Experts hired by federal government offer recommendations to improve health in Tarrant County Jail

After a year of controversy for the Tarrant County Sheriff's Office, the department has released a report from the federal government evaluating the physical and mental health care available inside the Tarrant County Jail.

Two experts, funded by the U.S. Department of Justice's National institute of Corrections , visited local jail facilities May 13-15.

They reviewed the physical and mental health care inside the Tarrant County Jail, and found staff committed to quality care but procedures in need of updates – particularly when it comes to people at risk of suicide.

More than 65 people have died in custody since Sheriff Bill Waybourn took office in 2017 – some under allegations of neglect and misconduct . The visit from experts came just weeks after Anthony Johnson Jr. died in an altercation with jail guards. One guard knelt on his back as Johnson said he couldn't breathe, and his death was ruled a homicide by asphyxiation. Two guards have been indicted for murder.

"The greatest concern and area for improvement is related to the restrictive conditions of confinement for those identified as having significant assessment and treatment needs, such as those at risk for suicide, those detoxing, and those on a mental health recommended single-cell status," the report stated.

The experts, Dr. Steven J. Helfand and Dr. Raymond Herr, work with Falcon Inc. , a consulting firm that exists to improve mental health care in jails and prisons. They reviewed policy, procedures, documentation, and interviewed staff members.

Best practices dictate people at acute risk of suicide should be under constant observation, according to the report. That is rarely done in the Tarrant County Jail, where staff checks on them every 15 minutes, the report found.

People considered "non-acute" should get checks at random intervals, no longer than every 15 minutes. Tarrant County checks on these people every 10 minutes or every 30 minutes, according to the report.

Their mental health should also be reassessed more frequently, so they can spend less time in the jail's most restrictive settings, the report recommended. Some people are confined for 23 hours a day and dressed in suicide prevention gowns — a type of garment that's hard to turn into a noose.

"While this practice may ultimately keep individuals from death by suicide, they are overly restrictive in the name of safety," the report reads.

People placed in single cells over mental health concerns, or people who are detoxing, are also confined for 23 hours a day.

"This level of confinement for any individual is detrimental to their mental and physical health," Helfand and Herr wrote of those detoxing.

The report does not explore other sheriff's office policies, like rules around use of force and restraints. Previous KERA reporting found those policies have not been updated in more than a decade . The sheriff has indicated he wants an outside review of those policies, too.

KERA submitted a public records request seeking a copy of the Department of Justice-funded healthcare report on Oct. 9. The Sheriff's Office fulfilled that records request on Oct. 17, after making the report public online.

In an eight-and-a-half minute video accompanying the report's release, Waybourn said he asked the DOJ for this review, in the spirit of transparency.

"We threw the doors wide open and said look at whatever you want to look at – and they did," Waybourn said in the video.

There have been four suicides in Tarrant County Jail custody in the last three years, the report states. Jailers stopped 279 suicides last year, Waybourn said.

The jail partners with the public county hospital, JPS, to offer healthcare inside the jail. My Health My Resources of Tarrant County (MHMR) provides mental health care .

Helfand and Herr praised MHMR for offering many pathways to getting help with mental health, and for aggressively searching for ways to get people with mental illness out of the criminal justice system.

The experts visited the county's Mental Health Jail Diversion Center, where people suspected of low-level crimes, who exhibit signs of mental illness, can get treatment and services instead of jail time.

The county is seeking funds to keep the center going .

The experts also praised aspects of JPS' jail healthcare, particularly the easy shift from in-jail care to out-of-jail care after release. They did recommend a 10 to 14-day medical follow-up with prisoners after their initial booking.

They also noted the jail's chronic understaffing problem is affecting healthcare. There aren't enough officers to transport people to off-site specialty visits.

There are 180 open detention officer positions, Waybourn said in the video.

"We're doing aggressive recruitment right now and trying to get people in the door, and we're going to continue that until we fill all those slots," he said.

Previous efforts have not been successful. A 90-day, $37,500 recruitment effort last year resulted in three hires .

Waybourn made it clear in the video not all the report's recommendations would be implemented. He defended his jail's detox protocols, calling them the "safest way to detox inmates in the jail environment."

The report also recommends that people detoxing should be placed in a different housing option that gives them more out-of-cell time and family visitation. Withdrawal comes with overwhelming mental and physical stress, the report states.

"This would be more appropriate for a rehab center or a hospital or a treatment center," Waybourn said. "But this is the county jail."

Helfand and Herr also recommend remodeling the jail's outdated housing units to include more sunlight – or at least redecorate with art and murals.

"This environment does not reinforce a culture of rehabilitation and humane treatment. This environment is unlikely to foster a feeling of humanity and rehabilitation," the report says about current housing.

Any renovations would need a lot of money and a vote from the county commissioners, Waybourn said.

The report gave kudos to the sheriff's office for opening its doors after a series of jail deaths.

Waybourn has been criticized for a lack of transparency. The day before this report was released, news broke that his office has not been getting the required independent investigations into jail deaths. The sheriff's office maintains it has not broken the law.

Waybourn wants the public "to see everything," he said in the video.

"I know there are those that will find fault with anything that we do and will not be quieted by this report," Waybourn said. "However, my hope is that the majority of good people that read this and see the good things that we're doing, see the suggestions that have been made, and know that we are doing what we should be doing to keep the good citizens of Tarrant County safe."

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