MARKUS SCHMIDT

(VM) – A newly released report by the disAbility Law Center of Virginia (dLCV) reveals that the death of Irvo Otieno, who was killed at Central State Hospital in Dinwiddie County during a mental health crisis while in police custody last year, could have been prevented had sheriff’s deputies and hospital staff not used prone restraint, a controversial method of subduing individuals.

In a presentation of the findings before the House Appropriations Committee at the state Capitol in Richmond Tuesday, Colleen Miller, the dLCV’s executive director, urged lawmakers to end the criminalization of mental illness, remove law enforcement from the state’s response to people with mental health episodes and address the conditions in Virginia’s jails, where thousands of inmates with mental illness are being kept.

“There is serious reform needed in Virginia because the events that happened to Mr. Otieno resulted in his death, and it got a lot of media attention. But people with mental illness are encountering these issues every single day in Virginia, and we need to do something about it,” Miller told the panel.

Otieno, a 28-year-old man with a history of mental health challenges, died on March 6, 2023, after being transported from the Henrico County Jail to Central State Hospital. The dLCV confirmed that sheriff’s deputies and hospital staff’s use of prone restraint — a technique where an individual is held face down — was a key factor in Otieno’s death.

“The thing that led to his death, the prone restraint, is prohibited in our state facilities, and yet at Central State Hospital he was placed face down, people piled on top of him, and it killed him. So we really need to think about how to eliminate the prone restraint,” Miller said.

Ten Henrico County deputies and hospital workers were initially charged with second-degree murder in Otieno’s death, which was captured on video. But prosecutors later asked a Dinwiddie Circuit Court judge to dismiss the charges against seven of the accused.

The investigation by the dLCV, a non-profit designated by the federal government as the protection and advocacy organization for people with disabilities in Virginia, also found that while jailed in Henrico’s Regional Jail West for three days after suffering a mental health episode, Otieno was subjected to hours — possibly days — in an emergency restraint chair, and the jail failed to provide him with any psychiatric treatment.

“A restraint chair all by itself can be very dangerous, you are kind of caved in on yourself while you are in that chair, making it difficult to breathe. The correctional restraints require that someone be restrained only as long as necessary, while they are acting out,” Miller said.

From Otieno’s initial encounter with police and the hospital emergency room to his incarceration and transfer to Central State Hospital, the 27-page report details “a complete breakdown of Virginia’s mental health crisis system, compounded by a culture of criminalizing individuals with mental illness, particularly communities of color.”

The system that was supposed to help Otieno “utterly and completely failed him,” the investigation concluded.

Del. Mark Sickles, D-Fairfax, the committee’s vice chair, called the report “disturbing.”

“We’ve been trying to work on this area, and law enforcement is getting training in many places,” Sickles said. “Maybe it’s not uniform, I don’t know what happened in Henrico, but they are training law enforcement every day in dealing with people who have serious mental illness, and they need the appropriate training.”

Sickles emphasized the ongoing struggle to fill positions for mental health workers in Virginia, despite the legislature’s approval of additional funding.

“We don’t have professional staffers, we are trying to fund psychiatric residencies, there is a shortage of all these mental health workers. We would hire them, we have openings,” he said.

Sickles also pointed to housing shortages as a significant barrier, noting that many patients remain in hospitals longer than necessary due to a lack of community housing options.

“They shouldn’t be in these situations, and we are working on this,” he added.

Del. Rodney Willett, D-Henrico, called Otieno’s death a “tragedy on every level.”

Willett is the sponsor of House Bill 1242, also dubbed Irvo’s Law, that the General Assembly passed earlier this year. The measure allows family members and caregivers to access loved ones who are in crisis during their emergency room evaluations, unless the presence of a family member would create a medical or safety risk or if the patient objects to their presence.

“Irvo’s mom never got the chance to provide that information,” Willett said. “It’s such an unfortunate situation, and it’s also unfortunate that we need to have these terrible situations to inspire action. But we already took action before Irvo’s terrible death, and we are certainly going to take more.”

The legislature this year also backed Gov. Glenn Youngkin’s “Right help, right now” initiative, which marked a major investment in building emergency room alternatives to care for patients experiencing a behavioral health crisis, among other measures to address mental health challenges in the state.

But Del. Delores McQuinn, D-Richmond, said that Virginia’s jails, police and sheriff’s departments still are not equipped to deal with situations involving mental health episodes.

“I talk often to my sheriffs in Richmond and Henrico County about these issues, and they are overloaded with individuals who have mental health challenges, and they really don’t have a clue of what to do with them,” McQuinn said.

“It is something that all of us must get to the table and bring some greater resolution to this, and I don’t think it’s going to happen swiftly, it’s going to be some years to get where we are trying to go.”

The timeline of the dLCV’s investigation shows the importance of removing law enforcement from mental health treatment, said Miller, the group’s executive director. “Everything that law enforcement is trained to do is contrary to what is necessary for a mental health response. They are trained to be intimidating, to be tough, to never retreat.”

Lawmakers and stakeholders “should do some hard thinking” about how to protect people and help them get the treatment that they need,” Miller concluded.

“We have seen different places throughout the timeline where Mr. Otieno was determined to need medical and mental health care and was prevented from getting that, time and time again.”