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(Editor's Note: This collaboration between Oklahoma Watch and StateImpact Oklahoma was aided by a grant from The Center For Cooperative Media at Montclair (N.J.) State, supported by the Democracy Fund.)

It was almost 11 p.m. when two Oklahoma City police cruisers, red lights flashing, blocked Northwest 106th Street in both directions.

As officers walked toward the front door, passing the small koi pond where neighborhood kids like to feed the fish, a woman waited on the front porch with a key.

Flipping on the bedroom lights, police told a sleepy 71-year-old named George Crooks to get dressed. It was time to go.

He slipped on his shoes, telling the officers "I expected you to come."

He had been depressed for weeks. He was losing sleep worrying about firing an employee. And then suddenly he was euphoric, telling people he was invincible and driving recklessly.

Crooks' family tried convincing him to get help. When he refused to check himself into a hospital, his sister who lives next door called police. Officers handcuffed him in the street, in front of peering neighbors, and drove him 40-minutes to Midwest Regional Medical Center, where Crooks spent three weeks under observation.

He has been picked up by police at least 50 times. Each time was a result of friends, family or counselors calling for help.

Oklahoma City police Capt. Jeffery Pierce has made a career of answering those calls. Now, he's training a team of officers to identify and respond to people with mental illness.

And Pierce's team can't keep up.

Oklahoma City police answered 19,658 mental health calls in 2019, reports obtained by Oklahoma Watch and State Impact show. That's a 95% increase since the current tracking system took effect in 2013.

More than 50 times a day, Oklahoma City police respond to a mental health crisis and are presented with a critical choice: Should the individual be arrested? Detained and transported to a hospital or crisis center for care? Or do they just need the phone number of a counseling service?

The answer is seldom clear, and fewer than 14% of the city's officers have received the specialized training designed to help them make that call.

State law requires police to respond to emergency calls involving mental illness. Mental health advocates say the assignment is a legacy of the stigma that people suffering from mental illness are violent. Yet, as encounters between armed police and these people in crisis increase, the problem is compounded by the gaps in available treatment and funding for low-income and uninsured Oklahomans.

Pierce considers working with and for people with mental illness the most rewarding job he's done in 32 years with the force. Yet, he insists police should not be doing this work.

Bipolar disorder has left Crooks behind the barrier of a police cruiser so many times that he's lost count. Now, he advocates for people like him as executive director of the Depression and Bipolar Support Alliance of Oklahoma. And he doesn't see another way.

These men with decades of experience, one in handcuffs and the other with a badge, disagree on the best way forward.

"I wouldn't go without police," Crooks said.

"It's unfortunate that we're in a situation as law enforcement officers, not only here but nationwide, of having to put people in the back of a police car, behind a cage and take them for mental health treatment," Pierce said. "That's horrible."

The Odds of Fatal Encounters

Oklahoma City's mental health calls are up 5% in the first half of the year as compared to the same time in 2019. And the number continues to rise, even as a national debate over policing calls the practice into question.

The killing of George Floyd at the hands of Minneapolis police sparked worldwide protests for racial justice and calls to defund or reform policing. Then came Daniel Prude.

A week after being handcuffed, placed in a spit hood and suffocated by Rochester, N.Y. officers, Prude, 41, died from "complications of asphyxia in the setting of physical restraint," according to the autopsy report.

His brother called 911 for help when Prude ran into the freezing March night. According to published reports, he told responding officers that Prude had a history of mental health struggles and, earlier that day, had ingested PCP, made suicidal threats and threw himself down a flight of stairs.

The risk of being killed during a police encounter is 16 times greater for individuals with untreated mental illness, according to a 2015 report by the Treatment Advocacy Center. Despite the fatal flaws in the practice, cities nationwide continue to rely on law enforcement to respond.

And while most calls in don't result in violence, Pierce said, some have turned deadly.

In the early morning hours on Nov. 15, 2017, Dustin Pigeon called police and said he intended to commit suicide. When officers arrived, the 29-year-old stood in his front yard in Oklahoma City, doused in lighter fluid, holding a bottle of accelerant in one hand and a lighter in the other.

Body camera footage shows two officers pleading with Pigeon to drop the bottle when a third officer, Sgt. Keith Sweeney, came running up to the scene yelling "I will f–ing shoot you. Get on the ground."

Oklahoma City police body camera footage shows Dustin Pigeon with his hands in the air seconds before Sgt. Keith Sweeney shot and killed him on Nov. 15, 2017.

Seconds later, Sweeney fired five shots killing Pigeon.

Pigeon's sister told The Oklahoman that her brother struggled with substance abuse, bipolar disorder, anxiety and depression for years.

On Nov. 2, 2019, nearly two years after Pigeon's death, a jury convicted Sweeney of murder.

Oklahoma County District Attorney David Prater and two police training officers said at his trial that Sweeney was taught to de-escalate confrontations. Prater said Sweeney did the opposite. He had not been trained in crisis intervention, an optional program that teaches officers about mental illness.

In Rochester, public outcry following the delayed release of body camera footage of Prude's death prompted the mayor to move the city's crisis intervention unit from the police force to the Department of Youth and Recreation Services.

In Oklahoma City, nearly three years after Pigeon's death, there has been no change to police training or crisis intervention, Capt. Larry Withrow, a department spokesman, said.

Oklahoma City police do not track how many people with a mental illness have been killed or injured while in custody. The department refused multiple requests by Oklahoma Watch to review use-of-force reports.

Incident reports, however, provide insight into what mental health calls are coming to the department and how officers respond. Oklahoma Watch and State Impact reviewed more than 150 reports from February and April 2020.

The incidents described include a grandmother suffering delusions from Alzheimer's and other mental illnesses. A man with paranoid schizophrenia roamed naked in the street. And an elementary school student who had an outburst in class after changing medication.

Police also refused to provide Oklahoma Watch and State Impact with details about its de-escalation training.

The department defines de-escalation as an effort to "minimize the need to use force during an incident and to increase voluntary compliance," in its operations manual. Procedure calls for de-escalation to be used "whenever possible."

'Not Every Officer's Cut Out For It'

Officers who complete Oklahoma City's police academy receive 1,105 hours of training. Of those hours, 16 teach officers to respond to individuals with mental illness.

Cadets learn to identify symptoms of mental illness and self-medication, and the uses and effects of commonly prescribed drugs through classwork and role-playing.

The department's 28-week academy covers criminal investigation, administrative duties, driving techniques and sobriety testing. The most class time - a combined 312 hours - is dedicated to firearms and patrol training. Mental health training is folded into the patrol curriculum.

Officers can volunteer for the department's Crisis Intervention Team, which provides 40 additional hours of mental health training.

The program utilizes a curriculum developed at the University of Memphis and is used by law enforcement nationwide. Oklahoma City's training is offered in conjunction with the Oklahoma Department of Mental Health and Substance Abuse Services. Officers are taught how to spot verbal and physical cues that signal mental distress and assess if a person is a danger to themself or others.

Of the department's 1,170 officers, 158 are trained in crisis intervention. Pierce, who became commander of the team in 2013, said the program is voluntary because it requires a more nuanced approach than traditional police work. It takes time and patience to understand the underlying issues that contributed to a crisis, he said.

"Not every officer's cut out for it, and not every officer wants to do it," Pierce said.

But they don't have a choice. With an average of more than 1,600 calls a month, it's impossible to ensure an officer trained in crisis intervention is available to respond.

Oklahoma City police are on track to answer a record 20,000 mental health calls this year. Pierce said that number could be even higher since staff can't always determine if mental illness was a factor in the call.

Basic police training can be counterintuitive when people in a mental health crisis often need patience and to feel like they're in control.

Employees at Oklahoma's crisis intervention centers are taught to step back if someone is becoming agitated.

Carrie Slatton-Hodges, the head of the Department of Mental Health and Substance Abuse Services - the state agency that calls itself a "safety net" for Oklahomans struggling with mental illness and addiction - said oftentimes, the person will calm themselves down in a few minutes if given the time and space to express themselves.

Police are trained to work more quickly and take control of the situation. That can mean shouting commands at someone who may not comprehend. Or attempting to restrain someone whose past trauma may trigger an altercation.

"Persons with mental illness oftentimes have had repeated traumas and those traumas change the way they react to situations," Slatton-Hodges said. "And so when someone's coming at them or appears like they're going to confine them or restrict them...it's just like a re-traumatization that then you need to fight your way out of."

'Come Back After You've Had a Heart Attack'

Deep cuts to the Department of Mental Health and Substance Abuse Services' budget mean fewer resources for people with mental illness.

In fiscal years 2011 and 2012, the department's funding was cut by more than 8% due to the state's budget shortfall.

When funds are low, services are prioritized for those who are most sick. But without early intervention and consistent support, symptoms go untreated, become worse and can trigger a crisis.

Rehabilitation programs used to teach social and personal skills and provide a safe place where individuals with mental illness could spend hours with counselors and relating to others. The agency's budget cuts diminished those programs, contributing to the increase in calls to Oklahoma City police, Slatton-Hodges said.

Summer King, who counsels at Hope Community Services, Inc. in Oklahoma City, said it's like going to the doctor with chest pains and being turned away.

Summer King, Chief Operating Officer at Hope Community Services, Inc. in Oklahoma City, has seen patients tackled after running away from officers and a woman wielding a knife tased by police. (Whitney Bryen/Oklahoma Watch)

"The doctor says 'come back after you've had a heart attack and then I can help,'" said King, who used to run a rehabilitation program.

Some people overcome by mental illness or substance abuse can become violent. And mental health calls aren't clear cut.

Capt. Pierce said when police are dispatched, they don't often know whether mental illness is a factor. It's up to the responding officers to make that determination and decide the best course of action.

Funding rebounded in 2014. By then, services had already dissipated and the agency was left playing catch up, Slatton-Hodges said. Cuts returned in 2017, again forcing difficult decisions about which services to save.

Over the past decade, the agency's budget has grown 15%. Much of that new money was locked in by lawmakers to fund specific programs like expanding drug court, construction of a new crisis center and children's services.

Those programs serve Oklahomans with specific needs but leave others behind.

King, who is Hope's Chief Operating Officer, said the presence of handcuffs, uniformed officers and marked cars criminalizes mental health emergencies.

She prepares patients for police interactions by telling them what will happen when officers arrive. But police presence often heightens their anxiety.

King has seen patients tackled after running from officers. And in one case a woman wielding a knife was tased by police.

But George Crooks, who's had more interactions with police than most, said without officers forcing him to go, he might not get the help he needs.

Crooks, now 73, began experiencing symptoms of his bipolar disorder in college.

He thought he was smarter than everyone else and started telling people he was the son of God.

That was the first time his family turned to law enforcement for help. It was 1970.

Regular counseling sessions help reduce Crooks' symptoms. Growing older has, too. He still experiences occasional episodes usually brought on by stress and a lack of sleep.

Once he fled from police and flew to California, eventually returning home and checking himself into a hospital.

On another occasion, while shoe shopping at Quail Springs Mall, Crooks became argumentative with a salesman and was nearly kicked out of the store.

Family and friends often recognize the warning signs of a crisis, even when Crooks can't. So, they turn to law enforcement for help.

Crooks' sister Susan Linford requests a crisis trained officer and is usually the first to greet them when they arrive. After introducing herself, she quickly assures officers that her older brother has never been violent and doesn't have any weapons so "you don't need to be rough with him. You don't need to taser him."

The 67-year-old dental hygienist said her brother can seem scary when he is manic and she doesn't want officers "to get jittery with their gun or violence or their aggressive, typical behavior."

In April, 2019, Edmond police were called to respond to reports of a possible domestic assault. They arrived in the early afternoon to find 17-year-old Isaiah Lewis yelling and running naked through a suburban neighborhood.

Officers pursued the black high school student, who broke into a nearby home where he fought with police punching them several times, according to the district attorney's report. Neither officer wore a body camera. After unsuccessfully tasing him multiple times, one of the officers, Denton Scherman, fatally shot Lewis.

Lewis' parents filed a federal civil rights lawsuit against the city and two responding officers. The district attorney declined to file criminal charges.

Though not commenting specifically about the Lewis case, Slatton-Hodges emphasized the need for mental health professionals to be part of the solution. Some situations call for police who can flash their lights and get there quickly, she said. But in most cases, there is a better way.

"The best evidence is around the tiered system," she said. That means an alternative line to 911 for mental health calls where a counselor can evaluate the situation and offer help by phone. If that wasn't enough, a mobile crisis unit would provide in-person counseling and provide transportation to a treatment facility if necessary. Police would respond only as a last resort.

But that would require an unprecedented investment from the state.

"The system has to adjust to keep the police out of it as much as possible," said Capt. Pierce, whose team helps train other Oklahoma agencies in crisis intervention. "That's really the only way you're going to reduce the stigma and get people help."

Oklahoma Watch is a nonprofit organization that produces in-depth and investigative journalism on important public-policy issues facing the state. The organization's website is at http://www.oklahomawatch.org.