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Analysis

What Irvo Otieno’s Killing Tells Us about Mental Healthcare in the U.S.

The system can end up prosecuting patients and relying on police — with sometimes fatal results.

From left, Caroline Ouko, mother of Irvo Otieno, with her older son, Leon Ochieng, and attorney Ben Crump, in Richmond, Va. Otieno died while in custody at a psychiatric hospital.
From left, Caroline Ouko, mother of Irvo Otieno, with her older son, Leon Ochieng, and attorney Ben Crump, in Richmond, Va. Otieno died while in custody at a psychiatric hospital.

The suffocation of Irvo Otieno, recorded on video, recalled the deaths of other Black men who perished under the weight of law enforcement: Daniel Prude, Eric Garner, George Floyd. However, Otieno died not on the street but inside a Virginia state psychiatric hospital — a place where he was meant to be cared for, not punished, by the state.

This article was published in partnership with The Washington Post.

His death — for which seven deputies have been charged with second-degree murder — forces an examination of how our mental health care and criminal justice systems can end up prosecuting patients and over-relying on police, with sometimes fatal consequences.

Addressing Otieno’s death, Virginia’s Republican Gov. Glenn Youngkin said in a news conference that it was clear the state’s mental health-care system was “overwhelmed.” But it was not just a lack of services that killed Otieno. A crisis team was present during his initial encounter with police, who brought him to a specialized receiving center. And he was in the care of a state hospital when he died. Yet being admitted for treatment did not protect him from what prosecutors say was a deadly use of police force.

More mental health care is no simple panacea. In my years of covering mental health care and our justice system, psychologists and disability rights advocates have told me that getting people the care they need requires not only a ramping up of mental health resources but also rethinking how those people can still be criminalized every step of the way.

“It starts at the beginning,” said Colleen Miller, executive director of the disAbility Law Center of Virginia. “Did he have access to services before he went into crisis? Was there something different that could have happened at the hospital? Could something different have happened at the jail? There’s so many ways we could have avoided this.”

According to his family, Otieno was experiencing a mental health crisis on March 3 and wandered onto his neighbor’s property, picking up lights on their lawn and banging on their door. Otieno’s mother, Caroline Ouko, had called her son’s psychiatrist that day for help, hoping to get him into a hospital. Henrico County police officers said they responded to a report of a “possible burglary,” along with their Crisis Intervention Team.

The specially trained team had been established more than a decade ago, to help people in mental distress and avoid “unnecessary incarcerations or hospitalizations.” Even with their presence, Ouko told reporters, multiple officers had their stun guns out, scaring her son. She said she implored them to take him in an ambulance to treatment.

Officers recognized Otieno’s mental state and brought him to a hospital. But when he continued to act out, they arrested him. Otieno was removed from psychiatric care and charged with felony assault on law enforcement, among other offenses. He ended up facing five criminal charges, even though he was in the psychiatric unit of a hospital exhibiting what many psychiatrists would deem symptoms of his mental illness.

After he was jailed, Otieno appears to have deteriorated further. Psychologists say the isolation, lack of treatment and potential violence in jail makes it one of the worst places for someone in a psychiatric crisis, yet it is the frequent landing spot for people with serious mental illness. Despite growing efforts to send trained mental health professionals to many 911 calls, police remain the primary responders in most of the country. Those interactions can easily end in uses of force or being detained for minor crimes such as disorderly conduct, trespassing or resisting arrest.

Virginia created its own version of a crisis-response program in 2021, as an alternative to police, three years after biology teacher Marcus-David Peters, an unarmed Black man in mental distress, was shot by a Richmond police officer. But Henrico County, where Otieno was apprehended, has yet to fully implement the program, according to the local NAACP. And non-police responder teams across the country have had limitations, sometimes lacking the resources to operate 24/7, or facing restrictions on the kinds of calls where they’re deployed.

Otieno’s family said he was denied his medication while at the Henrico County Jail. Video from inside the jail, shortly before he died, shows staff rushing inside his cell and one appearing to throw several punches. Officers carried Otieno to a van and took him to a state psychiatric hospital, to admit him for the care he likely needed when he was first apprehended. Hospital surveillance video shows that deputies dragged Otieno, his wrists and ankles shackled, into an admissions room, where officers and hospital employees piled on top of him for 11 minutes, until Otieno asphyxiated.

Defense attorneys for the sheriff’s deputies (three hospital staff members are also charged with second-degree murder) have said Otieno was combative when he entered the psychiatric hospital.

Mental health cases can devolve into this damaging back-and-forth. Police take someone to the hospital when that person is too ill for the level of care officers can provide. Then the hospital summons police when they deem that same person too disruptive for them to control.

The patient is pulled from hospital room to jail cell, cutting them off from treatment and destabilizing them even further. As understaffing in hospitals worsens and health-care workers report increasing violence, these cases could become more common and create a pressing need for alternative solutions, research suggests.

Even patients who are in transit to longer-term care — when it’s recognized that someone needs treatment — are subjected to police force and the possibility of being arrested.

This is not solely a Virginia problem. The Justice Department’s investigation into the Louisville police found a pattern of discrimination “against people with behavioral health disabilities when responding to them in crisis.” In one case, Louisville officers took a man to a psychiatric hospital and taunted him, making sexually inappropriate comments, then pinning him to the ground and injuring him. In another, police responded to calls from a treatment facility about a teenage girl who was cutting herself, and ended up tasing her multiple times, possibly causing a medical seizure.

In my reporting, I’ve found that if cities want to keep people like Otieno from being “vacuumed” into the criminal justice system, as Ouko’s lawyer put it, it might require police and prosecutors to reconsider arresting and prosecuting someone who is clearly acting out because of their illness. And it may necessitate greater resources for health-care providers to increase staffing and rely less on law enforcement.

“Mental illness should not be your ticket to death,” Otieno’s mother Ouko said. “There was a chance to rescue him, there was a chance to stop what was going on. And I don’t understand how all systems failed him.”

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Christie Thompson Twitter Email is a staff writer reporting on mental health, solitary confinement, and prison conditions. Her investigative series with NPR examining violence in double-celled “solitary confinement” won a George Polk Award for Justice Reporting and was a finalist for an IRE Award and the John Bartlow Martin Award.