MONTGOMERY, Ala. (AP) — Fernando Clark has spent the last 10 months of his life in a jail cell awaiting court-ordered psychiatric treatment after he was arrested for stealing cigarettes and fruit from a gas station.
He died while waiting for treatment that never came, 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 delay the evaluation and treatment of mentally ill people accused of crimes.
Seven years after the federal deal, the problem is only getting worse. The waiting list at the state’s only secure psychiatric facility is nearly five times longer than when the decree was passed, according to court documents released in September.
Arrestees 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’s “spend more time in bed than if they had just pleaded guilty,” said Bill Van Der Pol, a lawyer for the Alabama Disability Advocacy Program, which won federal approval.
Delayed progress
in 2010 the Department of Mental Health’s budget was cut by $40 million due to the recession. At least 10 state mental institutions have closed over the past three decades, leaving only three inpatient facilities with a total of 504 beds and only one where criminally prosecuted men can receive treatment to restore their competency.
The lawsuit that led to the consent decree was filed in 2016, alleging delays at every step of the process in violation of constitutional due process.
Psychiatric evaluations had to be awaited first. Then, if he was found unfit to stand trial, he awaited placement at the only secure facility that serves men: the Taylor Hardin Secure Medical Facility. Finally, any person deemed ineligible to be returned to court had to wait for extended treatment in community facilities.
in 2018 the consent decree gave the state two years of all mental health evaluations and reports within 60 days of the court order. A man deemed incompetent to stand trial must go to Taylor Hardin within 30 days thereafter.
The state was also required to expand the number of beds for continuing care if someone cannot be rehabilitated.
According to August Taylor Hardin’s waiting list has grown to 273 men, according to a court filing. This is more than in 2017. approximately 60 men. 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 mediating with the plaintiffs.
A national matter
According to the nonprofit Treatment Advocacy Center, the number of public hospital beds for adults with serious mental health problems nationally in 2023 reached an all-time low of 36,150 beds, more than half of which were occupied by people hospitalized under the criminal justice system. The organization found that the number of beds decreased by 17 percent compared to 2017.
“There really isn’t a state where it hasn’t become a more visible problem — and in fact, it’s been expanding rapidly over the last decade,” said Lisa Daly, executive director of the Treatment Advocacy Center.
In Nevada, for example, one county was ordered to pay $500 a day in April because defendants did not receive treatment in a timely manner. Officials at the time estimated the payout would be $3.6 million in fiscal years 2026 and 2027.
In some ways, the worsening trend is part of an insurmountable paradox, Daly said. Courts are “doing a better job over time of determining when mental illness is a factor in someone’s arrest or criminal charges.”
For example, one Colorado study found that the number of court-ordered restitutions increased from 87 in 2001, according to the U.S. Department of Health and Human Services’ federal Substance Abuse and Mental Health Services Administration. up to 900 in 2017
That’s a good thing, Daly said. But the infrastructure—the number of beds in secure treatment facilities and the number of staff to operate those beds—has not kept pace with increasing demand.
In other words, instead of waiting for assessments, people are now waiting for treatment.
“It really changes where the bottleneck is,” Daly said.
Noticeable improvements
Alabama has taken steps to remove that obstacle.
Based on 2024 published in its annual report, Taylor Hardin, which currently has 140 beds and serves just over 200 people, currently has 80 beds under construction.
However, staffing is critical and the extra beds will only be available if “adequate staffing is available”, the report said. The facility is only half filled for mental health technicians and nurses, Alabama Department of Mental Health Commissioner Kim Boswell said at a board meeting in 2024. August, according to The Alabama Reflector. Boswell said the average wage increase would be about $6 an hour in 2024. helps you find and keep a job.
The department trained 94 people in competency recovery programs at the jails to ease Taylor Hardin’s burden, court records show. Programs now exist in five of Alabama’s 67 counties, with plans to expand to three.
September Alabama has spent $175 million over five years to build six 180-bed crisis centers across the state to provide “better alternatives to jail or the emergency room” for people in mental health crises, an audit shows. Those centers completed 22,297 evaluations, Boswell testified in September.
Boswell said during a recent budget hearing that her agency is working with the judges who preside over the consent decree to extend the time for evaluation and treatment.
A spokesman for the Alabama Department of Mental Health declined to comment in response to multiple emails. mailed requests.
Unable to exit
Jennifer Tompkins, an Alabama criminal defense attorney, said the root of the problem isn’t just the number of beds. It could be decades before Taylor Hardin is released — either to court if he’s been treated for a mental health crisis or to an outpatient program that provides ongoing support.
“It’s almost like you’re guilty because you’re mentally ill and you’re in poverty,” Tompkins said.
One of her clients, charged with murder more than 10 years ago, is still awaiting trial while he remains in a secure facility, where state psychiatrists have issued a series of conflicting assessments of his mental capacity. Community facilities like Clark are similarly lagging behind.
Boswell acknowledged those challenges at a recent budget hearing, saying her agency is working with the judges presiding over the consent decree to improve turnover.
Nowhere to turn for help
Clark, who was 40 when he died, was known as “Puppy”, a nickname his mother gave him as a child because he was small and cute like a puppy.
But he was troubled, had a long history of petty crime and severe mental health problems.
His sisters said he was often picked up wandering aimlessly within miles of where he lived with his family in Montgomery. Permanent treatment was often difficult to obtain as many facilities refused to treat his mental problems because he also used drugs and had to be sober in order to receive treatment.
“It’s a lot. We just had so many different incidents,” said Kawanda Key, one of Clark’s older sisters. Clark worked briefly in hospitals where he would call his sisters and ask them to bring him chocolate. When one of them met him on the side of the road, they would try to convince him to return home, where they could eat and wash.
Last year, Clarke disappeared again, missing the 2022 race. on a burglary charge. His sisters asked the police to help find him, despite their fear that he would end up in prison without being able to provide for his needs. He was eventually found and imprisoned in 2024. in February, and it was not until September of that year that his mental illness was declared incurable and he was ordered to remain in prison until a bed could be found where he could receive care.
“He wasn’t aggressive,” said Subrina Hamilton, one of Clark’s other sisters, but “these people in prison don’t know that.”
His sisters wanted to see him, but they weren’t on his visitor list. Another sister, Tameka Clark, regularly called the prison to check on him, and prison staff assured him that his younger brother was fine.
However, in 2024 December 11 Clark was found unresponsive in his cell. The temperature in the chamber rose to 110 degrees Fahrenheit (43.3 degrees Celsius) at the time the boiler was repaired. His autopsy lists congestive heart failure as the cause of his death, but forensic pathologist Tom Andrews, 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 specifics. Given the temperature in his cell, Andrew said it was “problematic” that the autopsy did not record Clark’s core body temperature and rule out other signs of dehydration.
Andrew also noted that prison staff had given Clark antipsychotic medication at the time of his death, which sometimes impairs the body’s ability to regulate temperature, making him particularly vulnerable to overheating.
The burden of prisons
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 as they wait for a psychiatric bed. Jails struggle to identify mental health problems, prescribe medication and deal with complex behavioral problems, he said.
Cunningham said even with the department’s significant improvements, the jails will continue to struggle.
“If you look at the number of beds we have and the wait times, I mean, it’s still not enough,” he said.