Missouri's Department of Mental Health building in Jefferson City (Annelise Hanshaw/Missouri Independent).

There are 285 people in Missouri jails waiting to be moved to state psychiatric hospitals for treatment, the Department of Mental Health told lawmakers Monday.

There were 229 people waiting for treatment in March, 253 in September, 260 in October and 272 in November. These individuals were arrested, deemed unfit to stand trial and ordered into rehabilitative mental health services that could allow them to stand trial, a process called competency restoration. 

They wait in jails for months to be transferred to state-run psychiatric hospitals, without having been found guilty of any crime.

“Those lines don’t seem to be going in the right direction,” Rep. John Black, R-Webster, who chairs the House subcommittee on appropriations for health, mental health and social services said of the numbers of people waiting for evaluations.

“You’re absolutely correct,” replied Valerie Huhn, director of the Department of Mental Health.

The state is working to mitigate the situation in several ways, Huhn said, but the number of people waiting in jail for services “does keep going up.”

A new program, which aims to bring treatment to jails, is in the process of being implemented, Huhn told lawmakers, and the agency hopes to have contracts with the county jails signed soon.

Staffing issues along with an increase in court-ordered referrals have contributed to the capacity issues. There are also limited options for community-based treatment for patients in the hospital who could be discharged.

Vacancies in the department are “getting better incrementally,” Huhn  said, citing pay increases earlier this year, but the agency is still short-staffed, particularly at Fulton State Hospital. Many of the existing staff are part-time.

The department this year added state-operated beds in Fulton and St. Louis, she said, though there are still 16 beds in Fulton that are not open.

Huhn also cited a focus on recruitment and retention in the department. 

“We recruit like it’s 1980 and everybody just wants to come work for the state and that’s not the case anymore. We have got to be a more active recruiting type organization,” Huhn said, adding that they have seen success working with a contractor to help with hiring in Independence and Higginsville. 

The department received $300 million this year to open a new hospital in Kansas City and expects 100 beds there to be used for competency restoration, Huhn said. Site selection for that hospital is underway and the agency expects it to be built in around four or five years.

A law passed this year gives the agency the authority to treat people within jails, called jail-based competency restoration, or on an outpatient basis if the person can be safely released. This year’s budget set aside $2.5 million for the jail-based competency programs to be established in jails in St. Louis, St. Louis County, Jackson County, Clay County and Greene County. Counties are in the process of reviewing contracts.

Services will include room and board, along with medical care for 10 people at each jail, contracted staff from a local behavioral health organization, and psychiatric care from the department’s “mobile team practitioners,” which is expanding. 

“We’ve been working with the community providers who will then be going into the jails,” Huhn said,”and hopefully we can get some folks restored to competency in those settings so that they don’t need to come into the state operated psychiatric hospital.”

Languishing in jails, individuals’ mental health, the department’s budget book notes, “will continue to deteriorate… in many cases individuals never fully recover from the extended period of decompensation.” 

At least 13 other states have offered jail-based competency restoration services since the first program was established in the late 1990s, though they vary widely in design, and some oppose the programs, arguing jails are the wrong treatment setting for a person with severe mental illness. 

“Those programs are not going to work for everybody,” Huhn said. “But one of the things we know with jail-based is that if we can at least start maybe we get somebody, when we can actually get them into the state psychiatric hospital they’re in a better position than they would be if we weren’t doing anything.”

Huhn said this will save the state money and is  “also better for the people we support and the jail and everybody else who’s involved in their life.” 

Rep. Deb Lavender, D-Kirkwood, asked about money in the budget for legal expenses related to those waiting for treatment and asked whether anyone is “looking at a lawsuit against the state.”

“Not yet no, not that I know of,” Huhn said. “They have in many other states gone down that path.”

Elsewhere, there have been recent high-profile lawsuits against long wait times in jail for those needing mental health services in states including Indiana, Kansas and Pennsylvania, arguing that long wait times are unconstitutional because they deprive people of due process. 

Investigations nationally have found many of the people awaiting hospital beds are held for longer than they would be if they had simply been convicted of the crime.