ST. LOUIS — Delays in Missouri’s mental health system are putting scores of criminal cases on hold and leaving people to languish in jails that exacerbate mental illnesses, experts say.
Crime suspects in the Ƶ region are waiting an average of nearly six months to be evaluated, when required, to determine if they are competent to stand trial, according to data from the Missouri Department of Public Health.
And if they are deemed incompetent, they wait an additional eight months for treatment.
In the meantime, criminal cases are halted until those evaluations are complete. The result is crime victims left waiting for a resolution, and suspects, who haven’t yet been convicted of a crime, stuck in jails that often don’t have capacity to care for them.
“Something needs to change,” said Annie Legomsky, who runs a program for the Missouri Public Defender’s office that helps clients meet non-legal needs, including mental health.
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In one recent case, a 66-year-old woman accused of killing her roommate in a Ƶ assisted living facility by dousing her with hot oil will likely wait six months to receive a competency evaluation. In another, a man who pleaded not guilty by reason of mental illness in March to killing a man in the city’s Shaw neighborhood must wait until February for a completed evaluation. And a man charged in January with murder in the car crash deaths of two sisters is still waiting in the Ƶ jail for a bed in a state hospital.
The process starts with an attorney’s request for a mental evaluation of their client.
Demand for those evaluations and inpatient treatment has been increasing in recent years, a Missouri Department of Mental Health spokeswoman said. From 2018 to 2021, evaluators completed a yearly average of 650 pretrial reviews. This year, they have already completed 968. There are still 277 pending.
And the wait time for a bed at a treatment hospital has remained at roughly eight months since at least last year.
The trend mirrors national increases in evaluation requests, which have doubled since the 1960s to roughly 50,000 a year for adults, according to a 2019 literature review in the American Academy of Psychiatry and Law.
In Missouri, the state has struggled to keep up with the increase while competing with higher-paying private providers for doctoral-level psychologists and psychiatrists, a Department of Mental Health spokeswoman said. The state recently hired two additional staffers to conduct evaluations in the Ƶ region, which covers 32 counties and the city of Ƶ, to “address the backlog,” a spokeswoman said.
The same demand and staffing woes are evident in the state’s hospitals, the spokeswoman said, though “efforts are underway to address these issues.”
Meanwhile, Legomsky said, the waiting can be “disastrous,” as the stress of jail can be detrimental to a person’s mental health, especially if they have an existing illness.
“They’re already in such a compromised and terrible and vulnerable position,” she said.
Many jails across the state don’t have the resources to employ doctors, let alone psychiatrists who could prescribe mental health medications and offer treatment. In some cases, Legomsky said, providers don’t offer certain medications, or they charge clients for drugs they can’t afford.
Even in places like Ƶ, which contracts with a company to provide health care, advocates say deficiencies remain. The city paid $515,000 last year to settle claims that health care providers at the Ƶ jail did not warn officials that a man had been on suicide watch before he was transferred to Jennings. The man later died by suicide.
And since last year, eight deaths in the jail were attributed to overdoses, suicide and natural causes. Mayor Tishaura O. Jones said recently that the city would seek a new health care provider once its contract expires to “provide a high standard of care.”
Legomsky recalled the plight of one mentally ill client who was jailed in Ƶ years ago and whose symptoms landed him in solitary confinement. The client was getting bullied and suffered physical harm, she said. His condition worsened.
But just two months after arriving at a state hospital, he was found competent to stand trial. She said the basic change in his environment and regular medication helped him immensely.
“These clients need treatment and livable conditions,” she said. “With that they could do so well, but instead, they’re just being deprived at every turn.”
Matthew Mahaffey, Ƶ’ chief public defender, said he also worries about clients who are deemed competent and sent back to the jails that exacerbated their mental health problems in the first place. As they wait for trials, their mental health can deteriorate again, he said.
“That’s not a place that was providing care in the first place,” he said. “It’s a terrible place for those clients to be.”
The trouble extends beyond defendants, too. Ƶ County Prosecuting Attorney Wesley Bell said the delays can have ripple effects to his side of the case, even though prosecutors have no role in the evaluation process.
“Every delay in the criminal justice process prolongs closure for victims and can make it more difficult to prosecute the case,” he said. “It’s in the best interest of justice and victims for the competency review of defendants to be as efficient as possible.”