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Hit squads from the Mexican mafia. Gangs of painkiller-thieving youths. The government. They were coming, always coming. From around the corner or down the street, he couldn’t know where.

Michael Mahoney, 36, had a hard life, spending months in juvenile detention centers and six years in prison before deciding to turn things around. He enrolled in welding courses and cared for his ailing father in their Oxnard, California, home. Then his schizophrenia took over. He lived his last months in fear and paranoia, once screaming out, “Kill me!”

Then someone did.

Mahoney died Aug. 14 of a gunshot wound to the chest after three officers, responding to a report of a man with a weapon, fired on him. He was one of 64 mentally-ill people who died after being shot with a gun or electroshock device by U.S. law enforcement this year, according to data compiled by Bloomberg. That’s about three times the number police indicated in a 2009 U.S. Department of Justice survey, the last year for which statistics are available.

At least 16 of the 64 had schizophrenia, were prone to violence and avoided taking medications. Some had been released from hospitals after stays families thought were too brief to be therapeutic. Mahoney spent 45 hours in a psychiatric center where he’d been confined for his own safety, discharged nine days before he died with a flare gun in his hand.

“It is a shame that a bullet is what our mental health safety net has become,” said Louis Josephson, chief executive officer of Riverbend Community Mental Health Inc. in Concord, New Hampshire, which offers outpatient and residential programs.

System’s Failures

The failures of the U.S. health care system in treating the seriously mentally ill have swelled the workload of police in all 50 states and put the emotionally disturbed at the mercy of officers who may have little or no training in defusing situations fueled by psychosis.

While no diagnosis has been made public, the emotional state of Adam Lanza, who killed 20 children and six adults at Sandy Hook Elementary School in Newtown, Connecticut, has focused attention on the role of mental health in violence. At a news conference Dec. 18, President Barack Obama vowed to make treatment for mental illness as easy to obtain as a gun. Lanza’s main weapon was a Bushmaster AR-15 rifle.

“Clearly, he was troubled,” Connecticut Governor Daniel Malloy said in an interview with CNN. “You have to be deranged to carry out this kind of crime.”

Diminishing Care

In a 2011 survey, 82 percent of 2,400 police chiefs and sheriffs said calls to deal with the mentally ill had increased substantially over their time in office, according to Michael Biasotti, president of the New York State Association of Chiefs of Police and chief of the department in New Windsor.

Now the use of force against the mentally ill is a major focus of U.S. Department of Justice investigations, according to Jonathan Smith, head of the agency’s civil rights special litigation section. “You’ve got your finger on what is among the largest issues in law enforcement,” he said.

Smith tied the shootings, in part, to the diminishment of U.S. health care for the mentally ill. The number of beds in state hospitals has plummeted 92 per cent to 42,385 in 2011 from the mid-1950s. Laws in 44 states designed to force the most seriously ill to stay on their medication are often underused or ignored, according to Brian Stettin of the non-profit Treatment Advocacy Center.

The average duration of acute-care psychiatric hospital stays has dropped 60 percent since 1993, and is now at 7.8 days -- far from the two weeks doctors say is the minimum for introducing new drug therapies and stabilizing patients.

‘Going Downhill’

Mahoney’s family is convinced the brevity of his last hospitalization left him agitated and delusional, and led to the episode that ended his life. “My brother didn’t have to die,” said his twin sister, Tara.

She and her brother, Brian, and their father said they are also angry at the police. “The society’s going downhill when the cops can just shoot anybody they want,” Brian said.

Oxnard Police Commander Scott Hebert rejected the suggestion of improper behavior. “We never want to put our officers in a spot where they have to do what they did,” he said. “The story, in my opinion, is the mental health system.”

None of the officers in the 64 incidents Bloomberg documented has been found criminally liable.

Last year, the Justice Department conducted its first investigation based solely on violent police encounters with the mentally ill, in Portland, Oregon. The agency found a “pattern or practice of unreasonable force” in nine cases, and gaps in mental health care that increased the frequency of potentially fatal police encounters.

Toy Guns

In a proposed settlement with the federal agency, Portland agreed to hire additional staff to train officers and work with mental-health groups in the city, among other steps. The cost in the first year is estimated at $5.8 million.

The Justice Department ordered New Orleans police in 2011 and Seattle police in 2012 to take similar actions after wide-ranging probes of their departments. How officers deal with the mentally ill will be a necessary component of all future police investigations, Smith said.

In 49 of the 64 incidents in Bloomberg’s count, individuals were armed or appeared to be. Twenty-one had knives and 19 had guns. There were two with hammers, two with machetes, one holding a bat and another a sword. Three carried toy guns.

Stealing Coffee

In Saginaw, Michigan, on July 1, it was a folding knife. Milton Hall, a 49-year-old homeless man with schizophrenia, was shot 46 times after six officers responded to a call that he’d left a convenience store without paying for a cup of coffee, according to the attorney for his estate, Debra Freid. Hall had “acted aggressively,” brandishing the knife, according to police.

Some of the 64 did serious harm to others. Pralith Pralourng, 32, had taken nothing for his schizophrenia for more than a year in July when he injured a coworker with a box-cutter at a San Francisco chocolate factory. Police shot and killed Pralourng when he turned the box-cutter on them.

In August, Charlene Fears, 38, released recently from a hospital, fatally stabbed her four-year-old grandson at her home in Buffalo. Covered in blood and wielding two butcher knives, Fears, one of six women in Bloomberg’s survey, charged at officers trying to help the boy and was shot and killed.

A preponderance of those in uniform have no idea how to deal with mental illness, and “man, are they quick to shoot,” said Michael Woody, president of CIT International, a Memphis-based nonprofit that organizes programs in 50 states and four countries in crisis intervention training, or CIT.

Road Rage

Only 10 percent of the nation’s 25,000 police departments offer CIT or teach de-escalation techniques to deal with the mentally ill in crises, psychotic or otherwise, according to a University of Memphis study.

In CIT sessions, officers learn to engage in what’s called reflective listening: “So, I hear you saying. . . ” The next step is to have a disturbed individual sit, as officers maintain eye contact and, finally, to convince the person to come along peaceably, said Woody, a retired 25-year veteran of the Akron, Ohio, police department.

Lack of training is cited in a lawsuit filed in November against the Albuquerque, New Mexico, police by the parents of Christopher Torres, 27, who was shot and killed in April 2011. At the same time, the Justice Department opened an investigation of 25 police shootings over the last three years in the city. Thirteen involved people with mental illnesses, according to Albuquerque Police Chief Ray Schultz.

Torres was under a doctor’s care for schizophrenia on April 12, 2011, when two detectives went to the family home to arrest him for a road-rage incident, according to the lawsuit.

Mental-Illness Database

He was in the backyard when one of the plain-clothes detectives jumped a fence and the other broke a section of the fence to gain access, according to the suit. It claims they both beat Torres, and that within two minutes one had allegedly shot him three times in the back at point-blank range.

Torres punched one detective in the face, grabbed his gun and aimed at both before he was shot, according to the city’s public safety department.

Kathleen Love, the attorney for his estate, disputed the notion that Torres “got his hands on a gun or was in any position to have control over the gun.”

Detectives should have known he was schizophrenic and to approach him differently, she said, because his parents had told police to summon a CIT officer or call them if there was ever an incident involving their son.

Schultz, the police chief, said the department has recently hired a full-time psychiatrist, set up a database to identify residents with mental illnesses and offered more CIT training.

‘Suicide-By-Cop’

“The instances of police shooting the mentally ill are rising but not as fast as they could be because of the measures we’ve taken,” Schultz said.

Tony Monheim, a retired Miami-Dade police officer who teaches courses in officer-involved shootings and homicide investigations, said training can only go so far.

“It’s perfectly clear to me that someone who attacks a police officer with a piece of a plate-glass window is not thinking clearly,” Monheim said. “But what is a cop supposed to do? Put them on a couch? Analyze them? There’s just no time for that.”

In a 2009 study of 707 officer-involved shootings in North America, Los Angeles forensic psychologist Kris Mohandie characterized 36 percent of them as “suicide by cop” --meaning those who were killed had provoked the lethal response.

Deaths Report

As far back as 1984, controversy has followed the police-shooting deaths of the mentally ill. That was the year Eleanor Bumpurs, a 300-pound woman who New York City police say was emotionally disturbed, was killed in her Bronx apartment.

Bumpurs had fallen behind in her rent, and officers entering the apartment to evict her were confronted by the 69-year-old holding a knife. They struggled and she was fatally shot, sparking protests.

The best approach would have been to “to wait the person out, starve them out, unless there was some other reason they were a danger to other people,” said former Mayor Ed Koch, who was in office at the time.

In 2009, the U.S. Bureau of Justice Statistics decided to try to include data on encounters with the mentally ill in its annual arrested-related deaths report, according to Howard Snyder, the bureau’s deputy director.

It added a new question to a survey that police departments fill out in every case of a death during an arrest or confrontation: “At any time during the arrest/incident, did the deceased exhibit any mental health problems?”

In all but rare instances, “nobody would check that box,” said Andrea Burch, a statistician who directs the annual report.

Too Sketchy

The question was just too difficult to answer correctly, or honestly. “If someone is running down the street, naked, screaming they’re God,” she said, does an officer have any way of knowing whether the person is mentally ill or drunk or on drugs? So the question would often go unanswered, she said.

In 2009, the only year for which survey results were made available to Bloomberg, 3 percent of the 729 questionnaires showed the box for that question checked, Burch said, for a rough estimate of 22 arrested-related deaths identified as involving someone with a mental illness or mental health issues.

The bureau never made the results public and next year will stop asking the question because the data it yielded was too sketchy, Snyder, the deputy director, said.

Learning Disabilities

For its survey, Bloomberg gathered more than 100 news articles about police shootings involving the mentally ill in 2012. After checking with police, district attorneys and medical records, only those incidents in which mental illness could be confirmed were counted. The discarded reports show the actual number of such shootings could be much larger.

By his calculation, based on conversations with police officers, Woody of CIT International said he believes 25 percent of the 400 or so fatal shootings captured annually in Justice Department statistics involve someone with a mental illness or mental health issues.

The records for Michael Mahoney show an evolving range of disorders that culminated in his final hospital stay with a diagnosis of schizophrenia.

He and his twin were born in 1975 in Paramount, California. “I was five minutes ahead of him,” Tara said. “He used to tell everybody I stepped on his forehead to get out first.”

They grew up in Oxnard, a city of 200,000 about 60 miles northwest of Los Angeles. He coped with learning disabilities and was reading at a second-grade level in the fifth grade, according to his teacher, Nesta Campbell, who taught him in a classroom of special-needs children.

Prison Letters

By 13, he was part of a gang of skinheads. He praised Hitler and came home with swastikas tattooed on his leg. When he was 19, he moved with a friend to Phoenix, where he was charged in the beating of an Hispanic man. He pleaded guilty to aggravated assault and was sentenced to six years in prison.

He wrote letters to his sister. One dated April 24, 1998, hinted at what was to come. “I need you to send me a doctor,” he wrote. “I will die if you do not get me help. Something is (expletive) me up inside.”

A few lines later: “Ask Dad. He said I was crazy.”

He came home when he was 27. The violent streak was gone, yet his mental illness blossomed. He was admitted to hospitals as a psychiatric patient at least five times between 2009 and 2011, county health records show. Then he made a concerted effort to straighten out his life, his sister said.

‘Kill Me!’

When he wasn’t taking courses toward a certificate in welding, he was his father’s caretaker, cleaning and cooking, she said. And he doted on his nephew, James, now three.

“He was just starting to live,” she said.

An aspirin overdose in November 2011 led to infection and surgery to remove sections of his large and small intestines. He came home at the end of the year, gaunt and pale, with two colostomy bags strapped to his abdomen, according to his father.

In June, his father embarked on a seven-week trip across the country, leaving him home with his older brother, Brian. While Brian was at work, Michael would tell neighbors wild tales about youths ransacking his house for painkillers and Mexican assassins looking to do him in.

Just before midnight Aug. 1, a neighbor called police after he heard Mahoney screaming. When they arrived, a neighbor said he heard Mahoney yell, “Kill me!”

Flare Gun

He was taken to the hospital, where he stayed for two days, treated for an overdose of aspirin, Vicodin and amphetamines. On Aug. 4, he was transferred to the Hillmont Psychiatric Center, described as dangerous to himself, paranoid and guarded. He was put on a 72-hour hold and started on a daily dose of the antipsychotic Abilify.

Forty-five hours later, he was “remarkably better,” according to his medical records. Tara said she found him on the porch of her apartment, where he’d been dropped off. He was agitated and angry, she said. “I don’t know how they came to the conclusion that he was OK to leave.”

Cyndie Cole, the administrator of the 43-bed Hillmont Psychiatric Center, declined to comment on Mahoney’s case, citing medical privacy laws.

The day before he died, Mahoney visited a neighbor, Ben Velazquez, handing him a slip of paper with his father’s cell phone number scribbled on it. “Call him at 7 tonight,” Velasquez recalled Mahoney saying. “My body will be ready.”

The next day, Mahoney showed another neighbor, Rick Pallazuelos, a flare gun. Pallazuelos asked what he was going to do with it. “You’ll see, you’ll see,” Mahoney told him.

Irish Wake

A short time later, a motorist passing the Mahoney house called 911 to report a man “with a gun, in the street,” according to a department press release issued at the time.

Three officers were dispatched. Mahoney was inside, stepping in and out of view of the officers, who stayed outside, said Hebert, who heads the professional standards division. When they saw Mahoney point the flare gun in their direction, all three fired, Hebert said.

Mahoney was pronounced dead at the scene. His father, in the tradition of his Irish ancestry, waked his son’s body in the living room. The casket was surrounded by family photos and an Irish flag. The vigil lasted more than two weeks. “I didn’t want to let him go,” Edward Mahoney said as he began to sob.

There’s enough blame to go around, beginning with the mental-health care system, his twin sister said. ‘They should have done more, and I don’t know why they didn’t,’’ she said. “This should never have happened to my brother.”