Central State Hospital – the State’s Only Maximum Security Mental Health Facility, a Legacy of Jim Crow and Not Nearly Good Enough

By James C. Sherlock

I have written often about the state of mental health support in Virginia. The Governor has a major initiative to improve it.

But it does not go far enough.

The state maximum security mental health facility at Central State Hospital needs to be disbanded and the duties dispersed across the state.

The legacy of that hospital is indefensible, and carries over to today.

The video published showing the death in Central State Hospital (CHS) of Irvo Otieno showed an almost entirely Black group of people — victim, sheriff’s deputies, and CHS staff.

It turns out not to be an anomaly.

Before integration, Central State was Virginia’s Black mental hospital.

Based on records provided by the Virginia Department of Behavioral Health and Developmental Services, Central State Hospital, the state’s only mental hospital built to maximum security standards, is today:

  • a largely Black institution;
  • with a largely Black staff. Of 930 current staffers at CHS, 649 are Black; 77 are “other” races and 204 are White;
  • providing services to a largely Black patient population. Of 264 patients, 160 are Black, 80 white and 24 other races.

That arrangement is not working, even it you think it should, because in the current location it cannot.

And the victims of substandard treatment and their families, as in the death of Mr. Otieno, tend by the relative numbers of patients to be Black as well.

Staffers deserve better working conditions and more help than the staff vacancies will permit. The patients deserve better treatment, their relatives deserve better access, and the entire situation is a legacy of Jim Crow.

There is no realistic scenario in which the required number and quality of mental health professionals, in shortage statewide, can be attracted to work in Petersburg.

I offer a solution. One which will get the patients proper treatment. Bring the patients to where the mental health professionals are.

Close CHS and open a series of smaller facilities adjacent to existing major teaching hospitals.

Staff vacancies.  Current staff vacancies total 246, including:

  • 6 treatment team case managers;
  • three psychiatrists, a psychiatric nurse practitioner;
  • 3 senior psychologists, 3 psychology associates/assistants;
  • a Nurse Educator, a Nursing Executive Assistant;
  • 33 registered nurses;
  • 16 licensed practical nurses;
  • 52 Psych Techs; and
  • a therapy counselor.

That represents more than a 20% staffing shortfall overall.  In the clinical medical professional specialties I have listed, I suspect the shortfalls represent much higher percentages.

There was reportedly no Central State staff available to accept Ivo Otieno’s transfer when deputies arrived at the hospital on March 6. Deputies waited outside for 20 minutes before bringing Otieno inside the facility, which staffers should have done.

The video appears to show that the CHS medical staff who were in the room at the time did not immediately provide Otieno assistance or medication.

Restraint of a patient on his stomach is specifically banned at Central State because it can result in death. It did.

Sheriffs. The Sheriffs of Petersburg and surrounding counties bear the brunt of violent mentally ill patient transportation work. For sheriffs at the western and eastern ends of the state, it is a very long trip.

Murder charges.  Seven Henrico sheriff’s deputies are charged with murder in the second degree in the death of Mr. Otieno at CHS.   Three CHS employees are facing the same charges.  Eight of the ten are Black, as is the victim.

The relatives of the victim and the relatives of those charged with his murder are victims as well.

Bottom line. I think we need to consider why the citizens of the Petersburg/Dinwiddie County area continue to bear the burden of the state’s only facility for the criminally insane.

I would like to know why the state’s only maximum-security mental hospital remains at the city limits of the Blackest city in Virginia. The same city with what has traditionally been the state’s worst general hospital.

It was put there, if you had not guessed, by leaders of massive resistance in order to comply with federal integration laws in the 60’s, while making a mockery of them at the same time.

I know how it happened. But I would like to know why maximum-security mental health inmates from across the state are still housed at Central State 60 years on.

That credit likely goes to inertia and local politicians protecting jobs.

I would like to know from where, exactly, in Virginia the state is supposed to draw to Petersburg mental health professionals qualified to treat the criminally insane, much less assess the mental readiness for trial of persons whose mental capacity to stand trial is in question.

We must inquire:

  1. Why there are not at least three, or perhaps more, smaller institutions across the state where maximum security inmates are brought for treatment and assessment. And where they can be visited by family and attorneys;
  2. Why those institutions are not located in close proximity to and integrated with mental health services of major teaching and research hospitals:
    • existing hospitals with mental health services staffed with professionals qualified for the tasks,  
    • Who can be funded by the state to provide those services to the criminally insane and those being evaluated for fitness for trial as part of their hospital duties.

Just asking.

Updated with additional commentary April 20 at 7:12 AM