A regular Source column, Undercurrents explores issues, ideas and events developing beneath the surface in the Virgin Islands community. This is the second in a two-part series about health care in the Virgin Islands prison system.
Mr. X has lived much of his life going in and out of the Golden Grove Correctional Facility. He has family on St. Croix, but they can’t always deal with him. Chronically mentally ill, Mr. X has periods when he simply “goes off” and “acts out.” He doesn’t like it, but that’s the way it is.When he’s out on his own and he does something unacceptable, he lands back in jail.
The cycle was well established when Vernita Charles, Health Services administrator for the Bureau of Corrections, first met Mr. X.
He was so withdrawn, she said, “I didn’t know he could talk.”
But recently he received a new medication and the result was astounding.
“This time around, he actually got treatment,” Charles said. “He’s present and lucid …There was a person under there all the time.”
The cost is also astounding: $2,500 a month. But he’s eligible for medication assistance, Charles said, so he can take a monthly shot and function – outside the prison.
More than a quarter of the prison population is classified as “mentally ill.” All of them have special needs and all, by federal mandate, must be isolated from the rest of the other inmates.
As of the end of October, there were 55 mentally ill inmates at the territory’s main prison on St. Croix, Golden Grove, and another 35 on St. Thomas, which has two smaller facilities designed for detainees awaiting trial and/or sentencing and for people serving relatively short sentences.
That’s 90 out of a total population (detainees and convicted prisoners) of 350 prisoners territorywide.
Another 13 mentally ill Virgin Islands prisoners are in stateside facilities because they require a higher level of care than is available in the territory.
Corrections lists 27 different diagnosis classifications. The most common at Golden Grove are schizophrenia, psychosis/paranoia, major depressive disorder, drug induced psychosis and mental retardation. On St. Thomas the top five are similar: bipolar disorder, schizophrenia, borderline personality disorder, major depression and drug induced psychosis.
“We actually have one of the best mental health facilities in the territory,” Charles said. There are professional case managers, clinical social workers and counselors working regularly with inmates. Additionally psychiatrists on both islands make routine visits and are available for crisis intervention. Dr. Leighmin Liu serves on St. Thomas, and Dr. Evadney Sang serves on St. Croix.Sang is a forensic psychiatrist, the only one in the Caribbean.
“It’s a really good program we have. However, we’re limited,” Charles said.
The limitations have drawn considerable attention for many years from critics who charge that the territory uses its prison system as the dumping ground for troubled citizens failed by the regular health system.
In 2013 a V.I. commission charged with improving mental health care received a comprehensive report from its consultant, Christopher Heginbotham of Synaptic Healthcare and Athena Consulting, that recommended a complete overhaul of the system.
With or without the overhaul, Heginbotham said, one absolute “must” was the establishment of a forensics unit that could house chronic seriously mentally ill persons like those now shunted off-island to stateside facilities.
Unless and until that happens, Corrections will continue to deal with individuals struggling with alcoholism, drug addiction and various types of mental disorders that drive them to anti-social behavior – as well as providing dental and eye care and regular medical care to all inmates and detainees.
Charles said the bureau recently drafted its health policies for approval under the federal consent decree whi