Fernando Clark spent the last 10 months of his life in a jail cell, waiting for psychiatric treatment a court ordered he undergo after he was arrested for stealing cigarettes and some fruit from a gas station.
He died waiting for treatment.
Clark was just one of hundreds of people across Alabama awaiting a spot in the state's increasingly limited facilities, despite a consent decree requiring the state to address delays in providing care for people who are charged with crimes but deemed too mentally ill to stand trial.
The problem only worsened. The waitlist for the state's sole secure psychiatric facility is almost five times longer than when the decree was issued, according to court documents released in September.
A framed photo of Fernando Clark, who died in Montgomery County Jail in 2024, sits Oct. 8 in the living room of his sister's home in Montgomery, Ala.
Experts say the problem is nearly universal — and worsening — across the United States.
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National crisis
Nationally, the number of state hospital beds for adults with serious mental health issues reached a historic low in 2023 with 36,150 beds, more than half of them occupied by people committed to the hospital through the criminal legal system, according to the nonprofit Treatment Advocacy Center. That's a 17% decline in beds from 2017, the organization found.
"There really isn't any state where this hasn't become an increasingly visible problem — and it's actually expanding in scope rapidly over the last decade," said Lisa Dailey, executive director of the Treatment Advocacy Center.
She said courts are "doing a better job over time of identifying when mental illness appears to be a factor in why somebody might've been arrested or why somebody might be facing criminal charges."
However, the infrastructure — the beds available at secure treatment facilities, along with the staffing levels to make those beds operational — has not adjusted to the increasing demand.
Need for change
Construction is underway to add 80 beds to Alabama's sole psychiatric facility for men, which has 140 beds and serves just a little more than 200 people, according to an annual report published in 2024.
However, there is a significant staffing shortage and the added beds will only be usable if the state can hire enough staff, according to The Alabama Reflector.
Boswell said an average pay increase of about $6 an hour in 2024 helps with recruitment and retention. At a recent hearing, she said her agency works with the judges presiding over the consent decree to improve the time it takes to get evaluated and treated.
A spokesperson for the Alabama Department of Mental Health declined to comment, citing pending litigation.
The department also trained 94 people for competency restoration programs in jails to relieve the burden on Taylor Hardin Secure Medical Facility, court records show. Programs exist in five of Alabama's 67 counties and are slated to expand to three more.
Alabama also spent $175 million over five years to build six crisis centers with 180 beds across the state to provide an alternative for people suffering a mental health crisis, a September audit shows.
Those centers conducted 22,297 evaluations, Boswell testified in September.
Deadly consequences
Those changes came too late for Clark. After the state conducted an evaluation that determined it was not possible to restore him to a mental state stable enough for him to stand trial, a judge ordered that he receive care in a community mental health center, which are backlogged.
His sisters said he was often picked up wandering aimlessly miles away from where he lived with family in Montgomery. Whenever one of them encountered him on the side of the road, they'd try to persuade him to come home where he could eat and shower. He had short stints in hospitals.
"It's a lot. We just had so many different incidents," said Kawanda Key, one of Clark's older sisters.
Last year, Clark went missing again, skipping out on a 2022 burglary charge. He eventually was found and jailed in February 2024. In September of that year, his mental illness was deemed untreatable and he was ordered to stay in jail until a bed could be found for him to receive care.
On Dec. 11, Clark was found unresponsive in his cell, where the temperature rose to 110 degrees Fahrenheit as boiler repairs were being done. His autopsy lists congestive heart failure as his cause of death.
Tom Andrew, a forensic pathologist who reviewed the autopsy, said it was "problematic" that the autopsy didn't record Clark's internal body temperature or rule out other signs of dehydration. He noted jail staff gave Clark antipsychotic medication that sometimes impairs the body's ability to regulate temperature, making him especially vulnerable to overheating.
Clark, 40, was known as "Pooch," a nickname his mom gave him as a kid because he was small and sweet like a puppy.
