These mothers called 911 to seek help for their struggling sons. Their children ended up dead.

• The police shootings of Daniel Prude and Walter Wallace Jr. highlight both how ill-equipped police officers are to deal with mental-health crises and the pain and guilt that family members can feel after calling the police to intervene.
• Insider spoke with five mothers who called the police during their sons' mental-health crises, only for the officers to kill their sons.
• This is part one in a six-part series.

One exhausted mother in North Carolina feared that her depressed son would take his own life. She hadn't left the house in days, but she needed a respite, and he needed treatment.

A mom in California was told that her son had a knife and was expressing suicidal thoughts. She didn't want to take a chance by dismissing it as just a teenage cry for help.

Another mother had done everything in her power to ensure that people in her community knew her son with schizoaffective disorder was not a threat to them.

In each case, the desperate parent made the only choice they thought they had: They called 911.

But instead of summoning relief, those calls triggered a deadly response by armed police officers.

Police officers in the US have fatally shot nearly 1,000 people each year since 2015, The Washington Post reported in June. A few of those shootings have a certain terrible distinction: They occurred after someone called the police for help with a relative in a mental crisis. Choosing to call for help has left these families suffering from a particular kind of survivor's guilt, one for people who were failed by a broken system that gave them nothing but bad options.

"The debris and wreckage that leaves behind for the family members who are essentially survivors, who may themselves feel like they had a hand in contributing to the death of a loved one - this survivorship is one of the most under-recognized sources of mental-health disparities in the country," Alexander Tsai, a psychiatrist and researcher at Massachusetts General Hospital, told Insider.

Five mothers from around the country talked to Insider about the day the police killed their sons after they or another family member called the authorities for help. They described the devastation it left behind.

Some of them have been propelled into activism or advocacy to reform how the police respond to mental-health calls. Others have fled the homes they once shared with their children, trying to run from anything that reminded them of the worst day of their lives. Several still struggle with establishing emotional or social balance.

All of them said that if they were put in the situation again, they would not call 911 for assistance in a mental-health emergency, no matter how desperate they felt.

Mental health is a factor in nearly 20% of fatal police shootings

Researchers have found that in the US, about 10% of police calls for service each year involve some form of mental crisis, Dennis Kenney, a former officer and current professor at the John Jay College of Criminal Justice, recently told Insider.

In 2015, police records indicated that about 25% of the people the police fatally shot were experiencing such a crisis, The Post reported; as of mid-October this year, that figure was nearly 20%.

A 2015 study by the Treatment Advocacy Center found that the risk of being killed by law enforcement for people with an untreated mental illness - about one in 50 people - was 16 times as high as the risk for other people.

Tsai, whose research analyzed racial disparities in police killings and their effects on mental health, says it's normal for people whose call to 911 resulted in police violence to feel lingering grief and responsibility.

"Grief is normal. Not only have they lost a loved one, but they feel complicit in that loved one's death, even if it's not their responsibility," Tsai said. "The key is how can you begin to reconstruct your life and reconstruct your narrative around what happened so you can be merciful to yourself and begin to have a life worth living again?

"I think in this country we put too much on the backs of the families put these in these types of situations, where they feel like they have to basically make up for gaps in the system because the system failed them," he continued. "We do not have a functioning system for mental-health treatment or substance-use treatment in this country."

Police killings are not a modern phenomenon, but the growing availability of officer body-camera footage and cellphone videos has shed light on their disturbing prevalence.

In March 2020, one such video captured the death of Daniel Prude, 41, of Rochester, New York. Prude's brother had called 911 because Prude was acting erratically. Body-camera footage showed Prude naked and handcuffed with a "spit hood" over his head, struggling to breathe for several minutes. The Monroe County medical examiner found that Prude died of asphyxiation and ruled his death a homicide.

Months later, protests erupted over the shooting death of Walter Wallace Jr., a 27-year-old man in Philadelphia who was killed during what his family said was a mental-health crisis. Relatives had called emergency services several times that day for help for Wallace, who had bipolar disorder. Family members told reporters that they had called for medical aid but that the police showed up first.

"When you come to a scene where somebody is in a mental crisis, the only tool you have to deal with it is a gun. That's a problem," Shaka Johnson, an attorney for the Wallace family, told NBC News. "I would have a problem if my carpenter came to my house with only a hammer. Where is your screwdriver, sir? Where is the proper tool for the job?"

"We know that people - certainly Black and brown people - with mental illness are much more likely to be killed by police and more likely to be killed by police while unarmed," Tsai said. "We know that ungodly percentages of people killed by police are in a mental-health crisis. And so, understandably, people, even before they pick up the phone to call the police, have a large degree of skepticism about whether they should call the police, whether it's the right thing to do, whether some bad outcome is going to result."

Every decision shouldn't be a 'bad choice'

For most communities, there is no easy answer, Tsai said.

Some cities, like Eugene, Oregon, have developed nonpolice units to respond to mental-health crises. In Eugene, people can call a number and have trained, unarmed emergency medical technicians and clinicians respond. It's called Cahoots, short for Crisis Assistance Helping Out on the Streets, and the city has been using it for more than 30 years.

The White Bird Clinic, which runs the Cahoots program, reported that in 2019 it received 24,000 calls but required police support only 150 times.

Police departments in other cities, including Los Angeles and New York, have announced similar pilot programs.

Many departments around the country now provide crisis-intervention training, which offers tools to address mental-health emergencies. But the training isn't the be-all and end-all in preventing police shootings.

It's designed to teach officers how to identify when they're dealing with a person in a mental-health crisis so they have context for when and how to use de-escalation tactics, Kenney said.

While that context can be helpful, it only goes so far in situations where officers believe their lives are in danger, he said.

"In theory, that works somewhat. But when it comes to very aggressive behavior - or at least perceived aggressive behavior - it doesn't change that you believe you're about to be hurt," Kenney told Insider. "If I feel terribly threatened, then the reason why you're threatening me becomes much less important than the threat itself."

Research on police shootings suggests the opportunity to alter the outcome of a possibly fatal police response doesn't happen in the seconds a police officer has to decide "shoot or don't shoot," Kenney said. It happens the moment the police approach the person.

In many cases, the greatest opportunities to intervene in mental-health crises come before the police ever arrive, Kenney said.

"Yes, we do need more training, but we also need a system where it doesn't burden the police officers with responsibility, so it doesn't burden the families with responsibility," Tsai said. "So that we have a more functioning system where not every decision is a bad choice."

Reshaping the crisis-response system to provide support and lessen the burden on the police

Angela Kimball, the national director of advocacy and public policy at the National Alliance on Mental Illness, agrees that the Cahoots model is the right path to prevent violent encounters between the police and people in crisis.

NAMI has been at the front of a national push to rebuild the crisis-response system, and its efforts have gained support from law enforcement, she said.

"Responding to people who are experiencing mental-health, suicide, or substance-abuse issues, that's not the job law enforcement signed up for," Kimball told Insider. "It's not a position we should ask our law-enforcement professionals to be in."

Kimball said the existing crisis-response system in most states was built to fail both the person with a mental illness and the officers called to respond.

"One of the most challenging and, in fact, devastating aspects of a severe mental-health condition is that a person doesn't always recognize that there is something wrong," Kimball said. "And that gets to the fact that our system is set up such that we don't have ways to get people into treatment when they aren't voluntarily doing so, except for civil-commitment laws."

The civil-commitment process - in which a person can argue that a loved one needs to be entered into treatment even if they oppose it - usually involves the courts or law enforcement, she said.

"That is often a very stressful or at times traumatizing way of getting someone into treatment," Kimball added.

The skills needed to respond to people with mental illness are often at odds with the traditional ways that law enforcement operates.

For example, Kimball said, it's natural for people in crisis to act in a way that others would perceive as irrational, such as not responding to commands, fleeing, or waving a weapon in the presence of an officer.

It's not uncommon for people with mental illnesses to be exceptionally intelligent, articulate, and verbal, but they might also have impediments that slow down their processing and prevent them from abiding by officers' commands.

For this reason, many police shootings of people with mental illnesses are technically considered justifiable, Kimball said.

That doesn't mean they're not also traumatic for the officers.

Capt. Zach Hall of the Riverside County Sheriff's Office in Southern California told Insider that when officers pull the trigger, it's usually because they believe their lives are somehow in danger. When they find out they killed someone in a mental-health emergency, they, too, can live with a sort of survivor's guilt.

In some situations, particularly those where a person is seeking "suicide by cop," the person will leave behind a note apologizing for putting officers in that situation, Hall said.

The officer might later learn that a gun the person was holding was empty, or was a toy gun, and realize their death was unnecessary, Hall said.

"Some of them never recover," Hall said.

To protect families from this kind of devastation, the crisis-response system needs to be rebuilt to involve behavioral-health specialists trained in de-escalation who can get the person the assistance they need, Kimball said. She cited the Cahoots model and the launch of a national mental-health-crisis hotline as potential solutions.

The hotline, expected to launch by July 2022, is a means to use the Cahoots model on a national scale. The idea is that people experiencing or witnessing a crisis will be able to dial 988 instead of 911 to reach a call center staffed with experts who will offer an assessment of the situation over the phone. Ideally, the centers would also be able to dispatch mobile crisis-response units.

A goal would also be to feed cases that come through the hotline to stabilization programs, Kimball said.

"Funding is the primary barrier," Kimball said. "We've not chosen to invest in this kind of crisis-response system in most parts of the country, but I think their incredible success is opening up the eyes of other state officials in other places.

"With 988, it's happening, and it's really important for people to understand that the kind of system they have in the future will depend on them getting involved now," Kimball added. "This is a unique opportunity to really reshape things."

Tsai said that "Black and brown families have every right to be skeptical or fearful for when they pick up their phone about what's going to happen."

"Wouldn't it be better if that phone call resulted in a mobile mental-health-crisis van that came to your home with people who are trained in de-escalation and recognizing signs of mental-health illness and acute intoxication and can actually connect your loved one with treatment?"

• Read more from this series:
• Miles Hall's mother did everything she could to protect her son with schizoaffective disorder. Police still killed him.
• Eric James Andrews was struggling with his mental health. His mother called the police for help, but they shot him dead.
• 4 years after police shot Jamarion Robinson more than 50 times in an Atlanta suburb, his mother is still waiting for answers
• When her 19-year-old son wasn't acting like himself, she trusted the police to get him help. Instead, they killed him.
• A police officer said 'I don't have time for this' before shooting an 18-year-old with a mental illness dead in his home, his mother says