More than 500 Missourians await court-ordered mental health services, languishing in jails

Missouri Department of Mental Health Director Valerie Huhn testifies before the Senate Appropriations Committee Wednesday (Steph Quinn/Missouri Independent)

The number of Missourians waiting in jail for services from the state’s mental health department continues to rise, with a backlog of more than 500 people with stalled cases.

None of the people on the wait list have been convicted of the crime that led to their incarceration. They were found incompetent to stand trial due to mental health disorders or cognitive disabilities and court-ordered to receive treatment from the Missouri Department of Mental Health.

Mental Health Director Valerie Huhn told state lawmakers Wednesday that 528 people are currently waiting for spots in state psychiatric hospitals for these services and treatment, which are called competency restoration.

While “some of them may be out on bond” in their communities, “they are most likely in jail cells,” Huhn told the Senate Appropriations Committee.

They wait an average of 14 months to be admitted to a hospital after a judge commits them to the department.

The statewide average number of people on the waitlist in January was 518, an increase from 505 in December, according to data shared by the department with The Independent. In September, that number was 487. The waitlist has more than doubled in size since July 2023.

With several bills filed this year designed to shrink the backlog and a federal lawsuit alleging the department has turned jails into “de facto mental health wards,” state lawmakers asked Huhn what could address the problem.

She said the department hopes to use $6.1 million set aside in Gov. Mike Kehoe’s proposed budget for fiscal year 2027 to provide outpatient competency restoration treatment to 50 individuals. Kehoe also recommended appropriation of an additional $3.1 million for this outpatient treatment in the current fiscal year.

A 2023 law authorized the department to provide jail-based and outpatient competency restoration services. But outpatient competency restoration services were not funded until the current fiscal year.

The department launched four jail-based pilot programs in the last two years in St. Louis city and county, along with Jackson and Clay counties. But law enforcement officials involved in those pilots have reported mixed results, and a spokesperson for the Clay County Sheriff’s Office told The Independent in December that the agency would terminate its agreement with the department after its backlog failed to decrease.

Huhn also told lawmakers that the department is exploring options to give courts alternatives to ruling people incompetent to stand trial.

State lawmakers are also proposing ways to keep Missourians off the incompetency waitlist.

A bill filed by Republican state Sen. Cindy Crawford of Bolivar would allow judges to ask the department to refer defendants to community mental health treatment services rather than rule them incompetent to stand trial. Only defendants charged with nonviolent misdemeanors would be eligible, and the court would dismiss their charges upon successful completion of treatment services.

“That gives judges the opportunity…to go the route that allows you to just get treatment in the community, which is what you really need,” Huhn said.

While discussing these options, state lawmakers raised concerns about the possibility that the waitlist will continue to grow and the potential cost to the state of the federal lawsuit.

Democratic state Sen. Maggie Nurrenbern of Kansas City, who is co-sponsoring a bill that would establish guidelines for court-ordered involuntary outpatient treatment before a person is charged with a crime, described the backlog as “a huge, huge, huge concern.”

“It’s really hard for me to even fathom,” Nurrenbern said, “that we continue to have individuals who are being held, quite frankly unconstitutionally, because they’re not competent to stand trial.”

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com.