdays.
“I only have them for three hours,” Warren said. Other than that, there is no other staff to work specifically with the mentally ill. “It’s me.”
A social worker with a master’s degree, Warren said she has been at BOC for about four years.
She said she helped create some mental health programs for the bureau and assists with drafting policy and procedures as well as assessing inmates, seeing clients and developing and facilitating therapy groups.
The treatment provided consists mostly of medication, individual therapy, and group therapy, for those who are able to work in a group. Warren also makes referrals to the psychiatrist working at the hospital’s behavioral unit when that seems necessary.
Many of her clients already have been formally diagnosed. Others are exhibiting behaviors that suggest a mental disorder or substance abuse, so they are evaluated by Warren and the psychologists.
Female prisoners are a very small minority of the prison population. There are no mental health programs offered for them at the jail, Warren said, citing that as a definite lack.
With few exceptions, the men suffering from mental disorders are housed in a separate unit from the rest of the inmates, Warren said. “The goal for us is to get them into the general population” once they are well enough to function there, but there are relatively few such transfers.
Warren said BOC has started to do some training for Corrections officers in how to handle prisoners who are mentally ill, but indicated that much more is needed.
“It’s really hard dealing with people when you don’t understand the nature of the illness,” she said.
Let’s take the example of a mentally ill man who is experiencing a psychotic episode. He is hallucinating; he thinks people are talking about him; he thinks there is something in his cell that can harm him, and he’s afraid to go in there. He isn’t paying attention to the guard who is telling him to get back into his cell; he is listening to other voices.
If the man were in a mental health facility, a staff person could talk with him patiently and help him come to terms with the circumstances, perhaps even help him through the episode.
“Here, you’re not going to get the time to deal with him,” Warren said. The guard has a job to do, and right now it is to get all the prisoners back into their cells.
A prison guard’s focus is threefold: Secure, Monitor, and Custody Control, Anderson interjected. That’s primarily what they are trained to do.
When a prisoner and a guard don’t understand one another “everything they do kind of gets out of control,” Warren said.
“We have several people who go in and out of the hospital,” she said.
Mental patients in crisis are seen at the hospital’s behavioral unit where they are stabilized, generally with medication. Some may be referred to facilities off-island or to the Shulterbrandt facility, but most return to their previous circumstances. So if they were in jail, they go back to jail.
Warren did not have actual statistics, but said she thinks the numbers of mentally ill in the V.I. prison system are rising somewhat.
In a recent two-week period, three veterans have joined the ranks, exhibiting symptoms of trauma and possibly post-traumatic stress disorder (PTSD).
“This group is new to us,” she said, adding that she is now trying to work with Veterans Affairs to get them assistance.
“A lot of stuff that brings them to jail is domestic issues,” she said. The men may be suffering from nightmares, agitation and fear-provoking issues, and they respond inappropriately.
Similarly, Warren said men who are chronically homeless and wander the streets are often incarcerated because they exhibit bizarre or threatening behavior. She has a theory that when the downtown area becomes more crowded, as during tourist season or Carnival, the police are more active in responding to complaints of homeless people harassing others.
“We seem to get a few more people in here” during those times, she said.
Of course, there are some mentally ill inmates in the system because of serious crimes. But Warren suggests far more of them are incarcerated because of infractions they committed precisely because they are ill.
Sentences are generally short, especially for those housed at the Farrelly and Swan complexes, and BOC is obligated to ensure the men have an address to go to when they are released from jail.
“We try to do that,” Warren said. BOC works with family members to establish placement. If that doesn’t work, they contact one or another of the non-profits who work with homeless people, most likely Karen’s House (which is specifically for the mentally ill) or Bethlehem House Shelter for the Homeless.
If none of the non-profit organizations can take them, “They’re back on the street,” she said. “There’s no other place to go.”
“We’re just warehousing them and sending them back on the streets,” said Richards. “I think it’s unfair … All we’re doing is medicating them rather than treating the illness.”
(Next: Up close and personal with mental illness)