The V.I. Department of Health is searching for new treatment placements for three Virgin Islanders currently at the Sylmar facility in California after a court judgment directed that the remaining patients there be removed “as soon as possible,” health officials told lawmakers Tuesday.
At least two of the three require levels of care that the Virgin Islands currently cannot provide, Deputy Health Commissioner Renan Steele told the Senate Committee on Health, Hospitals and Human Services. The department is therefore exploring other mainland facilities while considering whether one of the patients could eventually return to a local behavioral health setting.
The issue arose after Senate President Milton Potter asked whether any mainland behavioral-health providers had threatened to discharge or return Virgin Islands patients because of unpaid bills.
Mr. Steele said the situation at Sylmar was different. “Sylmar was not interested in renewing the contract, so we couldn't continue services there,” he said. The department must now move the three remaining Virgin Islands patients following the court's instruction that they be removed from the facility as soon as possible.
The cases illustrate the different levels of care the territory is attempting to secure.
One patient requires a “skilled nursing center,” Mr. Steele said, and DOH is examining a Florida facility capable of providing that level of care. A second patient's placement is connected to the V.I. Bureau of Corrections because the individual was found not guilty by reason of insanity.
The third patient may require a less intensive setting. Mr. Steele said that individual is “probably able to go to a step-down facility,” with DOH considering another facility in Florida or a possible placement at the territory's Eldra Schulterbrandt Residential Facility.
The three patients are part of a much larger off-island behavioral healthcare system maintained by the Virgin Islands because certain specialized services are unavailable locally. Mr. Steele told senators that 56 Virgin Islanders are currently receiving care at mainland facilities, at an annual cost to the government of approximately $11.8 million.
Those facilities provide treatment the territory cannot currently deliver for some patients, but the arrangements create considerable financial and administrative demands for DOH.
Sylmar currently costs the territory approximately $550 per patient per day, Mr. Steele said. Depending on the facilities ultimately selected for the three individuals, he said the department could actually reduce its off-island expenditure after the transfers are completed.
The broader dependence on mainland placements was a recurring concern during Tuesday's hearing.
Mr. Steele said those placements “create significant financial and operational obligations for the Territory,” reinforcing the need to expand both treatment and step-down capacity locally so that residents do not have to remain thousands of miles from home for services that could eventually be provided in the Virgin Islands.
The territory's behavioral health system is already serving a substantial population locally. According to Mr. Steele, the Division of Behavioral Health provided services to 818 people during fiscal year 2025, including what he described as a significant number of residents living with serious and persistent mental illness.
That population, he said, underscores the need for sustained psychiatric services, clinical care, case management and recovery support.
The division is simultaneously dealing with staffing shortages. Mr. Steele identified five critical vacancies involving substance-use services, opioid response, nursing and clinical care. Seven general-fund positions that were previously eliminated have also not been restored, including clinical, supervisory, outreach and support jobs.
Those vacancies “limit the Division's capacity,” he warned.
Lawmakers focused much of Tuesday's discussion on what happens before a behavioral-health crisis becomes severe enough to require hospitalization, institutional care or law-enforcement intervention.
Senator Kurt Vialet questioned a system in which families may repeatedly seek help for relatives but intervention does not occur until an individual meets the clinical threshold of being a danger to themselves or others. He cited the experience of a mother who repeatedly sought assistance for her daughter before the woman ultimately attacked someone in public.
“We have to sit down and collectively do something different with this definition of danger to self,” Mr. Vialet said.
Mr. Steele said he understood the frustration experienced by families, but emphasized that decisions involving involuntary intervention require specific clinical assessments.
“When it comes to a clinical determination, when you deal with a mental patient, it's very specific,” he said.
A person who does not satisfy the clinical criteria at one point may later deteriorate, Mr. Steele explained. In those circumstances, DOH attempts to remain in contact because “they may be okay today and tomorrow they may now meet criteria.”
Senator Novelle Francis Jr. similarly questioned whether earlier intervention could prevent behavioral-health problems from progressing into the severe crises increasingly visible in the community.
If treatment occurred earlier, Mr. Francis suggested, some cases “would not have manifested into what we are seeing today.” He asked what interventions would be necessary to prevent individuals from reaching what he described as a “manic stage.”
Mr. Steele called the problem a “complex situation,” noting that there is no single path through which people arrive at a behavioral-health crisis.
Some patients stop taking prescribed medications and subsequently experience a return of psychosis, he said. In other cases, DOH encounters “substance-induced psychosis” associated with street-drug use. Still others may begin with heavy alcohol consumption before progressing into depression and further decline.
Compounding the problem, Mr. Steele said, is the territory's lack of a dedicated short-term residential facility where people can receive structured care without requiring long-term institutionalization or being returned immediately to the community.
Mr. Francis said the absence of such options also places tremendous strain on relatives, leaving some families effectively living “under siege because again they have no help.”
“We don't want to wait until individuals become a danger to themselves because if they're a danger to themselves, they're a danger to the community as well,” he said.
The three impending transfers from Sylmar therefore represent only one immediate challenge within a much broader problem confronting the territory: finding appropriate care for residents who cannot safely be served by the existing local system while simultaneously building enough capacity at home to reduce the Virgin Islands' dependence on expensive mainland placements.
