A regular Source feature, Undercurrents explores issues, ideas and events as they develop beneath the surface in the Virgin Islands community.
After years of grappling over the issue, the private-public sector Mental Health Care Commission finally agreed on the way to overhaul mental health care in the territory. Now they can’t get the government to sign off on the agreement.
The Five Year Mental Health Strategic Plan 2014-2019 is dated September 2014, but it has not been released to the public because its authors are still awaiting some government signatures.
A community activist group has asked District Court to intervene and move the implementation forward.
The so-called “final” plan calls for the creation of an independent monitor and a Mental Health Policy Board, which would serve as an “overarching entity” to oversee mental health services that are funded by and provided by the Department of Health, the Department of Human Services and the hospital corporations.
The plan also enumerates a multitude of specific steps for addressing shortcomings in the current system and for improving services. Among them are the establishment of a psychiatry emergency department, extending the time for involuntary commitment from five days to 10 days, establishing an adolescent psychiatric unit and establishing a neuroscience research center.
An earlier version of the plan, drafted by paid consultant Christopher Heginbotham of Synaptic Healthcare and Athena Consulting, recommended privatizing mental health care, or moving it out of the Health Department to the hospitals. Government officials reportedly balked at that idea. The creation of a Mental Health Policy Board and a monitor appears to be the compromise.
The commission has been working on the plan for more than four years, but the issue goes back much further than that. In 2003, several advocacy groups, under the umbrella V.I. Alliance, sued the V.I. government and the various government departments, agencies and officials responsible for delivering mental health care service, charging that it is inadequate. A consent decree resulted and the commission was formed to work out the details to improve service. Its members included government representatives and private sector advocates.
Contacted Monday, Liston Davis, the commission chairman, said the plaintiff side in the case – the advocacy groups – signed off on the plan months ago. But the defendant’s side – the government – has not.
Government signatories are supposed to include the commissioners of Health and of Human Services, officials at both territory hospitals and the attorney for the government, as well as the governor.
When the commission agreed on the plan, they included a period of 120 days, or roughly four months, for implementation. That deadline passed Jan. 15, Davis said.
The government’s attorney for the matter, Raymond Jones, is the one collecting government signatures, Davis said. A message left for Jones Monday afternoon was not returned before press time.
Obviously frustrated, Davis said he’s not even sure which spaces are still blank on the government’s side of the signature page. He said he pushed to get all the necessary signatures before government officials began to leave office because of the change of administrations, but that didn’t happen.
Now some people familiar with the project are gone and some officials are awaiting legislative confirmation.
Davis asked, “Why do you think it took four years” even to agree on a plan? “It was one tra-la-la to the next.”
At this point, another deadline is looming. The plan calls for naming the members of the Mental Health Policy Board by March 15.
Attorney Archie Jennings, representing V.I. Alliance and one of its members, the Disability Rights Center, said he filed a copy of the plan with the court last week even though the government has not signed off on it, because the court gave the parties until Jan. 15 to implement the plan and that date has passed.
“I asked them to reopen the case,” he said. Jennings said he’s hoping the court will “get us to the table … so we can move forward with implementation.”
Jennings said the two sides were even talking about issuing a joint press release about the plan last October. Now he’s worrying about further delays unless the court steps in.
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.