The Department of Mental Health building in Jefferson City, Missouri (Annelise Hanshaw/Missouri Independent).
There are currently 344 individuals in Missouri jails who require court-ordered mental health treatment, and they are facing an average wait time of one year for a hospital bed.
According to data provided to The Independent by the Missouri Department of Mental Health, the number of individuals waiting in jails for treatment has increased from 254 people last year. The department’s spokeswoman explained that this rise can be attributed to the fact that the agency’s inpatient beds are currently at full capacity.
According to Debra Walker, the department’s spokeswoman, the number of individuals waiting in February exceeded 300 for the first time ever.
All individuals on the waitlist have not been convicted of any crime. They were apprehended, but later deemed unfit to stand trial by the court. Consequently, they were ordered into mental health treatment to restore their competency for trial. This process, known as competency restoration, typically entails therapy and medication.
“We are committed to increasing the number of individuals receiving competency restoration,” stated Jeanette Simmons, deputy division director of the Missouri Department of Mental Health’s Division of Behavioral Health, during a recent mental health commission meeting. “There is a growing demand for these services, and we want to address the needs of those individuals waiting for them.”
Missouri has been grappling with this issue for several years now, as the number of court referrals for competency restoration continues to rise. In addition, the state is dealing with staffing challenges and a shortage of psychiatric hospital capacity. The situation has only worsened over the past year.
The Department of Mental Health has been granted a budget of $300 million by the legislature this year to establish a new hospital in Kansas City. However, it is estimated that the construction of the hospital may take approximately five years to be finished.
State officials are currently taking steps to implement a program called “jail-based competency restoration,” which was approved by the legislature this year as a response to the issue. As part of the initiative, $2.5 million from this year’s budget has been allocated for the establishment of jail-based competency programs in various counties, including St. Louis, St. Louis County, Jackson County, Clay County, and Greene County.
In jail-based competency restoration, individuals will receive a comprehensive range of services. These services will encompass room and board, as well as medical care. Each jail will have 10 slots available for this program. The staffing for this initiative will be provided by a local behavioral health organization through contracted staff. Additionally, individuals will have access to psychiatric care from professionals who will be part of the “mobile team practitioners.”
The department is presently providing training to two agencies in Kansas City that will offer jail-based treatment in county jails. Simmons mentioned that Clay County has set a “tentative go live date” for September.
She expressed anticipation for the launch of the multifaceted approach, as she believes it will effectively target the numbers.
The agency is actively addressing the issue of mental health in county jails by deploying mobile teams of doctors. These doctors prescribe medications to help stabilize the mental illness of incarcerated individuals. Simmons emphasized the importance of getting people the necessary services, and for this purpose, the department collaborates with community behavioral health liaisons and jail mental health or medical staff.
The Department of Mental Health is actively striving to ensure that the courts receive comprehensive information regarding outpatient restoration. This initiative aims to cater to individuals who can be safely treated within the community and do not require hospital-level care. A recent law passage has granted the agency the power to provide outpatient treatment to specific individuals who have been arrested.
Simmons expressed his belief that outpatient treatment is not given enough consideration by the courts, stating that it is a relatively new concept.
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Lawsuits have also been filed in other states, including some neighboring Missouri, concerning similar wait times. These lawsuits argue that such delays infringe on individuals’ rights to due process and violate the Americans with Disabilities Act.
A lawsuit was filed in Oklahoma last year, alleging that jails were holding patients for three months to one year. A proposed settlement aimed to establish a maximum wait time of 60 days, with a long-term goal of 21 days. However, the governor has expressed opposition to this settlement.
A lawsuit filed in Kansas in 2022 claims that individuals are being detained for longer periods while waiting for a psychiatric bed compared to the time they would spend if they had been convicted. National investigations have revealed that many of these charges are for low-level crimes.
County sheriffs and jail administrators in Missouri are expressing concerns about the difficulties they face in providing adequate care for individuals who are detained pretrial. The long waiting periods have been acknowledged by state officials as contributing to mental deterioration.
The Missouri Sheriffs’ Association recently released an edition of their ‘Missouri Jails’ magazine that delved into the management of mental health challenges in county jails. The magazine highlighted various local cases, including an instance where a county had to spend $30,000 to maintain 24/7 surveillance on a suspect for two months due to a lack of available beds in secure medical centers.
According to the magazine, certain county sheriffs are seeking ways to address the problem by constructing or expanding jails. One approach is to increase the number of solitary cells in order to separate individuals with mental health diagnoses from the general population. In addition, some sheriffs have partnered with Turn Key Health Clinics, a private health provider, to enhance mental health care for individuals awaiting transfer.
Magazine contributor Michael Feeback highlights the independent efforts of sheriffs and other agencies in the face of the mental health crisis. As mental health professionals and legislators grapple with finding solutions, these law enforcement bodies are actively seeking answers on their own.