Hundreds of Missouri residents wait a year in jail for court-ordered treatment – ​​before going to trial | KCUR

The number of people languishing in Missouri prisons requiring court-ordered psychiatric treatment currently stands at 344 – and the average wait time for a hospital bed is one year.

That's an increase of 254 people from the same period last year, according to Missouri Department of Mental Health data seen by The Independent. A department spokeswoman said the number of people waiting for treatment in jails will continue to rise as the agency's beds are full.

Debra Walker, a spokeswoman for the department, said February was the first month in which the number of people waiting exceeded 300.

None of the people on the waiting list have been convicted of a crime. They have been arrested, declared incompetent to stand trial, and ordered by the court to receive psychiatric treatment to enable them to stand trial. This process is called competency restoration and typically involves therapy and medication.

“We want to increase the number of individuals who are getting competency restoration,” said Jeanette Simmons, deputy division chief 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 waiting for these services.”

Missouri has struggled with this problem for years due to an increasing number of remand cases, staffing issues, and limited capacity at psychiatric hospitals. The situation has worsened in the last year.

Lawmakers approved $300 million this year for the Department of Mental Health to open a new hospital in Kansas City, but construction could be about five years away from completion.

State officials are also working to implement the Prison-Based Skills Recovery program, which lawmakers approved this year in response to the problem. This year's budget allocates $2.5 million to implement the prison-based skills programs in prisons in St. Louis, St. Louis County, Jackson County, Clay County and Greene County.

Prison rehabilitation services include room and board and medical care for ten places in each prison, contracted staff from a local mental health organization, and mental health care provided by “mobile team practitioners.”

The department is currently training two employees in Kansas City who will provide treatment in county jails. Clay County has a “tentative start date” of September, Simmons said.

“So we're really excited about this and the launch because we believe we need a multi-pronged approach to achieve these numbers,” she said.

Simmons said the agency has mobile medical teams in county jails that prescribe medications “to try to get people the medications they need to stabilize their mental illness.” The department works with local health officials as well as prison psychiatric or medical staff, she said, to get people services.

The health department is also trying to provide the courts with information about outpatient rehabilitation programs for those who can be safely treated in the community and do not require hospital treatment. A law passed this year gives the department 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. “This is something completely new.”

Lawsuits have been filed in other states, including some that border Missouri, over similarly long wait times, arguing that they violate individuals' due process rights and the Americans with Disabilities Act.

A lawsuit filed in Oklahoma last year alleges that prisons hold patients between three months and a year. A proposed settlement sets a maximum wait time of 60 days and ultimately aims for 21 days, but faced opposition from the governor.

A 2022 lawsuit filed in Kansas alleges that people are being held longer while waiting for a mental health placement than they would be if they were convicted. Many of the charges are for minor offenses, national research found.

County sheriffs and prison administrators in Missouri have raised alarm about the difficulty of caring for people held in pretrial detention, and state officials have acknowledged that the long wait times contribute to mental deterioration.

The Missouri Sheriffs' Association recently published an issue of its magazine, “Missouri Jails,” that looks at how mental health issues are being handled in county jails and cites several examples of local problems. For example, one county spent $30,000 to keep a suspect under 24-hour guard for two months because there were no spaces available at closed medical centers.

Some county sheriffs are looking to build or expand jails to combat the problem, according to the magazine. Among other things, they are looking to increase the number of solitary cells to keep people with mental illnesses away from the general population. Others have signed contracts with private health care provider Turn Key Health Clinics to provide improved mental health care while people await transfer.

“While psychologists and politicians are trying to find solutions to the crisis,” writes magazine writer Michael Feeback, “sheriffs and other agencies are searching for answers themselves.”

This story originally appeared in Missouri Independent.