April 6, 2004 – Voices choked with emotion and held back tears as mental health workers banded together to bemoan the public service they described as an inefficient, chaotic, bureaucracy.
"The mental health care that is given here is a big joke," Dr. Derrick Spencer, chief psychiatrist at Roy L. Schneider Hospital, told members of the Congressional Black Caucus, various charitable foundations, and Sen. Douglas Canton Jr. on Tuesday evening at a Virgin Islands Mental Health Roundtable at the Holiday Inn Windward Passage Hotel.
"Unless we admit and address it, we're wasting time," Spencer said.
Maria Ferreras, who has worked in the shops of downtown Charlotte Amalie for 16 years, said she has seen the mentally ill ignored, spat on, hit with sticks and even chased into the sea. "I've dealt with the mentally ill every day," she said. "It's a heartbreaking sight."
Ferreras said when she calls for help in dealing with the dozen or so mentally ill people sleeping in the streets and eating garbage downtown, she is often told there are no resources available to deal with the problem. "I beg you to do whatever it takes — increase funding for the Virgin Islands — to fix this heart-breaking problem," she said.
Dr. Hillary Wynn introduced herself as the Health Department's only psychiatrist — with a caseload of more than 300 patients while being paid only on a part-time basis. She was near tears when she told of her frustrations. "I don't know why I stay," she said as the audience called out in support. "I have made four consecutive appointments with the commissioner of Health, and she has canceled every one."
Because of the Health Department's fractured system, Wynn said, nurses don't necessarily have to follow her orders, and hospital staff often simply choose not to admit her patients when she refers them. She recounted a recent case when a patient became psychotic: There were no male staff members to restrain the patient, and the staff members present could not find the key to the seclusion room.
Wynn said when a child-abuse victim came to her recently, she was the only person still at work, and she had no video camera to record the child's testimony. "I'm a clinician at heart," she said, "but I'm finding I might need to be a politician. And that is disgusting."
Politicians present, including Delegate Donna M. Christensen, who hosted the meeting, said federal mental health funding has been chopped since the 1980s and, because of that, the burden has been put on the truly dedicated.
"But two people can't struggle alone," Christensen said, referring to Wynn and Celia Victor, director of the Mental Health Division.
Clarese Holden, an administrator with the federal Substance Abuse and Mental Health program, said she has fought hard to get the Virgin Islands federal funds, but the territory has found ways of dragging its feet in drawing down the money. "There is no system for actually accepting the funds," she said. "We want to put the monies in your hand, but it's difficult when you give us the wrong I.D. number in the wrong agency. If someone was going to give me $3.6 million in my account, I'd give them the right account number."
Holden said the territory shoots itself in the foot in other ways too. "When we call, we can't get answers," she said. "You don't have the basic necessities you need."
She said, however, that since Victor became director of Mental Health, the territory has been assured of the $3.6 million in federal money that was offered.
Some presenters said money is not the issue. "It's a systems problem," Dr. Rita Dudley-Grant said.."We won't be able to use $3 — forget $3 million — until we can hire and fire when it's needed."
Dudley-Grant said infighting and unwillingness to work for a common goal keep the territory's various mental health agencies apart. "If we can actually be what we're supposed to be — Caribbean people working together — there is nothing we can't do," she said.
Sen. Usie Richards, speaking from the perspective of an 18-year professional in the health-care field, said he believes the key missing elements are structural, not financial.
"My first observation is that there is no structure for organization and providing services to clients," Richards said. "It's not about money. It's about the design of the system is very poor."
He said many agencies are created specifically to meet criteria for federal grants. Then when the grant money runs out, the territory is left with a permanent, unfunded program with an often ill-prepared director.
Richards also said it is common to assume that since money for a service has been spent, the service being offered is adequate. And he said another common problem is to point to the governor or the Legislature as the people responsible for the fixing a problem, rather than looking to community-based answers.
"We need to look at all approaches, at all the factors," the St. Croix senator said.
Some presenters pointed out that the executive branch of the local government was conspicuously absent from the meeting.
There will be more meetings Wednesday and Thursday on St. Croix. A luncheon with discussion begins at noon Wednesday at the Tamarind Reef Hotel. There will be a town hall meeting from 6:30 to 8:30 p.m. Thursday's agenda has a conference from 8 to 9:30 a.m., followed by a press conference from 10 to 11 a.m.
Families with mentally ill members, mental health professionals and anyone else interested in the topic are invited to participate. Christensen said the round-table sessions are intended to foster discussion on how the local government, along with private and not-for-profit agencies, can provide better support for the territory's mentally ill.
For more information, call Christensen's St. Croix office at 778-5900
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