Jen Dold, whose brother, Alex, died after a physical altercation with law enforcement Tuesday, March 21, said her family was hesitant to call 911 that evening.

The 29-year-old man lived with his mother, Kathy Duncan, at her home in the Echo Lake neighborhood. He developed schizophrenia almost 10 years ago. The two women were trying to involuntarily hospitalize him; Alex Dold had recently stopped taking his medications, she explained.

“He has been on medication since he was 19, and the medication worked really good for him for probably six years or so,” Jen Dold said. “As you age the medication stops being as effective. Doctors find different dosages and different medications had to keep him stable.”

Alex Dold started to exhibit “ups and downs” as the effectiveness of the medication waned, said his sister, who is also on the board of directors for the Seattle chapter of the National Alliance on Mental Illness (NAMI). He became psychotic at times.

Pychosis is a state of losing contact with what is real and what isn't, according to the National Institute of Mental Health. Alex Dold also had anosognosia, a symptom of mental health issues that reduces the person's capacity to perceive their illness.

One in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression, according to the U.S. Department of Health and Human Services.

Jen Dold said her brother's death highlights flaws in the ways mental health is addressed in Washington state. The family was fearful to involve Alex Dold with the police because many law enforcement officers are not trained to respond to people with mental illness, she said.

Jen Dold and her mother called a series of local crisis lines that night in hopes that a Designated Mental Health Professional would be dispatched to the home to decide if Alex should be involuntarily hospitalized. They were turned down because Alex Dold was not considered to be enough of a threat to himself or others.

The majority of people with mental health issues are not violent, with 3-5 percent of violent acts attributed to people with serious mental health problems, according to HHS. People with a mental illness are 10 times as likely to be the victim of a violent crime than the general population.

Alex Dold had recently become more argumentative with his mother about wanting control over his social security disability checks, Jen Dold said. The evening he died, Alex Dold and his mother had a dispute over money.

Duncan called for a non-emergency transport for Alex around 9:15 p.m., hours after their argument. The call was classified as a domestic dispute.

In a recording of the call released by the sherrif's office, Duncan told the dispatcher she had a fat lip from where Alex Dold hit her. He had tried to take her phone, ripped a lanyard from her neck and flipped over the recliner she was sitting in. She said he had never been violent before, and she wanted him to have a psychiatric evaluation.

Duncan and her son were watching television when Snohomish County Sheriff's deputies arrived. Jen Dold was called by her mother once the interaction escalated, and listened in over the phone, she said.

Before the phone call began, deputies knocked. They spoke to Alex through a cracked front door, Jen Dold said. At one point he began to shut the door and said he wanted to talk to them later. He was not on drugs, and did not have any weapons at the time, she said.

“That is when they busted into the door, and wrestled with my brother, and tried to contain him,” Jen Dold said. “He got to my mom's room and laid on her bed with his hands up. That is when my mom said they tased him.”

Officers requested backup soon after arriving, and within eight minutes sent out a help-an-officer call, which is used in the event law enforcement believes they are in danger. Law enforcement from more than 13 jurisdictions responded to the request. About 12 minutes after the first contact was made with Alex Dold, he was in custody and unresponsive.

Resuscitation efforts by responding law enforcement and medical units were unsuccessful. Two Monroe Police Department officers, a Snohomish County sheriff's sergeant, two deputies and a master patrol deputy were placed on paid leave following the incident.

Jen Dold said he was punched and kicked before he was finally subdued. She said the Snohomish County Medical Examiner could not distinguish how many times he had been tased because he was so scratched and bruised. She said the use of force to restrain Alex Dold wasn't necessary. The more the situation escalated, the less he was able to concentrate “and communicate and understand what was going on.”

“It is not a matter of going against what the officers said, it's not being able to be present in that moment,” she said. “It is very hard for them to concentrate...he could not comply with their commands, because they [people like Alex] have cognitive damage from schizophrenia.”

Most Washington law enforcement officers have eight hours of crisis intervention training — CIT — or de-escalation training. The Douglas M. Ostling Act requires all general authority peace officers to meet those mandatory training requirements by 2021. It is recommended in the bill that 25 percent of all officers take a 40-hour CIT class.

"We have 12 officers that have completed the 40 hour course and one officer that has completed the 8 hour required course during his academy training," wrote Monroe Police Department administrative director Debbie Willis in an email. "So far, we have over half of our patrol officers that have attended the training and we continue to schedule those that have not yet been trained."

NAMI Seattle executive director Ashley Fontaine said the minimum isn't enough. However, passage of the bill does show the community perceives the approach as effective. The training can connect members of law enforcement with other members involved in mental health response, she said.

Jen Dold said she does not disregard how tough police officers’ jobs are. It’s also the lack of available beds and long wait times in the hospitals, she said, and it’s the verbiage in adopted laws. People in crisis need more than the 72 hours allowed for emergency custody in state statute to stabilize. There is a specific skill set required by those who respond to someone going through a severe mental health event, she said.

Only 44 percent of adults and 20 percent of children with diagnosable mental health problems get the treatment they need, according to HHS.

The medical examiner released Alex Dold's identity, but has yet to disclose the manner and cause of death. A toxicology report is still pending.

Snohomish County Multi-Agency Response Team detectives investigated the March 21 altercation between law enforcement and Alex Dold. It may take weeks or months to finish, said Edmonds Police Sgt. Josh McClure, SMART public information officer.