State lawmakers are seeking solutions to a growing backlog of jailed Missourians awaiting help from the Missouri Department of Mental Health to move their cases forward.
These Missourians have been charged but not convicted of crimes, and they were found incompetent to stand trial due to mental health disorders or cognitive disabilities. State law requires the department to provide services and treatment to help them. But in October, the average number of people on the waitlist reached a new high of 487.
Several bills filed ahead of the 2026 legislative session seek to reduce the backlog or build out options to get treatment for people with serious mental illnesses outside of jail. Some stakeholders say the bills have loopholes, but their sponsors maintain they will amp up discussion between lawmakers and the department about the roots of the problem and how the legislature can help.
Two bills add requirements or consequences for the department. State Rep. Jeff Vernetti, a Republican from Camdenton, filed a bill that would require the department to reimburse jails for housing people on the waitlist at a rate of $200 per person, per day, as well as the cost of medication.
Another bill, sponsored by state Rep. Brian Seitz, a Republican from Branson, would impose a 45-day deadline on the department to conduct court-ordered evaluations and require the department to transfer people ruled incompetent to a hospital within another 45 days. The bill would also require the department to submit annual reports to the General Assembly on competency restoration.
Seitz said a key goal of his bill is to bring the department and lawmakers together in conversation to identify solutions.
“This will open the dialogue to [say], ‘We see there’s a problem, let’s diagnose the problem and solve the problem,” Seitz said. “And I think creating deadlines like I did in the legislation and then requiring an annual report will show us where the problem lies.”
Vernetti said the entire state “has to do a better job of finding ways to get people the help that they need.”
A bill filed by a pair of Democrats — state Rep. Aaron Crossley of Independence and state Sen. Maggie Nurrenbern of Kansas City — seeks to establish guidelines for court-ordered involuntary outpatient treatment before a person gets a criminal charge.
The state’s framework for competency restoration — treatment and services designed to allow defendants to have their day in court — has been moving away from department-run psychiatric hospitals.
A 2023 law authorized the department to offer jail-based competency restoration services and also allowed outpatient treatment for people who could be safely released on bond. The department launched four jail-based pilot programs in St. Louis city and county, as well as Clay and Jackson counties, but law enforcement officials involved in those pilots have reported mixed results.
Crossley said his bill, which delineates a process for courts to assess whether involuntary treatment is necessary and for the person to respond, is designed to “make sure that we’re not forcing people into a situation that is against their will unless it’s absolutely necessary.”
He said it could also help slow the growth of the waitlist for competency restoration services by helping people get treatment earlier.
“We’re talking about getting people help as early as we can,” Crossley said, “and we know that when we help people with any health care issue, the earlier the better, and the more restored they will be to live dignified lives in the community.”
Nurrenbern said the bill would lay out a pathway to get treatment for people with serious mental health conditions who would be better served outside of a psychiatric hospital.
“As we look at this from a state perspective, I think one of the things that should be compelling to individuals is that this is a more efficient model,” Nurrenbern said, “that it can be a more fiscally responsible model, and it can be a model that can be used to ensure that we’re also not breaking individuals’ constitutional rights.”
A persistent problem
The department has long acknowledged the growing number of Missourians who are waiting for a hospital bed to move their cases toward trial or dismissal.
Months before the filing in November of a federal class action lawsuit against the department, Mental Health Director Valerie Huhn in May told lawmakers on the House Health and Mental Health Committee that the waitlist left the state vulnerable to litigation.
“I just wanted to make everybody aware of some of the risks that we know we’re taking on because we can’t get these individuals from jail into our state operated hospitals,” Huhn said in May. “Obviously their illness is worse, and as their treatment is delayed, that makes it harder for us to turn them around.”
Dr. Jeanette Simmons, the department’s deputy director, told The Independent in October that the waitlist is growing because courts are requesting more competency evaluations and the department has a static number of hospital beds.
“As that number continues to increase, I’m not surprised that the number of folks found incompetent increases,” Simmons said. “It clearly correlates together.”
The department maintains that everyone on the waitlist is getting help.
In addition to the jail-based pilot programs, the department indicated in October that two mobile teams of clinicians that visit jails statewide helped 117 people attain competency last year.
But the jail-based programs have met roadblocks.
Sarah Boyd, spokesperson for the Clay County Sheriff’s Office, said Friday that the agency is terminating its agreement with the department in January.
“Our goal in participating in this pilot program was to reduce the number of Clay County inmates awaiting placement in a Missouri Department of Mental Health facility,” Boyd said, “and that did not happen.”
Boyd said the number of people awaiting hospital placement in the jail stayed steady at 7-8 people during the pilot and that the compensation the jail received from the department did not cover the cost of dedicating a pod to competency restoration.
Returning that pod to full occupancy, Boyd said, “will save hundreds of thousands of dollars.”
The sheriff’s office will continue working with mental health staff the department had contracted as part of the pilot program, Boyd said.
“We wanted to be part of a broader solution, but in the current form of this program, it didn’t work out,” Boyd said.
Proposed solutions
Cape Girardeau County Jail Administrator Richard Rushin said his agency built two mental health pods in the new jail opened in September, partly because the jail is expected to house people awaiting services from the state’s mental health department.
Rushin estimated that the pods, which contain 28 single-bed cells with cameras, cost $7.5 million of the $54 million the sheriff’s office spent on the jail.
Rushin said he supports Vernetti’s jail reimbursement bill partly because of the cost of housing people with acute mental health needs, including medications and extra staff.
Taney County Sheriff Brad Daniels said “it wouldn’t hurt to get some of those funds back from housing the inmates.”
“But to me, that’s not the big thing,” he said. “I’m not in this job to make money off of housing prisoners. I feel like we need to get them the help that they need so that they can move on.”
Vernetti said “the money is not the motivation.”
“This is about the discussion on the issue,” Vernetti said, “because I think that if we just threw money at the current problem, that’s only continuing the problem.”
Daniels said he likes that Seitz’s bill would give the department a 45-day deadline to place someone in a hospital.
In recent weeks, Daniels said, the department has been taking about two weeks to complete competency evaluations, often via telehealth. That’s an improvement, he said, but wait times for a hospital bed are still long.
Of the seven people in his jail who have been ruled incompetent, Daniels said on Wednesday, one has been waiting over 14 months for hospital care.
“Once they’ve been determined to be incompetent,” Daniels said, “we need to get them out of here.”
Rushin said he would support the 45-day deadlines Seitz’s bill imposes on the department “if [the bill] would actually hold them accountable for that.” But he doubts the department would meet the deadlines.
“I hate to sound negative, but right now, all they have to do is keep asking for extensions,” Rushin said.
While state law already requires the department to complete competency evaluations within 60 days, the department often takes longer — an average of 75 days, according to its fiscal year 2027 budget request.
There is no law capping how long the department can take to transfer someone to a hospital.
Rushin said that many of the people who have been jailed and ruled incompetent in his county were charged with misdemeanors like trespassing.
“If they plead guilty upon the first hearing with an attorney present, they might get 30 or 60 days, [or they] might get six months,” Rushin said. “Yet they end up going about 18 months to two plus years through this process because of the backup.”
It’s gotten to the point, he said, where “there’s no due process anymore for these lower-lying laws, which is a violation of their rights.”
Money matters
Addressing the underlying causes of the backlog, Nurrenbern said, comes down to funding.
“Departments have been telling us to do more to increase wages, and we haven’t done that,” she said. “Unless we spend significant state resources to invest in our workforce in the Department of Mental Health and Department of Health and Senior Services…we’re not going to do anything to be able to alleviate the gaps that exist there.”
Seitz and Vernetti underlined a need to keep the department accountable in its spending.
“We spent money on the mental health department,” Seitz said. “I’m sure they do a great job in very many areas, but this is one area seemingly that people have fallen through the cracks.”
Vernetti said a shortage of hospital beds “would be the wrong answer [for the department] to give.”
“Then we’re going to start looking at their budget and seeing, ‘OK, let’s maybe move some of your budget from an area that you’re not spending all of it, or maybe not spending it wisely,” Vernetti said.
Daniels and Rushin said they hope lawmakers’ attention to the backlog of people awaiting mental health services in jails will yield solutions.
“They don’t deserve to be living like that,” Daniels said. “They need to get the help that they need so that they can either be found guilty or not guilty of the crime that they have allegedly committed, and get on with their lives or serve their time.”
