The number of Missourians languishing in jail while they wait for a spot in a state-run psychiatric hospital continues to climb, with nearly 450 people stuck in limbo in need of mental health treatment.
Individuals on the waitlist have been charged with crimes but not convicted. Many are detained for longer than they would be if they’d received the maximum sentence for their charges.
The length of the waitlist is up by over 40% from a year ago and over 80% from 2023, according to the latest figure provided during a monthly Mental Health Commission meeting on Thursday and data previously received by The Independent.
Nora Bock, director of the behavioral health division of the Missouri Department of Mental Health, said the “silver lining” of the situation is that more individuals have begun receiving care through a pilot program the legislature passed in 2023, which brings treatment to the jails. There are 18 individuals currently enrolled in that program, Bock said, “so this is good movement.”
People on the waitlist 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. Their cases are on hold while they wait for competency restoration.
The average wait time in Missouri has held steady at 14 months, Bock said.
There have been successful lawsuits in several other states arguing that months-long wait times for competency restoration is a violation of due process and the Americans with Disabilities Act.
The consequences can be fatal.
Last month, a 64-year-old named Timothy Beckmann, who had been found incompetent to stand trial and been waiting for months for treatment, was found unresponsive in the Jackson County Detention Center and brought to a hospital where he was declared dead.
In the seven months he spent in pretrial detention, Beckmann’s mental and physical health deteriorated, public defenders involved in the case told The Independent after his death.
The Department of Mental Health previously declined to answer questions, citing patient privacy laws, and Bock didn’t mention Beckmann in her presentation. The Jackson County sheriff’s office is still investigating Beckmann’s death and the medical examiner’s office hasn’t concluded its report yet, a spokesperson for the sheriff told The Independent Thursday.
The legislature in 2023 passed several measures in an attempt to ameliorate the waitlist. Those have been slow to get off the ground. Some of the remedies are years away, such as a new psychiatric hospital being built in Kansas City.
Bock said that there are two individuals receiving outpatient competency restoration now — meaning they were charged with low-level offenses and deemed safe enough to receive treatment in their community — “and I do anticipate that as we work with our other stakeholders that we’ll see that that increases over time.” Advocates have raised concern that patients are rarely referred to community-based treatment.
There are more patients in the pipeline: 61 people were evaluated and found incompetent who are waiting to be court ordered into DMH custody, Bock said. There are 213 open pretrial evaluations, of which Bock said the department expects around half to be found incompetent.
The waitlist is a result of limited bed capacity, workforce and a lack of community placements, officials have told lawmakers, as well as a surge in the number of court-ordered competency evaluations.
Bock shared staffing data during the presentation as well. The group with the highest vacancy rate across state psychiatric hospitals is social workers, at 71%.
“This is across our system, so it will vary by facility, but that’s a pretty staggering number for us to deal with,” Bock said. She said Fulton State Hospital struggles the most with staffing, with one-quarter of their direct care positions open, and a Kansas City hospital called the Center for Behavioral Medicine struggles the least, which Bock attributed to the job market and population.
This story was originally published by the Missouri Independent, part of the States Newsroom.
