Mental Health Challenges: Long Waits for Psychiatric Care in Alabama

MONTGOMERY, Ala. reports The Seattle Times, Fernando Clark spent the last 10 months of his life in a jail cell, awaiting psychiatric treatment as ordered by the court after his arrest for minor theft. Tragically, he died in that cell, a sobering reminder of Alabama's ongoing mental health crisis.

Clark was just one of hundreds across the state, stuck in a system that continues to struggle with long wait times for psychiatric care, despite a consent decree aimed at reforming these delays. Seven years after the federal agreement, the situation has deteriorated; the waitlist for the state’s only secure psychiatric facility has nearly quintupled since the decree was issued.

According to court documents released in September, the waitlist at the Taylor Hardin Secure Medical Facility now includes 273 men, up from about 60 in 2017, with some waiting over two years for care. The facility, designed to assess and treat individuals deemed incompetent to stand trial, has become overwhelmed due to budget cuts and the closure of numerous state-run psychiatric facilities, leaving only three with a total of 504 beds.

The Department of Mental Health's budget was slashed by $40 million in 2010 following the recession, leading to significant operational challenges and facility closures. With the average wait for treatment exceeding a year, many individuals find themselves spending longer in jail awaiting psychiatric care than they would if they pleaded guilty, as noted by Bill Van Der Pol from the Alabama Disabilities Advocacy Program.

This issue is not unique to Alabama; nationally, the number of available state hospital beds for adults with serious mental health issues has hit a historical low in 2023, with more than half occupied by individuals committed through the criminal justice system.

As Lisa Daly, executive director of the Treatment Advocacy Center, points out, while courts are better identifying mental illness in defendants, the treatment infrastructure has not kept pace. In response to the growing crisis, Alabama is attempting to address these challenges by expanding the Taylor Hardin facility and building crisis centers across the state.

Although construction is underway to add 80 beds to Taylor Hardin, staffing shortages remain a significant hurdle, with only about half of necessary positions filled. Meanwhile, initiatives to train mental health technicians for competency restoration programs in jails are being implemented to alleviate the burden on the Taylor Hardin facility.

Jennifer Tompkins, a criminal defense attorney, highlights that the systemic issues extend beyond just the number of beds; individuals can face decades waiting for treatment or release from facilities like Taylor Hardin.

The story of Fernando Clark exemplifies the tragic outcomes of this broken system, as his family struggled to navigate a landscape where treatment options were scarce and ineffective. Clark's death, ruled as resulting from congestive heart failure, raises troubling questions about the conditions he faced while incarcerated and the overall inadequacy of the mental health care system, as noted by forensic pathologist Tom Andrew.

Montgomery County Sheriff Derrick Cunningham emphasizes that jails are ill-equipped to manage individuals with mental health issues, underlining that without sufficient psychiatric beds and resources, the situation is unlikely to improve.