Missourians with serious mental illness and other cognitive disabilities so severe that they are deemed incompetent to stand trial are languishing in jails for months, and in some cases even years—suffering detrimental and at times irreversible negative effects—waiting for the Missouri Department of Mental Health (DMH) to provide court-ordered treatment. The MacArthur Justice Center is fighting alongside a class of plaintiffs, including caregivers and families, to hold Missouri’s DMH accountable and require the agency to provide timely, adequate treatment to individuals with severe mental illness and cognitive disabilities currently imprisoned across the state.
In city and county jails across Missouri, individuals with severe mental illness and cognitive disabilities who have been deemed incompetent to stand trial are left waiting for court-ordered treatment from the Missouri Department of Mental Health (DMH). Though Missouri law requires competency evaluations to be conducted within 60 days of a court order, there is currently a backlog of nearly 500 people in pretrial detention waiting for evaluation.
On average, those in Missouri with mental illnesses and cognitive disabilities are held for 14 months before receiving the restoration treatment necessary to participate in their criminal proceedings. As DMH knowingly abandons its legal duty to provide care, some individuals are even held in jail for longer than the maximum time they would receive if they were convicted.
On November 24, 2025, the MacArthur Justice Center, alongside co-counsel from the Arch City Defenders and ACLU of Missouri, filed a class-action lawsuit against the Missouri Department of Mental Health to seek relief for those on the DMH waitlist. Through numerous declarations from class members, impacted family members, and caregivers, the problem is abundantly clear: DMH is unconstitutionally withholding care and resources from people suffering in custody, who are risking detrimental and irreversible negative effects. The time for DMH to provide consistent and timely mental health and disability treatment is long overdue.
US District Court Western District of MO Central Division
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