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Mental health center offers two different services

FARMINGTON – There have been 20 escapes from the Southeast Missouri Mental Health Center’s long-term forensic unit in the past 10 years.

There have been 133 elopements from the short-term acute services program in that same time period.

Those numbers might seem extremely alarming for individuals living in the community who don’t understand the different kinds of services offered at the Farmington facility.

Dr. Melissa Ring, chief operating officer for the Southeast Missouri Mental Health Center, said there are two types of services offered at the mental health center: acute/intermediate and forensic. She said the Farmington facility is the only facility in the state to offer both forensic and acute services.

Acute Services

Most patients at the Farmington mental health facility are acute/intermediate patients. Over the past two years, the average per year admissions to this service is 1,837.

These patients receive short-term hospitalization and are usually returned to their homes within a five to 15-day period. The average length of stay for these patients is eight days.

“Most persons admitted are having some type of mental health crisis and are assessed to need hospitalization,” Ring said.

Individuals admitted to this service may be referred by themselves, their family, guardian, another mental hospital, or jails.

She said they may be admitted voluntarily; under a 96-hour hold – like James Eakes who escaped in June; or under a mental health commitment.

Ring said many of the patients who left the facility were admitted voluntarily. Some left the administrative office or emergency room before they were even admitted. Many were returned to the facility right away and most of them posed little to no danger to the community.

Ring said the number of elopements peaked at 22 in 1997. She is pleased that the number of elopements has declined each year since then.

Eakes was one of seven acute patients to escape or attempt to escape this year. There were also seven elopements in 2003.

Forensic Services

The Farmington facility does not have many forensic patients. In fact, the facility was in contact with only 116 forensic patients during the past 12 months.

Most forensic patients have been committed by the courts for pretrial evaluations or because they were found incompetent to proceed or not guilty by reason of mental disease or defect.

Ring said most individuals who are committed to a mental facility, and have been charged with a violent crime, receive initial treatment at the maximum security facility in Fulton.

Ring said the Farmington facility is a minimum security facility and does not treat patients who have been charged with violent crimes such as murder, first-degree arson, sexual assault, first-degree assault, kidnapping, and attempted forcible rape.

Ring said a lot of the forensic patients have been charged with less violent crimes such as drug possession or perhaps a less serious degree of assault.

Ring said they are required by law and by certifying and accrediting agencies to provide treatment in the least restrictive environment possible. In the event that a person receiving treatment does require a higher level of security, there are procedures to transfer the patient to a maximum or intermediate facility.

Ring said a patient could be transferred to a higher security facility if they are assaultive or attempt to escape.

According to statistics released by the Department of Mental Health, there were 17 escapes from the forensic unit from August of 1994 to August of 1997. For six years, from August of 1997 to August of 2003, there were no escapes.

However, there were three escapes from the forensic unit from August 2003 to now. Ring said all three of those patients were located very quickly.

One patient was at the facility voluntarily and was located within minutes. The second patient was also located right after the police was called.

The third patient, Marcus Engesser, was found 13 hours later near the Farmington Correctional Center. Just days before his escape, Engesser had been found mentally unfit to stand trial for charges of committing violence against a correctional employee. The community was alerted because he was considered dangerous.


Ring said the Southeast Missouri Mental Health Center and the Department of Mental Health are continually looking for ways to improve and thus, reduce the number of elopements or escapes.

A committee has been formed to review security measures at the facilities division-wide and the committee has already made recommendations.

Ring said they were in the process of getting estimates to modify the fence between the time of Eakes’ escape and Engesser’s escape. The committee has recommended more modifications and they will be getting estimates for those changes.

“In the interim, a staff member is assigned to patrol outside of the courtyard fence during all times that clients are in the courtyard,” Ring said.

She said the staff members have radios and have the ability to follow if a patient does climb the 12-foot mesh fence.

Ring said they are also reviewing how they assess patients for escape risk.

In addition, patients who have not been assessed or evaluated will not be allowed into the yard for a “fresh air break.”

Ring said it is important for them that their patients, especially acute patients, be able to go outside. However, she said they also want it to be safe for the community.

The mental health center had just received Engesser two days before his escape. They had not completed an evaluation of Engesser, who had been incarcerated in the county jail for the entire year before.

Engesser reportedly escaped during a fresh air break. It is believed he climbed over the wall and proceeded into a wooded area.

Some History

According to their Web site, the mental health center provides inpatient mental health services to 31 counties in southeast Missouri, and works hand-in-hand with six administrative centers.

The mental health center, the second largest employer in Farmington, has been around 100 years.

State Hospital No. 4, as it was originally designated, was authorized by the Missouri General Assembly in 1899 and actually received its first seven patients in January of 1903.

It later became known as Farmington State Hospital and in 1987, with construction of a modern new facility, became Southeast Missouri Mental Health Center.

Some of the original state hospital buildings are still part of the Farmington Correctional Center, a medium security prison that opened in 1986. The sexual predator’s unit, for example, is located in the Hoctor Building on the Farmington Correctional Center grounds

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