No Good Options: Navigating an Acute Mental Health Crisis in the Home

Borrowed from The Washington Post.

Borrowed from The Washington Post.

As I came home from work on Thursday, I could see one of my roommates on the phone at the other end of the house, waving me towards him, a look of concern and distress in his eyes. We went outside, where he shared what had happened a few minutes prior. He, who I’ll call L, had just had a bizarre interaction with our other roommate, who I’ll call M. (I’ve changed the identities, left out specifics and received M’s permission before posting this.)

M had all of the sudden begun speaking incoherent non-sequiturs to L and locked herself in her room. He didn’t know what was going on and didn’t know what to do. What followed was a four-hour series of events where I tried to assist someone experiencing a severe mental health crisis while encountering my own unfitness to do so and the frustration at a lack of safe options available.

M has what is considered in the dominant society to be a mental illness requiring medication. It’s unclear if she stopped taking the medication or if recent events led to the medication not being effective. Fortunately for this situation, I have both experienced and spent much time with people who have unmanaged mental health issues. While feeling intense frustration, weariness, and helplessness during our encounter, I tried to be guided by both compassion for the intense suffering of an unwell person and by reflecting on how I would want to be treated if I were experiencing what she was experiencing.

It came down to the fact that she needed help which we could not provide. I had a long talk with her to figure out what was going on. I then asked for her mom’s phone number or to unlock her phone so we may call her together. Failing in that, I called the county crisis line in her presence and explained what was happening. They suggested I take her to the emergency room or call 911. M refused to go to the ER. I tried to convince her, but to no avail. As her state was quickly deteriorating and her willingness/ability to communicate diminishing, we were in a difficult situation.

I felt out of options. I felt angry that I might have to call 911 and I felt fear and responsibility over what might happen if I did. I have little confidence in the ability of the police to assist someone in acute mental crisis. M is Black and I have even less than little confidence in the ability of the police to assist a Black person in acute mental crisis. Feeling a tremendous responsibility and concern for this person’s well-being and my own incapacity to tend to it, I was at a loss. In that moment, I felt severe frustration that there was no way that I was aware of to provide help to someone without involving the authorities. I was aware that I was not about to create such supports within the next five minutes.

Between a rock and a hard place and with the hour growing late, I had to make a decision. I again requested that M allow me to take her to the ER. She again refused. I told her that I was going to call 911. I told her what would probably happen and I made sure the house was police appropriate. I sat next to her as I dialed. I told them I was requesting a wellness check, that my roommate was in crisis, but stressed that she was calm, unarmed and non-threatening. I hung up wondering what I had set into motion.

Fortunately, the police took quite a while and before they arrived, M agreed to go to the psychiatric ER. The police were arriving just as we were driving away and I told them it was all under control. We arrived at the psychiatric hospital and M was evaluated and 5150ed, or placed on an involuntary psychiatric hold for 72 hours. I went home to begin the task of checking in with my other roommate, trying to find a way to contact M’s mother, and taking care of myself.

I do not know if I did the right thing. I don’t know if there was a right thing to do. After reading The Icarus Project’s handout on “Navigating Crisis”, I feel better about what transpired, though still not satisfied. I did the best I could with the information and tools that I had. I don’t write this to gossip or draw praise, but to reflect. How do we as individuals and communities support individuals in crisis? What would that look like? What options exist that I am unaware of? How would you have handled this situation?

Bringing M to an institution where she is being held against her will and encouraged to take medication does not sit well with me. I am not saying anything new, but I feel that not only do we need different ways of assisting those in crisis, we need different criteria for what constitutes a crisis. Medicating someone who is experiencing reality differently in order to bring them back into conformity is not an acceptable solution. Deinstitutionalized spaces need to be created to allow for different expressions of existence to occur in a safe place. Medication should be a last resort. Some “abnormal” mental states may be strictly biological in nature, though that does not necessarily make them undesirable and unwelcome. More often than not, I believe what is currently considering “mental illness” is the body and consciousness naturally rebelling against the unnatural strictures placed on it by an unhealthy society. As Krishnamurti said, “It is no measure of health to be well adjusted to a profoundly sick society.” Or Vonnegut, “A sane person to an insane society must appear insane.”

The role of psychiatry and psychology is far too often to assist in adapting people to their circumstances, when those circumstances are alienating, unrewarding, depressing, stressful, and violent. Instead, mental health should be focused on healing the traumas inflicted by life under modernity while empowering individuals and communities to actualize their manifestations of a life and world worth living – where police, psych wards and medications are not the one and only solution, but where those in crisis are held and cared for within a liberatory framework as they experience their distress/transformation. Fortunately there are many exceptional mental health professionals doing just such work. One hopes that they move from being outliers to being the norm, and in doing so reorient the field as a whole.

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