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(Missouri Independent) – A 34-year-old man has been waiting 472 days in the Greene County jail for services and treatment from Missouri’s mental health department that could enable him to stand trial.
A 31-year-old man in the Jackson County jail has been waiting 445 days for treatment.
A 64-year-old man in the Buchanan County jail has been waiting 304 days.
None of these men has been convicted of the crime that landed them behind bars. They’ve been ordered to receive treatment by a court and instead have languished in jail, part of a backlog of almost 500 people awaiting help from the Missouri Department of Mental Health, according to a federal class action lawsuit filed Monday.
The lawsuit, brought by the MacArthur Justice Center, ArchCity Defenders, and the ACLU of Missouri, alleges the department has illegally denied timely evaluations and services to Missourians with mental health and cognitive disabilities who stand accused of crimes.
These individuals were arrested, deemed unable to stand trial, and ordered into services designed to allow them to move their cases forward — a process called competency restoration.
“[The department] is knowingly derelict in its duty to these hundreds of Missourians, all of whom suffer while abandoned in county jails, some decompensating beyond restoration,” the lawsuit says.
When a court orders the department to evaluate a defendant, Missouri law requires the department to do so within 60 days. But Missourians “routinely” wait six months or longer to be evaluated, the lawsuit says.
Once the department has ruled someone incompetent to stand trial, Missouri law requires the department to take custody of the individual to receive restoration services in a “reasonable” time. But people who have been assessed to be incompetent spend an average of 14 months in jail before receiving treatment, according to the department.
The department on Monday declined a request from The Independent to comment. In previous statements, a spokeswoman for the department maintained that people on the waitlist are receiving help.
“All individuals on the waitlist receive services, providing they are willing to participate,” said Debra Walker, spokesperson for the department, in an October email.
The department has rolled out initiatives in recent months to help people move toward competency when there are no available beds in state psychiatric hospitals, including jail-based competency programs authorized by a 2023 state law. Since launching last year, 12 people have achieved competency after completing one of four pilot programs in St. Louis city and county, along with Jackson and Clay counties. More than 50 people have participated in these programs.
But the lawsuit argued jail-based services are a “non-solution,” indicating that services focus on coaching detainees “in hope that they will memorize the ‘correct’ answers” to the competency exam.
Amy Malinowski, an attorney from the MacArthur Center representing the plaintiffs, said jail-based treatment is a “contradiction in terms, because jails are not therapeutic environments.”
The lawsuit described a man in the St. Louis County jail who was arrested in May after wandering naked around a St. Louis airport terminal and knocking off a law enforcement officer’s eyeglasses. He lost access to his caseworker, treatment plan, and medications when he was detained, the lawsuit states, and “he is not aware of where he is or why he is there.” He is waiting for an evaluation by the department.
People on the competency waitlist are typically housed in isolation. One plaintiff, who has been awaiting services in the St. Louis city jail for 252 days, is locked down in his cell between 23 and 24 hours a day, according to the lawsuit. He had not been allowed a single phone call during the nearly two years of his incarceration.
“I think [the department] itself will acknowledge that being in a loud, noisy jail by yourself most of the time, for 23 hours a day, without access to medication, without access to a support system, is literally the worst thing you could do,” said Maureen Hanlon, an attorney from ArchCity Defenders who is also representing the plaintiffs.
The 2023 law also permitted outpatient treatment for individuals who could safely be released on bond.
But the lawsuit describes that option as “grossly underutilized,” saying that only two people had been ordered into community-based restoration as of January.
The department has two small forensic mobile teams of clinicians who provide medication and case management to people on the waitlist, in-person or via telehealth.
The lawsuit quoted a jail operator who described these mobile teams as “a joke.”
The department has long acknowledged the growing waitlist.
Dr. Jeanette Simmons, deputy director of the department, told The Independent in October that with a static number of state hospital beds and increasing numbers of competency evaluation requests from courts, the increasing backlog isn’t surprising.
“Our numbers have increased,” Simmons said. “We predicted that they would increase.”
In May, Valerie Huhn, the director of the department, warned the Missouri House Health and Mental Health Committee that the state could face litigation due to its competency waitlist.
Malinowski said the attorneys for the plaintiffs plan to call in experts, including former mental health directors from other states, to help forge a path forward.
“What are things that we can do as a state,” she said, “to ensure that the most vulnerable citizens aren’t being warehoused in jails for years while they wait for treatment?”
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