There are 430 Missourians across the state in jails waiting to be moved to state psychiatric hospitals, up from around 300 at this time last year.
The average time those people wait in jail before receiving treatment has held steady at 14 months, according to Missouri Department of Mental Health data.
Those individuals were arrested, found incompetent to stand trial and 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. Those being held in jail are sometimes incarcerated for longer than they would be if they'd received the maximum sentence for the crime they were charged with.
Testifying before the Missouri House Health and Mental Health Committee earlier this week, Valerie Huhn, the state mental health agency's director, called the issue the "most critical" of the department's various waitlists for services.
"I just wanted to make everybody aware of some of the risks that we know we're taking on because we can't get these individuals from jail into our state operated hospitals," Huhn said. "Obviously their illness is worse, and as their treatment is delayed, that makes it harder for us to turn them around."
The state also faces potential lawsuits, Huhn said.
"We also know that there are federal lawsuits in five states for inappropriate detention and imprisonments, and there are federal lawsuits in 10 states for violation of due process," she said. "So there are a lot of risks for us not being able to address the needs of these populations."
State Rep. Kent Haden, a Republican from Mexico, said county jails are ill-equipped to hold individuals awaiting psychiatric treatment for so long.
"My sheriff continually tells me, 'I am not prepared to handle mental health issues in my jail.' And he had a suicide," Haden said. "He said: 'We were not prepared to handle this situation.'"
The waitlist peaked in February and March, when the average stood at 440 people per month, and has since declined to 430 as of May 1.
Huhn attributed the slight decline to the launch, over the last few months, of a handful of pilot programs that were signed into law two years ago. These jail-based competency restoration programs are designed to bring treatment to jails, rather than require individuals be transferred to psychiatric facilities.
"That program was slower starting than we wanted to see, but it is now open," Huhn said.
It has a capacity of 40 people, she said, and currently is serving 19.
Those programs are in the Jackson, Clay and St. Louis County jails, Deb Walker, the spokeswoman for the department, told The Independent.
In 2023, the state legislature approved $300 million to build a psychiatric hospital in Kansas City, which will add 150 beds. That is estimated to open in 2029, Huhn said, which is "not soon enough" to ameliorate the issue.
The legislature that year also worked to increase outpatient competency restoration, which has been slow to get off the ground, to treat those who can be safely released in their communities. Huhn said the agency is working to bolster that, including with money in the budget for community behavioral health liaisons to work between the agency and court. Outpatient treatment efforts will be targeted for those charged with low-level offenses, meaning misdemeanor charges and parole violations.
More Missourians are in the pipeline who will need competency restoration.
There are 80 people awaiting court orders and 230 more in open pretrial evaluations, of which the department estimates around half will be found incompetent.
The waitlist is a result of limited bed capacity, workforce, and a lack of community placements, Huhn told lawmakers, as well as a surge in the number of court-ordered competency evaluations. There has been a 48% increase in the last five years in those evaluations.
This story was originally published by the Missouri Independent.
