The Alabama Department of Mental Health is working to reduce the number of people with mental health needs waiting in county jails for treatment.
At a Joint Mental Health Task Force meeting last week, ADMH reported 291 people waiting in jails in July. In January, that number was 327. The department’s goal is to reduce the number to 100 by the end of 2026.
The wait list is also at the center of a longstanding federal lawsuit. Filed in 2016, Hunter et al. v. Beshear alleged that people whose competency to stand trial had been questioned were being held in jails for months while awaiting psychiatric evaluations or treatment. A federal consent decree reached in 2018 established deadlines for providing those services and required the state to expand the number of available beds.
Rather than relying solely on new hospital beds, Commissioner Kim Boswell said ADMH is using jail-based competency restoration, community placements and forensic navigators to determine who actually needs inpatient treatment.
“Nothing was moving, ’cause as soon as we got somebody else, somebody was coming in,” Boswell said.
Boswell said the current challenges are tied in part to decisions made after a $40 million reduction in the department’s General Fund budget in 2010. That period led to facility closures and the loss of 725 beds, leaving the state with fewer resources to serve people with serious mental illnesses.
“We’ve got to have a new revenue stream,” Boswell said. “You cannot do it on current revenues.”
Chairman Reynolds said replacing the 787 beds would cost an estimated $590 million in construction alone, based on an estimated $750,000 per bed. The figure does not include the cost of operating the facilities. The beds primarily serve people under civil commitment and are separate from the state’s forensic mental health beds.
The department has expanded its forensic capacity to address the immediate problem. Taylor Hardin Secure Medical Facility in Tuscaloosa, the state’s only maximum-security forensic facility, completed an expansion within the last year, increasing its capacity from 140 to 225 beds. About 200 beds are currently filled.
The remaining 25 are expected to be filled after a plumbing issue in the older portion of the facility is repaired, which Boswell said is expected during the first week of October.
The department also has begun treating some people in county jails through a telehealth competency restoration program. Boswell said 32 people have been restored to competency through the program since summer 2025, allowing them to continue with their criminal cases without waiting for a hospital bed.
Other efforts include forensic navigators who identify people who may be better served outside the forensic system. Some people on the wait list have intellectual disabilities, traumatic brain injuries or dementia, Boswell said, and may be eligible for other forms of treatment or diversion.
Individuals found incompetent to stand trial generally cannot proceed through their criminal cases until they receive treatment to restore their competency. That can leave people who have not been convicted of a crime sitting in county jails while they wait for specialized mental health care.
Boswell said the department’s concern extends beyond the current wait list to the broader capacity of Alabama’s mental health system.
For the department, Boswell said, the consequences of inadequate funding are ultimately measured not only in beds or dollars, but in whether the state has somewhere to care for people who need treatment.
