Missouri lawmakers raise concerns about long waits in jail for court-ordered mental health care
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).
Leaders of Missouri's public defender system urged lawmakers on Monday to take action to reduce the growing number of people languishing in jails across the state who are in need of mental health treatment.
As of last month, 418 people were in Missouri jails waiting to be transferred to a state mental health bed, up from around 300 at this time last year. The average wait time was 14 months, with some held longer than the maximum sentence for the crime for which they were charged.
These are Missourians who were arrested but found incompetent to stand trial and ordered into treatment designed to restore their ability to have their day in court. Competency restoration generally includes medication treatment and therapy.
Missourians waiting in jail for court-ordered mental health care reaches all-time high
The Missouri House Health and Mental Health Committee spent most of an informational hearing Monday addressing the Department of Mental Health's competency restoration program, with a presentation by Mary Fox, the director of the Missouri State Public Defender system, and Annie Legomsky, who runs the state public defense system's holistic defense services program.
'When somebody sits in a jail unmedicated and uncared for,' Fox said, 'their mental health can get worse and so bad that they can never be cured.'
Legomsky and Fox urged changes to state law to increase court referrals to community-based treatment, instead of holding those charged with nonviolent, low-level offenses in jail for months.
'If we could figure out a way to take care of more of these folks in the community,' Fox said,'we're not only saving the state money in the competence restoration process, but we're setting them up for success when they return to the community.'
The state can't create beds overnight, Fox said.
'And until we can either create the community restoration and let folks receive the treatment that way or create the beds, we don't have a quick solution to the problem,' she said.
Many of the public defender's office's clients who are found incompetent have schizophrenia, intellectual disabilities or are on the autism spectrum, Fox said.
The legislature in 2023 passed a law giving the department the authority to provide treatment on an outpatient basis if the person could be safely released and wasn't charged with a dangerous felony. But the department told The Independent last month that only two people have participated in the program so far.
The state also passed a law giving the department of mental health the ability to treat people within jails. The programs have been slow to get up and running, and three counties are in their early days of getting the programs started, the department told The Independent.
Legomsky said Monday that solution is 'not ideal' since 'the jail is not a therapeutic environment.'
The hearing was designed to inform lawmakers, not to discuss any particular legislation.
Several of the legislators serving on the committee expressed concern with the waitlist.
'We just don't have enough beds, that's the answer,' said state Rep. David Dolan, a Republican of Sikeston 'We don't have enough beds, and restoration within county jails is very hit and miss.'
State Rep. Tony Harbison, a Republican of Arcadia, said small counties are footing the bill, since counties are responsible for paying for jail stays.
'Fourteen months — we're already spending a lot of money,' he said.
Legomsky estimated that the state would save around $480 in savings per day to do community-based competency restoration as opposed to the hospital setting, not to mention the cost savings for counties currently housing those individuals in jails.
One client, Fox said, was a 78-year-old woman with dementia who tossed lit matches in a laundromat waste basket — but was held in jail for a year, waiting for a mental health bed.
State Rep. Jo Doll, a Democrat of St. Louis, responded: 'Where's the common sense part of that? How does someone, how do you all these people see this person day after day and let someone sit there for a year?'
A handful of lawmakers asked about the potential for a public-private partnership, and whether private hospitals could be included. The public defenders said that would be a question for the department of mental health.
Others asked about states that do things better. Legomsky said Washington state limits the wait time to 14 days, and recommended time limits be established in Missouri statute.
'Even closer to 30 days would be a huge improvement over 14 months,' she said.
Other recommendations included increasing funding for community crisis care, housing and substance use disorder treatment — wraparound services to help people become competent and remain healthy, Legomsky said. The state could also make community-based treatment the presumption for those charged with low-level, nonviolent offenses. She said the public defenders estimate around 80% of those on the waitlist are charged with low-level, nonviolent offenses, and could be treated on an outpatient basis.
'We're on the same side as the prosecutors, the sheriffs, the courts,' Legomsky said. 'I think we all just want to find a solution.'
SUPPORT: YOU MAKE OUR WORK POSSIBLE
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
3 days ago
- Yahoo
Kansas abortion clinic leader was ready for Missouri abortion ban, fears it won't be short-lived
Kathryn Boyd, the new CEO and president of the Wichita-based abortion clinic Trust Women, appeared on the Kansas Reflector podcast to discuss how Missouri's abortion ban might affect Kansans. (Submitted) TOPEKA — In May, as Kathryn Boyd began her new role as president and CEO of the Trust Women clinic in Wichita, one of the first conversations she had with the clinic's leaders was how to deal with a new ban in Missouri and what it might mean for Kansas. A late-May decision from a Missouri judge triggered an all-out ban on abortion in the state, but that wasn't much of a surprise to Kansas abortion providers who were preparing for the worst. The majority of abortion patients in Kansas already come from out of state, and now, Trust Women is making its physicians more available and expanding its hours to brace for an influx. 'This is a case of lawmakers who, despite what Missourians voted for, have decided that they're going to just throw that out the window and do what they want anyway,' Boyd said on the Kansas Reflector podcast. 'So I think my first reaction was like, OK, here we go again.' 'Before the ban, Missourians were able to receive abortion care in major cities, reversing years of restrictions implemented by state lawmakers. Those rulings came after voter approval of a constitutional amendment in November enshrining reproductive freedom in the state constitution. All of that was undone in a two-page ruling last month from Missouri Supreme Court Chief Justice Mary Russell, who ordered Jackson County Circuit Court Judge Jerri Zhang to vacate the December and February decisions and reevaluate the case, restoring a ban on abortions and restricting facility licensing. Health centers in Missouri provided care to people who wouldn't have to travel as far as they do now, Boyd said. Following the anger, fear and worry in the wake of the decision in Missouri, Boyd said the primary focus of Trust Women is to expand access. The clinic's message, she said, is, 'We're still here.' 'We're still providing care. We need to expand, and we need support. You know, that's really what it comes down to. And I think that that is a similar story of many, many providers throughout the country, regardless of what state they're in,' Boyd said. However, her fear is that the ban won't be short-lived. Boyd, who has worked in the field of abortion and reproductive care for years, entered the top job at Trust Women about a year after intense turmoil within the clinic. Reports of mass resignations and multiple leadership shakeups led the clinic to temporarily close its doors. Boyd, though she wasn't working at the clinic at the time, describes it as 'very, very hard' for the organization. 'Coming in after a culture shock like that can be really challenging for any leader,' Boyd said. 'Making sure that I come in with that in the back of my mind, I don't want that trauma to, like, dictate what we do going forward, but it definitely is like a side dish.' Her goal is to create a culture of transparency and collaboration, and that requires building back trust and listening, she said.
Yahoo
6 days ago
- Yahoo
Republicans' new Medicaid red tape will push Missouri to the brink and block healthcare for millions
New paperwork and work rules for Medicaid will impose new burdens on state government systems (Getty Images). This week, Senators have started their consideration of President Trump's big tax bill, which was passed by the U.S. House of Representatives in May. Missouri U.S. Sen. Josh Hawley was clear in his priorities for the legislation, writing in early May that 'slashing health insurance for the working poor is … both morally wrong and politically suicidal.' President Donald Trump was blunter, telling lawmakers not to 'f**k around with Medicaid.' The bill passed by the House, does not pass their test – it does not, as Trump and Hawley claim, contain 'NO MEDICAID BENEFIT CUTS.' Instead, it will kick millions of people off of Medicaid by piling on new red tape. And it will bury under-resourced state Medicaid offices in so much paperwork that they will be at risk of collapse. Together, these forces will mean that eligible Americans in Missouri and around the country will not have access to their Medicaid. Many will be left without health care as they prepare to bring a child into the world, face a new cancer diagnosis, or manage a chronic illness. In other words, if this bill passes, Medicaid will be cut for Missourians when they most need it. The House bill imposes new bureaucratic requirements on Medicaid beneficiaries, forcing them to file piles of new paperwork about their jobs, schools, disabilities, or sick family members to keep the health insurance they are already eligible for under the law. These so-called 'work requirements' do not boost employment as advertised – experiments in other states have repeatedly failed to do so. This is, in part, because the vast majority of Medicaid beneficiaries who can work already do. That makes sense – you can't buy food and pay rent with a health insurance card. The reason this bill reduces the cost of Medicaid by billions of dollars is that it assumes regular people will get tangled in the red tape of proving they are eligible for Medicaid. Experts project that over 10 million eligible people will lose their health care because of all the paperwork, including over 180,000 Missourians. But we believe that even this prognosis is too optimistic. Most analyses only consider the difficulty that people will have proving that they are entitled to Medicaid under the law, but not the difficulty states will have in administering the new paperwork requirements. We have spent the last several years modernizing the systems that deliver benefits to millions of Americans, including Medicaid. What we have learned is that state Medicaid systems, including MO HealthNet, are already on the brink – and lack the resources and resilience to take on the onslaught of requirements and deadlines about to hit them. Trump's tax legislation, the new requirements it imposes, and the lightning-fast timeline it requires, are setting Medicaid up for a collapse. Here's how it could play out. States are responsible for determining Medicaid eligibility. They allow people to enroll in one of four ways – by mailing in documents, enrolling online, applying over the phone, or walking into a physical office. Each of these pathways is already at a tipping point. Medicaid agencies around the country have staff vacancies as high as 30 percent, which means there are already too few workers to open mail, process applications, answer the phones, and staff walk-in centers. As a result, even under the current system, eligible people can see their Medicaid lapse because their paperwork is not processed in time. Missourians have recent experience with the effects of an overburdened Medicaid system. By law, Medicaid applications are supposed to be processed in 45 days, but as of last May, Missouri missed that deadline 72% of the time – the worst record in the nation – causing the federal government to step in to help for the second time in two years. The wait time on the Medicaid call center was 56 minutes in February 2024. The House bill will immediately explode the workload for state Medicaid offices. Medicaid beneficiaries will need to prove their eligibility twice a year instead of annually. And then it piles on the new paperwork rules. Missouri will have to figure out how to verify that a beneficiary is working, going to school, or meeting the new requirements some other way. They'll need to send out millions of paper notices, emails, and text messages to notify enrollees about the changes and train staff to handle the deluge of documents that will flood in. Just hours before the bill passed, Congress quietly moved up the deadline for states to make these changes, requiring implementation by the end of 2026 or sooner. And all this new bureaucracy rests on technology that is already failing. We've seen just how broken states' health care infrastructure is – Luke helped uncover state software errors that improperly terminated coverage for nearly 500,000 eligible kids across 29 states after the pandemic. The added strain imposed by this legislation will crash websites, jam call centers, and trigger even more software errors – trapping working people in the chaos. Under these conditions, failure isn't just likely — it's inevitable. We don't need to guess at how this plays out. When Arkansas tried to implement Medicaid work requirements in 2018 the results were disastrous. People received confusing instructions about how to prove they were working and many never knew about the requirement. The state's website repeatedly crashed. In the end, more than 18,000 people lost coverage, employment rates did not budge, and the state wasted $26 million on a failed experiment. In some states, that will mean lines around the block at overwhelmed county offices. In others, dropped calls, system outages, and piles of unprocessed renewals. These challenges compound. When the website breaks, you call. When your call drops, you drive to the office. Attrition will spike as the overmatched Medicaid staff are increasingly under siege, overtime is mandatory, and time off is cancelled. Smaller and smaller numbers of staff will bear larger and larger workloads until the system collapses. And, eligible Americans – working adults, kids, seniors, students, and adults with illnesses and disabilities – will still have no Medicaid. Hospitals will provide more uncompensated coverage, putting some – especially rural hospitals and children's hospitals – at risk of failure. This bill sets up state Medicaid agencies to fail at their most basic task – ensuring that eligible people have health insurance. It doesn't matter to a pregnant mom why her Medicaid is cut, she is going to miss prenatal visits and skip her toddler's check-up. If Hawley wants to stand up for over one million Missourians who rely on Medicaid, he should oppose this bill. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
7 days ago
- Yahoo
Can you hold a plank longer than others your age? Fox hosts test their core strength
How long can you hold a plank — and how does it stack up to others in your age group? That's the question that was posed on "Fox & Friends" Thursday morning, when co-hosts Brian Kilmeade and Lawrence Jones competed in a plank challenge. A plank is an isometric move where the person holds a push-up position for a set period of time. Army Unveils New Fitness Test With Tougher Standards — Could You Pass It? Both held a low plank for well over a minute, exceeding the thresholds for their ages, although Kilmeade held his for a few seconds longer. A fitness expert at Lifetime in New York City provided the below targets for how long you should be able to hold a plank by age. Read On The Fox News App 20s: 1 to 2 minutes 30s: 1 to 2 minutes 40s: 1 minute or longer 50s: 30 to 60 seconds 60s and above: 20 to 30 seconds Planks are often touted as an abdominal exercise, serving as an alternative to traditional sit-ups and crunches, which can strain the back and neck. However, the isometric move benefits the body in many other ways beyond just sculpting a six-pack. In addition to working the abdominals, planks also strengthen the muscles in the arms, legs, chest and back, according to Healthline. They can also help improve posture while sitting or standing and can boost flexibility by stretching the lower half of the body, the above source stated. While Kilmeade and Jones both held low planks, some may opt for a high plank, which is where the arms are straight and the person balances on the palms of the hands. Click Here To Sign Up For Our Health Newsletter For those who are still working up to holding a full plank, the move can be modified by dropping the knees to the floor. There are also variations of the plank that target different parts of the body. Those include side planks, knee touches (touching alternating knees to the ground), hip dips and leg/arm extensions. For more Health articles, visit If you've just started planking, experts recommend starting with 15 to 30 seconds and gradually increasing the duration, with two minutes generally regarded as a good article source: Can you hold a plank longer than others your age? Fox hosts test their core strength
