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 Oklahoma, Kansas, 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.
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