Another Mental Illness Tragedy Spurs Questions About Virginia’s Health System

One evening in May 2018, a 24-year-old high school biology teacher crashed his car at a highway exit in Richmond, Va. He got out of the car, naked and apparently in mental distress, and for several moments writhed on the ground. Then, with nothing in his hands, he stood, strode toward a police officer and lunged. The officer shot and killed him.

The death of the young man, Marcus-David Peters, has come up again and again in Virginia since Irvo Otieno died on March 6, after he was pinned to the floor by sheriff’s deputies for nearly 12 minutes at a psychiatric hospital in Petersburg. To his family and many others across the state, the death of Mr. Otieno, a 28-year-old musician with a history of mental illness, proves that despite incremental signs of improvement, Virginia’s mental health system is still profoundly flawed in how it responds to people in acute distress, especially when law enforcement agencies are involved.

“Having a mental health crisis cannot be a death sentence,” said Princess Blanding, Mr. Peters’s sister, who pushed for improvements to the system but believes that the changes that resulted from her brother’s death were still inadequate. “When a person’s kidneys fail them or their heart stops functioning, we don’t throw them in jail. Why are we doing that when their brains are not functioning the way they normally would?”

Mr. Otieno’s death minutes after sheriff’s deputies brought him to Central State Hospital falls into a bleak pattern that goes back years, in which a tragedy involving someone with mental illness inspires pledges of change until the next tragedy reveals how short the changes have fallen.

The 2007 mass shooting at Virginia Tech by a young man with a history of psychiatric problems prompted urgent calls for a greater investment in mental health initiatives, but the recession that began later that year drained much of the funding that the state had allocated for it. An explosion of violence within a state lawmaker’s family in 2013 led to an overhaul of how the authorities respond to people experiencing acute psychiatric episodes, but the pandemic exacerbated many of the problems they were designed to address.

“We made lots of changes,” said the lawmaker, State Senator Creigh Deeds, who became an outspoken crusader for reforming Virginia’s mental health infrastructure after he was attacked and almost killed in his home by his 24-year-old son, who had been diagnosed with bipolar disorder and who later died by suicide. “The pandemic then undermined everything we were doing.”

“We lost workers and we developed crises and mental health issues throughout the population, so the need exploded,” Mr. Deeds said.

The 2017 death of a mentally ill young man who languished for months in a jail cell awaiting a hospital bed led to a flurry of bills, with state lawmakers vowing that they would do everything they could to ensure similar incidents never happened again. Yet, as Mr. Otieno’s death showed, they are still happening.

“Don’t fail us this time,” said Mr. Otieno’s brother, Leon Ochieng, at a news conference on Wednesday at a church in Richmond. “We don’t need another Irvo after this.”

In the initial hours of Mr. Otieno’s fatal encounter with the authorities, there were some indications that the system was working better than it had in the past.

After the police in Henrico, a suburb of Richmond, showed up at the home he shared with his mother on the morning of March 3, they initially put Mr. Otieno in handcuffs and prepared to arrest him after a neighbor reported that she thought he was trying to burglarize her home. But they eventually relented after his mother, Caroline Ouko, pleaded with them, explaining that he was having a mental crisis and needed help.

According to the police, the response that day included a crisis intervention team, made up of officers trained in handling acute mental health episodes. Mr. Otieno was taken by ambulance to a designated “crisis receiving center” at a nearby community hospital. In an interview on Monday, Ms. Ouko said at that point she felt reassured he was going to get treatment.

But in the still-hazy sequence of events that followed, things seemed to go wrong. At the hospital, Ms. Ouko said she was repeatedly rebuffed when she asked to see her son. “I said to a doctor, ‘Can you intervene?’” she recalled. “The doctor threw up his hands and said ‘It’s the police.’” Around 9 p.m., she said, someone in the reception area approached and told her that her son had been taken to the county jail.

Mr. Otieno was charged that night with assault on law enforcement officers and disorderly conduct on hospital grounds. He spent the weekend in the jail; Mark Krudys, a lawyer representing the family, said they had no indication that he received any medication or was seen by a doctor during that time.

Mr. Krudys said it was still unclear how it was decided to send Mr. Otieno to Central State Hospital; his mother said he appeared by video from jail at an arraignment hearing that Monday morning. In surveillance video from the jail, released by the local prosecutor on Wednesday, Mr. Otieno can be seen in a small cell on Monday afternoon, hours after the hearing. He appears to be partly naked and in distress when a group of sheriff’s deputies rush in and overpower him. They carry his limp body to a van, which takes him to Central State Hospital, about 50 miles away.

There, in an admissions room, Mr. Otieno was pinned to the ground until, the prosecutor said, he died from asphyxiation. Seven sheriff’s deputies and three employees of the hospital who were working security have been charged with second-degree murder. Some lawyers for the defendants have argued in bond hearings that their clients were struggling with Mr. Otieno, who, they said, had become combative.

Inadequate mental health systems across the country have left almost one-third of the 14 million Americans with severe mental illnesses without treatment, and the rest with limited options. The Justice Department is pursuing investigations in a handful of states, probing whether they hospitalize too many people that could benefit from less drastic measures.

The scarcity of resources stems from a nationwide effort in the 1960s to deinstitutionalize people from large, warehouselike psychiatric hospitals that had become hotbeds of neglect and abuse. States dismantled hospitals but built almost nothing in their place, and decades later, jails and a small number of state hospitals have become de facto housing for people in need of acute treatment.

Virginia’s 12 state psychiatric facilities have struggled to keep up with demand for care. In July 2021, five of them — including Central State Hospital, where Mr. Otieno died — temporarily halted new admissions because of bed and staff shortages.

Ongoing shortages have put more of the onus on a tangle of authorities, including law enforcement and public health departments, to respond to acute mental crises, without a clear notion of who is in charge.

It is unclear whether blurred lines of authority were a factor when Mr. Otieno was taken from the community hospital on the night of March 3, hours after he arrived, and put in a jail cell for the next few days — a move that may have intensified his mental breakdown. But the response to his mental distress appeared to ignore the protocols in the law, said State Senator John Edwards, who sponsored a 2009 law formalizing the establishment of crisis intervention teams in Virginia.

“We had enough laws in place to keep this kind of thing from happening,” Mr. Edwards said. “But we’ll find out more about what happened and maybe there’s something we can do to improve the situation in the future.”

Outrage over the death of Mr. Peters, who was Black, coursed through local racial justice demonstrations in the summer of 2020; after a statue of Robert E. Lee was toppled from its plinth in Richmond, protesters unofficially renamed the plaza “Marcus-David Peters Circle.”

After his death, Ms. Blanding, who ran for governor as a third-party candidate in Virginia in 2021, pushed for the creation of teams including mental health specialists to respond to people in mental distress. A version of her idea passed into law: an opt-in system for counties to have mental health professionals and trained peers accompany law enforcement officers who address behavioral emergencies.

But the law, named the Marcus Alert after her brother, was written “too loosely,” Ms. Blanding said, adding that the law allows officers to take the lead in handling such crises with no way of holding them accountable.

“There’s no consistency” on when law enforcement or mental health professionals take charge, Ms. Blanding said. “And that’s what can be so deadly and dangerous.”

Gov. Glenn Youngkin, a Republican who has proposed a $230 million plan to shore up Virginia’s behavioral health infrastructure, told reporters this week that Mr. Otieno’s death showed “the heart-wrenching nature of the challenges in our behavioral health system and why I think it is so important that we press forward with aggressive transformation of that system.”

One way of keeping people in acute mental distress out of jails and hospitals could be creating more community resources — 24-hour observation centers, for example, or short-term crisis stabilization programs — said Bruce Cruser, executive director of Mental Health America of Virginia, a mental health advocacy nonprofit.

“Right now, the system is broken,” Mr. Cruser said.

But even some of the most committed advocates for change, including Mr. Deeds, say that the video of Mr. Otieno’s death revealed a more fundamental breakdown, one that legislation and funding might not be able to fix.

“This is a total failure on the part of law enforcement and hospital employees to see the humanity in this person that needed care,” he said. “It’s something I’ve seen before, the complacency that we have, each one of us, I guess. Whatever it is we do, we get so used to doing it that we fail to understand the people we’re dealing with are people.”