AUSTIN (KXAN) — When Amy Ortiz stepped up to the microphone at a packed Capitol hearing of the Texas Commission on Jail Standards, she had one message to the board members: Please keep my brother alive.

Ortiz recounted how her family called a crisis line to get help for her mentally ill brother. Instead, the police arrested him and put him in Smith County jail in January 2024. 

By February’s hearing, Ortiz said her brother’s physical condition was so deteriorated she feared he may soon die.

“He was just skin and bones,” Ortiz told commissioners at the hearing. 

On Feb. 1, 2024, more than a dozen family members expressed similar anecdotes at the Texas Commission on Jail Standards hearing. They voiced their concerns about their family members experiencing mental crises inside of jail, mistreatment and declining physical health — with some experiencing severe dehydration and noticeable weight loss.

Maintaining proper nutrition for people with mental illness in jail can be a challenge with dire consequences, and, according to experts, it may be a problem that is flying under the radar. 

“My brother isn’t able to get commissary because he is in suicide watch,” said Ortiz, making it hard for the family to help him while they watch him lose more and more weight. 

The Smith County Sheriff’s Office did not respond to KXAN’s multiple requests for comment. 

Jails “are environments that are stressful and known to exacerbate stress levels,” said Alycia Welch, associate director of the Prison and Jail Innovation Lab (PJIL) at the University of Texas at Austin. The PJIL serves as a bridge between academic researchers and policymakers on issues of prison and jail confinement. 

“For individuals living with mental illness, exacerbated stress often results in exacerbating the symptoms of mental illness,” Welch said.

The stressful jail environment took a physical toll on Ortiz’s brother, causing him to drop a noticeable amount of weight, according to his family. 

For some people with mental illness, it can be difficult to keep them fed regardless of whether food is available or not, Dr. Steve Stratowski, associate vice president for regional mental health at Dell Medical School, said. 

“There is a belief that the food is dangerous. If there is anyone that’s available that they can trust or work with: a family member, friend, case manager — that is another alternative. Of course, the best thing is to not have them in jail,” Stratowksi said. 

Hypernatremia

A separate Tarrant County case shows living in jail with mental illness can be deadly, according to a federal lawsuit filed last year.

On June 22, 2023, the estate of Georgia Baldwin filed a federal lawsuit against Tarrant County Jail claiming Baldwin was denied her constitutional rights and died because of neglect. 

On Sep. 14, 2021, Baldwin was found unresponsive in the Tarrant County Jail and died within an hour of being found, according to a custodial death report. She died from severe hypernatremia, according to court records, inches from a water fountain in her cell. 

Severe hypernatremia is consistent with someone who does not drink enough water. This is consistent with the extensive research in schizophrenia where the brain condition causes a loss of attention to normal cues — like thirst, explains Stratowski.

Baldwin had a history of mental health treatment through the North Texas Behavioral Health Authority, according to her case files. Her psychiatric report indicated that she was incompetent to stand trial. She was then sent to the Tarrant County Jail for a 120-day outpatient competency restoration (OCR) program. After 60 days, she was required to be sent to a North Texas state hospital. 

“Individuals who are flagged by the court system as potentially not competent to stand trial need to be given constant competency restoration services,” Welch said. 

The treatment plan must address physical health concerns, medication management, and contain a level of family and community support, according to the Texas Health and Human Services Competency Restoration guidelines regarding jail-based competency restoration programs. After completion of the program, the staff should work with the courts to secure a daytime release of incarcerated individuals. 

The Tarrant County Jail incarcerated Baldwin longer than mandated, according to court records.

During Baldwin’s time in Tarrant County Jail, she was held in a small cell without a window. Her interactions were with a jailer at check-ins, the lawsuit states.

The Tarrant County Sheriff’s Office did not respond to KXAN’s request for comment. 

A Texas Ranger investigation referenced in the Baldwin lawsuit said that when cell checks were made – like the one done before Baldwin was found – nobody would enter Baldwin’s cell.

After Baldwin’s death, Tarrant County contracted with CGL Companies to conduct a comprehensive review of the facility, in which it was determined Tarrant County had “sufficient notice to remedy issues involving Baldwin’s suffering and death.” 

According to the CGL report, Tarrant County “had a policy, practice, and or/custom of understaffing its jail.” 

The Baldwin case remains pending in U.S. District Court Northern District of Texas.

Beyond the Baldwin case, Texas jail and mental health authorities have struggled for years to move people found incompetent to stand trial from jails to state hospitals for competency restoration.

In March, there were nearly 2,000 people on the state’s maximum security and non-maximum security waitlists for a state hospital bed. The total waitlist has been trending down since January 2023, when it was above 2,500 people. As of March, some individuals on the list were waiting a year or more for treatment, according to data compiled by the Health and Human Services Commission’s Joint Committee on Access and Forensic Services.

Understaffing

“Jails and prisons alike are experiencing critical shortages and staffing, and that really impacts the ability of an agency to do the proper check in on individuals with mental illness,” Welch said. 

Understaffing can lead to overworked jail staff, directly affecting the quality of care the inmates receive and resulting in inadequate jail checks, according to a National Library of Medicine experiment on short-term imprisonment under low-prison staffing.

During the Texas Commission on Jail Standards hearing, Harris County stated that they need more staffing — a common issue echoed by many Texas County Jails during the session. 

In 2022, 50% of the Tarrant County jail population needed psychiatric or behavioral health care, according to the Texas Jail Project. 

The Baldwin court records highlighted other cases of inmates with a prior history of mental illness dying within jail custody who refused to eat food or drink water. Their refusal to eat or drink is documented, indicating that the county jails were aware of the issue.

Without proper check-ins, people with mental illness lack a continuity of care, which includes physical and mental health check-ins, including checking hunger and thirst cues — something that is vital in supporting these individuals, according to Welch.