Behavioral health, substance abuse issues and mental health care for the V.I. community as a whole, in jails and in schools, remain severely under-addressed with ripple effects on everyone’s quality of life. V.I. senators talked about a lot of those vexing problems during a hearing Thursday where they sent a bill establishing “Mental Health Awareness Month” out of committee.
Gov. Albert Bryan Jr. unveiled legislation in January that attempts to offer a comprehensive approach, if not unlimited resources, to mental and behavioral health, including alcohol and substance addiction. It is not a cure-all. But the sooner the Senate considers and acts on it, the sooner the government can begin digging its way out of the hole it has remained in for so long. So where does that bill stand in the Legislature, and how well does it match the problems senators raised this week?
Senate President Novelle Francis Jr. said Friday that Bryan’s bill is currently being reviewed by the Legislature’s Office of Legal Counsel. That office reviews all bills to determine if they are legally sufficient, do what they purport to do, change the correct portions of the V.I. Code, conflict with other local or federal laws or court decisions and so forth.
“It’s very voluminous legislation, more than 100 pages,” Francis said. Because it is a long, complex piece of legislation, it takes some time to review, he said. He added the process will be complete “very soon, perhaps in the next 45 days or so.” From March 6, when Francis gave the estimate, that would be sometime after April 20 or so, barring some unexpected delay.
He said once it is reviewed, he will sponsor it and send it to the Health, Hospitals and Human Services for consideration, stating, “I’m sure, after some amendments and tweaking, we will act on it.”
Many of the concerns raised by senators during Thursday’s hearing are also discussed in Bryan’s proposal.
“In the Virgin Islands, we pick up people with mental health disorders, then they go to court and the court orders them to go away, and things happen while they await the Department of Health to enter a contract with a facility,” Sen. Janelle Sarauw said Thursday. “In the meantime, because we have no facility, we house them in the prison.”
Bryan’s bill (Bryan’s Behavioral Health Bill) mandates that the government establish the territory’s first government-run behavioral health, mental health, developmental disability and alcohol and substance abuse facility.
Sarauw said Thursday she wanted to understand “what dots were being connected” between the Bureau of Corrections, the police and health departments, doctors, nurses and patients because the “process is failing.”
Health Commissioner Justa Encarnacion said they have made progress towards contractual agreements with off-island behavioral health facilities, which will speed up the waiting process a bit.
Bryan’s bill contains provisions outlining the role of the Health Department, its proposed new behavioral health division and the health commissioner, specifically in dealing with the hospitals and schools. It also outlines roles for the Bureau of Corrections and Human Services Department. The bill details who pays for what, under what circumstances and gives the V.I. government and Health Department responsibility to pay up front and then collect from those with insurance or otherwise able to pay.
Sarauw said Thursday the Education Department had $1.1 million in a grant designated for mental health services, which will expire this month, but the department has not spent a single dollar.
“We have not done any wrap-around services for our students in the alternative education system in this district, not one,” she said.
Bryan’s bill has multiple provisions detailing how wrap-around services would be restructured and radically rewrites and consolidate passages of V.I. law concerning behavioral health, mental health, addiction treatment and civil commitment.
Sarauw gave an anecdotal example of a specific, current case where a woman has been held and is “suffering, weighing only 87 pounds and just waiting to be sent to a mental health facility. In the time span it will take to get her from the prison to a facility, she is going to die.”
Bryan’s bill specifically details how the government is to handle and pay for moving individuals into mental health facilities.
Creating a new law is not waving a magic wand. It must be funded, and its provisions actually carried out. And any law carries the possibility of not really accomplishing its goal, having unintended consequences or provisions some may disagree with.
The bill mandates the creation of a new volunteer citizens board: The Behavioral Health Council of the Virgin Islands, a seven-member citizens advisory board and development of an enforceable set of standards for public and private treatment facilities.
The territory currently has well over 100 boards and commissions, most of which do not have full complements of members and many of which are unable to make quorums to act. Bryan has pushed hard on this problem, nominating large numbers of volunteers for various boards.
If Bryan’s proposal is enacted, the Health Commissioner and Health Department will primarily oversee mental and behavioral health programs, coordinating program development with the Department of Education, Bureau of Corrections, V.I. Police Department, Judiciary, Department of Human Services and other agencies.
The bill does not come with a lot of new money for treatment and care. However, it does aim to address gaps in services to residents who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism and drug addiction.
The proposal gives 21 percent of slot machine taxes in the Casino Revenue Fund to the new behavioral health division. According to the Bureau of Internal Revenue, the Casino Revenue Fund received a little less than $2 million in 2019, which is up from around $1.5 million per year in recent years but fairly typical of past years. This comes to about $410,000. That is more than the Source estimated at the time, based on the language of the governor’s press release, which was ambiguous about what percentage of the casino taxes would be diverted.
The bill also says the new division will have a line item in the governor’s annual executive agency budget proposal. While that is not new money, it means the government is committing to allocating a portion of regular projected revenues to the cause but also means that some other priorities will get a little less.
The actual funding for the new facility will be unveiled when Bryan sends down his proposed 2021 budget, due in late May. But there will be specific funding as well as specific lines of authority and people the Senate can call to account who are specifically responsible for precisely these issues.
The legislation is not a cure-all. Sen. Donna Frett-Gregory said Thursday that she was tired of “seeing the wheel go around and round.”
“I know over the years, DOE has received funding for school safety, behavioral health issues, etc. But we are still talking about being in the planning stages. What I would have loved to hear is that we are building on what we have, but it always seems as if we are reinventing the wheel … and in the meantime our children are being left behind,” Frett-Gregory said.
Acting on the proposal would not instantly fix the problem. Frett-Gegory is right to worry about children who might be left behind right now.
But the sooner the Legislature acts, the better.