'It's really devastating': Mentally incompetent inmates languish without care while state waits for open beds

Julia Matlock’s brother is sick. Everyone including the state of Missouri knows this, except him.

Matlock’s brother is in jail; his mug shot still appears on the county sheriff’s online jail roster. Next to his mug shot, you’ll see the explanation for his presence there: two first-degree trespass charges and a second-degree property damage. Those nonviolent charges, all misdemeanors, have come with an $11,000 bond. Matlock’s brother has not had any serious criminal charges in about 15 years, and even those were nonviolent offenses.

But you won’t find his recent charges on the Missouri court’s online database. Those charges have been hidden from public view.

Matlock’s brother has been ruled mentally incompetent by the court system, which means he cannot face trial or defend himself against the charges brought against him.

Matlock says her brother doesn’t believe he is mentally ill. Her brother, who the Southeast Missourian is not naming for health and online privacy reasons, has been diagnosed with paranoid schizophrenia, Matlock said. As such, he believes people are out to harm him. His illness makes him behave in irrational ways. In jail, she said, he cannot receive Medicaid benefits, meaning her brother is not taking medication that would relieve his suffering. She says he has described his mental condition as painful.

The events that led to his arrest, Matlock said, were two trespassing charges in which he was “picketing” at businesses he thought could help him in some way. The property damage charge dealt with kicking in a door when he believed he was trying to save his children from harm. These odd behaviors at the peak of a psychiatric episode landed him in jail.

The maximum sentence for someone who commits a class B misdemeanor is six months in jail. He has been in the county jail since Feb. 2, 2024. He remains there because the Missouri Department of Mental Health won’t, or can’t, take him. Matlock says his next evaluation is set for Thursday, Aug. 21.

Matlock’s brother is one of about eight people sitting in the Cape Girardeau County jail after being ruled mentally incompetent to face charges, according to numbers provided by the county as of December. He’s one of more than 400 people in Missouri waiting for a transfer to a psychiatric hospital, according to reporting from the Missouri Independent. Others can sit in jail for months — longer than sentences for the misdemeanors for which they’ve been accused — waiting to be evaluated for mental competency. They’re often too poor to meet bond. They’ve not been proven guilty. They often desperately need psychiatric care.

Matlock’s brother’s issue represents a statewide problem that frustrates a sister who cares about her brother’s well-being, or lack thereof. The situation also frustrates prosecutors, judges and defense attorneys, not to mention jailers who must retain people who can make loud noises and big messes.

Richard Rushin, Cape Girardeau County jail administrator, is pushing for change. He says this problem is one that needs more public discussion. He has raised the issue with state and local mental health professionals as well as journalists. He empathizes with mentally ill people, especially those who are nonviolent, being held in jail. Rushin respects the constitutional rights of individuals and basic fairness, which he believes often calls for treatment, not jail time, for mentally ill nonviolent misdemeanor offenders.

“You gotta understand where I come from,” Rushin said. “In 1987 or ’88, when I started, you got a court order. You had, I think, 24 hours to deliver them to the mental hospitals. So they were taken immediately. We used to take them to Farmington, and they stayed there until they got corrected, or they go off to institutions.”

According to information provided by Rushin, one of the incompetent individuals who remained incarcerated in Cape Girardeau County jail as of December was arrested Aug. 20, 2021.

Rushin said most of the incarcerated people declared incompetent — or people waiting for evaluations of such — are not violent offenders. He said it’s more typical that mentally incompetent inmates are trespassers, many times homeless individuals, who have not committed a violent crime. Often, he said, they are arrested after loitering at businesses and refusing to leave when requested. Occasionally, they argue or resist police when property owners call the police to remove them, which can lead to upgraded charges.

Rushin also pointed out that incarcerated people, even those who have not yet been found guilty, are cut off from Medicaid benefits once they are put in jail. This means they often cannot afford the medications that will help take the edge off their psychiatric conditions, which leads to deteriorating health. The lack of medication is compounded by being in a prison environment around other inmates, which exasperates anxiety and paranoia symptoms.

Rushin said he would like to see mentally ill people get the psychiatric care they need, but the Missouri Department of Mental Health can refuse to take them. The problem is that the DMH doesn’t have space in facilities. But there is also a lag time for getting mental health professionals to do the tests, either by phone or remotely, which also prolongs the time these inmates are incarcerated.

On top of the care, the simple logistics cause problems at the jail.

“They take up twice the space because you usually put them in a cell by themselves. … The staff have to deal with them 10 times more than your normal inmate,” Rushin said.

Cape Girardeau County is one of the more progressive counties in Missouri regarding mental health care for its inmates. The Jail Navigator program, supported by Cape Girardeau Community Counseling Center, makes mental health care accessible to inmates as part of an overall plan to help equip inmates to handle basic needs once they leave the jail. The recidivism rates have dropped as a result. But the program can only do so much. Some inmates need more acute care than what the jail can realistically provide. And when the state rules people incompetent, the state is obligated to take custody of the individuals for psychiatric care.

In 2023, Rushin sent an invoice to the Department of Mental Health to recover the county’s cost of housing incompetent inmates who should have been in state custody. The cost over a year, he calculated, was about $750,000. The state did not pay the invoice, telling the county that no statute supported such a payment. The inference is that the state’s failure to meet its responsibilities to serve the mentally ill population has fallen on local jurisdictions to pay for the housing and feeding of these individuals, in jails, which are already crowded.

Clara Bates ~ Missouri Independent

Meanwhile, across Missouri, the average waiting time for an inmate to a psychiatric hospital has exceeded 400 days for the first time, according to numbers compiled by the Missouri Independent from the Missouri Department of Mental Health. The average time these individuals waited in jail before receiving treatment is 14 months.

The numbers are getting worse, even after court officials' pleas to the state Legislature to address the problem.

Locally, Cape Girardeau Community Counseling Center identified the treatment of jail inmates as a secondary priority in its recently released needs assessment. The report stated that homeless people were incarcerated for minor charges and inmates had long waits for forensic evaluations and a lack of forensic beds. The evaluations fall under the umbrella of the Department of Mental Health and are not sourced out to CCC, but the needs assessment stated that “further discussions, outside of the forensic population, and coordination with county jails will need to take place to determine the extent of need and what will assist them in getting services initiated. Lack of funding for these services is an issue.”

Mary Fox, the director of the Missouri State Public Defender system, said the wait times are the worst she’s seen, the Missouri Independent reported. She said public defenders identified at least 12 cases where such inmates have been held longer than what their maximum sentences would have been. She told the Independent she has been trying to get some of the cases dismissed.

Annie Legomsky, who runs the state public defense system’s holistic defense services program, testifies to the Missouri House Health and Mental Health Committee on Monday as Mary Fox, the director of the Missouri State Public Defender system, looks on. Tim Bommel ~ Missouri House Communications via Missouri Independent

Annie Legomsky, who runs the state public defense system’s holistic defense services program, said the wait time and solitary confinement “just completely deprive them of humanity, and it’s the antithesis of anything you could call a therapeutic environment. We see clients who do just really sad things like eating their own feces, having suicidal ideations and actions, who are just completely decompensating.”

On Monday, Feb. 17, Legomsky addressed members of the House Health and Mental Health Committee to take action to address the problem. She testified that people with mental health problems who languish without care can worsen to the point where they cannot be cured. She encouraged lawmakers to change Missouri law to increase court referrals to community-based treatment instead of holding those with nonviolent offenses in jail for months, the Independent reported.

Rep. David Dolan, a Sikeston Republican, speaks at the House Health and Mental Health committee on Monday.Tim Bommel ~ Missouri House Communications

David Dolan, a Sikeston Republican and former judge, said in the hearing that the ultimate answer is increasing the number of available beds. He added that restoration within county jails is “very hit and miss”, according to reporting from the Independent.

In 2023, the Missouri Supreme Court chief justice told the Missouri General Assembly that the state’s courts needed help in dealing with the “mental health crisis” in this country.

"Too often, we are confronted with individuals manifesting mental health conditions so profound they are not even competent to stand trial," former Chief Justice Paul C. Wilson told legislators at the time. "Police have to arrest them and prosecutors charge them — both to protect those defendants and the rest of us — but we can't proceed with their case. Medication, case management and treatment can often restore competency, but delays in getting defendants into traditional in-patient facilities leaves them — and our courts — stuck in limbo, unable to move forward or back."

Data at the time provided by the Supreme Court showed that 610 cases were suspended, pending a mental evaluation since 2020. During that time, only 375 exams were filed.

The Legislature passed a law in 2023 giving the Missouri Department of Mental Health authority to provide treatment on an outpatient basis if the person could be safely released and wasn’t charged with a dangerous felony. However, the Independent reported that only two people have participated in that program.

In 2023, Cape Girardeau County Prosecuting Attorney Mark Welker said the court sets a 60-day deadline for the completion of the exams but, often, the state “is taking six to nine months to have these examinations completed.”

While justices, public defenders and prosecutors lament the delays, the mentally ill continue to get sicker, alone in jail cells without treatment.

Matlock said her brother is confined to a cell by himself after telling corrections officials he was going to jump off the balcony. She explained his personality is typically submissive.

“When you’re schizophrenic, you lose 15 to 20 years of your life,” Matlock explained. "And so, one year to him is like two years to us. His oldest son is graduating from high school in May. ... He’s missed. I mean, all of us are getting older, you know what I mean, and he’s just sitting in there wasting away. It’s really devastating. I think about him every single day, all the time.”