Missourians who are arrested, deemed unfit to stand trial and ordered into mental health treatment are now detained in jail for an average of eight months before being transferred to a mental health facility.

And that’s “some good news,” Nora Bock, director of the Missouri Department of Mental Health’s Division of Behavioral Health, said during a monthly mental health commission meeting last week where she shared the new number. 

That’s because, Bock said, the mid-September wait time is down from July, when it stood at 11 months.

“None of that is really good in the big picture, but it is a decrease,” she said. “So we will take the wins where we can get them.” 

For years, the state has struggled to transfer people from jails into mental hospitals once they are found to be incompetent to stand trial, in part because of a lack of hospital beds and an increase in referrals. 

Missourians with developmental disabilities languish in hospitals, jails, shelters

Those patients are supposed to be moved to receive rehabilitative mental health services that allow them to become competent to stand trial, a process called competency restoration. Instead, they languish in jails — often solitary confinement because they must be isolated from the incarcerated population — without having been found guilty of any crime.

The problem is not unique to Missouri. 

There have been recent high-profile lawsuits against holding those needing mental health services in jail in states including Indiana, Kansas and Pennsylvania, arguing that long wait times are unconstitutional because they deprive people of due process. In 2003, after a group of disability rights advocates in Oregon sued, the Ninth Circuit Court of Appeals ruled that the limit on holding patients in jail should be 7 days before it violates the constitution. 

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.  

Missouri this year passed a law to bring treatment to the jails — “jail-based competency restoration” — which Department of Mental Health officials said will reduce the wait time. They started implementing the program last month. 

Valerie Huhn, the department’s director, said last week that she is hopeful the program “will help us get folks through the process faster, either restored to competency, at least get services to them more quickly for our individuals that are in jails right now.”

More patients in the pipeline

The improved wait time, Bock said, is “due largely” to the re-opening of a ward at the Jay Nixon Forensic Center in Fulton State Hospital, which was only possible because of increased staffing.

A 25-bed ward had been closed from November 2021 to July 10, 2023, said Debra Walker, Department of Mental Health spokesperson. Since it reopened, “approximately three to four individuals were admitted each week from the waitlist,” Walker said.

Regarding overall hospital staffing, Bock said there is a higher level of employees but many are part-time. 

“Of concern is that more than a third of the current employees work less than 20 hours a week,” she said, later adding: ”So that is not a great position to be in.”

There are currently 253 people in jail waiting to be transferred to a state hospital for mental health treatment, Bock said last week. In early March, it was 229. 

There are more in the pipeline. 

The department will add 57 people who have been evaluated and determined incompetent to stand trial once they receive the court’s order to do so.

There are 267 open pre-trial evaluations ordered by the court, Bock said, of which the agency estimates roughly half will be found incompetent to stand trial, meaning another 133 people could soon be in need of mental health treatment. 

A law passed this year gives the agency the authority to treat arrested people within jails or in an outpatient basis if the person can be safely released and treated. 

And 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.

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

Walker said the agency is “working on a timeline with each county to include…training for all stakeholders, hiring of qualified behavioral health staff, and identifying adequate space within the facilities to provide services.”

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. 

States often frame the option as cost-effective and reducing waitlists, because they see creating enough in-patient mental hospital beds to meet demand as unlikely. Those opposed to the program nationally have said jails are the wrong treatment setting for a person with severe mental illness.