Before Walter Wallace Jr. died at the hands of Philadelphia police, his need for mental health services seemed apparent. During his past interactions with the criminal justice system — Wallace had been convicted and jailed for assault and robbery — judges repeatedly tried to get him mental health treatment. His family said that when they called 911 Monday afternoon, they had wanted an ambulance to come.

As recently as the previous Friday, Wallace had visited the West Philadelphia Consortium, a mental health crisis response center. Behavioral health experts who worked with him said the 27-year-old had shown so much improvement that they planned on starting his job search process soon.

The crisis response center was not notified when Wallace suffered a mental health crisis on Monday outside his home. And when the police showed up, everything seemed to work against him — from his gender and race, to a 44-year-old state law some experts deem outdated, to how law enforcement handles mental illness, even the fact that police didn’t have the equipment they need to subdue rather than kill. What they all reveal, experts say, is a system stacked against people like Wallace.

How police deal with mental illness

The very reason the family sought help — Wallace’s mental health — placed him at much higher risk when police responded to the call.

The Treatment Advocacy Center estimates that at least one in four fatal encounters with police involves an individual with an untreated severe mental illness and that people with untreated mental illness are 16 times more likely to be killed during a police encounter.

When law enforcement officers are the first responders to a mental health crisis, however, the situation might not be treated like other medical conditions, said Jack Rozel, the medical director for Resolve crisis services at University of Pittsburgh Medical Center Western Psychiatric Hospital.

“If I have a heart attack and I call 911, there’s a pretty good chance that I land in the emergency room,” Rozel said. “But if I have a psychotic break and I call 911, there’s still a chance I could land in the emergency room, but I could also be jailed, injured, or killed. It’s a really scary equation for people to solve when their loved one is ill. They have to ask themselves, ‘Is the risk of them doing something really dangerous right now more or less than the risk of whoever responds to the crisis making it worse?’ There’s no good way to know how it will go.”

Outdated commitment laws

In Pennsylvania, a person can be involuntarily committed only if they are a “clear and present danger” to themselves or others. The restriction is part of the Mental Health Procedures Act, which was passed in 1976. And while some experts believe that mental health law has held up reasonably well for the last 44 years, others believe that Pennsylvania’s requirement for involuntary commitment can cause people to not receive the help they need in time.

As for involuntary outpatient treatment, that was legalized in Pennsylvania last year, and requires only “clear and convincing evidence that the person would benefit." But the state never budgeted money for it, so no counties have such a program.

“Pennsylvania is the poster child for how much of a problem this is,” said John Snook, the CEO of the Treatment Advocacy Center. “If someone’s loved one is really sick and they call to get them help, officials will say there’s nothing they can do until they’re violent.”

In Wallace’s case, police had been repeatedly called over the last few months for reports of disturbances at his home in West Philadelphia, including twice on Monday before his final fatal encounter with police. In that call, police radio recordings show, dispatchers reported a “27-year-old male assaulting an elderly female and male” at the home. Yet still, family members and advocates say, there should have been a better way to subdue him.

Stephen J. Morse, a professor of psychiatry and law at the University of Pennsylvania, pointed out that Dane County, Wis., has effectively implemented an outpatient system that has led to a lower rate of hospitalizations for mental health issues.

“Their outpatient services are available 24/7,” Morse said. “And they make treatment contracts with patients, but not in a way makes the providers seem like cops. And it’s been shown that if you treat people with respect, dignity and kindness, without pushing them around, they listen to doctors. So even though the system is very expensive because it is labor intensive, they’re saving money by avoiding unnecessary hospitalization.”

Assisted outpatient treatment, were it more available, “might prevent some tragedies,” Rozel said. “It won’t prevent them all, but it can prevent a reasonable number of them. It can make a real difference by giving people who live with psychiatric illnesses a greater chance to live on a safer and healthier trajectory.”

Systemic racism

Generally, Morse noted, people with mental illness are no more prone to violence than anyone else, another reason that assisted outpatient treatment, court-supervised mental health care in the patient’s own community, makes a lot more sense than involuntary commitment. But for a Black man with mental illness like Wallace, the misimpression is especially pronounced and deadly.

A 2018 study published in the International Journal of Law and Psychiatry found that 23% of individuals killed during interactions with the police demonstrated signs of mental illness, and that rates of death for African Americans with mental illness were the highest at 26 per million.

“African American men with mental illness bear the burden of two stereotypes,” said Paul Butler, a professor in law specializing in race relations and criminal justice at Georgetown University. “The first is that Black men are more dangerous. The second is that people with mental illness are more dangerous. Neither of those is supported by the evidence, but just like how research tells us a cell phone in the hands of a Black man looks more like a gun to people than in the hands of a white man, a Black man suffering from a mental health crisis looks more like a criminal than an ill person.”

Butler also pointed out that Black people with mental health issues might not be capable of behaving in a way that sends a message to police that they’re not dangerous, which heightens their risk.

“If you’re mentally ill, you might not understand the need for acting in that way, because you might not understand why anyone thinks you’re a threat,” he said.