MONTGOMERY, Alabama. Fernando Clarke spent the last 10 months of his life in a prison cell awaiting psychiatric treatment a court ordered him to receive after he was arrested for stealing cigarettes and fruit from a gas station.
He died while waiting for treatment that never arrived and was found inactive in his prison cell.
Clark was just 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 assessing and providing care for people with mental illness and accused of crimes.
Seven years after the federal agreement was signed, the problem has only gotten worse. The waiting list at the state's only secure mental health facility is nearly five times longer than it was when the order was issued, according to court documents released in September.
Those arrested sometimes wait years to be placed in a facility designed to treat their illness and ensure their health before they can stand trial, a problem faced by many states across the country.
In Alabama, that means people charged with lesser crimes like Clark “spend more time waiting for a bed than if they had just pleaded guilty,” said Bill Van der Pol, a lawyer for the Alabama Disability Rights Program, which won the federal consent decree.
In 2010, the recession cut the Department of Mental Health's budget by $40 million. At least 10 state psychiatric institutions. closed over the past three decades, there are only three 504-bed inpatient facilities left, and only one where men facing criminal charges can receive treatment to restore their competency.
The lawsuit that led to the consent decree was filed in 2016, arguing that delays at every step of the process violated constitutional due process.
First we had to wait for a psychiatric examination. Then, if he was found unfit to stand trial, he had to wait for a spot at the only secure facility serving men: the Taylor Hardin Secure Medical Facility. Finally, anyone deemed incompetent to stand trial had to wait longer for treatment in community facilities.
The 2018 consent order gave the state two years to complete all mental health assessments and reports within 60 days of the court order. A person found incompetent to stand trial must contact Taylor Hardin within 30 days thereafter.
The state was also required to expand the number of beds for more permanent care if someone could not be rehabilitated.
Taylor Hardin's waiting list increased to 273 people, according to an August court decision. This is up from about 60 men in 2017. The average wait time is more than a year, and more than 30 people on the list have been languishing 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 problems reached a historic low in 2023, at 36,150 beds. more than half According to the nonprofit Treatment Advocacy Center, these include people who have been institutionalized as part of the criminal legal system. According to the organization, this is a 17% decrease in the number of beds compared to 2017.
“There really isn't a single state where this problem isn't becoming increasingly visible—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, in April one county was ordered to pay $500 a day because defendants were not provided timely assistance. Officials calculated at that time that the payment will be 3.6 million dollars for fiscal years 2026 and 2027, based on current caseload and wait times, as outlined in the district memo.
In some ways, the worsening trend is part of an unresolvable paradox, Daly said. Courts have “over time gotten better at identifying cases where mental illness is a factor in why someone might be arrested or why someone might face criminal charges.”
For example, one study in Colorado found that the number of court-ordered reinstatements 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 good,” Daly said. But the infrastructure—the number of beds in secure treatment facilities, as well as the number of staff to keep those beds running—has not adjusted to the growing demand.
In other words, instead of waiting for evaluations, people now wait for treatment.
“It actually changes where the bottleneck is,” Daley said.
Alabama has taken steps to address this bottleneck.
Construction 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 released in 2024.
However, there are significant staffing shortages and additional beds can only be used if “adequate staffing can be ensured”, the report said. The facility has only filled about half of its mental health technician and nursing positions, Alabama Department of Mental Health Commissioner Kim Boswell said at an August 2024 board meeting: according to The Alabama Reflector. Boswell said the average wage increase of about $6 an hour in 2024 will help with recruitment and retention.
The department trained 94 people to participate in competency restoration programs in prisons to ease Taylor Hardin's burden, court records show. Programs currently exist in five of Alabama's 67 counties, with plans 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 an emergency room visit” for people suffering a mental health crisis. September audit show. Those centers have completed 22,297 assessments, Boswell said in September.
At recent budget hearings, Boswell said her agency is working with judges presiding over consent decree decisions to reduce the time required for evaluation and subsequent treatment.
A spokesperson for the Alabama Department of Mental Health declined to comment in response to multiple email requests.
Jennifer Tompkins, a criminal defense lawyer in Alabama, said the root of the problem is not just the number of beds. It could take decades to free Taylor Hardin, either through the courts if the mental health crisis has been treated, or into an outpatient program that offers more permanent support.
“It's almost like you're guilty because you're mentally ill and living in poverty,” Tompkins said.
One of her clients, charged with murder more than 10 years ago, is still awaiting trial in a secure facility where state psychiatrists have given numerous conflicting assessments of his mental capacity. There is a similar backlog of public institutions as that which Clark expected.
Boswell acknowledged those problems at a recent budget hearing, saying her agency is working with judges presiding over consent decree to improve staff turnover.
Clark, who was 40 at the time of his death, was known as “Pooch,” a nickname his mom gave him as a child because he was small and cute, like a puppy.
But he was concerned about a long history of petty crime and serious mental health problems.
His sisters said he was often picked up wandering aimlessly miles from where he lived with his family in Montgomery. Permanent treatment was often difficult to obtain because many institutions refused to treat his psychiatric problems because he was also a drug user and needed 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 spent some time in hospitals, where he called his nurses and asked them to bring him chocolate. Whenever one of them met him on the side of the road, they tried to convince him to come home where he could eat and take a shower.
Clark went missing again last year, escaping burglary charges in 2022. His sisters asked police to help find him, despite their fears he would end up in prison unable to meet his needs. He was eventually found and incarcerated in February 2024, 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 to help him.
“He wasn't violent,” said Subrina Hamilton, one of Clark's sisters, but “these people in prison don't know that.”
His sisters wanted to see him, but they were not on the visitor list. Another sister, Tameka Clark, regularly called the prison to check on him and was assured by prison officials that her younger brother was “fine.”
But on December 11, 2024, Clark was found unconscious in his cell. The temperature in the chamber rose to 110 degrees Fahrenheit (43.3 degrees Celsius) while the boiler was being repaired. The autopsy listed the cause of death as congestive heart failure, but Tom Andrew, a forensic pathologist who reviewed the autopsy for The Associated Press, said it left “more questions than answers.”
Clark's autopsy showed he had access to water but did not elaborate. Given the temperature in the cell, Andrew said, it was “problematic” that the autopsy did not record Clark's core body temperature or rule out other signs of dehydration.
Additionally, Andrew noted that prison staff were giving Clark antipsychotic medications at the time of his death, which sometimes impair the body's ability to regulate temperature, making him especially vulnerable to overheating.
State law enforcement officials 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 people like Clark waiting for psychiatric beds. Prisons have difficulty identifying mental health problems, prescribing medications and addressing complex behavioral issues, he said.
Even with significant improvements the department is making, prisons will continue to struggle, Cunningham said.
“If you look at the number of beds that we have and also the wait times, I mean, it's still not enough,” he said.
