Alabama promised to improve psychiatric care for men charged with crimes

MONTGOMERY, Ala. — Fernando Clark spent the last 10 months of his life in a prison cell, awaiting psychiatric treatment that the court ordered him to undergo after being arrested for stealing cigarettes and fruit from a gas station.

He died while awaiting treatment which never arrived, found unconscious 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 evaluating and providing care to people with mental illness accused of crimes.

Seven years after the federal agreement, the problem has only gotten worse. The waiting list for the state’s only secure psychiatric facility is almost five times as long as it was when the executive order was issued, according to court documents released in September.

Sometimes those arrested wait years to be placed in a facility designed to treat their illness and ensure their good health before coming to court, a problem facing 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 Pol, an attorney with the Alabama Disability Defense Program, which obtained the federal consent decree.

In 2010, the Ministry of Mental Health’s budget was cut by $40 million as a result of the recession. At least 10 state psychiatric facilities have closed over the past three decades, leaving only three inpatient facilities with 504 total beds, and just one where criminally charged men can receive treatment to regain their capacity.

The lawsuit that led to the consent decree was filed in 2016, alleging delays at every step of the process that violated constitutional due process.

First, there was a wait for psychiatric evaluations. Then, if he was found unfit to stand trial, he had to wait to get a place in the only secure facility for men: the Taylor Hardin Secure Medical Center. Finally, anyone deemed unable to regain competency for a trial had to wait for longer-term treatment in community facilities.

The 2018 consent decree gave the state two years to complete all mental health assessments and reports within 60 days of a court order. A man found incompetent to stand trial must appear before Taylor Hardin within 30 days of that date.

The state also had to increase the number of beds for more permanent care if a person could not be rehabilitated.

Taylor Hardin’s waiting list has grown to 273 men, according to a court filing filed in August. That’s up from about 60 men in 2017. The average wait is well over a year, and more than 30 people on the list have languished for more than two years. The state is still in mediation with the plaintiffs.

Nationally, the number of public hospital beds for adults with serious mental health issues reached a historic low in 2023 at 36,150 beds, more than half of which are occupied by people hospitalized through the criminal justice system, according to the nonprofit Treatment Advocacy Center. This represents a 17% drop in the number of beds compared to 2017, the organization found.

“There’s really no state where this problem hasn’t become increasingly visible — and its scope has actually expanded rapidly over the last decade,” said Lisa Daly, executive director of the Treatment Advocacy Center.

In Nevada, for example, a county in April was ordered to pay $500 per day because defendants failed to receive timely care. Officials estimated at the time that the payment would be $3.6 million for fiscal years 2026 and 2027, based on current caseload and wait times, according to a county memo.

In some ways, this worsening trend is part of an intractable paradox, Daly said. Courts “do a better job over time of identifying cases where mental illness appears to be a factor in why a person may have been arrested or why a person may face criminal charges.”

For example, a study in Colorado found that the number of court-ordered restorations increased from 87 in 2001 to 900 in 2017, according to the 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 centers, as well as the staffing needed to make those beds operational – has not kept up with the growing demand.

In other words, instead of waiting for assessments, people are now waiting for treatment.

“It actually changes where the bottleneck is,” Daly said.

Alabama has taken steps to address this bottleneck.

Construction is underway to add 80 beds at Taylor Hardin, which currently has 140 beds and serves just over 200 people, according to an annual report released in 2024.

However, there is a significant staff shortage and the extra beds will only be usable if “adequate staffing is obtained,” the report said. Only about half of the mental health technician and nursing positions are filled 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. Boswell said an average wage increase of about $6 an hour in 2024 would help with recruitment and retention.

The department trained 94 people for skills recovery programs in prisons to ease the burden on Taylor Hardin, according to court records. Programs now exist in five of Alabama’s 67 counties and are expected 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 appropriate alternative to incarceration or emergency room visits” for people suffering a mental health crisis, according to a September audit. Those centers have completed 22,297 assessments, Boswell said in September.

Boswell said at a recent budget hearing that his agency was working with the judges presiding over the consent decree to improve the time it takes to be evaluated and then processed.

A spokesperson for the Alabama Department of Mental Health declined to comment in response to several emailed inquiries.

Jennifer Tompkins, an Alabama criminal defense attorney, said the root of the problem isn’t just the number of beds. It may take decades to secure Taylor Hardin’s release — either in court, if the mental health crisis has been treated, or in an outpatient program offering more permanent support.

“It’s almost like you’re guilty because you have a mental illness and you live in poverty,” Tompkins said.

One of his clients charged with murder more than a decade ago is still awaiting trial while in a secure facility, where state psychiatrists have issued numerous conflicting assessments of his mental capacity. There is a similar backlog for community facilities like the one Clark expected.

Boswell acknowledged those challenges during a recent budget hearing, saying his agency was working with the judges presiding over the consent decree to improve the revenue figure.

Clark, who was 40 when he died, was known as “Pooch,” a nickname his mother gave him when he was a child because he was small and soft like a puppy.

But he was troubled, with a long history of petty crimes and serious mental health problems.

His sisters said he was often caught wandering aimlessly miles from where he lived with his family in Montgomery. Permanent treatment was often difficult to find because many facilities refused to treat his psychiatric problems because he also took drugs and had to be sober to receive treatment.

“It’s a lot. We’ve had so many different incidents,” said Kawanda Key, one of Clark’s older sisters. Clark would take short stays in hospitals, where he would call his sisters and ask them to bring him chocolate. Every time one of them encountered him on the side of the road, they tried to convince him to go home where he could eat and shower.

Last year, Clark disappeared again, avoiding a burglary charge in 2022. His sisters asked police to help find him, despite their fear that he would end up in prison, unable to meet his needs. He was finally 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 treatment.

“He wasn’t aggressive,” said Subrina Hamilton, one of Clark’s other sisters, but “those people in prison don’t know that.”

His sisters wanted to see him but they weren’t on his visitors list. Another sister, Tameka Clark, regularly called the prison to check on him, assured by prison staff that her younger brother was “fine.”

But on December 11, 2024, Clark was found unconscious in his cell. The temperature in the cell had reached 110 degrees Fahrenheit (43.3 degrees Celsius) by the time boiler repairs were underway. His autopsy listed congestive heart failure as the cause of death, but Tom Andrew, a medical examiner who reviewed the autopsy for The Associated Press, said it left “more questions than answers.”

Clark’s autopsy indicated he had access to water but did not provide details. Given the temperature in his cell, Andrew said, it was “problematic” that the autopsy did not record the internal temperature of Clark’s body or rule out other signs of dehydration.

Additionally, Andrew noted, prison staff were giving Clark antipsychotic medications at the time of his death, which sometimes impair the body’s ability to regulate temperature, making it particularly vulnerable to overheating.

State law enforcement investigating Clark’s death declined to comment, citing an ongoing investigation. Montgomery County Sheriff Derrick Cunningham also declined to comment specifically on Clark’s death.

Cunningham said prisons are ill-equipped to deal with men like Clark waiting for psychiatric beds. Prisons struggle to identify mental health issues, administer medications and manage complex behavioral problems, he said.

Even with significant improvements made by the department, Cunningham said, prisons will continue to struggle.

“If you look at the number of beds we have and the wait time, I mean, it’s still not enough,” he said.