KANSAS CITY — A federal class action alleges that the Missouri Department of Mental Health and members of the Missouri Mental Health Commission are violating the constitutional rights of hundreds of pretrial detainees with severe mental illness by allowing them to languish in jails for months or even years without court-ordered mental health evaluations or treatment intended to restore their competency to stand trial.
Six plaintiffs claim the state is knowingly abrogating its duties under the Due Process Clause, Title II of the Americans with Disabilities Act, and the Rehabilitation Act by failing to provide timely evaluation and restoration services, resulting in widespread deterioration of detainees’ mental health and, in several cases, death, according to the complaint filed Nov. 24, 2025, in the U.S. District Court for the Western District of Missouri.
The lawsuit seeks declaratory and injunctive relief for two statewide classes representing all individuals awaiting competency evaluations or restoration services beyond constitutionally acceptable time frames.
It alleges that by May 2025, more than 230 detainees were waiting in jail for competency evaluations, while 430 more waited for restoration treatment.
By October 2025, the number of people needing restoration had reached nearly 500, an increase by a factor of four in four years.
The complaint cites statutory requirements mandating that evaluations be completed within 60 days unless a court finds good cause for delay, but asserts that detainees routinely wait six months or more, with many waiting over a year for admission to a state hospital.
The filing notes that individuals deemed incompetent are held an average of 14 months before receiving treatment, and that some remain jailed longer than the maximum sentence for the crimes with which they are charged.
As of the filing, the six named plaintiffs had collectively spent 1,619 days in jail awaiting treatment.
The complaint further alleges that the Department of Mental Health acknowledges the problem yet has not taken reasonable steps to address deteriorating conditions.
According to internal statements referenced in the filing, DMH officials recognized that individuals on the waitlist often experience worsening symptoms, sometimes resulting in permanent loss of competency and civil commitment.
The complaint describes county jails as ill-equipped to provide mental health care, citing overcrowding, lack of appropriate medication, insufficient staff training and reliance on solitary confinement.
It reports that many jails refuse to administer medications that detainees previously received, and cannot legally provide involuntary medication, which is something often necessary for individuals with schizophrenia or schizoaffective disorders to regain competency.
The lawsuit includes accounts of detainees decompensating severely: some become nonverbal, eat feces, pick at their skin, or lose track of personal identity.
Several deaths are referenced, including two individuals who died in custody while awaiting DMH services, one after seven months on the waitlist and another whose untreated diabetes led to fatal complications.
The complaint asserts that DMH has fewer inpatient psychiatric beds than in past decades and continues to face high staff turnover.
It states that although expansion plans exist, including a new facility expected no earlier than 2028 and another not projected to open until 2029, current capacity remains insufficient, with only three hospitals providing competency restoration services.
Legislative changes enacted in 2023 and 2024, such as allowing early findings of permanent incompetency and creating community-based or jail-based restoration options, have not alleviated the backlog, according to the complaint, which contends that community placement is rarely used and jail-based restoration is inadequate and sometimes limited to coaching detainees on how to answer competency exam questions.
The plaintiffs, who are identified as M.R., K.M., M.T., O.J., C.T., and D.W., each allege prolonged detention and worsening mental health while awaiting state-mandated services.
Their next friends, largely parents or siblings, report drastic deterioration, isolation, loss of hygiene, weight loss, delusions and in some cases, inability to recognize family or understand why they are incarcerated.
The complaint argues that without court intervention, unconstitutional delays and systemic failures will continue to harm Missouri’s most vulnerable detainees.
The plaintiffs are seeking compensatory damages. They are represented by Amy E. Malinowski of MacArthur Justice Center; Gillian R. Wilcox, Jason Orr, Kristin M. Mulvey and Jonathan D. Schmid of the American Civil Liberties Union of Missouri Foundation; Maureen Hanlon and Ebony McKeever of ArchCity Defenders; and Brent Dulle and Kevin Cowling of Husch Blackwell.
U.S. District Court for the Western District of Missouri, Central Division case number: 2:25-cv-04268
