The final moments of Stacy Kenny’s life are captured on a recorded 911 call. Kenny, who had been diagnosed with paranoid schizophrenia, begs an emergency operator to explain why she’s been pulled over. Amid screaming and rustling sounds, police officers smash the windows on her red Nissan, Taser her twice, punch her in the face more than a dozen times and try to pull her out by her hair.

But Kenny, 33, who legally had changed her gender but still appeared to be a man, was anchored to the car by a locked seat belt. Her life ends, as does the 911 call, when she tries to flee by driving away with one of the officers still inside the car. There’s a burst of gunfire, then an officer says: “We are all okay. Bad guy down.”

The 2019 death in Springfield, Ore., was one of 1,324 fatal shootings by police over the past six years that involved someone police said was in the throes of a mental health crisis — about a quarter of all fatal police shootings during that period, according to a Washington Post database.

Although the number of these fatalities has declined, these confrontations remain a deadly and vexing issue, especially in small and midsize metropolitan areas. A Post analysis shows fatal police shootings of those who are mentally ill are more likely to take place in areas with populations of fewer than 1 million, like Springfield, which is part of a metropolitan area of about 382,000.

The Post reviewed the number of mentally ill people killed by police over the past six years and compared it with the overall number of people living in the area to determine the per capita rate. Such shootings are 39 percent more likely in small and medium-size areas than in large metropolitan areas or rural areas.

Last month, a video was released capturing a fatal police encounter months earlier with Daniel Prude, an unarmed, 41-year-old Black man with mental health problems. Prude died after officers in Rochester, N.Y., placed a hood over his head, pinned his naked body to the ground, and pressed his chest into the pavement. The video sparked protests across the nation and renewed public demands for officers to use less aggressive tactics during encounters with people who are mentally ill.

The issue arose at a nationally televised town hall meeting Thursday night when Democratic presidential nominee Joe Biden said it was “really, really important” that psychologists and social workers join police on calls involving mentally ill people “to de-escalate the circumstance, to deal with talking them down.” The day before, the Los Angeles City Council voted to create an unarmed crisis response team to handle nonviolent calls, including those prompted by mental health, substance abuse and suicide threats.

The police encounter with Kenny began after she pulled to the side of the road of her own volition, which an officer thought was “weird,” so he pulled behind her to investigate. Her side-view mirrors were covered in duct tape, and she tossed out a small plastic noisemaker that made a high-pitched squeal seconds after the officer approached. Then she slowly pulled back into traffic, signs of mental distress that the Springfield Police Department acknowledged in an interview with The Washington Post.

“They are shooting the people that can’t defend themselves,” said Christopher Kenny, the father of Stacy Kenny. “The victims are mentally ill, or homeless, or people of color or they are poor. . . . A lot of families don’t have the resources to do anything about it. We were able to fight.”

The Kenny family received a $4.55 million settlement in July from the city of Springfield — the largest lawsuit settlement involving police in Oregon’s history. The officers were not criminally charged. The department cleared the officers of any wrongdoing, saying they did not violate any laws or department policies. The city acknowledged that it needed to improve training and oversight.

For police, encounters with mentally ill people can be especially challenging because their behavior is often frantic and unpredictable. They can be in a state of psychosis, making it impossible for them to follow regular police commands. The encounters also can be dangerous, The Post database shows, because in most cases the mentally ill person is armed with a gun or knife.

Yet some departments, mostly in larger metropolitan areas, have made progress. Larger police departments with bigger budgets have moved more quickly to embrace training in de-escalation skills. Those departments are also more likely to dedicate resources to refresher training and to work as a team with local mental health professionals, experts said.

This article is based on a review of hundreds of pages of depositions, court records and police reports, as well as several videos and 911 calls. Interviews were conducted with more than a dozen police and mental health experts, as well as family members of those who died.

The Post database was launched after the 2014 fatal shooting of 18-year-old Michael Brown in Ferguson, Mo. During the first year, in 2015, more than 26 percent of those shot and killed by police were experiencing problems with mental illness, according to police reports. Each year after, those percentages have declined while the overall number of annual fatal police shootings have remained steady, at about 1,000.

So far this year, nearly 20 percent of fatal shootings involve someone who has mental health problems. The incidents often involve drugs or alcohol. Almost all of the decline in fatal shootings of the mentally ill happened in large metropolitan areas with populations of more than 1 million.

The decrease coincides with an expansion in new police training that teaches officers better ways to approach people with mental illnesses, typically called Crisis Intervention Team (CIT) training. Officers are taught to de-escalate tense situations, slow down the interactions with people in crisis, speak in a calm voice, and take cover so they can safely take whatever time is needed to bring the person safely into custody.

Barry Spodak, who trains officers and agents with the Capitol Police, Secret Service and FBI to de-escalate encounters with the mentally ill, said they have become more receptive to the training.

“Early on officers said, ‘You are trying to turn me into a social worker,’ ” Spodak said. “That has changed. They see these skills as important tools they need. Still, it runs counter to their nature, which is to quickly move in and take action.”

The specialized training doesn’t guarantee success. Springfield Sgt. Richard A. Lewis, who broke Kenny’s passenger-side window, punched her repeatedly and then shot her five times, was in charge of Crisis Intervention Team training at that police department.

During a deposition for the lawsuit, Lewis said he saw that Kenny was unarmed and was buckled into her car. The other officer, who first encountered Kenny and smashed her driver’s side window, had received 40 hours of the special training.

Six months earlier, Kenny, who was White, legally changed her name from Patrick and her gender from male to female, telling her family that if the outside world believed she was a woman, she would be better protected from violence. She never changed her appearance and was wearing a black hoodie and jeans the night she died.

The police department said Kenny used her car as a weapon when she fled the scene with an officer inside. Her family says she used it to flee a brutal beating that ultimately involved four officers.The officer’s union did not respond to requests for comment.

In addition to the payment to the Kenny family, the city also agreed to revamp its use-of-force policy, help finance a review of the officers’ actions, and beef up its internal review process after the use of excessive or fatal force. The department has changed some of its training, particularly with how it handles traffic stops.

“In hindsight, we are asking officers to slow it down. As opposed to smashing out the window and trying to pull someone out of a car, let’s look at this situation as best we can. Gather information,” said Lt. George Crolly, who oversees the patrol division of the department. “Maybe this isn’t a wanted felon trying to commit a crime, maybe this is someone in crisis and in need of help.”

Harsh realities

The Post database shows that the mentally ill people who died by police gunfire since 2015 were largely White, accounting for 58 percent of the deaths, with Blacks at 16 percent and Latinos at 13 percent. No other single race accounted for more than 1 percent of deaths. Men with mental health problems were far more likely to be fatally shot by police than women, accounting for 94 percent of the deaths.

The youngest were two White 15-year-old boys — Zane Terryn of Cocoa, Fla., and Jacob Peterson of San Diego — who were both suicidal on the nights they fired their guns in 2015 and 2017, respectively, at officers who returned fire, records show.

Among the oldest was 88-year-old Robert Coleman, a Black man from West Sacramento, who pulled his SUV behind several parked patrol cars one night last month and stepped into the darkness holding a gun. His family said he was struggling with depression and thoughts of suicide, and that police had no alternative but to shoot.

Coleman’s death reflects the harsh realities that police sometimes face when confronted with people who are mentally ill. Half the time the person with the mental illness had a gun; 28 percent had a knife or some other bladed weapon like an ax. In 36 percent of the cases, police said they were shot at or physically attacked.

Deep cuts to local mental health services and a lack of affordable treatment options for those struggling with substance abuse means the public is increasingly turning to local police for help with situations that often involve no criminal activity.

“All society’s failures fall on the shoulders of law enforcement,” said Dave Mahoney, the sheriff in Dane County, Wis., and president of the National Sheriffs’ Association.

The calls for reforms center on cases like that of Prude, when the person is clearly mentally ill and unarmed. They also focus on instances in which officers could talk someone into surrendering a weapon — like a kitchen knife — if they were trained to back away, take cover, wait for backup and calmly talk to the person in crisis.

That is the type of help Lucy Olango, a Ugandan refugee, hoped for as she called 911 in El Cajon, Calif., in September 2016 and told the operator her brother needed “mental help” but that he had no weapons, according to a transcript.

A half-hour before, Alfred Olango, 38, had showed up at her apartment and told her that people were “after him.” He started sweating profusely and darting in and out of the house. She attempted to calm him by engaging in “reality testing” — opening the window blinds and closets to show him that no one was there.

He learned his best friend had killed himself days before. And Lucy Olango, who works as a medical assistant at a mental health hospital, knew her brother was having a mental breakdown, she said in an interview. She wanted to get him to a hospital but could not communicate with him.

So she called 911. But nearly an hour later, police had not arrived and her brother had left.

Lucy believed he had gone home. She began driving to work but soon spotted her brother staggering in and out of traffic. She pulled her car to the side of the road and called 911 a second and third time.

“He’s just walking erratically on the street,” she told the operator on the second call. “He’s desperate. He’s going to get hit by a car.”

Two officers arrived in separate patrol cars shortly after the third call, and Lucy Olango pointed them in the direction her brother headed, then ran to the spot with the hopes of getting there first.

However, when she arrived, Officer Richard Gonsalves — a 25-year veteran who has since retired — had already pulled up in his patrol car. He cornered Alfred between a chain-link fence and a truck, stood directly in front of him with his gun drawn, and repeatedly shouted at Alfred to remove his right hand from his pants pockets, surveillance video shows. Instead, Alfred pulled out a vaping device and pointed it at the officer.

Gonsalves immediately fired four shots. Olango was later pronounced dead at a nearby hospital. An autopsy revealed he had cocaine and a small amount of alcohol in his system.

Ten minutes after the shooting, a Psychiatric Emergency Response Team (PERT) arrived. The team consists of a mental health professional and a specially trained officer. Only one PERT team works at any given time in El Cajon, a city of about 103,000 in San Diego County. This one did not arrive earlier because it was sent to investigate a trespassing report at a children’s recreation center, records show. That incident did not involve someone experiencing a mental health crisis.

El Cajon Police Lt. Randy Soulard would not comment on the incident but said “dispatchers keep PERT units available as much as possible. However, the officer may respond to crimes in progress and other incidents that require an immediate response.”

Mark W. Marvin, a psychiatrist who runs the PERT division in San Diego County that includes El Cajon, would not comment on the Olango case but described how those trained in PERT should use techniques that run counter to how Gonsalves handled the 911 call.

“The teams are trained that before you interact, you slow things down and get context. You find out what information the dispatcher may have on the person,” said Marvin, who runs the nonprofit organization. “You try to have a conversation with the person, connect.”

The department said a majority of its officers have received training through PERT, but Gonsalves’s lawyer, Mitchell Dean, said Gonsalves had not received PERT training.

Gonsalves was not disciplined or criminally charged. During testimony that he gave in a 2019 civil trial, Gonsalves said he received some form of specialized training for handling emergency calls involving people with mental health problems.

Gonsalves defended how he handled the call, saying he was trying to confine Olango to an area so he would not be hit by cars and that the escalation of the encounter was caused by Olango. The jury found in favor of Gonsalves and the city. Some aspects of the case are on appeal. “The jury took into consideration all the pre-shooting tactical conduct and how the situation unfolded” and sided with Gonsalves, Dean said.

A pledge to train

Ron Bruno, a 25-year police veteran and executive director of the nonprofit Crisis Intervention Team International, said it is a mistake for departments to have only one small team on call with specialized skills.

“There should be quick access to CIT officers on every shift,” Bruno said. “That means training between 20 to 30 percent of your department. If you are a small department where you only have one officer patrolling at a time, they all need to be trained.”

Soulard said most El Cajon patrol officers have received PERT training but declined to say what percentage of the force has completed it.

The departments that offer this type of robust training tend to be larger. For example, a year after Olango’s death, the International Association of Chiefs of Police launched its One Mind Campaign, which asks departments to pledge to provide the crisis training to at least 20 percent of its force and to forge partnerships with local mental health professionals.

So far, 551 departments have signed the pledge. That’s just 3 percent of the nation’s 18,000 police departments, although most of the signers are from large departments, said Louis Dekmar, past president of the association.

Neither the El Cajon Police Department nor the Springfield Police Department have signed the pledge. Both departments declined to answer questions about why they have not signed the pledge.

Dekmar said he was not surprised that shooting rates in rural areas are much lower than those for departments in small to medium-size metropolitan areas. Although rural areas have similar funding problems and attitudes about training, officers there often know the people in their town who suffer from mental health problems and develop a successful routine for getting them help.

“You know who the relatives are, so you call them,” said Dekmar, who started his career at a 10-person police department in a rural town. “There is a lot of informal interventions or informal discussions that occur. That allow officers to rely on relationships to handle these encounters.”

In the case of Kenny, her parents believed the Springfield Police Department was small enough, with its 45 officers, to look out for their mentally ill child.

They met with police officials a year before Kenny’s death, alerting them to her diagnosis of schizophrenia and told them Kenny had stopped taking medication.

“We told them he might behave oddly, but that he was never violent or dangerous,” said Kenny’s mother, Barbara, who uses male pronouns for her child. However, the officers did not call for a background check when they encountered Kenny, records show.

The Sunday evening incident included three traffic stops with police in which Kenny’s odd behavior should have tipped officers off to her condition, her family said.

Initially, Kenny pulled over even though an officer had not indicated she should do so, police records show. When Officer Kraig Akins pulled in behind her, Kenny then threw a plastic object the size of a plum — which emitted a high-pitched noise — out the window before slowly pulling back into traffic. Barbara Kenny said Kenny carried around noisemakers, believing they would provide protection from people who might harm her.

After the second stop, Kenny called the 911 operator, saying she was confused about why officers were pulling her over, while Akins ordered her to put her hands outside the window. Instead, she slowly pulled back into traffic.

At the third stop, Akins made no effort to talk to Kenny, records show. Instead, Akins walked up to Kenny’s driver’s side window and shattered it with a special tool, leading to the events that ended in Kenny’s death.

The Kenny family was discouraged by the immediate response from the law enforcement community. After the officers were cleared by the department and prosecutors, Sgt. Lewis, who shot and killed Kenny, received a Purple Heart commendation from the Oregon Police Officers Association for the injuries he received during the encounter — abrasions and a broken wrist — which required that his actions did not result from “poor judgment.”

Kenny’s family said they will never know why her odd behavior didn’t prompt the officers to use the de-escalation skills they had been taught, or to ask the 911 operator for help with communicating with Kenny. “What was the hurry to extract Patrick from the car immediately?” Kenny’s sister, Kimberly Kenny, wrote in a blog post after the settlement. “Why not slow down and think? Why go straight to violence?”

Abigail Hauslohner contributed to this report.