Montgomery, Ala. – Fernando Clark spent the last 10 months of his life in a prison cell, after a court ordered him to await psychiatric treatment after he was arrested for stealing cigarettes and some fruit from a gas station.
He died while waiting for treatment, which never came, after he was found unresponsive in his jail cell.
Clark was one of hundreds of people across Alabama waiting for a spot in the state’s increasingly limited facilities, despite a consent decree requiring the state to address delays in evaluation and care for people with mental illness who are accused of crimes.
Seven years after the federal settlement, the problem has gotten worse. The waiting list for the state’s only secure psychiatric facility is nearly five times longer than it was when the order was issued, according to court documents released in September.
People who are arrested sometimes have to wait years for an appointment at 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 who are charged with less serious crimes, like Clark, “spend more time waiting in bed than if they had just pleaded guilty,” said Bill Van Der Pol, an attorney with the Alabama Disability Advocacy Program, which won the federal consent decree.
In 2010, the Department of Mental Health had its budget cut by $40 million in the wake of the recession. At least 10 government psychiatric facilities has stopped Over the past three decades, only three inpatient facilities remain with 504 total beds, and only one where men facing criminal charges can receive treatment to restore their competency.
The lawsuit leading to the consent decree was filed in 2016, alleging delays at every point in the process that violated constitutional due process.
First, psychiatric evaluation awaited. Then if deemed ineligible for testing, a spot awaits at the only secure facility serving men: Taylor Hardin Secure Medical Facility. Ultimately, anyone deemed unable to restore eligibility for testing had to wait for long-term treatment at community-based facilities.
The 2018 consent decree gave the state two years to complete all mental health evaluations and reports within 60 days of the court order. A person deemed unfit to stand trial must approach Taylor Hardin within 30 days.
The state also needed to expand the number of beds for more permanent care if someone could not be rehabilitated.
According to an August court filing, Taylor Hardin’s waiting list has grown to 273 men. This is up from about 60 men in 2017. The average wait is more than a year, and more than 30 people on the list have waited more than two years. The state is still in arbitration with the plaintiff.
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 According to the nonprofit Treatment Advocacy Center, many of them were occupied by people who were committed to the hospital through the criminal legal system. The organization found that beds had declined by 17% since 2017.
“There’s really no state where this hasn’t become an increasingly visible problem — and the scope of it has been growing rapidly over the last decade,” said Lisa Daly, executive director of the Treatment Advocacy Center.
For example, in Nevada, a county was ordered in April to pay $500 per day because defendants did not receive timely treatment. Officials estimated at the time that the payment will be 3.6 million dollars For fiscal years 2026 and 2027, based on current caseload and wait times, a county memo shows.
In some ways, the worsening trend is part of an intractable paradox, Daly said. Courts “are doing a better job over time of recognizing when mental illness appears to be a factor in why someone is arrested or why someone may face criminal charges.”
For example, a study in Colorado found that the number of court-ordered restitution increased 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 at secure treatment facilities, as well as the staffing levels to staff those beds – has not adjusted to the increasing demand.
In other words, instead of waiting for evaluation, people are now waiting for treatment.
“What it really does is it changes where the bottleneck is,” Daly said.
Alabama has taken steps to remove that obstacle.
According to an annual report published in 2024, construction is underway to add 80 beds to Taylor Hardin, which currently has 140 beds and serves more than 200 people.
However, there is a severe shortage of staff and additional beds will only be usable when “appropriate staffing is achieved”, the report said. Only half of the mental health technician and nursing positions at the facility are filled, Kim Boswell, commissioner of the Alabama Department of Mental Health, said at a board meeting in August 2024. According to Alabama ReflectorBoswell said an average wage increase of about $6 an hour by 2024 is helping recruitment and retention,
Court records show the department trained 94 people for competency restoration programs in prisons to ease the burden on Taylor Hardin. The programs now exist in five of Alabama’s 67 counties and are expected to expand to three more counties.
Alabama has 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 an emergency room visit” for people suffering mental health crises. 1 september audit Shows. Boswell testified in September that those centers had conducted 22,297 evaluations.
Boswell said at a recent budget hearing that his agency is working with judges who preside over consent decrees to improve the time it takes to get evaluated and then treated.
A spokesperson for the Alabama Department of Mental Health declined to comment, citing the pending litigation.
Alabama criminal defense attorney Jennifer Tompkins said the root of the problem isn’t just the number of beds. It could take decades for Taylor Hardin to be released — either in court, if the mental health crisis has been treated, or into an outpatient program that provides more permanent support.
“It’s almost like you’re guilty because you’re mentally ill and in poverty,” Tompkins said.
One of his clients was charged with murder 10 years ago and is still awaiting trial, while in a secure facility, where state psychiatrists have issued several conflicting assessments of his mental competency. There’s a similar backlog for community-based facilities, which Clark was waiting for.
Boswell acknowledged those challenges at a recent budget hearing, saying his agency was working with the judges presiding over the consent decree to improve turnover.
Clark, who was 40 when he died, was known as “Pooch”, a nickname given to him by his mother as a child because he was small and cute, like a puppy.
But he was troubled by 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 family in Montgomery. It was often difficult to obtain permanent treatment as many facilities refused to treat his psychiatric issues because he also took medications, and he needed to remain conscious in order to receive treatment.
“It’s a lot. We had a lot of different incidents happen,” said Kawanda Key, one of Clark’s older sisters. Clark worked for a time in hospitals, where he would call his sisters and ask them to bring him chocolates. Whenever any of them met him on the roadside, they would try to persuade him to come home where he could eat and take a bath.
Last year, Clark went missing again, set to be released in 2022 on burglary charges. His sisters asked the police to help find him, despite their fear that he would end up in jail unable to make ends meet. He was eventually found and imprisoned 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 to care for him.
“He was not aggressive,” said Subrina Hamilton, one of Clark’s other sisters, but “these people in prison don’t know that.”
His sisters wanted to meet him but they were not on the list of visitors. Another sister, Tameka Clark, regularly called the prison to check on him, with prison staff assuring her that her younger brother was “fine.”
But on December 11, 2024, Clark was found unresponsive in his cell. While the boiler was being repaired the temperature in the cell rose to 110 degrees Fahrenheit. His autopsy listed 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 stated that he had access to water, but did not provide specific details. Andrew said, given the temperature of his cell, it was “problematic” that the autopsy did not record Clark’s internal body temperature or rule out other signs of dehydration.
Additionally, Andrew said, prison staff were giving Clark antipsychotic medication at the time of his death that sometimes impairs the body’s ability to regulate temperature, making him especially sensitive to overheating.
The state law enforcement agency investigating Clark’s death declined to comment, citing the 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 because they are waiting for psychiatric beds. Prisons have difficulty identifying mental health issues, administering medication and addressing complex behavioral issues, he said.
Despite significant reforms being made by the department, struggles at the prisons will continue, Cunningham said.
“If you look at the number of beds we’ve got and then the wait times, I mean, it’s still not enough,” he said.
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