Tuesday, January 28, 2025

Incompetent Missourian inmates wait up to 14 months for mental health treatment

In Missouri some people who are arrested and found incompetent to stand trial are ordered into mental health treatment designed to allow them to have their day in court — a process called competency restoration that generally includes therapy and medication.

However, the average time these individuals wait in jail before receiving treatment is 14 months, according to the Missouri Independent.

Efforts to remedy the problem in the 2023 legislative session, including through a pilot program and increasing outpatient competency restoration, have been slow to get off the ground. 

Greene County, which was included in the pilot program, decided not to participate. Clay County’s program was in operation for just three weeks last year before staff turnover put it on pause. 

Only three people are currently enrolled in the jail-based treatment pilot program statewide, according to Debra Walker, a spokesperson for the state's Department of Mental Health. And only one person is currently in the outpatient treatment program.

Walker said the agency is working on solutions but “none of them will impact the numbers quickly.”

Last year, Department of Mental Health Director Valerie Huhn told the House budget committee the problem would get much worse before it gets better. 

“It’s probably going to be 1,000 individuals,” Huhn said, “long before we’re at 100 individuals.”

‘Deprives them of humanity’   

Mary Fox, the director of the Missouri State Public Defender system, said the wait times for mental health treatment are the worst she’s seen. She has been going to courthouses throughout the state trying to get some of the cases dismissed.

Public defenders have identified at least 12 cases of individuals in Missouri being held longer than their maximum sentences would have been, Fox said, without receiving competency restoration.

“It's gotten so bad that people aren't getting any treatment within the time period of when their case should be over and done with,” Fox said.

One client was having paranoid delusions and called the police himself, convinced he was being watched. The police then arrested him because his license plate was expired and because he didn’t stop driving when they put on their lights. 

Fox said he’s waited in jail for longer than he would’ve for the maximum sentence on those two charges.

In a recent case filing, Fox called detention beyond the maximum sentence “unconstitutional, illegal and improper.”

Walker said the agency is “aware of such circumstances.”

“Individuals are admitted in the order in which the court order is received, and admissions are triaged based upon clinical acuity,” she said, adding that DMH is also working to provide medication and case management to individuals while in jail, through mobile teams of clinicians.

While individuals wait in jail, their mental health often deteriorates, said Annie Legomsky, who runs the state public defense system’s holistic defense services program. 

Many are placed in solitary confinement, isolated for 23 or 24 hours a day, she said, and can end up with irreparable damage.

“It just completely deprives them of humanity, and it’s the antithesis of anything you could call a therapeutic environment,” she said. “We see clients who do just really sad things like eating their own feces, having suicidal ideation and actions, who are just completely decompensating.”

And there isn’t anything those individuals can do: Their case is on hold until they’re restored to competency to stand trial, so they can’t get released after they’ve waited the maximum sentence.

“They can't do anything to, kind of, control their fate,” Legomsky said. “They're at the mercy of (the Department of Mental Health) getting them the treatment they need.” 

In states including OklahomaKansas, and Washington, lawsuits filed by groups like the American Civil Liberties Union over similar wait times have succeeded, arguing the practice violates individuals’ rights to due process and the Americans with Disabilities Act. 

So far, similar litigation hasn’t been filed in Missouri. A spokesperson for the ACLU of Missouri declined to comment. 

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