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

The number of people languishing in Missouri jails in need of court-ordered mental health treatment currently stands at 344 — and the wait time for a hospital bed averages one year. 

That’s up from 254 people this time last year, according to Missouri Department of Mental Health data provided to The Independent. A spokeswoman for the department said that because the agency’s inpatient beds are at capacity, the number of people waiting in jails for treatment will continue to rise.

Debra Walker, the department’s spokeswoman, said February was the first month the number of individuals waiting ever exceeded 300.

None of the people on the waitlist have been convicted of a crime. They were arrested, found incompetent to stand trial and ordered by the court into mental health treatment, designed to allow them to stand trial, a process called competency restoration that generally includes therapy and medication. 

“We do want to increase the number of individuals who are getting competency restoration,” said Jeanette Simmons, deputy division director of the Missouri Department of Mental Health’s Division of Behavioral Health, during a mental health commission meeting earlier this month. “We have a growing number of individuals who are waiting for those services.”

Missouri has faced a years-long struggle with this issue, due to increasing numbers of court referrals for competency restoration, staffing issues and limited psychiatric hospital capacity. It’s worsened over the last year.

The legislature appropriated $300 million this year for Department of Mental Health to open a new hospital in Kansas City, but it could be around five years before construction is complete.

State officials are also working to implement the “jail-based competency restoration” program approved by the legislature this year in response to the issue. 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 in jail-based competency restoration 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 “mobile team practitioners.”

The department is currently training two agencies in Kansas City that will be going into county jails to provide jail-based treatment. Clay County has a “tentative go live date” for September, Simmons said.

“So we're really looking forward to that and getting that launched, because we do believe that it's going to take a multifaceted approach to target those numbers,” she said.

Simmons said the agency has mobile teams of doctors going into county jails prescribing medications “to try and get folks started on those medications that they need to stabilize their mental illness.” The department is working with community behavioral health liaisons as well as jail mental health or medical staff, she said, to get people services.

The Department of Mental Health is also working on trying to get information to the courts about outpatient restoration, for those who can be safely treated in the community and don't require hospital-level care. A law passed this year gives the agency the authority to treat certain arrested people on an outpatient basis.

“Sometimes I think the courts don’t really consider that as an option,” Simmons said of outpatient treatment. “It’s something very new.”

In other states, including some bordering Missouri, lawsuits have been filed over similar wait times, alleging they violate individuals’ rights to due process and the Americans with Disabilities Act.

A federal lawsuit filed last year in Oklahoma alleged jails are holding patients for three months to one year. A proposed settlement set a benchmark of a 60 day maximum wait and ultimately a goal of 21 days, but it has faced opposition from the governor.

A lawsuit filed in Kansas in 2022 alleged that individuals are detained for longer waiting for a psychiatric bed than they would be if they had been convicted. Many of the charges are for low-level crimes, national investigations have found.

County sheriffs and jail administrators in Missouri have raised the alarm about challenges caring for individuals who are being detained pretrial. And state officials have acknowledged the long waits contribute to mental deterioration.

The Missouri Sheriffs’ Association recently published an issue of their ‘Missouri Jails’ magazine focused on managing mental health challenges in county jails, which shared several examples of local issues, including that one county spent $30,000 to provide around-the-clock guarding over a suspect for two months, because the secure medical centers didn’t have any openings.

Some county sheriffs are looking to build or expand jails to combat the issue, according to the magazine, including by increasing the number of solitary cells to keep those with mental health diagnoses out of the general population. Others have contracted with private health provider Turn Key Health Clinics to provide increased mental health care while people are awaiting transfer. 

“As mental health professionals and legislators struggle to find solutions to the crisis,” magazine contributor Michael Feeback wrote, “sheriffs and other agencies are looking for answers on their own.”