With few treatment options available in the U.S. Virgin Islands, the burden of housing and treating people with mental illness falls substantially on the V.I. Corrections Bureau.
BOC Director Wynnie Testamark told lawmakers on the Senate Budget, Appropriations and Finance Committee Wednesday that the BOC — one of the territory’s primary providers of mental health care — spent close to half a million dollars on psychological and psychiatric support services in 2024 and nearly $350,000 in 2025. Approximately 40% of the inmates housed in the territory receive some form of mental health treatment.
“These investments are essential to meeting the behavioral health needs of the incarcerated population, including those facing serious mental illness, substance use disorders and trauma-related conditions,” she said.
Incarcerated people who require specialized treatment are frequently remanded to the custody of the Health Department, which bears the cost of placing them in off-island treatment facilities. Health Commissioner Justa Encarnacion told the Source in May that it costs $250 to $1,000 per day to house these individuals, and the territory spends close to $14 million per year to do so, up from approximately $10 million just three years ago.
According to Wednesday’s hearing, the cost to the territory is even higher.
Testamark said during Wednesday’s testimony that the bureau spent close to $5 million on overtime in 2024. As of this week, the BOC has spent nearly $3 million on overtime in 2025, which Testamark said was largely driven by officers having to accompany those being sent for behavioral health treatment on the mainland.
“So once the officer leaves the territory, they have overtime until they get back,” she said. “So a lot of that is attributed to that — those special details — or if we have someone in the hospital, you know, special details.”
Besides being expensive, court filings show that the system frequently leaves incarcerated people — many of whom have not or cannot be convicted — languishing in prison.
In May, Corrections, Health and Justice officials scrambled to find a legal path to treat a nonverbal 18-year-old with development delay, autism spectrum disorder and a traumatic brain injury who had already been found unfit to stand trial earlier this year. Arrested again in April and denied treatment at Luis Hospital, Kyjauni Joseph was taken to the John A. Bell Correctional Facility, where he remained in a catatonic state. He was later transferred to Schneider Hospital.
On the same day BOC leadership testified before the Senate, a V.I. Superior Court judge ordered the V.I. Health Department’s Behavioral Health Division to perform a mental health evaluation for a man who was arrested for violating a restraining order two years ago, and who had already been found unfit to stand trial by a psychologist in March 2024. The man was accepted by a Florida treatment facility last May, according to Wednesday’s order.
“However, the Defendant remains at the Bureau of Corrections and has been waiting for over a year to be transferred to the Larkin Community Hospital Behavioral Health Services,” Judge Denise Francois wrote. “While the parties and the Court were waiting for the Defendant to be transferred to Larkin, the competency hearing was delayed. Hence the need for an updated evaluation.”
Ahjara Francis was arrested and charged with murder in November 2022, and three months later, a judge ordered that he receive a psychological evaluation. That evaluation was performed at some point before May 2023, but, in a familiar pattern, had to be redone because the report’s author was not available for a competency hearing. Francis was eventually found unfit to stand trial and committed to the custody of the Health Department in February 2024.
Over the next year, it appears the government struggled to place Francis at a treatment facility. Health Department leadership then skipped a May 8 review hearing, prompting Judge Kathleen Mackay to order the officials to show cause on May 20 as to why Francis remained in BOC custody. According to a status report filed in court Wednesday, Francis was transported to Larkin on May 23.
Superior Court documents show that the Health Department, Corrections personnel and prosecutors have repeatedly been ordered to explain delays in providing mental health evaluations and placing incarcerated people in treatment facilities abroad.
Akeal Wilkins was arrested in November and charged with arson after setting fire to an office inside the Wilbur Francis Command Center on St. Croix. Wilkins was found unfit to stand trial, and in January Magistrate Judge Venetia Velazquez ordered that the “Bureau of Corrections and the DOH must coordinate the use of their staff and resources to safely deliver the Defendant to a behavioral health facility either in or out of the Territory for mental health treatment as soon as is practicable.”
Four months later, officials were summoned to court to explain to Velazquez why that never happened. Court documents offer a detailed look at the precarious arrangement — and how it can be derailed by miscommunication between government agencies and delays.
According to a lengthy email thread, the government filed by way of explanation, Wilkins and one other person were set to be taken to a South Carolina facility on May 9 after several delays.
Presciently, Assistant Attorney General Chad Mitchell wrote to Health and Corrections on April 29 seeking information about the travel arrangements and urging compliance with the court.
“I do not want to turn the new and friendly Judge Velezquez into a judge who will start threatening sanctions and fines,” he wrote. “Let’s do our best to follow her orders and keep her informed and involved if there are legitimate reasons for delays.
“All other details and behind the scenes maneuverings are not my concern, but please play nice. Whoever is on the hook for paying for the transport, please pay and get [it] set up today,” he added.
A May 2 email by Behavioral Health Director Gesil Ramos outlined the difficulty in even making the arrangements due to “severe limitations in available crew and flight options.”
“From St. Croix … there is only one viable flight with a single stop, a requirement due to the condition of the patients and the protocols for assisting officers,” she wrote to the Columbia Regional Care Center.
On the morning of May 9, Testamark’s executive assistant emailed the group advising that if the accompanying officers did not receive their cash advances by noon that day, they wouldn’t be traveling. A Health Department staffer replied that the payments were pending with the V.I. Finance Department. By 12:30, the trip was canceled.
“I am writing to express deep disappointment regarding the recent decision to cancel the travel arrangements for our patients,” Ramos wrote that afternoon. “It is disheartening to see that, in this instance, the treatment and well-being of the patients were not prioritized, especially when we all understand the immense effort it takes to get individuals into treatment.
Writing that the Health Department has “consistently worked to collaborate with our sister agencies in good faith, under the shared belief that we are one government, united in our mission to serve the people,” Ramos called on her colleagues to do better.
The last minute cancellation, she wrote, cost the Health Department $13,965.
“At the end of the day, it appears to be the position of BOC that DOH is to blame for processing the payments untimely,” Mitchell wrote in a May 22 informative motion after Velazquez threatened to hold the agencies in civil contempt. “It appears to be the position of DOH that BOC should have waited to cancel the travel, and that they would have had the per diem checks eventually.”
A Jan. 10 letter the Justice Department sent to Health indicates that the above are not isolated incidents.
“The criminal and family courts have recently been ordering the Department of Health to perform specific tasks by very specific date deadlines. When these deadlines are not met, the court has been inclined to impose sanctions, with the Department of Justice often caught in the middle,” according to the letter, which included a series of guidelines for DOH to follow.
Though court-mandated oversight of the territory’s prisons has shown some improvement in the Corrections Bureau’s mental health care capacity over the years, the most recent federal consent decree monitor’s most recent report still puts the John A. Bell Adult Correctional Facility’s mental health and suicide prevention regimen at 68% sustained compliance with federal requirements.
“Over the last several years, it has been impossible to sustain the previously obtained level of compliance with the Mental Health provisions and build upon that success, largely due to staffing issues … i.e., an overall shortage of mental health staff following the resignation of half the staff, the hiring of staff who were not qualified for the position for which they were hired, the organization of mental health staff within the Medical Department, and also the shortage of security staff required to support all mental health programs,” monitor Kenneth Ray wrote in an April report. “However, within the last 6+ months, there have been efforts to address some of these staffing issues….”
Ray noted several areas of concern, including: timely and well-documented assessments; timely initial comprehensive, interdisciplinary mental health treatment plans; provision of mental health treatment and other therapeutic interventies; assessment, monitoring and provision to individuals in segregation and others; and internal compliance monitoring.
In May, Encarnacion told the Source that one solution to the mounting challenges could be a dedicated mental health facility adjacent to the prison.
“It wouldn’t be that we would be placing individuals in BOC,” she said. “It would mean that we would be negotiating a portion of BOC, separating it completely from BOC. But they have the space that would allow us to offer forensic medicine outside of BOC.”
St. Croix Source
Local government, Local news
