Montgomery, Alaa.. Fernando Clark spent the last 10 months of his life in a prison cell, awaiting court-ordered psychiatric treatment after he was arrested for stealing cigarettes and some fruit from a gas station.
He died while waiting for treatment, which never arrived, and he was found unresponsive in his prison cell.
Clark was just one of hundreds of people across Alabama waiting for a place in the state’s increasingly limited facilities, despite a consent decree requiring the state to address delays in providing care to people accused of crimes but deemed too mentally ill to stand trial.
But seven years after the federal agreement, the problem has worsened. The waiting list for the state’s only secure psychiatric facility is about five times longer than it was when the ordinance was passed, according to court documents released in September.
The problem extends far beyond Alabama. In fact, experts say the problem is almost universal — and getting worse — across the country. Here’s what you should know.
Nationally, the number of state hospital beds for adults with serious mental health problems reached a historic low in 2023 with 36,150 beds. More than half Of them are occupied by people hospitalized through the criminal legal system, according to the nonprofit Treatment Advocacy Center. The organization found that this represents a 17% decrease in beds compared to 2017. The bed shortage means that a group of states have similar waiting lists.
“There is virtually no state where this has not become an increasingly visible problem — and in fact it has been rapidly expanding in scope over the past decade,” said Lisa Daly, executive director of the Treatment Advocacy Center.
In some ways, this worsening trend is part of an intractable paradox, Daly said. Courts “are doing a better job over time at identifying cases where mental illness appears to be a factor in why someone was arrested or why someone might face criminal charges.”
But the infrastructure—the beds available in secure treatment facilities, along with the staffing levels needed to operate those beds—has not adapted to the increased demand.
Instead of waiting for evaluations, people are now waiting for treatment.
“What that really does is it changes where the bottleneck is,” Daly said.
Construction is underway to add 80 beds to Alabama’s only men’s psychiatric facility, which has 140 beds and serves just over 200 people, according to an annual report published in 2024.
However, there is a significant staff shortage and the additional beds will not be usable unless the state can hire enough staff. According to the Alabama Reflector. An average wage increase of about $6 per hour in 2024 helps with recruitment and retention, Boswell said.
Boswell said at a recent budget hearing that her agency is working with judges who preside over consent decrees to improve the time it takes for evaluation and then treatment.
A spokesperson for the Alabama Department of Mental Health declined to comment on the multiple emailed requests.
The department also trained 94 people in prison competency recovery programs to ease the burden on Taylor-Hardin, court records show. The programs are now in five of Alabama’s 67 counties, and are scheduled to expand to three more.
Alabama also spent $175 million over five years to build six 180-bed crisis centers across the state to provide an alternative for people experiencing a mental health crisis. September audit He appears.
These centers conducted 22,297 evaluations, Boswell testified in September.
These changes came too late for Clark. After the state conducted an evaluation that concluded he could not be restored to a stable enough mental state to stand trial, the judge ordered that he receive care at a community mental health center, which is a backlogged center.
His sisters said he was often caught wandering aimlessly miles from where he lived with his family in Montgomery.
“It’s a lot. We’ve had a lot of different accidents,” said Kwanda Key, one of Clark’s older sisters. Clark had short stints in hospitals. Whenever someone encountered him on the side of the road, they would try to persuade him to return home where he could eat and shower.
Last year, Clark disappeared again, after escaping a burglary charge in 2022. He was eventually found and put in prison in February 2024, and it was not until September of that year that his mental illness was deemed untreatable and he was ordered to remain in prison until a bed could be found for him to receive care.
On December 11, 2024, Clark was found unconscious in his cell. The temperature in the cell rose to 110 °F (43.3 °C) while repairs were being made to the boiler. His autopsy lists congestive heart failure as the cause of his death, but Tom Andrew, a forensic pathologist who reviewed the autopsy for The Associated Press, said it left “more questions than answers.”
Andrew said that given the temperature in his cell, it was “problematic” that the autopsy did not record Clarke’s internal body temperature or rule out other signs of dehydration.
Additionally, Andrew noted that prison staff were giving Clarke antipsychotic medications at the time of his death that sometimes impair the body’s ability to regulate temperature, making him particularly vulnerable to overheating.
Clark, who was 40 when he died, was known as “Pooch,” a nickname his mother gave him as a child because he was small and cute like a puppy.