Overburdened and Underfunded: SRMC's Behavioral Health Crisis

Testimony reveals high costs and extended stays driven by lack of community mental health services

  • Nelcia Charlemagne
  • June 06, 2024
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The Schneider Regional Medical Center in St. Thomas, USVI By. V.I. CONSORTIUM

The effective operation of the Behavioral Health Unit of the Schneider Regional Medical Center is being frustrated by a series of factors outside of the hospital’s control.

That was the message from SRMC Chief Executive Officer Tina Commissiong, who testified before the Committee on Health, Hospitals, and Human Services on Wednesday, where the territory’s behavioral health challenges were discussed. Ms. Commissiong was one of over a dozen testifiers who delineated shortfalls in local mental health management.

The lack of wrap-around services, she said, is forcing an increasing number of patients to seek behavioral support from SRMC’s Behavioral Health Unit. Consequently, the unit continues to report an “extraordinarily long average length of stay,” averaging 83 days. The unit can accommodate eight inpatients and there are typically six individuals at any given time. According to Ms. Commissiong, diagnoses range from psychosis, bipolar disorder, substance abuse issues and “suicidal ideations secondary to depression.”

The constant influx of patients who may have otherwise accessed support services elsewhere is creating a major financial burden. “It cost SRMC more than $1.17 million to operate the Behavioral Health Unit in FY 23 and for FY 24, we have already expended more than $764,000,” Ms. Commissiong revealed. In FY 23, the hospital treated 541 patients for “behavioral health-related concerns.” Air transportation, too, is costing the hospital tens of thousands of dollars – $53,000 thus far to transport patients to outside facilities.

‌Mounting issues are further compounded by what Ms. Commissiong described as “the mandate to accept court-ordered patients from the Bureau of Corrections’ Golden Grove prison and patients under the responsibility of the Department of Health.” Inmates with mental health issues are regularly committed to SRMC as they await overseas placement, requiring additional security investments. “They have targeted and injured other vulnerable mental health patients on our unit,” complained Ms. Commissiong, lamenting the cost of additional, 24/7 security service.

‌SRMC remains concerned that the unit could become “overwhelmed by the sudden influx of BOC or Golden Grove patients that should ideally be managed in a psychiatric service within the BOC or Golden Grove [John A. Bell] system.” Ms. Commissiong mentioned that on the mainland, jails and prisons are equipped with their own teams of psychiatrists and psychologists who provide mental health services to the inmates.

‌Compounding the additional therapeutic and security expenses that SRMC must incur to treat those within the criminal justice system, is the large sum owed to the medical facility by the BOC. The Bureau of Corrections, she revealed, owes the hospital “more than $877,000 for services rendered to their clients from 2020 to present.” The Department of Health is also indebted to SRMC to the tune of almost $700,000, of which $157,000 is for security expenses. SRMC’s CEO appealed to the Legislature to source the necessary funding to “resolve this arrearage.”‌

Circling back to the dearth of wraparound services in the territory, Ms. Commissiong informed lawmakers that until short-term housing, outpatient community treatment options, case management follow-up and substance abuse rehab treatment facilities are developed, the hospital’s challenges will persist. While SRMC may prescribe newer long-acting, anti-psychotic monthly injectables “that are easily accessible and affordable in the States,” local Medicaid does not cover their cost. This, explained Ms. Commissiong, “leads to medication non-compliance…and then readmission to SMRC.”‌

Ms. Commissiong neatly summarized the crux of Wednesday’s discussion when she proposed that “to improve mental health care in the territory, we need to work together to ensure that the mentally ill and our community receive the necessary support to be successful.”

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