ÁñÁ«ÊÓƵ

“They are innocent and incompetent,� Roediger says. “In theory, we don’t have a system that puts innocent and incompetent people in jail.�

Roediger is director of the at the St. Louis University School of Law. He and law students represent indigent people accused of a crime. The clients often have mental health issues, and many have been found incompetent to stand trial.

But in Missouri, Illinois and other states, there are not enough mental health beds to transfer people from a jail to a hospital for treatment. So they sit in jails in the city of St. Louis, St. Louis County, Kansas City and rural areas of the state. The problem is so bad in Illinois that a group of sheriffs has sued the state, trying to force action.

“We are not a mental health facility,� Maj. Tammy Grimes, the jail superintendent in St. Clair County, told me a year ago, when her jail had seven detainees awaiting a state mental health bed. “We can’t provide them the health care that the court is ordering them to receive.�

In Missouri, Roediger says, judges, lawyers, sheriffs, police chiefs, jail directors and mental health officials are all raising alarm bells about the problem. Jeanette Simmons, deputy director for behavioral health at the state Department of Mental Health, says there are 252 people who fit Roediger’s dual categories of “innocent and incompetent.�

They haven’t been convicted. A judge has found them incompetent to stand trial and has ordered them into the Department of Mental Health. But there are no beds available and not enough staff members — social workers, nurses, psychiatrists — to provide services the jail detainees need and deserve.

There are another 261 people somewhere in the pre-trial process who are in a similar situation — stuck in jail, where their mental health issues are often exacerbated.

“It’s very bad, all throughout the state, rural and urban,� Roediger says. “There’s delays in just getting people evaluated. Once people are evaluated, they are just stuck sitting in jail.�

The state’s plan is to launch five pilot projects — in the city of St. Louis and the counties of St. Louis, Jackson, Greene and Clay — to provide on-site workers at jails and help “restore competency� through mental health services.

Scott Anders, who retired last week as director of the St. Louis County Justice Center, thinks the proposal has promise. To deal with the growing number of detainees with mental health issues, Anders created a dedicated unit for them, with corrections staffers trained in crisis intervention. The county jail now has room for 25 patients in its special unit, with hopes to expand.

It’s working, says Mario Reed, a case manager in the unit.

“This is how it should be in all jails,� says Reed, who has worked in the facility for more than 20 years.

In many city and county jails, with no staff trained in mental health needs, detainees end up in administrative segregation. And the isolation can make their conditions worse.

Anders knows there is a serious need for jails to improve how they deal with mental health needs. It’s why on top of the new mental health unit, the county jail started offering classes through St. Louis Community College and programs to battle drug addiction.

The National Alliance on Mental Health suggests that 44% of the people in city and county jails shouldn’t be there because they need treatment for drug addiction or mental health issues. If applied in St. Louis County, that percentage would drop the jail population from the 1,004 on a day I visited to fewer than 600.

But for that to happen, there would need to be a whole lot more funding for mental health services and serious cooperation among police, judges and lawmakers.

“We’ve got to be able to figure out how to help folks so they are not getting justice involved,� says Simmons, of the Department of Mental Health.

For now, the plan is to triage folks on site and hope that, by adding mental health workers at local jails, beds can eventually be freed up at the state level. There are fewer of those beds than there used to be. In 2005, the state of Missouri managed or had access to 1,540 mental health beds. By 2011, the number had dropped to a low of 1,203. As of July, the number of beds stood at 1,294.

Anders said that, with the pilot project, the detainees in St. Louis County and other sites will end up higher on the list to access state beds.

In Missouri, this is another example of how the low-tax policies of the Legislature are having long-term impacts on its residents. For more than a decade, even with some recent raises, state workers have been among the lowest paid in the nation, making it hard to recruit nurses and corrections workers.

Rather than add beds, the state is trying to cut costs by providing mental health services to people who don’t belong in jail in the first place. It’s a playbook other states have tried, with no data yet to show how it is working.

“Adding beds means you have to build facilities,� Simmons says. “You’re looking at building a new structure vs. trying to tackle alternative options.�

Roediger is glad to see his clients get mental health services, but he questions whether a jail is a proper — or constitutional — place to receive such services. In the city of St. Louis, the jail is facing multiple lawsuits alleging horrible conditions and abuses of detainees. Roediger would rather see the state add more beds in facilities designed to help mental health patients.

“It’s only cheaper,� Roediger says, “if you don’t do it well.�