The number of people languishing in county jails for court-ordered mental health treatment before trial is a problem that must be addressed, both for the well-being of the inmates and their communities but also to make sure justice is fairly administered, Missouri Supreme Court Chief Justice Mary Russell told a joint session of the state legislature Wednesday.
In many counties, she said, the jail is the largest local mental health facility.
“Jails should be used in the short term to detain people accused of crimes or found guilty of minor crimes,” Russell said in the annual State of the Judiciary speech. “Concrete cell blocks are not conducive for treating mental health or addiction issues.”
At the beginning of March 2023, there were 229 people in county jails deemed incompetent to stand trial, with court orders for treatment. As of this week, that number is 297 and growing, Department of Mental Health Director Val Huhn told the House Budget Committee Monday. “We’re going to be at 500 by the end of the year,” she said. “And it’s probably going to be 1,000 individuals long before we’re at 100 individuals.”
Under state law, courts are supposed to receive regular reports on the progress of people committed to the Department of Mental Health because they are incompetent to stand trial. The first report is a six-month evaluation.
Russell said a rural Missouri judge told her of an inmate who had to wait eight months to be admitted to a mental health facility, “creating difficult, if not impossible conditions for deputies trying to keep control in the jail.”
That wait is not an extreme but average time inmates are waiting for court-ordered services in a state mental health center.
“The longer inmates with mental health problems remain detained — without treatment or without being tried for a crime, let alone convicted — the worse they get,” Russell said.
During the 2023 legislative session, lawmakers approved $2.5 million to create jail-based competency restoration programs in St. Louis, St. Louis County, Jackson County, Clay County and Greene County.
Services will include room and board, along with medical care for 10 people at each jail, contracted staff from a local behavioral health organization, and psychiatric care from the department’s “mobile team practitioners,” which is expanding.
Lawmakers also approved $300 million to replace the Center for Behavioral Health in Kansas City. The new 200-bed hospital would replace an obsolete facility built in 1966, with 100 beds dedicated to competency restoration services.
But that new facility won’t be available for several years, Huhn said in her budget testimony.
Her department is also asking for $3.2 million to create small housing units at the St. Louis Forensic Treatment Center to create additional space.
The new facilities won’t solve the issue of long wait times for treatment, she said.
“You can’t build me out of this,” Huhn said. “We cannot do that. I will never have enough staff to support it.”
The department continues to have major staffing shortages, Huhn said. More than one-third of the licensed practical nurse slots are unfilled, two out of every five jobs for psychiatrists are unfilled and fewer than one-third of the licensed clinical social worker slots are filled.
“Those are all categories that we are in constant recruitment and struggle to recruit,” Huhn said.
In her speech, Russell said the problem needs a comprehensive solution that involves “all branches of government, at the state and local levels, and with the nonprofit and private sectors.”
One measure that would help, she said, would be for lawmakers to include money to expand pretrial services so that inmates across the state can be evaluated for possible enrollment in diversion programs.
“We know the success of these programs can be far-reaching,” Russell said, citing examples from Montgomery County and Jasper County of people who had substance abuse and behavioral issues who are now receiving treatment instead of spending time in jail.
The judiciary requested $10.8 million to hire an additional 152 personnel to provide the pretrial services. Gov. Mike Parson did not recommend it in his budget.
State Rep. Scott Cupp of Shell Knob, chairman of the budget subcommittee overseeing the judiciary, said Russell’s speech will prompt him to take another look at the request.
A major focus should be substance abuse and mental health issues, Cupps said.
“We have to make sure that the stuff we’re funding actually is the stuff that is addressing the true issues,” he said, “and getting us results.”