Greene County’s jail is set to become one of five in the state to offer mental health treatment to inmates who need to be restored to competency before standing trial, part of an attempt by the state to address the need for services quickly and efficiently.

When suspects arrive at jail and await trial, they may be ordered by the court to be evaluated for mental health competency. Those deemed to be incompetent to stand trial often are ordered to receive competency restoration treatment. Previously, the only option for this treatment was to go to a state hospital to receive inpatient mental health treatment. With a recent surge in people who were determined to need the services in order to proceed with their criminal cases, the limited number of available beds left many waiting in jail for months.

As of Sept. 28, there were 35 inmates at the Greene County Jail awaiting an inpatient bed to receive competency restoration services. Statewide, there were 253 individuals awaiting admission into state hospitals and 57 waiting to be added to that list as of Sept. 14. At the same time, there were 267 evaluations requested, with about 50% estimated to be found incompetent, according to a presentation to the state’s Mental Health Commission.

This summer, the Missouri legislature amended statute to allow mental health restoration services to be provided within county jails and out in the community. With the new law, the state allocated $2.5 million to establish jail-based restoration programs across five counties, including Greene.

Jeanette Simmons is the deputy director for the Missouri Division of Behavioral Health. She said the program was based on similar programs in other states that have faced the same problem.

“We have more individuals needing competency restoration services than we have inpatient hospital beds,” Simmons said. “This is not just a Missouri issue; this is a nationwide phenomenon.”

The program aims to solve this by easing the demand for inpatient beds while cutting down wait times for people to get treatment.

Sheriff’s office questions use of resources but state says moving ahead

Although state authorities said work to implement the program in Greene County is moving ahead, the sheriff’s office expressed doubts.

Deputy Paige Rippee, public information officer for the Greene County Sheriff’s Office and the jail, said that while many inmates have been waiting for treatment for several months, the program would not be the most efficient use of the jail’s resources.

Rippee said in order to create space for treatment, the jail would have to shut down one to two units. The inmates who would be housed there for treatment would not fill the units to full capacity, she said, which would mean the space is not used in the most cost-effective or efficient way.

“It is something we have looked into, but it’s just not in the cards for us,” she said of the jail-based model.

Debra Walker, spokesperson for the Missouri Department of Mental Health, reiterated however that the state is still moving forward with implementing the program in Greene County and currently working out the details of the contract.

Ironing out the details

The program will operate using the state’s Forensic Mobile Teams, which include nurses, nurse practitioners and social workers. Two staff members from a local community mental health center also will be hired to work at the jail.

The two existing Forensic Mobile Teams were expanded with state funding in the most recent budget. One of these teams was established a couple of years ago. Currently, the teams are serving those needing restoration services in jails across the state regardless of county while they await inpatient treatment.

The jail-based program will also be implemented in Clay County, the City of St. Louis, St. Louis County and Jackson County. Simmons said other counties have already requested to be included if the program expands, though currently the services are limited. She said the counties were selected based on the volume of referrals that come from each jail — no surprise considering that these are the most populated areas of the state.

While an option, the jail-based model will not become the default.

“We don’t anticipate that it will be the answer for every client, but I think individually we can look at it and make those types of assessments and ensure that people are receiving those treatment services while they’re there,” Simmons said. “That’s the intent they would receive the same types of treatment services they would receive in an inpatient setting.”

Stephanie Appleby, the executive director of NAMI Southwest Missouri, said she is grateful the department is putting time, energy and effort into providing more resources, which previously have been very limited.

“I think it’s fabulous and long overdue,” she said of the program. “I hope it works.”

Appleby said she hopes this program and any future efforts can establish a more continuous network of care providers. Creating a playbook on an individual’s care that both law enforcement agencies and mental health professionals can reference to determine best ways to support those needing care is a way to ensure a more sustainable approach to address mental health in the community, she said.

Other treatment options

Outpatient treatment will also be an option for some in need of competency restoration treatment. Simmons said this program would allow people to receive the needed services at their local community mental health centers. Providing this as an option would be a court decision for those demonstrating that they would be successful while free on bond, she said. Individuals held on dangerous felony charges are not eligible.

Rippee, with the sheriff’s office, said there are concerns about this model of service as well. In order for those out on bond to get to these services, they might have to rely on someone else for transportation, along with other potential obstacles.

“Homelessness often goes hand in hand with mental health issues,” she said.

Those who do not have the resources to actually get to their outpatient competency restoration treatment provider or keep on top of their medication may not fully benefit from the program, she said.

More: In the year since 988 went live, here’s what a Springfield mental health provider has seen

Appleby also has concerns about the outpatient portion of the effort. She said inpatient care is generally always a better option, since in order for patients to be successful in outpatient, they “have to really want to live a self-directed life.” Many who find themselves within the criminal justice system are not at that point in their recovery, she said.

But Simmons said the department hopes to work on more ways to connect individuals with treatment before they are within the criminal justice system. Increasing awareness and education of current resources like the 988 suicide and crisis hotline and local behavioral health programs is a large part of this.

“We’ve got to look at getting more upstream to try and help individuals engage in treatment services,” she said.

Marta Mieze covers local government at the News-Leader. Contact her with tips and story ideas at mmieze@news-leader.com.

This article originally appeared on Springfield News-Leader: Missouri plans new mental health restoration program at county jails

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The race to be the next US president is intensifying.

Will Joe Biden be back for another four years? Are we headed for a Donald Trump White House 2.0… or will there be a new face in the Oval Office?

Sky News takes a look at the list of hopefuls competing to be commander-in-chief – from Florida’s anti-woke warrior and Trump’s main rival, Ron DeSantis, to a leading anti-vaxxer who also happens to be a member of the Kennedy clan, and a self-help guru.

Can Uncle Joe do it again?

Joe Biden, Democrat, 80

The “battle for the soul of America is” ongoing, says President Biden, and he needs a second term to secure victory.

His first term has been marked by delivering on some of his core campaign promises (creating millions of jobs, returning America to a sense of normality post-COVID) but there have been lows too (see the chaos in Kabul as it fell to the Taliban).

His critics point to his age – he is the oldest candidate in the race, several years older than Trump – and his propensity for gaffes and the odd unfortunate tumble.

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Biden with Ukrainian President Volodymyr Zelenskyy

While he is unlikely to face a serious challenge for his party’s nomination, his poll ratings leave something to be desired, with only 41% of Americans holding a favourable view of the president in mid-June.

The soundbite: “The question we are facing is whether in the years ahead we have more freedom or less freedom. More rights or fewer.”

Did you know? Biden is a lifelong car enthusiast and the proud owner of a 1967 Corvette convertible. The commander-in-chief even took it for a spin for the TV show, Jay Leno’s Garage.

Making America Great Again…again?

Donald Trump, Republican, 77

This week Donald Trump became the first-ever former president of the US to appear in court facing federal criminal charges.

However, he remains determined to seek a second term as president in 2024.

He writes off the accusations against him as politically motivated – and his loyal supporters seem energised to defend him.

That’s despite facing 37 criminal charges over retaining classified information, obstructing justice and false statements, as well as various other legal problems.

The former president is simply adamant he will reclaim the Oval Office in 2024.

The current front-runner in the Republican race, his perception among some Republican voters has taken a hit following his indictment over boxes of documents stuffed in a bathroom at his Mar-a-Lago residence.

But there are still plenty who back America’s most divisive politician.

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What has Trump been indicted for? Sky’s Martha Kelner explains

Announcing his intention to run in November 2022, Trump depicted Biden’s America in apocalyptic terms, describing “blood-soaked streets” in “cesspool cities” and an “invasion” at the border.

His vow to execute those convicted of selling drugs was greeted with cheers from his supporters.

While he’s leading the Republican field, polls of a potential Biden v Trump matchup produce varying outcomes.

One published at the end of May, though, has Biden with a slim lead.

The soundbite: “I have assumed for years that I am a Target of the WEAPONIZED DOJ & FBI.”

Did you know? He’s the only US president to ever be impeached twice.

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DeSantis is taking on Trump for the Republican nomination

The culture warrior-in-chief

Ron DeSantis, Republican, 44

The rise of Florida’s governor, Ron DeSantis, has been impossible to ignore.

A former little league baseball star who hates everything “woke”, he is now seen as the only Republican with a chance of defeating Trump in the primary, although his poll ratings have been falling.

Under his watch, the Sunshine State has become a hotbed for so-called anti-woke laws, including a ban on teaching critical race theory.

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Florida Governor Ron DeSantis made the first trip of his presidential campaign to Iowa

He’s also managed to make an enemy of entertainment giant, Disney, ever since the company publicly opposed his “Don’t Say Gay” bill that focuses on discussion of sexuality and gender identity in classrooms.

The soundbite: “What I’ve found is when people start talking about things like global warming, they typically use that as a pretext to do a bunch of left-wing things that they would want to do anyways. And so we’re not doing any left-wing stuff.”

Did you know? His wife Casey – a former news journalist, breast cancer survivor and mother of three – has been described as his “greatest asset”. She is credited with helping mastermind his rise and even taught him how to contour his face for TV – a beauty trick made famous by Kim Kardashian.

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Robert F. Kennedy Jr

The anti-vaccine activist

Robert Kennedy Jr, Democrat, 69

Yep, he’s from the Kennedy family. The assassinated president, John F Kennedy, was his uncle and his father, Robert F Kennedy, was killed while running for the Oval Office in 1968.

But while he is a Kennedy, he’s not the typical establishment politician – far from it.

Once an environmental lawyer who worked on issues such as clean water, he adopted an anti-vaccine stance over 15 years ago.

During the COVID-19 pandemic, he gained notoriety as an anti-vaxxer despite health experts – and a member of his own distinguished family – calling his position dangerous and misleading.

Then in 2022, he was forced to apologise after suggesting that conditions were worse for those living under COVID-19 restrictions and mandates than they were for Anne Frank during the holocaust.

Recently he courted further controversy by claiming he has conversations with dead people. He later clarified that the “conversations” were one-way and that he did not get “strategic advice from the dead”, the Free Press reported.

But despite the depiction of him as an outsider – and criticism of many of the things that he says – he has gained enough support to suggest a potential desire for a populist approach from the left.

Two recent polls have him at 16% and 20% in the race for the Democratic nomination, with Biden far ahead at 62% and 60%.

The soundbite: “My mission over the next 18 months of this campaign and throughout my presidency will be to end the corrupt merger of state and corporate power that is threatening now to impose a new kind of corporate feudalism in our country.”

Did you know? In 2005, he wrote Deadly Immunity, an essay that repeated the debunked claim vaccines were linked to autism in children.

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Can Mike Pence defeat Trump? Pic: AP

The Trump VP-turned-challenger

Mike Pence, Republican, 64

He was Trump’s vice president but has since broken away from his former boss over the 6 January 2021 insurrection that saw Trump supporters calling for his head.

Pence says “history will hold Trump accountable” for his role in the attack.

The former Indiana governor has been known for his socially conservative and deeply religious views, passing laws in the state affecting abortion and LGBTQ rights.

The soundbite: “We will restore a threshold of civility in public life.”

Did you know? Marlon Bundo, the Pence family’s late rabbit, had his own Instagram account and starred in children’s books. BOTUS (Bunny of the United States) died in 2022.

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Tim Scott

The ‘opposite’ of Donald Trump?

Tim Scott, Republican, 57

The only black Republican US senator has low name recognition outside his home state of South Carolina, but his optimism and focus on unifying his divided party have helped him to draw a contrast with the more aggressive approaches of Trump and DeSantis.

He’s got an uphill struggle to win the nomination, however. Scott has only 1% of support among registered Republicans, according to an average of polls in April and May.

The soundbite: “Joe Biden and the radical left are attacking every rung of the ladder that helped me climb.”

Did you know? He would be the first unmarried US president since 1884.

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Chris Christie launched his campaign with a distinct anti-Trump message. Pic: AP

Trying to take down Trump

Chris Christie, Republican, 60

Former New Jersey Governor Chris Christie, who advised Trump’s White House campaign in 2016 only to become a vocal critic of the former president, enters the race as an underdog.

He’s also known for a controversy surrounding the closure of two lanes on the George Washington Bridge that caused huge traffic jams in Fort Lee, New Jersey.

Only 1% of Republicans said he would be their preferred 2024 nominee in a poll conducted in mid-May.

The soundbite: Taking aim at Trump, Christie remarked: “A lonely, self-consumed, self-serving mirror hog is not a leader.”

Did you know? His favourite book is The Great Gatsby. He says he’s read it twice.

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Democrat hopeful Marianne Williamson. Pic: AP

The self-help guru

Marianne Williamson, Democrat, 70

The best-selling author has launched her second, longshot bid for the White House.

She ran as a Democrat in the 2020 presidential primary but dropped out of the race before any votes had been cast.

She has written 13 books – four of which have topped the New York Times bestseller list.

The soundbite: “It is our job to create a vision of justice and love that is so powerful that it will override the forces of hatred and injustice and fear.”

Did you know? She appeared multiple times on The Oprah Winfrey Show as a “spiritual adviser”.

The former UN envoy

Nikki Haley, Republican, 51

A former governor of South Carolina and Trump’s ambassador to the United Nations, Haley has emphasised her relative youth compared to Biden and Trump, as well as her background as the daughter of two Indian immigrants.

She has gained a reputation in the Republican Party as a solid conservative who has the ability to address issues of gender and race in a more credible fashion than many of her peers.

Haley is attracting around 4% support among Republican voters, according to an average of polling in April and May.

The soundbite: “I wear heels, but it’s not a fashion statement… it’s because if I see something wrong, I’m gonna kick ’em every single time.”

Did you know? She once competed in the Little Miss Bamberg pageant.

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Vivek Ramaswamy is running a longshot campaign. Pic: AP

The biotech expert

Vivek Ramaswamy, Republican, 37

Ramaswamy is a former biotechnology investor and executive. Last year he launched a firm to pressure companies to abandon environmental, social and corporate governance initiatives.

He remains a longshot to see off the likes of Trump and DeSantis, let alone defeat a likely Democratic nominee in Joe Biden.

His views have drawn controversy, including his claims that he would shut down the Department of Education and replace the IRS and FBI.

The soundbite: “We will use our military to annihilate the Mexican drug cartels,” he told the New York Times.

Did you know? If he were elected he would be the youngest US president ever, as well as the first Asian-American occupant of the Oval Office.

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Former Arkansas governor Asa Hutchinson. Pic: AP

The former Arkansas governor

Asa Hutchinson, Republican, 72

Asa Hutchinson says people want leaders that “appeal to the best of America” and not “our worst instincts”.

He has positioned himself as an anti-Trump figure, saying a re-election of the former president would be the “worst scenario” for Republicans.

The soundbite: “I’m running because I believe that I am the right time for America, the right candidate for our country and its future.”

Did you know? Hutchinson has identical twin sons who became the first twins to serve together in the Arkansas General Assembly as members of the House of Representatives.

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Larry Elder. Pic: AP

The talk radio host

Larry Elder, Republican, 71

Conservative radio personality Elder announced his bid for the White House on Fox News with Tucker Carlson back in April.

A longshot candidate for 2024, he made his first bid for public office in 2021, when he received the most votes out of 46 people who were hoping to replace California governor Gavin Newsom in a recall effort that eventually failed.

A lawyer who grew up in Los Angeles’ rough South Central neighbourhood, Elder attended an Ivy League college and then law school.

The soundbite: “America is in decline, but this decline is not inevitable. We can enter a new American Golden Age, but we must choose a leader who can bring us there.”

Did you know? During the recall campaign, a former fiancée said Elder showed her a gun during a 2015 argument. Elder denied the allegations.

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Doug Burgum

Running on small town values

Doug Burgum, Republican, 66

North Dakota Governor Doug Burgum entered the Republican nominee race relatively late but he’s hoping his small town values will help him stand out in a crowded field.

Burgum, a former software company executive, is largely unknown beyond his state, and he will begin his White House bid well behind rivals such as Trump and Florida Governor Ron DeSantis.

He has stressed his humble origins and said the next US president should be “someone who’s held jobs where you shower at the end of the day, not at the beginning”.

The soundbite: “I grew up in a tiny town in North Dakota… ‘Woke’ was what you did at 5am to start the day.”

Did you know? His personal wealth is derived from selling his startup to Microsoft more than two decades ago.

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Miami mayor Francis Suarez has filed paperwork to enter the race. Pic: AP

Make America more like Miami?

Francis Suarez, Republican, 45

Miami mayor Francis Suarez has filed paperwork to launch his bid to become the Republican nominee, adding to a crowded field not only of Republicans, but of Florida residents in the contest.

The only Hispanic candidate in the race, he is the son of Miami’s first Cuban-born mayor.

Suarez has gained national attention in recent years for his efforts to lure companies to Miami, with an eye towards turning the city into a crypto hub and the next Silicon Valley.

The soundbite: “If I do decide to run it’s starting a new chapter, a new conversation of a new kind of leader who maybe looks a little different, speaks a little different, had a little bit of a different experience, but can inspire people.”

Did you know? Suarez has said he did not support Trump in either the 2016 or 2020 presidential elections, instead writing in the names of Senator Marco Rubio and then vice president Pence on his ballot.

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