Tarrant County inmate's 'unnecessary death' spotlights mental health crisis in jails nationwide
The water fountain in Georgia Kay Baldwin’s jail cell was only inches from her bunk, but authorities suspect she died of dehydration.
Baldwin was in Tarrant County Jail custody, accused of leaving threatening voicemails for an Arlington police officer. When she died, she was living in a single cell at the Lon Evans Corrections Center, a red brick building that takes up a full city block in downtown Fort Worth.
Mental health practitioners who checked on Baldwin found her delusional, according to jail records obtained by KERA. She kept asking for a bus ticket to Arizona and insisted the government was out to kill her.
Baldwin's mental illness was so severe that, on July 27, 2021, a judge ordered her transfer from jail to a state psychiatric hospital.
County jails in Texas make up the state’s biggest mental health system. Even when an inmate gets ordered to a state psychiatric hospital, the waitlist is thousands of people long, and it can take months or years to get a bed.
Baldwin would never make it to one. On Sept. 14, 2021, staff found Baldwin unresponsive in her cell. A doctor at John Peter Smith Hospital declared her dead an hour later.
Baldwin’s autopsy determined she died of severe hypernatremia, an imbalance of sodium that usually results from dehydration.
The long wait at state psychiatric hospitals leaves people like Baldwin stuck in legal limbo and in jail, where their mental health is likely to spiral, and their lives are in danger, advocates say.
“What is happening in Tarrant County and so many other jails across Texas, is people are being punished for having mental illness," said Dean Malone, an attorney suing over Baldwin’s death.
Series of voicemails leads to arrest
Baldwin came to law enforcement’s attention in September 2020 because she called them.
That’s according to Arlington police, who accused Baldwin of leaving a series of threatening voicemails for then-Arlington police lieutenant Christopher Cook.
The voicemails, transcribed in Baldwin’s arrest warrant affidavit, urged police to make an arrest in the unsolved case of Amber Hagerman, an Arlington girl whose abduction and murder in 1996 led to the creation of the Amber Alert system.
“I want you dead like no other. Give me a gun... I just want to beat the [expletive] out of you. I want to pull your [expletive] hair out so bad. The governor of Mississippi needs to blow you away," she said, according to police.
Detective R. Munoz investigated the calls.
“Lt. Cook felt that if she knew his personal home address or encountered him on the street and had the means to do violence, she would enact it towards him,” Munoz wrote.
Cook, who is now the police chief of White Settlement, declined an interview request for this story.
During his investigation, Munoz learned of Baldwin's long history of mental illness. He talked to one of Baldwin’s sons, Joshua Mattix, who told Munoz that his mom had schizophrenia and was mentally unstable.
For the voicemails, Baldwin was charged with terroristic threat against a peace officer, a felony. She was booked into the Tarrant County Jail in April 2021.
She would die one year and five days after the last voicemail.
In June, Baldwin’s sons sued Tarrant County over their mother’s “tragic, completely unnecessary death.” Jail staff were negligent in caring for a woman whose severe mental illness was obvious from the voicemails alone, the lawsuit argues.
Dean Malone is the attorney representing Baldwin’s sons. He spoke to KERA about the lawsuit, as he advises his clients not to talk to the media.
Baldwin needed mental health treatment, not punishment, Malone said.
"What are they going to do, put her on trial for something that she had no clue of right from wrong when she did it?” he said.
The Tarrant County Sheriff’s Office, the agency in charge of the jail, declined a request for an interview for this story, citing the lawsuit.
The sheriff’s office also did not respond to questions unrelated to Baldwin’s case, like how many people in the jail have documented mental health issues.
Almost 40% of Tarrant County inmates "have consistently been identified with a mental health need," according to the county's proposed budget for the next fiscal year.
If authorities insist on arresting people with serious mental health concerns, they need to care for them, Malone said.
"I think that a jail has an obligation to assure that severely mentally ill people are eating and drinking,” he said.
A national problem demanding attention
A 2017 report from the federal Bureau of Justice Statistics found that 44% of jail inmates across the country had previously been diagnosed with a mental disorder.
As Baldwin’s case moved through the courts, it became clear she was too mentally ill to understand the charges against her.
On June 18, 2021, the court declared Baldwin incompetent to stand trial and ordered her into a treatment process called competency restoration.
The goal of competency restoration is not long-term recovery, according to the Texas Judicial Commission on Mental Health. People's cases get put on pause until they’re stabilized enough to participate in their own defense.
Competency restoration usually has to happen at one of Texas’ state psychiatric hospitals, but the supply of beds has not kept up with demand. There’s been a 38% increase in the number of people declared incompetent to stand trial in the past 20 years, according to a state report from 2021. Hospitals lose even more capacity to understaffing, and as of June, the waitlist for a bed was more than 2,300 people long.
People can end up waiting for years, in jail, with no movement in their cases.
“I believe it’s a civil rights issue,” State Sen. Lois Kolkhorst, R-Brenham, said in April. “You shouldn’t be waiting in jail to have mental competency restored to wait to go to trial.”
MHMR CEO Susan Garnett explained what can happen to someone's case during and after the competency restoration process.
- Sometimes, competency restoration doesn't work, which means the charges get dropped.
- Others wait for competency restoration longer than their maximum potential sentence, so they can be released.
- After release, people with nowhere else to go can try to get one of the limited number of beds at a residential home. Others end up homeless.
- It's not uncommon for people to go back out into the community, get picked up on other criminal charges and start the process all over again.
The court originally ordered Baldwin to try jail-based competency restoration – an alternative to the waitlist that offers treatment in jail instead of the hospital. But the program requires willing participation, and Baldwin wouldn’t participate. She declined to work with therapists throughout her time in jail, practitioners’ notes show.
Jail-based competency restoration isn’t right for everyone, but it provides another option alongside state hospitals, said Susan Garnett, CEO of My Health My Resources (MHMR), Tarrant County’s mental health authority.
“We think with those two resources together, we'll be able to do a better job of meeting people's needs and be able to get them in the program that's right for them,” Garnett said.
But not everyone sees jail-based competency restoration programs as a worthwhile solution. Jails are “just the worst place for people to be,” said Beth Mitchell, an attorney with Disability Rights Texas.
“Even if the jail does provide some mental health care, the environment is not suitable or conducive to helping somebody who has a mental illness," she said.
In fact, she said, jail makes people's mental illness worse.
“They need constant interaction, not just sitting in a solitary cell where all they're doing is hearing, potentially, the voices in their head,” Mitchell said.
State lawmakers approved billions of dollars in spending on the mental health system this year, funding revamps and rebuilds of state psychiatric hospitals and adding new beds.
Focusing on mental health treatment after arrest is funding the wrong end of the problem, said Krish Gundu, cofounder of the advocacy group the Texas Jail Project.
“If people got the right care, at the right time, at the right place, we would not be seeing this mental health crisis in the jails,” she said.
After 39 days in the jail-based competency restoration program, the court ordered Baldwin to be transferred to the first available state psychiatric hospital “without unnecessary delay.”
The order came down on July 27, 2021, but Baldwin would stay in jail until her death that September, where she remained disconnected from reality.
“When greeted, patient immediately starts talking about ‘conspiracies,’ being taken hostage, and being extradited to a foreign country,” therapist Leandrea S. Williams wrote about a visit dated July 30, 2021.
On Sept. 14, the day Baldwin died, Williams found her on the floor of her filthy cell, which was covered in shreds of toilet paper, jail records show. Baldwin lay on the floor with her pants around her ankles, and she seemed shaky, like she’d been crying.
Williams tried to talk to her.
“I’m fine, I’m fine,” Baldwin said, and then refused to speak again.
Williams told a jailer that Baldwin didn’t seem like herself. The jailer said she’d check in with medical.
Baldwin was dead a few hours later. It’s unclear if medical staff ever checked on Baldwin that morning. The Sheriff’s Office declined to answer questions about her death, citing the lawsuit.
Texas Ranger Travis Dendy, who investigated Baldwin's death, closed the case without criminal charges.
Although the Medical Examiner’s Office left the cause of Baldwin’s hypernatremia undetermined, the condition is common in people with “impaired mental judgment,” Dendy wrote in his investigation report. He pointed out there was a water fountain in her cell.
'Disease, violence and death’
The state doesn’t track how many people die in jail while waiting for a psychiatric hospital bed, Texas Jail Project cofounder Krish Gundu said.
Baldwin is not the only person to die while waiting for a state psychiatric bed. Austin NBC affiliate KXAN identified a dozen people who died in jail custody after being declared incompetent.
In February 2023, a Tarrant County inmate named George William Zink died in jail custody while undergoing jail-based competency restoration, court records show. His cause of death is unknown, pending autopsy, according to the Texas Attorney General’s Office.
People with mental illnesses are the least able to advocate for themselves, putting them in the most danger in jail, Gundu said. She’s pushing the state to prevent people with mental illnesses from going to jail in the first place.
"We already know that jails are engines of disease, violence and death," she said.
Tarrant County has taken some steps to alleviate the problem – like opening a Mental Health Diversion Center in 2022.
If police officers pick someone up for a misdemeanor like trespassing, marijuana possession or terroristic threat, they can bring them to the center for treatment and help finding housing. Most of the people brought in are homeless, according to MHMR, which runs the center.
If Baldwin had been arrested today, she still would not have been eligible for the diversion program. She was charged not with terroristic threat, but terroristic threat against a peace officer. Threatening a cop bumps the charge from a misdemeanor to a felony.
District attorneys and judges need to be part of the solution, too, Beth Mitchell with Disability Rights Texas said.
“If you have DAs that are not willing to drop charges, when you get these dumb charges like terroristic threat or trespass or any of the others, it doesn't work,” she said.
Gundu called Baldwin’s case heartbreaking. In a different world, she might have gotten treatment instead of an arrest.
“Some prosecutor in the DA’s office made the decision to charge,” Gundu said. “And that’s where it begins.”
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