Dr. Nicole Craigwell-Syms, assistant commissioner at the Department of Health, testifies before lawmakers on behavioral health funding gaps, including $18 million DOH says it has not received. Photo Credit: V.I. LEGISLATURE.
A V.I. Department of Health update on the state of behavioral health care in the Virgin Islands drew concern from lawmakers Thursday after officials said major appropriations intended for behavioral health infrastructure had either been insufficient, delayed, unused or never received.
Dr. Nicole Craigwell-Syms, assistant commissioner in the Department of Health, told the Committee on Health, Hospitals, and Human Services that a review of prior appropriations “reflects a pattern of delayed access to funds, partial utilization, and ongoing gaps in infrastructure and workforce capacity.”
She said that while the Legislature has “authorized significant investments in behavioral health, challenges in funding have affected sustainability.”
Craigwell-Syms then outlined several legislative actions, including some that did not result in full financial support for the projects they were intended to advance.
Act 8152 appropriated $3 million to establish a behavioral health facility at Anna’s Hope. However, she said “the total amount appropriated was insufficient to support demolition of the existing structure” and construction of an appropriate facility. The funding was instead used for architectural and engineering plans.
Act 8957 established the 988 Suicide Prevention and Mental Health Crisis System and created a 988 Trust Fund “supported by a $1 telecommunication surcharge.” According to Craigwell-Syms, “the Act allocates 30 percent of the Trust Fund revenues” to DOH. However, she said the Department has “not received any funds to date because surcharge revenues have not yet been collected.”
The most pointed discussion centered on Act 8920, enacted in September 2024, which appropriated $18 million from the Epstein settlement funds for a behavioral health facility at Anna’s Hope. The same act appropriated an additional $3.5 million for renovations to the Eldra Schulterbrandt Facility.
Craigwell-Syms told lawmakers that “these funds were not received by the Department of Health, preventing advancement of these critical infrastructure projects.”
The absence of a fully functioning behavioral health facility has limited the Department’s ability to provide comprehensive services to those most in need, an issue that became one of the main points of Thursday’s discussion.
DOH, however, said it continues to explore options. Craigwell-Syms told lawmakers that the true cost of a comprehensive behavioral health facility could be as much as $240 million, an amount senators said the government does not have.
Still, the department is also evaluating smaller-scale approaches to advance the behavioral health continuum of care. According to Craigwell-Syms, DOH is “evaluating potential uses of approximately 9.8 acres at the Anna’s Retreat site on St. Croix.” The department is considering a “small-scale, community-based housing model” using tiny homes to “provide transitional and supportive housing linked to behavioral health services.”
Craigwell-Syms said the “anticipated funding source” is the Fiscal Year 2027 Community Project Funding Request through the Office of Congresswoman Stacey Plaskett. The Department has requested $4.5 million.
Although funding has been requested, Craigwell-Syms said “any advancement of this concept would require a formal feasibility study, stakeholder engagement, and multidisciplinary planning…”
The lack of a facility, and the uncertainty surrounding funding to develop one, troubled lawmakers.
Senator Novelle Francis said he was “a little disappointed” regarding the Anna’s Hope facility, noting that the Department of Health has been advocating for the project “for quite some time.” He questioned the status of the $18 million settlement fund and the “difficulty” in accessing it.
Craigwell-Syms said a “deep dive” is needed. “We have been told that it's not there, so we would really have to do our due diligence,” she said.
Senator Francis continued to question the matter, noting that the “$18 million was cash on hand….So how is it that this money is not available?” Craigwell-Syms “couldn’t answer.”
Senator Kurt Vialet asked whether DOH had made a “formal request to OMB for the release of the $18 million.” Dr. Craigwell-Syms said it had not.
Vialet urged the Department to act quickly. “If you can't get that money, that mean it was spent, and those monies were not supposed to be touched,” he stated. He encouraged a cabinet-level discussion on the issue.
Senator Alma Francis Heyliger argued that DOH should not have to request money already directed to the Department by law.
“The Legislature already executed legal documents through bills to say where that money needed to go. Why do you have to ask them for it?” she asked.
Ms. Francis Heyliger spoke at length about the Department of Finance’s use of the settlement funds without legislative permission.
“They're spending the money; it's that simple. And then when it's not available, everybody acting surprise,” she accused.
There was no official confirmation Thursday that the $18 million is unavailable. Still, Francis Heyliger maintained that “you shouldn't have to beg for your $18 million. It was in that deal.”
DOH is expected to conduct its promised “deep dive” into the status of the funds as the gap between behavioral health crises and available care continues to concern lawmakers.
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