A regular Source feature, Undercurrents explores issues, ideas and events as they develop beneath the surface in the Virgin Islands community.
In a draft report that includes scathing criticism of the existing system, a government consultant recommends shifting the responsibility for direct mental health care from the Health Department’s Division of Mental Health either to a new entity or, more likely, to the existing hospitals.
Most desperately needed, he says, is an integrated system of care, the elimination of overlapping services and the creation of a “forensics” unit within the territory to house and treat patients whose violent behavior puts them at odds with the law.
A small group of government mental health care providers and private sector advocates who comprise the Consent Decree Commission are scheduled to meet this weekend to discuss the 58-page report and whether they will accept its recommendations.
The commission grew out of a 2003 lawsuit brought by the Disability Rights Center of the Virgin Islands and other groups against the government for its failure to provide adequate mental health care. Most recently, the commission has been working with consultant Synaptic Healthcare and Athena Consulting and the man who authored the report, Christopher Heginbotham. He last met with the group in October.
At the time, the commission considered various options, including maintaining the status quo. Doing nothing, however, is not really an option, Heginbotham said.
“The government’s values and those of professional staff are compromised, over-ridden and shattered by a system that does not appear to care about people with mental health problems,” he wrote. “This does not reflect the values of individuals within government, but the implications of attitudes towards the rights and needs of the most vulnerable members of society is a serious indictment of everyone on the USVI.”
The very fact that it took a class action case to get attention for the problem and that it has taken 10 years to get this far in correcting that problem is telling, he wrote.
The lack of forensic beds for “mentally disordered offenders” is one of the most obvious problems, he said. Moreover, “the lack of supportive and continuous case management, the lack of integration between inpatient and outpatient care, the paucity of staff especially in the DOH (Department of Health) services, and the lack of cohesive funding, all contribute to a pervasive sense of complacency and detachment.”
Heginbotham said, “The DOH services are not run efficiently and effectively. The difficulty in obtaining financial information and the cursory way in which some information was given during the preparation of the report testifies to a lack of grip and recognition of what should already have been done. It is tempting to suggest simply starting over, but that would not solve the problem.”
Instead he suggests changing the Department of Health’s role. Under the five-year plan he proposes, the department would no longer be the provider of mental health services, but it would purchase those services, regulate the providers and oversee the service to ensure quality.
“The most significant recommendation is the creation of an Integrated Mental Health Service (IMHS) that would achieve an integrated mental health and substance misuse service,” he says. Both inpatient and outpatient care could be coordinated through the same entity which would manage the entire “patient pathway” from one type of service to another.
That entity could be a newly created corporation in each island district. However, Heginbotham argues that using the hospitals is a more expeditious choice since they are already heavily involved. The report does not address the fact that the Gov. Juan F. Luis Hospital on St. Croix is currently facing major financial and administrative problems of its own and that its mental health ward has been closed for a year.
The report notes that a number of private sector organizations, including not-for-profit agencies, currently provide services to people suffering from mental illness, and states that it is essential to recognize their importance. But it also suggests that there is overlap and says that, as the restructuring is developed, it will be important “to ensure that the best community organizations are funded and deployed, which may mean some difficult decisions on priorities.”
Other highlights of the report:
– Virgin Islands law pertaining to mental health “almost certainly needs amending to make it compliant with relevant human rights conventions” and “the present committal or detention processes are haphazard and unclear.”
– “reducing stigma will be a critically important factor in encouraging patients to self-refer as early as possible.”
– the option of home treatment should be available in pertinent cases.
– the Legislature should pass a law creating a Consumer Mental Health Watch as a formal route for consumers and caregivers into the regulatory aspect of mental health.
– and even if the territory doesn’t revamp its system, it has to build a forensic unit; the report suggests a 10-bed facility.
The commission’s decision on the draft report is just the first step. The governor will also review it and the courts must approve it if the five-year plan is to be the settlement of the class action suit. Then the Legislature will need to implement it.
Heginbotham does not include much information about the cost of the plan because of the number of variables still to be determined. However, he says that besides the expenses, it would include some cost savings, particularly in personnel, because of the elimination of duplicative services.
The Source published a five-part series about mental health services in the Virgin Islands in November and December of 2013. See below for links to those articles.
