Missouri’s mental health system is flawed, advocates say

Kelcie Breece still has fond memories of her niece. 

Breece and Adrianna Stultz began parenting SL when she entered the foster care system at about 18 months old. The Beacon is only referring to the child by her initials to protect her privacy. 

One night, SL came into their room asking for whipped cream for her body. 

“She’s like, you know that stuff (for when) my skin is all itchy,” Stultz said. “We’re like lotion. You want lotion for your body.” 

SL calls taquitos “taco fries” and goes “barewalking for squirrel cones” when she walks barefoot outside looking for acorns. 

SL has mental and behavioral health issues, though. 

SL was about 2 years old when she began to hurt herself. She’d pull her hair, jump off the bed onto a pile of toys and pinch or bite herself. She’d even break items around the house when she was mad.

Breece and Stultz called the Missouri Department of Social Services asking for help, but they said the agency didn’t provide any. 

Another year passed and SL was becoming more violent. She stabbed a teacher with a pencil, pushed a classmate down the stairs and became abusive toward animals. She’d try stomping on the family cat, twirling the cats by their tails and punching the dog in the head. 

“We were begging,” Stultz said, “begging them to help us.” 

The couple lives in Harrisonville, Missouri, about 35 miles south of Kansas City. They struggled to find therapeutic services for SL. The foster care system was no help, they said. They might independently find a treatment option, but there were waitlists that prevented SL from enrolling in the services.

The couple did find a months-long residential program that SL’s other doctors recommended. SL was about to enter kindergarten, and the family wanted her behavior in check. They needed the judge to approve entry into the program, but the judge didn’t grant the request. 

Judge Andrea Vandeloecht ruled the mothers weren’t able to care for the child, and she placed the girl back with her biological mother in Oklahoma. Vandeloecht said in court documents that Stultz and Breece said they couldn’t care for SL — something they deny. 

Months after the move, SL’s biological mother and another man were arrested for child abuse. 

Breece and Stultz haven’t seen the girl in over a year. They said the state foster care system, Missouri’s mental health services and the judge failed them and the child. SL is still in the foster care system, and if they could afford a lawyer, they’d hire one to get her back. 

The couple already has spent $15,000 on lawyers and have been told they need one if they hope to gain guardianship in the Oklahoma case. 

“I guarantee you, we come up with the money for a lawyer … and we’re going to try to get her back,” Stultz said. “But at this time, we can’t really afford to do that.” 

“We’re never going to stop,” Breece said. 

Mental health access in Missouri 

Missouri has a pediatric behavioral health care crisis, said executives at four major children’s hospitals in a 2021 opinion piece published by the Missouri Independent. 

Youth suicides and hospitalizations because of suicides are on the rise, the article said. 

An April article from KFF Health News said mental health emergency room visits almost quadrupled at St. Louis Children’s Hospital. They jumped from 565 visits in 2019 to 2,176 in 2023. 

Dr. Erick Messias, who is with SSM Health and chair of the department of psychiatry and behavioral neuroscience at the St. Louis University School of Medicine, doesn’t like using the word crisis — but he sees how the needs for children are getting worse. 

Social media and the internet is one culprit. Social media increases cyberbullying and warped perceptions of reality. Youth are also seeing videos where influencers are self-prescribing treatments for diseases, like smoking marijuana to address behavioral health issues.  

“The mental health system we created in the last century cannot attend to the demands of this century,” Messias said. “It’s just impossible.”

Missouri’s mental health system has long wait times and not enough services, advocates say. The state lacks enough youth inpatient beds, it lacks community resources so people are helped in their towns, and there are long waits for certain programs. 

The state is adding hundreds of behavioral health beds in Kansas City, but those beds are being filled up quickly as they open, said Rep. Kent Haden, a Mexico Republican. 

The state has just 127 mental health providers per every 100,000 residents. Advocates say that’s not enough. 

The Kaiser Family Foundation estimates that the Missouri mental health system meets just 14% of the need — ranking 43rd out of 59 among the states, territories and the Federated States of Micronesia that it tracked. (Kansas ranked 30th.) Among foster children, 66% had mental health issues, yet just 23% had their needs met, a Missouri Hospital Association report said.  

A struggling mental health system is an issue nationwide. 

A March 2025 study analyzed pediatric mental health boarding. That’s when kids wait in an emergency room for another treatment option to open up. The study specifically looked at children who stayed more than two days at a hospital. 

Between 2017 and 2023, there were 100,784 boarding instances at 40 youth hospitals nationwide. The study reported a 66% increase in this practice from 2017 to 2023.

“We were begging, begging them to help us.” 

Adrianna Stultz

Mary Chant, CEO of the Missouri Coalition for Children, said that as a whole, nothing in the Missouri mental health system meets the demand. 

“I don’t know that there is a part of the state that I would say is better than others,” she said. 

Chant said Missouri doesn’t have enough mental health professionals per capita. That means people aren’t getting help in their communities. 

Breece took SL to Columbia, about three hours away. There was a yearlong waitlist for help in Kansas City and only a six-month wait in Columbia. 

The system is also confusing. Someone can head to a hospital if they break their leg. It isn’t that simple with mental health needs. 

Chant calls it “the deep end” — when families have already reached out before and didn’t know where to turn. These families sometimes reach out multiple times, yet the care they need is delayed. 

SL’s care 

Breece and Stultz saw that firsthand. 

Their first calls were to the Missouri foster care system. They said they were getting the runaround. They’d talk to someone who would tell them to call someone else and never end up getting any resources. 

Breece said she even called other foster care offices in the state, hoping any of them would help. Some tried more than others to help. 

Baylee Watts, media director for the Missouri Department of Social Services, said families having trouble in a case can call the Children’s Division Constituent Services Unit at 573-751-4920 or email them at [email protected]. There’s also the 988 hotline. 

Foster care agencies don’t offer treatments directly. They partner with community providers to do that. 

Those services just aren’t available, Breece said. The family was recommended all kinds of treatments and eight out of 10 weren’t available, she said, usually because of waitlists. 

“We’d stay on their waitlist,” Stultz said. “We’d wait, just hoping that that was going to be the answer.”

Other services said SL was too young to join or required the child to live in a specific county. Some programs accepted her, but didn’t provide long-term treatment options. They’d take SL for a few days and she’d be returned home before her more serious behaviors showed up. 

Messias, from SSM Health and St. Louis University, wants the system to have layers. Children with higher needs would go to a child psychiatrist while children with lower needs might work with social workers. 

There should also be general psychiatrists for older youth or psychiatric nurse practitioners for children with less severe needs. 

Messias said the system just doesn’t have this capability. The state could use additional child psychiatry programs in college, more support for doctors and a more robust telehealth system. 

“Primary care providers are not supported enough by those experts to provide the first and second step of mental health care,” he said. “Our pediatricians are not close to being adequately supported to provide those levels of care.”

Some doctors made progress with SL, the family said. There were also doctors who didn’t do as well. 

There was an amazing doctor in Columbia, but then he retired. There was a stint with a play therapist, but the family didn’t see the progress they were hoping for and switched providers. Eventually, two therapists were making some real progress, but then SL was moved to Oklahoma. The disruptions in care created problematic delays. 

Stultz said the lack of help from the state likely delayed years of therapy. 

As treatment was delayed, SL’s behaviors continued to get worse. At first, her problematic behaviors were limited to self-harm and destroying objects. She’d lash out for a day, then there wouldn’t be an episode for a week. 

Then her behaviors got worse and the episodes became a daily or every-other-day experience. 

SL’s fits would start like any other tantrum a young child might have. She’d want a toy someone else was playing with, and she would get more worked up after being told she couldn’t have it. She’d get more and more frustrated until she started to be violent. 

In one incident, she stuffed a bag of cookies down her throat in an attempt to choke herself. 

Missouri’s mental health investment 

All types of behavioral health needs are on the rise in Missouri. 

The 2024 status report on mental health, a report compiled by the state, looked at data over past decades. 

In 1990, there were 714 suicides in Missouri. In 2023, that rose to 1,131. In 2008, 3.6% of Missourians between 18 and 25 years old have serious mental illnesses. That number rose to 11.9% in 2021.

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Rep. Melanie Stinnett, a Springfield Republican who chairs the House Health and Mental Health committee, said Breece’s story has a lot of similarities to other issues in the state — waitlists, confusion about entering programs and not enough providers.  

Missouri has made some significant investments in recent years. 

Children’s Mercy in Kansas City launched a five-year, $275 million campaign to address mental health needs. The hospital has had a 67% increase in referrals since 2017 and said that 40% to 50% of youth in the area don’t get treatment for their mental health diagnosis. 

Funding for the state’s Department of Mental Health has also continued to rise. The agency spent $1.5 billion in 2015 and $2.2 billion in 2020. The agency was budgeted for $4 billion in funding for 2025. Money from the most recent budget was put in to help another 1,260 people with mental health needs or substance use. 

But Stinnett said the state still isn’t doing enough, despite the progress. For her, youth residential beds and short-term substance abuse programs are major issues to tackle. 

She and others say expanding community services has to happen. 

“I don’t know that anybody could logically say in any state … that we can solve the problem of mental illness or mental health challenges,” Stinnett said. “But what we can do is try and get upstream.” 

Oklahoma foster care

Back in Harrisonville, Breece and Stultz are still hoping they can be reunited with SL. 

She lives in Oklahoma now with another family member. Her biological mother is scheduled for sentencing. It’s possible that sentence prevents the mother from ever getting custody again, and the caregiver currently watching SL said she could send the child back to Missouri.

There is also talk of mutual parenting that would let Breece and Stultz see SL without a court order. 

Breece and Stultz just want her to come home. The couple talked to The Beacon for months about the case, but the last conversation was on Nov. 20 — SL’s seventh birthday. 

“I’ve only cried like two or three times today,” Stultz said. 

“I haven’t cried yet,” Breece said, “but my day is just getting started.” 

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Type of Story: News

Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources.