This is the second of a five-part “Undercurrents” series examining the subject of mental illness in the Virgin Islands – its scope, its effect, and how it is and how it is not being addressed.
Psychologist James Kloss, Ph.D., works for the V.I. government. He counsels people who have emotional or mental disorders, most of them under the age of 18, and he manages contracted care providers offering similar services. Based on St. Croix, he travels regularly to St. Thomas and sees clients from all three islands. He’s at the center of the territory’s front guard for children.
But he does not work for the Division of Mental Health. He works for the Department of Human Services because it takes the lead in residential placement for troubled youth. DHS also provides mental health-related services to children and their families.
Much of Kloss’s work involves evaluating children and teens for possible placement in residential care. Typically they have been referred to DHS by Education, by the Health Department, by the court, by their family or, often, by their foster family. Human Services places them in facilities run by private groups, generally non-profit organizations.
Kloss and Celia Victor, Pharm.D, the administrator of Residential Services for DHS, and, coincidentally, a former director of Mental Health, said they see a wide range of problems.
Among the more common, said Kloss, are children who are victims of domestic violence and/or sexual assault or who are abused or neglected; those who are developmentally disabled with conditions like attention deficit hyperactivity disorder (ADHD); and those who are “acting out,” committing “status offenses” – that is, things that aren’t wrong for an adult, but are breaking the rules for children, like skipping school or staying out late.
Kloss said he gets about 75 to 100 referrals a year.
“If Mental Health services were more robust,” many of these cases would go there rather than to Human Services, he said.
A major reason the Virgin Islands doesn’t have enough facilities is simply because of its size and its location. No community of 100,000 can support all the specialized services that may be needed, Kloss said, and, being isolated from the mainland, the Virgin Islands can’t easily depend on a neighboring jurisdiction to fill in the gaps either.
Still, he thinks the territory could do a better job.
“The resources we do have aren’t very well-organized or connected,” he said. That is especially true for human resources. While Mental Health and DHS have relatively few psychologists, Education has access to many because of federal funding but their role is primarily assessment, not counseling. And he believes some other professionals are underutilized.
“You don’t need a Ph.D. to do everything that I do,” he said. There are paraprofessionals, counselors and others who could deliver some mental health support services, working under supervision.
Dara Hamilton, Ph.D., a psychologist working for Education and also in private practice on St. Croix, agrees that “counseling is more needed everywhere.”
In the schools, “we do a lot of testing, but we don’t do a lot of counseling,” she said. “We deal with a very small percentage of the school population,” – basically those in special education – and “what you address is very narrow too.” Issues must be education-related.
Having said that, school psychologists can and do play a role in addressing mental health. Typically, Hamilton said, she works with students who have problems with learning, and that can include emotional problems. If the problem goes beyond education, the school psychologist will make a referral to Mental Health.
“We are able to help students who might (otherwise) fall through the cracks,” she said.
Experts say that genetics play a key role in mental disorders, but that environment can also be very important. Hamilton points to a number of factors that may exacerbate the problem in the Virgin Islands.
“I believe we live in a very violent community,” she said. “Violence goes along with poverty” as do many other negative factors such as poor nutrition, poor education and a lack of opportunity. All of these things create stress that feeds on itself. “I think it becomes a cycle, as many things do if they’re not interrupted.”
A case in point is the boy who approached her at school seeking help. He was very upset; he had seen a dead body after a shooting and was clearly traumatized by it. She made a referral to Mental Health, but sometimes the wheels turn slowly. Before any help came, the boy got into an altercation with a school administrator, and was arrested for assault.
“We could use some more resources in the territory” including more counseling, Hamilton said.
The number of children suffering from a mental disorder are large, according to Victor. She cited national estimates that about 20 percent of adolescents have a mental disorder and that 67 percent of youth in the juvenile justice system have some form of mental or emotional problem. Treatment is important, and it is costly.
“It costs lots of money to run residentials,” Victor said, and “the cost is extremely high” to place children off-island. That’s an extra incentive to try to keep children in their families, assuming the family is not the problem.
Victor provided the following list of placements within the territory, and the annual cost:
- Queen Louise Home for Children – for children birth to age 12, for abuse/neglect. Currently seven placements. Annual cost $656,250, Lutheran Social Services;
- Sister Emma Cottage – children birth to age 12, severe disabilities. Currently five placements. $619,500, Lutheran Social Services;
- Girls and Boys Group Homes – adolescent group homes for non-adjudicated youth with serious behavioral problems, currently 11 placements. Annual cost $1.1 million, V.I. Behavioral Services;
- Crisis Stabilization Center, short term crisis and evaluation center for youth. Currently four placements. Annual cost $1 million, V.I. Behavioral Services;
- Girls Cottage, adolescents in crisis who have history of abuse/neglect. Currently five placements. Annual cost $540,618, V.I. Behavioral Services;
- St. Thomas Healthcare/Seaview, short term psychiatric treatment for adolescents. Currently 10 placements. Annual cost $2.1 million.
There is also a day treatment program at Seaview for middle school and junior high students with emotional problems, currently six placements and an annual cost of $455,486.
Human Services also sponsors group homes for adults, one on St. Croix (Ginger Thomas) and one on St. Thomas (Yellow Cedar,) both operated by Lutheran Social Services.
Besides the people served in the territory, Human Services is paying nearly $7.5 million annually for people placed in stateside facilities for specialized services. Of the 57 patients currently housed off-island, 12 are under the age of 18. These are:
- Sequel Youth Services at Woodward Academy and Clarinda Academy in Iowa, adjudicated youth with behavioral problems for treatment needs beyond what is available on-island and at-risk delinquent females. Currently three placements;
- San Marcos Treatment Center, Texas, neuropsychological treatment, currently three placements under age 18;
- Carlton Palms, in Eustis, Fla., specialized, intensive treatment/autism, currently two placements under age 18;
- Devereux, Fla., long-term treatment for autism and mental dysfunction, currently four under age 18.
(Next: Incarcerating the mentally ill)
