The last phone call Earl McNeil ever made was to National City police.

He was outside the station on the morning of May 26, offering to be arrested on a possible warrant. While in custody, he stopped breathing and later fell into a coma. He died June 11 in a hospital bed, his brain in a vegetative state.

McNeil’s death is still under investigation. Despite the outrage that’s been expressed by activists in recent weeks, city officials have refused to release body camera footage or the names of officers involved until after a medical examiner’s report has concluded in mid-August.

At least one thing is certain: McNeil’s initial contact with police began in a familiar way. He reached out to them.

A report by the California attorney general’s office released last month shows that slightly more than 50 percent of all police interactions involving death or serious injury in San Diego County in 2017 began with a call for service. Almost all the civilians who were killed or seriously injured were men, and 20 percent were black, even though blacks make up 5.5 percent of the population regionwide.

It’s not a recent phenomenon. A San Diego County district attorney’s office review of all fatal police shootings and in-custody deaths between 1993 and 2012 concluded that 58 percent of those cases began with a radio call. About a third of the time, the contact with police was self-initiated.

Criminal justice experts caution against reading too closely into police stats without knowing the details of individual cases, and they note that cops spend most of their time bouncing between requests for help, so it makes sense that’s often their first point of contact with the public.

But the other common denominator in many of the most severe use-of-force cases – nearly a quarter in San Diego County last year – was people who displayed immediate signs of mental distress. Court records cited by the Union-Tribune suggest McNeil was schizophrenic. His aunt told The Appeal, a criminal justice-focused website, that he’d been diagnosed as bipolar at a young age.

Families with mentally ill relatives say they now avoid the authorities for non-emergency situations, knowing a phone call might lead to death or injury. Activists say it creates a chilling effect between law enforcement and the community they serve.

“People in our communities have to deal with mental illness alone for fear of having to deal with a police officer coming in and implementing procedures that are overly aggressive,” said Apollo Olango, whose brother Alfred Olango was fatally shot by an El Cajon police officer in 2016.

That incident began when another sibling, Lucy Olango, called 911 to request help for Alfred, who was experiencing a mental breakdown at a shopping center. A lawsuit filed by Lucy Olango alleges that she specifically asked for mental health professionals and told a dispatcher that her brother Alfred wasn’t armed. One of the arriving officers eventually shot Alfred, after he raised a metal vaping device.

The experience of calling police and then witnessing her brother’s death caused Lucy Olango “severe emotional distress in a form that an ordinary, reasonable person would be unable to cope with,” her lawyers wrote in court papers.

Typically in such situations, the county employs a psychiatric emergency response team, known as PERT, to act as a medium between law enforcement and the mentally ill. Its resources are limited but growing. As of this spring, the program had 41 personnel and another 10 were in training, according to the County Grand Jury.

“Enforcement procedures do not work for someone who cannot conceive direction,” Apollo Olango said. “That’s just fucking common sense, excuse my language.”

But it’s not just activists who wonder whether law enforcement belongs in these situations in the first place. There’s a debate in criminal justice circles at the national level: Should cops continue to respond to calls involving a mentally ill person if no one appears to be in immediate danger?

“We rarely wind up shooting bank robbers or rapists or murderers. They give up when we catch them,” said Ed Obayashi, a former San Diego cop-turned-lawyer who advises police agencies on use of force. “The majority of the shootings or deaths of people in custody are those who’ve been on drugs or suffered mental issues.”

Some think tanks push for better de-escalation and sensitivity training, which Obayashi sees as impractical and ineffective. Instead, he advocates that authorities assess the situation as early as possible from afar and avoid physical contact altogether if it’s not necessary.

“A lot of times,” said Obayashi, who now works as a Plumas County Sheriff’s deputy, “the kid just calms down.”

McNeil went to the National City police station to make his phone call, so his contact with police was likely unavoidable.

Police Chief Manuel Rodriguez said the officers who responded didn’t know McNeil’s medical history, otherwise they would have taken him to a county mental health facility. Instead, they treated him like a criminal and charged him with possession of a controlled substance.

“He may have been mentally ill,” Rodriguez said, “but how would we know? His mental illness was overshadowed by the influence of drugs.”

A police press release issued after McNeil’s family pulled him from life support said McNeil had been high and combative and was put in a restraining device that’s designed not to restrict breathing. At the county jail, he “began to display signs of medical distress,” police said, and so paramedics were alerted.

Rodriguez said he welcomes more mental health resources, but warned, “That’s not the catch-all.”

There are times in which his officers avoid a mentally ill person and the technique works, he said. Other times, “people call us and say the person is out of control and we get there and they go, ‘But don’t hurt him.’ But it’s like, they’re out of control and tearing up the room. How are we going to stop them? Honestly.”

“Most of the time,” he added, “we’re trying to use control holds. Somehow there’s a sense that we’re police, we’re gonna beat people. There are times in which we need force. The family obviously can’t handle it.”