A man jailed on felony drug possession charges has been waiting 469 days in the Clay County Detention Center for mental health services that could allow his case to move forward.
It took him 75 days just to get a court-ordered evaluation from the Department of Mental Health, according to Sarah Boyd, spokesperson for the Clay County Sheriff’s Office.
He hasn’t been convicted of a crime. He was found incompetent to stand trial and has been in limbo ever since – stuck in jail until a bed becomes available in a state psychiatric hospital or services from the mental health department or the jail enable him to satisfy a judge that he can stand trial.
“We want folks to be restored to competency, so that they don’t have their constitutional rights violated,” Boyd said, referring to the Sixth Amendment right to a speedy trial. “We want that to happen, and we wanted it to happen here, but that hasn’t really been the case.”
In September, an average of 487 Missourians were waiting for a bed in a psychiatric hospital run by the department. The waitlist has grown by a third since September 2024 and almost 88% since September 2023.
In August, that average number reached 492, an all-time high.
These numbers include people who are receiving services – including medication, therapy and competency education — in jails or out on bond, according to the department.
Lawmakers in 2023 authorized the department to provide jail-based competency, and programs have been established in St. Louis city and county, along with Jackson and Clay counties. The law also allows outpatient treatment for individuals who can be safely released on bond.
The department has also expanded two mobile teams of clinicians who provide medication and case management to people on the waitlist through in-person jail visits and telehealth.
A year after the launch of the first jail-based competency programs, sheriffs, corrections medical staff and jail administrators say that although the new initiatives have helped address mental health needs, they aren’t enough to tackle the waitlist — or address the underlying need for mental health and substance use treatment that keeps some people cycling in and out of jail.
Only 12 people have so far attained competency after completing a jail-based pilot program, according to the department, and 52 people have participated.
Dr. Jeanette Simmons, deputy director of the state mental health department, said the growing waitlist isn’t a surprise.
“Our numbers have increased,” Simmons said. “We predicted that they would increase.”
Simmons attributed the increase to a static number of hospital beds and increasing numbers of competency evaluation requests from courts.
“As that number continues to increase, I’m not surprised that the number of folks found incompetent increases,” Simmons said. “It clearly correlates together.”
Simmons said the department has dialed up efforts to help people take first steps toward competency while they are waiting in jail, and that the mobile teams in particular have seen successes. Last year, 117 people attained competency through the teams’ work, according to the department.
“Just by virtue of getting people started on their medications and stabilizing their psychiatric condition, they have restored to competence,” Simmons said.
Boyd, the spokesperson for the Clay County Sheriff’s Office, said Sheriff Will Akin was initially “frustrated” with the pilot program because it wasn’t clear to him at first that his jail would be expected to take patients from Platte, Buchanan and Andrew counties.
Boyd said the program has been successful for those who participated in it and that Akin and the department have agreed on a plan to work together.
“We definitely want to continue with the program here,” Boyd said, “and we’re moving forward in a way that he thinks will make it successful.”
The idea of county jails housing mental health patients from other counties has been a deterrent for some to participate. Greene County Sheriff Jim Arnott told The Independent in January that was the reason he opted out of the pilot program.
“I’m not going to participate in a warehousing contract of people that are mentally ill that shouldn’t be in jail in the first place,” Arnott said in January.
There are currently six people participating in the Clay County program, Boyd said on Monday. Four were transferred from counties in the Kansas City metro area and northwestern Missouri. Seven people are waiting for a spot in the pilot program or a hospital.
Boyd said that although the department pays the sheriff’s office $900 a day to cover program costs, the jail has sometimes had to send general population inmates to other detention centers to keep a pod available for competency restoration, at a daily cost of $65-$100 per inmate.
Dr. Paula Oldeg, director of corrections medicine in St. Louis County, said that while jail-based services will not eliminate the waitlist, participants in the county’s pilot program have received a higher level of care than is usually available in the jail.
“A jail is not the best place to really treat any condition,” Oldeg said. “A jail is not designed for that. That said, if we don’t treat it, my gosh, people can languish. They can decompensate. They can really suffer, not just mentally but physically.”
A man who waited months to be transferred to a psychiatric hospital died in a Kansas City jail in May. He started harming himself and lost touch with reality after being detained.
The St. Louis County pilot program, which accepted its first patients in January, has had 16 participants in all. Two have been deemed competent. One person was classified as permanently incompetent after multiple assessments. Two were released on bond or transferred. Two were dismissed for violent behavior. Two others opted out of the program.
Sheriffs in rural counties have had to rely on their own resources and community relationships to meet mental health needs in their jails.
Pemiscot County Sheriff Joe Bryant said his office contracts with a local company to provide services in his jail.
“They’ll come do that for us,” Bryant said, “which is great for us, because before that, there was really nothing.”
Perry County Sheriff Jason Klaus said there’s no room in his budget to hire a medical team, but he partners with a local provider to deliver substance use treatment in his 35-person jail at no charge to the sheriff’s office.
Klaus said that while he appreciates the mobile teams’ work, the competency restoration process doesn’t necessarily meet behavioral health needs.
He said that when possible, he works with attorneys and judges to allow inmates to enroll in residential treatment programs on bond or medical furlough. He’s looking into doing this for people in his jail on the competency restoration waitlist.
“I want to hold people accountable,” Klaus said. “No mistake about that. However, I also believe that somebody sitting in jail for an indefinite amount of time, it’s not getting anyone any kind of justice.”
