And without access to services suited for their needs, people with mental health issues end up clogging hospitals and medical centers. In 2008 alone, says Rosenblum, there were 118,000 avoidable emergency room visits by people with mental health issues.

“I have noticed an increase in psychiatric admissions,” says Cheryl Bilka, a nurse in the cardiac ward at Valley Hospital and Medical Center. “We’re seeing more and more patients who aren’t on their meds, probably because they can’t afford them.”

In June, Bilka admitted a man with obvious mental health issues. He refused to give up any personal belongings.

“He was hiding a pretty big knife,” Bilka says. “He pulled this knife, this switchblade, on me. He had to go to jail in shackles. He wasn’t a safe person to have around.

“It’s a growing problem,” Bilka continues. “Our hands are tied. What do we do with these people? Eastern State [Hospital] is full. Sacred Heart’s full. … It’s going to get worse until somebody gets hurt or killed.”

THE CLOSE CALL

Once, Ethan Corporon called his sister Tracy to say aliens were upstairs in his house and he had been trapped in the floor below for hours, sobbing.

Another time he told her that he was walking around his neighborhood in the middle of the night with a shotgun, trying to break into houses, because voices or aliens were telling him to do it. Recently, Ethan said his daughter, who lives with her grandparents, was communicating telepathically with him, telling him that someone was molesting her at day care.

When Tracy would check in on her 29-year-old brother, who was living in Spokane’s South Perry neighborhood, she would see it for herself: Ethan talking to people not there, holding hands with imaginary children, wiping their faces clean or fixing their seat belts in the car.

“Everything he was talking about was real to him,” Tracy Corporon, 38, says. “I would tell him, ‘I believe you’re experiencing everything you’re telling me. Let me know when you want to do something about it.’”

Then in late October, Ethan called Tracy again.

“I’m ready to do this … ”

“Ready to do what?” Tracy remembers asking.

“... if you can come pick me up.”

“Are you talking about going and getting some help?”

“Yeah.”

Tracy picked Ethan up and headed toward the emergency room at Sacred Heart. She knew her brother needed help, and some medication. Having suffered from mental health issues herself, she could tell things were getting out of hand. For months, Ethan had been growing marijuana in his house and self-medicating. Pot had seemed to help level out his moods at times, but he also had a violent streak — smashing things, punching girlfriends, threatening to kill them or himself.

Indeed, he had been arrested and institutionalized at several points in his life. “When he has emotions that he doesn’t know how to deal with, they come out explosively,” his sister says.

But at that moment, driving to the ER, Tracy was thinking only about Ethan’s shotgun, which he had buried in some mulch in the yard. She planned to get it as soon as he was admitted to the hospital.

In the waiting room, Ethan filled out a form indicating he was paranoid and delusional and, Tracy recalls, “I think he wrote on there, ‘I need some help.’” They waited for hours before being moved into a private room and then waited some more, Tracy says. When a mental health professional arrived, she asked Tracy to wait outside so she could talk with Ethan alone.

Less than 10 minutes later, Ethan came into the waiting room, angry, carrying a pamphlet with information about mental health providers.

“I don’t have insurance,” Tracy recalls him saying. “They can’t help me.”

Sacred Heart officials say Ethan was not turned away for lack of insurance — they don’t reject people who can’t pay for services — but they say he didn’t meet the criteria for in-patient care.

As they left the hospital, Tracy asked Ethan if she could get the shotgun when she dropped him off. No, he said, “The gun’s fine.”

“I had to take him back to that house, where I knew he had a gun, where I knew he was not himself, telling me he was walking around doing crazy shit, so I was scared for him,” Tracy says. “Kind of waiting for a phone call, to say something happened.”

Two weeks later, something happened. It’s not exactly clear what — Tracy’s come to believe “something happened in his head. I don’t think anything externally happened.”

On Nov. 12, Ethan fired a couple shots into a house on West Buckeye. His father, Marc, was inside and immediately called Ethan’s cell phone to stop him shooting. “He said, ‘I’m going to kill you. I’m going to make the news now,’” his father recalls.

Ethan fired a few more shots into the house and drove off. Officers stopped his truck less than a mile away, outside of the Shari’s restaurant on Monroe Street. Ethan got out and fired his shotgun into the air. Some witnesses said he also shot at police, and six officers returned fire, shooting a total of 26 rounds. He was hit twice and killed.

Tracy was shopping for winter gloves at Kmart when she got the call she had known was coming. It was her sister on the line. Something had happened.

Tracy rushed to a TV and watched the news. Ethan was dead, shot by police.

She doesn’t blame the officers — “I don’t believe they would have done that if there was some other way around it” — but she can’t help thinking about the day she took Ethan to the hospital, sitting there hopefully, waiting for him to be admitted so she could dig up the shotgun in the yard.

ON KILLING

Cops don’t like to talk about killing. It’s distasteful, uncomfortable. They deride colleagues who put themselves in the spotlight: Don’t act like a hero, especially when it comes to ending a life. And so it was with great reluctance that Spokane County Sheriff’s Sgt. Jay McNall talked about shooting someone.

He agreed to do it because he wants the community to know that cops are people — not killers, not saints — and none of them wants to shoot a citizen. He knows this from experience.

The night of June 3, 1994, McNall’s working the streets of the Valley when a report comes over the radio: person with a weapon on Alki Avenue. McNall is the closest deputy and as he pulls onto Alki, he sees a woman on the north side of the street yelling on the phone.

As he turns the wheel, his headlights light up a man in the middle of the street, covered in blood, holding a butcher’s knife. “I don’t know if it’s his blood. I don’t know if it’s someone else’s blood,” McNall recalls. “He’s just covered in blood.”

McNall stops his cruiser, gets out and from behind the door starts shouting at the man, who’s about 70 feet away, just at the edge of McNall’s headlights.

“Drop the knife! Get on the ground!”

The man starts moving toward him, at a trot.

“‘You’re going to have to f---ing kill me,’” McNall remembers him saying. “‘I’m not going to drop the knife. F---ing shoot me.’”

The woman behind McNall is shouting, and the man keeps coming.

“I’m telling him, ‘I don’t want to shoot you. Just drop the knife, get on the ground and we’ll deal with this.’”

As the man closes in, McNall moves from behind the car door and retreats to the rear of the cruiser. “I can’t back up as fast as he’s advancing,” McNall says.

“Drop the knife!”

The man raises the butcher knife and reaches the back of the cruiser. He’s not slowing. McNall fires twice and the man drops to the ground.

“Next thing, I’m on the air, telling them what happened,” he says.

Soon, the whole world is on the scene. The man, later identified as John Gary Hove, is dead. Someone stuffs McNall in a car and whisks him to a nearby fire station, where he gives up his gun and makes a brief statement.

“You go from being the police to feeling like a criminal in a matter of 30 seconds,” he says. “As nice as the department is … I felt like I had done something wrong. I felt that my career, my whole life, is in danger now.”

Then comes the torrent of second-guessing in the media. You can’t defend yourself, McNall says. You can’t clear your name or even talk to colleagues and family, because they could be part of the inevitable lawsuit. Soon you’ll start receiving letters from attorneys threatening to sue you.

A couple days after McNall’s name is made public, however, he receives a much more immediate threat: Hove’s friend, who was institutionalized at Eastern State Hospital, has escaped, but not before writing a letter graphically describing how he intends to hurt McNall and his entire family.

“I’m calling everyone who has any association with me, ‘If anyone shows up at your house … get on 911,’” McNall recalls. The media doesn’t cover the threat against McNall, but the escapee is captured the following day.

“It was the most stressful 24 hours of my life,” McNall says. “I have a very large family, and I can’t bring them all together and protect them.”

The stress doesn’t end there. There’s a criminal investigation, an internal review, a civil lawsuit.

And there’s the fact that he killed someone.

“You have to be an extremely emotionally stable and strong person to get through that without it completely and totally affecting your life,” McNall says. “It changed me some, and there’s just no way around that.”

Sixteen years later, McNall says the memory has lost some of its sting. He’s more troubled now by growing tensions on the streets — between law enforcement and citizens — and he attributes a lot of anger to the poor economy, to the uncertainty it creates.

As for the Lakewood ambush, he and his colleagues stopped going to coffee in groups. “It had a huge psychological effect on folks. That’s four people in uniform. They flat got murdered, for no reason. ...

“[Law enforcement officers] who were not paying attention, who were a little lax, are now paying attention.”

NEW REALITY

Back in 2000, Don Pierce, the executive director of the Washington Association of Sheriffs and Police Chiefs, was hired as Boise Police Chief after the city had been rocked by citizens dying in police shootouts.

Among his first actions? Looking for comparable numbers for officer-involved shootings elsewhere.

“I wanted to see was I crazy? Is this normal? And there was no data,” he says. “The FBI does good information collection on police officers killed in the line of duty, but …”

When it comes to citizens killed or injured in armed confrontations with police, “Nobody collects that data,” Pierce says.

Pierce made this point in October, during a special hearing called by the Washington State Senate Judiciary Committee. Senators had questions about the apparent rise in officer-involved shootings in the year after the Lakewood ambush.

“I chaired the Governor’s Committee that reviewed Lakewood. One of the recommendations was to get a grant to study armed conflicts,” Pierce says.

There is also a matter of perspective, Pierce adds. “One of the discussions that gets lost in all this is the thousands of times officers are legally justified to use force but they don’t, and nobody knows about it. If you are in a situation where you say, ‘Drop the gun!’ and he does, it’s over. It’s a two-page report.”

Next Page: Local law enforcement get defensive. Plus, an altercation at a bar turns deadly.