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Mental Health and Indigent Support in Crisis, Leaders Report

April 20, 2007 — The territory’s mental health and indigent-support system is in dire straits, government officials and charity leaders said Friday at a hearing of the Senate Health, Hospitals and Human Services Committee in Frederiksted.
High poverty levels, combined with shrinking federal assistance, finds housing and mental health services outstripped by the needs of the community, the experts said. Details of services provided came from Catholic Charities, Lutheran Social Services and other community-based groups that joined officials from the departments of Human Services and Health.
The information-gathering hearing served as a precursor to upcoming budget hearings, where all of these organizations will make their case for funding to the Legislature.
“We definitely have a crisis on our hands,” said Assistant Commissioner of Human Services Michal Rhymer-Charles. “We definitely need more resources if we are going to tackle the problem of mental illness and homelessness in the Virgin Islands.”
More restrictive federal assistance eligibility rules in the wake of federal welfare reform in 1996 has steadily cut the number of Virgin Islanders receiving federal welfare checks and food stamps, Rhymer-Charles said.
“Nationwide, welfare rolls have declined by 57 percent,” Rhymer-Charles said. “In the Virgin Islands, the caseload had declined by 67 percent since 1995. In 2000, there were about 1,300 families receiving welfare, and as of April 2007, the number was about 240.”
While the number of people receiving assistance has gone down, the number of families in need has not.
“In the territory 28.4 percent are under 18 and, of that amount, 30 percent are below the poverty level,” Rhymer-Charles said. "That is some 9,000 children living in poverty."
She asked the Legislature to do what it could to help coordinate a comprehensive approach to the problem of homelessness.
“If we don’t implement effective programs, we will continue to see the numbers of homeless rise,” Rhymer-Charles said. “As we begin to see an increase in parents who are substance abusers or mentally ill, it will have a domino effect and impact our children.”
Masserae Sprauve-Webster, chief operating officer for Lutheran Social Services, sees that pattern playing out among some of the children placed at the Queen Louise Home for Children.
“More frequently, we have had children placed due to the mental incapacities of their parents,” she said. “Our goal is the reunification of families. But that is extremely difficult when working with families with mental illness.” Some mentally ill parents are aggressive, and a mentally ill tenant cut her with a knife, she said.
“What is of major concern to us is that we are seeing much of these behaviors manifesting in their children,” Sprauve-Webster said. “Although we have secured counseling and some of the children are on medications, we are not seeing improvements and we are concerned we are merely raising another generation of dysfunctional individuals.”
Denese Marshall, director of Mental Health, Alcohol and Drug Dependency Services, said although her division within Health had improved and expanded services over the past several years, it faces a debt crisis from treating seriously mentally ill individuals in off-island long-term-care facilities.
“On average, the division pays $500 per day for inpatient care and $200 for day treatment at assisted-living facilities,” she said. “Currently the division owes $5,692,976.73 in off-island obligations, and the debt continues to grow.”
If the debt is not paid off, 26 mentally ill Virgin Islanders will either return here or wind up on the streets in the States somewhere, she said. To cut back on those costs and serve residents better, Marshall wants additional funding to construct another residential long-term-care facility and a transitional housing facility.
“Right now we only have the two extremes,” Marshall said. “We have some of the most expensive, long-term inpatient care, the least-expensive outpatient care and nothing in between.”
Senate President Usie Richards questioned whether the organization of the territory’s efforts needed to be rationalized.
“It appears — I emphasize appears — there has been a fragmentation of the effort, with no clear delineation of what group is responsible for what area, true?” Richards said.
A consortium of agencies and organizations has the goal of providing what Rhymer-Charles termed a “continuum of services.”
Richards assured Rhymer-Charles he was not attacking, but looking for answers: “My only goal is to ensure we as a government do not throw money in too many directions on repetitive overlapping efforts.”
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