No beds, no trial, no treatment: Mentally ill in Missouri jails caught up in yearslong cycle
COLUMBIA, Mo. (KMIZ)
The Sixth Amendment to the U.S. Constitution states that people accused of crimes have the right to a fair and speedy trial. But for those waiting for state-mandated mental health treatment before trial, speedy isn't always the case.
Jeanette Simmons, deputy director of the Missouri Department of Mental Health, said around 500 people have been deemed incompetent to stand trial and are waiting for a bed with the department. Two years ago, the number was just below 300, according to previous reporting.
Another 191 people in Missouri are waiting to get evaluated.
"If somebody were ordered today and for a bed, absent extenuating circumstances, they would wait about 14 months for that bed," said Simmons. So far this year, the department has completed 1,169 pretrial evaluations, an increase from 972 the year before.
Sitting inside the Boone County Jail are eight inmates waiting for a mental health evaluation, and 20 are waiting for a bed to open up with DMH. There are also eight Boone County inmates at a DMH facility receiving services so they can become competent to come back to the jail to await trial.
Currently, there are no beds available in the three DMH facilities designated to provide competency restoration and treatment (Forensic Treatment Center in St. Louis, Center for Behavioral Medicine in Kansas City for lower-level non-dangerous felony charges and Fulton State Hospital for dangerous felony charges and higher security) across Missouri, leaving detainees sitting with the question: "How long will I be here?"
"We had a detainee that first came into our facility in 2021, and it was in the last two weeks that they went to the Department of Mental Health for a bed. Now, during that process, they did go to the Department of Mental Health once," said Capt. Brian Leer with the Boone County Sheriff's Office. "But we're talking from early 2021 until fall of 2025, and this person's case is still not disposed of."
Multiple cases ABC 17 News has been following are at a standstill due to the backlog.
In Columbia, Demetrice Tatum is accused of murder in connection with the deadly stabbing of another man in a central Columbia park in April 2024. In December, Tatum was deemed incompetent to stand trial after his lawyers requested a mental evaluation in July 2024. Online court records from Sept. 22 say Tatum was No. 48 on the bed list for Fulton State Hospital. A mental health status hearing is set for Jan. 12, 2026.
Getting help
If you or someone you know needs mental health services, Simmons says reaching out to your community health agency is a good step to connect with local resources.
In Cole County, that would be Compass Health, and in Boone County, that is Burrell Behavioral Health. Both locations also serve as behavioral health crisis centers, according to Simmons.
The Missouri Psychiatric Center offers both short-term intensive inpatient treatment and outpatient treatment.
If you are unsure of which place to call, using the 988 Crisis Hotline will connect you to resources to help.
The lawyer for Emma Adams, the woman accused of killing a University of Missouri student and trying to burn his body in 2023, filed multiple motions to have her committed. Adams was committed to the DMH in November 2023, and was found unfit to stand trial in January. According to online court records, Sept. 25 was the deadline for DMH to give her evaluation report to the court. Her next court hearing is Oct. 14.
Another case in limbo in Boone County is Steven Strumpf, the man accused of arson and the murder of his father. Court documents in previous reporting say that on Jan. 19, 2024, firefighters discovered a body under debris in a garage on Deerfoot Way. They found the body later when looking for hot spots. He allegedly admitted to stabbing the victim multiple times and setting the body on fire, court documents in previous reporting say.
According to court records, a mental evaluation was granted for Strumpf in May to see if he is competent to stand trial. That was filed Aug. 22, and there have been no new developments since. His next hearing is set for Oct. 14.
How the mental evaluation process works
"If somebody is presenting with signs of mental health issues, the statute dictates that a defense attorney, a prosecuting attorney, or the court itself, based on observations in court, if they're suspected of having mental illness, somebody may not be competent to proceed with trial," said Melissa Buchanan, first assistant prosecutor for Boone County.
This is when the court would order a mental health evaluation. From there, the Department of Mental Health has 30 days to conduct the evaluation.
"Our experience has been that the Department of Mental Health almost always asks for an extension, which the statute does allow for," said Buchanan. "So then you're pushing it out further where, more likely than not, in many cases, it will be maybe 60 days before the Department of Mental Health reports back to the court."
If a person is deemed incompetent to proceed in court, DMH will file a report and send it to the courts. The court reviews and signs it so that the person can be ordered into the custody of DMH for competency restoration services like medication and therapy, so they can eventually proceed with the trial.
Buchanan says ideally, the person would be transferred from jail to a DMH facility relatively quickly after being deemed incompetent.
"The people in Boone County who have been judged incompetent are technically in the custody of the Department of Mental Health, but effectively staying in Boone County Jail for sometimes a year or more," Buchanan said. "That's really where, I think, the system breaks down in its current incarnation."
Effects on jails
Some argue that jails in Missouri and nationwide are becoming the psychiatric hospitals of 2025, causing a strain on jail space, jail staff, money and other resources.
"We are literally buying coloring books and crayons and stuff like that to bring in to help these people do what they need to do," Leer said. "I mean, it almost resembles a daycare type environment sometimes with the detainees, and I think everybody would agree that jail is not the place for that."
The Boone County Jail has a full-time mental health professional and contracted medical and mental health staff to provide services to everyone in the jail who needs them. An out-of-state psychiatrist does video calls with detainees suffering from mental health illnesses once a week.
"There's a lot of burden on the county jails when they have individuals who have mental health needs, and some of those medications, for example, are very costly," said Simmons. "That's a big burden on those county budgets."
Leer says the jail sees higher incidents of mental health issues with the homeless population and those suffering from drug addiction.
The Boone County Jail typically has to segregate the mentally ill, using a jail cell meant for two to house just one.
"If someone is not going to be safe or be able to function in a housing unit with other people, we have to segregate them," Leer said.
In turn, there is less space for other inmates in the jail, which causes the county to pay to house around 100 inmates in places such as Montgomery County, Randolph County and even Johnson County and the St. Louis area. Leer estimates the cost of housing inmates at other jails this year is around $1 million, but says that number could end up being higher.
Leer said the county doesn't send dangerous prisoners to other counties. That leaves Boone County Jail staff to deal with the worst offenders, along with the mentally ill.
Leer also believes this issue plays a factor in staff turnover at the jail, as the jail has 12 vacant detention officer positions to fill and five control room officer positions.
"One of the things to it right now, the hardest place for us to staff is the jail," Leer said. "I think a lot of that has to do with dealing with this exact issue, day in and day out, coming in, dealing with people who really the jail is not the place for them to be, they're a detention officer who has to almost be a babysitter at times."
Jail staff safety is also a concern at times. Mentally ill inmates have attacked staff, Leer said.
Buchanan says while jails can administer medication, they can not force a person to take it like the Department of Mental Health can, which can pose threats to the jail itself and its personnel.
"We have phones, we have fire alarms, we have sprinklers, we have showers and toilets, and they flood cells, they make messes that have to be cleaned up," said Leer. "Then you talk about self-mutilation. There's a lot of that that happens."
People who work with the system agree that jail is not the right fit for a person suffering from a mental health issue, but there is no other option for them.
"You'll see comments out on social media, you hear comments in public like, 'Why is the sheriff holding them in the jails? That's not a place for them.' We don't have that option," Leer said.
Effects on detainees
According to the National Alliance on Mental Illness, Department of Justice data shows that two-in-five people in jail or prison have a history of mental illness, with 44% of them being held in local jails.
"If you have mental health needs and you're not getting the treatment services that you need or getting medications you need, it can impact your ongoing stability and your ability to become stable down the road," Simmons said.
Annie Legomsky, director of client advocacy for the Missouri State Public Defender's Office, said people often end up in the criminal justice system due to their illness.
"A lot of these clients in the competence waitlist are not doing well; they are getting even worse while they're waiting in jail," Legomsky said. "It's disastrous for our clients. It is truly a crisis."
Legomsky said at least two-thirds of people on the waitlist are facing lower-level nonviolent crimes. Several charged with homicide are waiting for beds as well, according to Legomsky.
"I had a client who had received a trespass charge, a misdemeanor, because she was unhoused and was mentally ill," Buchanan said. "She went into a local restaurant, she did not smell very good. They asked her to leave, and she didn't leave, so they called the police on her. She ended up sitting in jail without an attorney for nearly two years for what should have been a six-month maximum, even had she been convicted."
While Leer says the jail takes many steps to prevent self-harm, like taking certain items away, where there's a will, there's a way.
"I've seen people, cases in our facility, where people self-mutilate with a Bible. You name it. I mean, we could probably come up with a way that somebody has done such," Leer said.
Most people suffering from severe mental illness need more regular checks from jail staff and the mental health staff, which takes away time from the other hundreds of inmates who need the services as well.
The backlog has left those involved in combating this issue frustrated.
While some detainees dealing with mental health issues are more difficult to manage due to the severity of their disability, Leer says most are cooperative and manage their mental health.
"They are very receptive to talking with our mental health people back there, staying on top of their medication and managing that, and are competent to stand trial," said Leer. "That's a lot larger number than the folks that we have that are incompetent and need to go to the Department of Mental Health."
Degreasing the slow-moving wheels of justice
Buchanan says once a person has been deemed incompetent to stand trial, the criminal justice process stops because the courts cannot ethically move forward with the case until the person can participate.
This, in turn, can affect the court's ability to present its best case as more time goes on.
Buchanan says ideally, after DMH has deemed a person incompetent to stand trial, they would quickly be transferred from jail to a DMH facility; however, that's not how it's been working recently.
"As time goes on, eyewitness accounts, memory degrades, people may pass away, people may move away, and the ability to put on the best case, in the interests of justice, is certainly greatly affected, as well as just the well-being of victims," Buchanan said.
Public defenders, like Legomsky, represent their clients' best expressed interest, not what they think their clients' best interest is. If their client doesn't want an evaluation done, it doesn't have to be done, unless an exception is made.
"There is an exception in issues of competence, where, when you do have a reasonable belief that someone is incompetent to proceed, you have to raise that with the court," Legomsky said. "So that does go against our client's expressed interest a lot of times, which is terrible. We don't want to do things our clients don't want to do; it destroys our relationship and our trust that is necessary for us to be able to represent them if they do regain their competence and we need to litigate issues with them."
Most of the mentally ill clients represented by the Public Defender's Office have committed crimes of poverty and mental illness, misdemeanors and probation violations, according to Legomsky.
Buchanan says some people with significant mental illness don't always want to take medication or be in a mental health facility, putting the defense attorney in a position where their client wants to try to move the case forward.
"If they're well enough to be able to plead guilty to a misdemeanor offense for time served, for instance, that is what the defense attorneys will advocate for, because that's what their clients want," said Buchanan. "But if they're well enough to try to plead to, especially on misdemeanor, lower-level offenses, to a time served offer, then you get them out of custody and they're just cycling back through, and so you'll see people that have been going in and out, in and out, in and out."
Bringing an inmate back from a DMH facility can itself aggravate their illness.
"If they become non-compliant with medications, Boone County can't force you to, and they degrade right back down into psychosis," Buchanan said.
Once a person has gone through the competency process with DMH, they go back to the bottom of the bed waitlist.
Looking for a cause
Decades ago, a movement sought to deinstitutionalize patients from mental health hospitals, which at the time were referred to as "insane asylums." The belief that mental hospitals were inhumane, the hope that new antipsychotic medications offered a cure and the desire to save money played a factor in the decision.
Officials say multiple factors are contributing to the already-long list of detainees waiting for a bed with DMH. Simmons noted that a provider and workforce shortage in social workers, psychiatrists and psychologists can contribute to the delay.
In addition, Simmons believes the growing awareness of mental health and behavioral conditions has led to more people needing services.
"I think that's part of what we're seeing. There may not necessarily appear that maybe there's an increased number of people that have mental health issues, and it may just be that more people are seeking those services because they're becoming more aware," said Simmons.
Leer believes the increase in mental health patients in jail can be attributed to more attention and awareness of mental health as a society, and adding more beds in DMH would help lower this number.
"The best place that they can be is somewhere where someone can stay on top of their medication, help them live a happy, successful life, safely, and we just don't have that opportunity for a lot of folks," said Leer.
While more beds could help lower the waitlist, Legomsky says more beds are not the long-term solution.
"They are building a new hospital in the Kansas City area that's some years away, that's 200 beds, so the waitlist is 500 right now. That will dent the problem," said Legomsky. "As the director of the Department of Mental Health has testified to before, she has said the waitlist will be at 1,000 before it goes down."
The legislature in 2023 amended the statute that regulates competency and allowed community-based restoration instead of going to an inpatient psychiatric facility. Legomsky says the person is let out on bond and goes into treatment in the community, but that has not been taken advantage of enough.
"DMH is training community providers now to do it, but there's still just a lot of hesitation, I think, from prosecutors and judges to release folks," said Legomsky. "The lack of supportive housing has been a huge barrier. So that is, I think, a huge solution to this crisis that's been implemented in other parts of the country very successfully; we need to do more to get the legal system comfortable and using it."
Buchanan also believes that more intervention services are needed before people end up in crisis mode.
"I really think by the time that you have picked up a criminal case, you're hitting a crisis point," Buchanan said. "I think it's just insanity, right? Doing the same thing over and over again and expecting different results, that's not going to happen. I think we need to decide how to do something different to meet the needs of the community."
Multiple states have sued over the backlog. In 2024, Kansas settled a lawsuit over delays in providing mental health evaluations and treatment for individuals in county jails.
What is being done to fix it?
"The thing that hasn't changed for the department is the number of beds available for individuals to be restored," Simmons said. "When you have a finite number of beds and an increasing number of referrals, you end up with a backlog."
Simmons said that before 2023, the only way to receive competency restoration was in an inpatient setting. That has changed over the past two years.
Some inmates can receive restoration in a jail setting. Simmons said these programs in Jackson County, Clay County, St. Louis County and St. Louis City offer 40 spaces, 10 at each jail.
Another new program is outpatient restoration.
"An individual can, if they're released on bond, receive those services from our community providers and we are really hoping that that grows," said Simmons.
A new behavioral hospital is being built in Kansas City, which will increase the department's beds in the Kansas City area to 215 beds. The hospital will come online in 2028.
Another factor aimed at helping decrease the backlog is two forensic mobile teams that go into county jails across Missouri and provide medication and treatment to people waiting for a bed with DMH.
But for now, the waitlist will continue to grow.
"Waitlists will continue to grow and will be caught up in this cycle with no end in sight," Buchanan said.
