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 that requires the state to address delays in evaluating and providing care to people with mental illness accused of crimes.
Seven years after the federal agreement, the problem has become worse. The waiting list for the state’s only secure psychiatric facility is about five times longer than it was when the decree was passed, according to court documents released in September.
Detainees sometimes wait years to be placed in a facility designed to treat their illness and ensure they are healthy enough to go to court, a problem faced by many states across the country.
In Alabama, that means people charged with less serious crimes, like Clark, “spend more time waiting for a bed than if they had just pleaded guilty,” said Bill Van Der Poel, an attorney with the Alabama Disability Defense Program, which obtained the federal consent decree.
In 2010, the Department of Mental Health’s budget was cut by $40 million in the wake of the recession. At least 10 state-run psychiatric facilities I’m closed Over the past three decades, there have been only three inpatient facilities remaining with a total of 504 beds, and only one facility where men facing criminal charges can receive treatment to restore their competency.
The lawsuit that led to the consent decree was filed in 2016, alleging delays at every stage of the process that violated constitutional due process.
First, there was a wait for psychological evaluations. Then if he was deemed unfit to stand trial, there was a wait for a place at the only secure facility serving men: the Taylor Hardin Medical Secure Facility. Finally, anyone deemed unable to regain competency to stand trial had to wait for long-term treatment in community facilities.
The 2018 consent decree gave the state two years to complete all mental health evaluations and reports within 60 days of a court order. A man deemed incompetent to stand trial must go to Taylor Hardin within 30 days afterward.
The state was also required to increase the number of beds for more permanent care if it was not possible to rehabilitate someone.
Taylor Hardin’s waiting list has grown to 273 men, according to an August court filing. That’s up from about 60 men in 2017. The average wait is more than a year, and more than 30 people on the list have languished for more than two years. The state is still in mediation with plaintiffs.
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. This represents a 17% reduction in beds compared to 2017, the organization found.
“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 Nevada, for example, a county in April was ordered to pay $500 a day because defendants did not receive timely treatment. Officials at the time estimated that compensation would be paid It will be $3.6 million For fiscal years 2026 and 2027, based on current case counts and wait times, a county memo shows.
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.”
For example, one study in Colorado found that the number of court-ordered restorations rose from 87 in 2001 to 900 in 2017, according to the federal Substance Abuse and Mental Health Services Administration, an agency of the U.S. Department of Health and Human Services.
That’s a good thing, Daly said. 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.
In other words, instead of waiting for evaluations, people are now waiting for treatment.
“What that really does is it changes where the bottleneck is,” Daly said.
The state of Alabama has taken steps to address this bottleneck.
Work is underway to add 80 beds to Taylor Hardin Hospital, which currently 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 “adequate staffing is obtained,” the report said. Only about half of the mental health and nursing technician positions are occupied at the facility, Kim Boswell, commissioner of the Alabama Department of Mental Health, said at an August 2024 board meeting. According to the Alabama Reflector. An average wage increase of about $6 per hour in 2024 helps with recruitment and retention, Boswell said.
The department trained 94 people in prison competency recovery programs to ease the burden on Taylor Harden, 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 “a more convenient alternative to jail or an emergency room visit” for people experiencing a mental health crisis. September audit He appears. These centers conducted 22,297 evaluations, Boswell testified in September.
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 in response to multiple email requests.
The root of the problem isn’t just the number of beds, said Jennifer Tompkins, an Alabama criminal defense attorney. It could be decades before Taylor Hardin is released — either to court, if her mental health crisis is treated, or to an outpatient program that offers more permanent support.
“It’s like you’re guilty because you’re mentally ill and in poverty,” Tompkins said.
One of her clients charged with murder more than 10 years ago is still awaiting trial while still in a secure facility, where state psychiatrists have issued several conflicting assessments of his mental capacity. There is a similar backlog of community facilities like the ones Clark had been waiting for.
Boswell acknowledged these challenges at a recent budget hearing, saying her agency is working with judges who preside over consent decrees to improve employee turnover.
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.
But he was troubled by his long history of petty crime and serious mental health problems.
His sisters said he was often caught wandering aimlessly miles from where he lived with his family in Montgomery. It was often difficult to get permanent treatment because many facilities refused to treat his psychological problems because he was also using drugs and needed to be sober to receive treatment.
“It’s a lot. We’ve had a lot of different accidents,” said Kwanda Key, one of Clark’s older sisters. Clark spent short periods in hospitals, where he would call his sisters and ask them to bring him chocolate. 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, Clarke disappeared again, after escaping a burglary charge in 2022. His sisters asked police for help finding him, despite their fear that he would end up in a prison unable to meet his needs. 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 incurable and he was ordered to remain in prison until a bed could be found for him to receive care.
“He wasn’t aggressive, but these people in prison don’t know that,” said Subrina Hamilton, another of Clark’s sisters.
His sisters wanted to see him but were not on his visitor list. Another sister, Tamika Clark, called the prison regularly to check on him, and prison staff assured her that her younger brother was “okay.”
But 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.”
Clark’s autopsy said he had access to water but did not provide details. 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.
The state law enforcement agency investigating Clark’s death declined to comment, citing the ongoing investigation. Montgomery County Sheriff Derek Cunningham also declined to comment specifically on Clark’s death.
Cunningham said prisons are not equipped to handle men like Clark while they wait for psychiatric beds. He said prisons have difficulty identifying mental health issues, administering medications and dealing with complex behavioral problems.
Even with significant improvements the department is making, prisons will continue to struggle, Cunningham said.
“If you look at the number of beds we got and then the wait time, I mean it’s still not enough,” he said.