Last week, we looked at a positive response from a mental health crisis team in New Zealand. Over the next two weeks, we’ll look at the darker side of the services.
It’s Friday afternoon at 3pm, and I’m starting to think about the weekend. I decide to take a break from my writing at the office, and phone up a mate to see what his plans are.
Five rings, maybe six, and he answers. We exchange the usual greetings, and something seems slightly off, like maybe I’ve caught him in the middle of something.
“So what are you up to?” I ask.
There’s a long pause, and he exhales. “Um…I’ve just finished writing up a note. I’ve locked the car in the garage, and I’ve got a hosepipe ready.” He speaks deliberately and factually, without any heightened emotion, as if he were talking about sneaking a Quarter Pounder meal when he’s supposed to be on a diet. “I was just heading to the car,” he adds, more quietly.
“OK,” I answer, trying to keep my voice as calm as his seems. “I’m going to get in the car right now and come over. Do you think you can hold off doing anything till I get there?”
I hang up, and try not to get overwhelmed by the fact that had my random thought about weekend plans popped into my brain ten minutes later I might not have got an answer on that phone.
I turn to my colleague Martin and explain what’s just happened, and race out the door.
I’m halfway there when my friend phones me up. “The police are here,” he says.
“I rang another friend after I spoke to you and he phoned 111 and they’ve sent the police here. They’re taking me down to the police station.”
“OK,” I process this new information on the fly, thinking it bizarre that the police have been sent out to the home of a suicidal person where there’s clearly no indication of violence, or that the person is in possession of a weapon. Where are the crisis team?
I tell my friend I’ll meet him at the police station.
Ten minutes later, I’m sitting in the waiting room at the police station, and I get another call from my friend. “I’m at the hospital now.”
“What’s going on?”
“They were going to take me to the police station, but then they’ve stopped and had a talk to someone, and they’ve been told to bring me to the hospital,” he answers.
I head up to the hospital, already amazed at the blind confusion caused over how to deal with my friend’s emergency. Although the two police officers were incredibly courteous and caring, he was still alarmed at their arrival, and while they’d told him he wasn’t under arrest, he says he was “strongly encouraged” to get into the car. At no point was he told why he was being taken away.
In retrospect, I suspect the to-ing and fro-ing of hospital vs. police station was a game of pass the buck going on. A pair of confused policemen were soon to be least of our worries.
I get through into the ward, where my friend is sitting up on a bed with a curtained-off screen around him. He’s already had his clothes bagged and taken off him, and been changed into a backless surgical gown (as asked by Red Dwarf authors Rob Grant and Doug Naylor, why backless? Why do doctors need to get to your arse in a hurry?)
We have a few minutes on our own, and my friend starts to tell me what’s been going on for him. It’s a classic male story of pressure upon pressure that’s been building up for a year, and he hasn’t felt able to tell anyone about it. Already, he feels embarrassed at the fuss he’s caused.
He tells me he’s been drinking non-stop since the start of the week, and not eating. An incident had occurred at the start of the week where he finally hit the wall, and Friday’s aborted suicide attempt was the culmination of several days in the mental wilderness of despair.
“I really need help,” he says, in the same matter-of-fact tone he’s had throughout the whole incident. “I just need a bit of time to recover, but I can’t be at home.”
This is not a man who would ever ask for help. To the outside world, he is a paragon of strength and independence. To make an admission like this is a watershed moment, and an incredibly vulnerable one.
From my cursory knowledge of the mental health system, I’m guessing that he’s not going to find it easy to get checked into a mental health ward, unless he is very clear about the fact that at present he is a danger to himself and needs to be supervised. I encourage him to be utterly truthful about what has happened this week and how he’s been feeling.
In the meantime, various staff shuffle in and out with clipboards asking questions. No-one identifies themselves or tells us what is happening.
Then come the big guns. I assume they’re crisis team staff, although they do not identify themselves as such. A man, and a woman. She has the clipboard, he has the look of a social worker who’s been brought in to tell off a bunch of schoolboys for scrumping.
For the next ten minutes, my friend patiently explains how difficult things have been for him. I remember holding his hand at various points because this was tough stuff to talk about. As soon as alcohol was mentioned, the shutters went up.
The man changed into the role of a head dean crossed with a ‘Just Say No’ campaign volunteer, and started saying things like, “Well until you sort this drinking out we can’t help you. Because it’s like the chicken and the egg. Are you drinking because you’re depressed or are you depressed because you’re drinking? We don’t know.”
The life events and circumstances that had been explained clearly showed to me that the drinking was a coping mechanism and not the root cause of my friend’s problems, but Head Dean wasn’t interested.
When my friend requested to be admitted to a ward, he responded “if we admitted everyone who came in here because they’ve been drinking we could fill this hospital three times over”.
At this point, my friend had had enough. He got up off the bed, and said firmly but not aggressively, “Right. You’re obviously not going to help me. Could I have my clothes please?”
“Now calm down.”
“I am calm, I just would like to go. I’ve come in here asking for help, and what you’re basically telling me is there’s nothing you can do and sending me off out to catch the bus home.”
The woman with the clipboard grips it more tightly, as if she’s about to get caught in a scene from a Bruce Lee film. And who knows, maybe she might have been – after my friend decided to get back on the bed, Head Dean casually slipped into the conversation that he had a black belt in martial arts.
The veiled warning did not go unnoticed by me. I couldn’t stay silent any longer.
“We’re hearing a lot from you about what you can’t do, how about you tell us what you can do for him,” I said. “I’m getting the distinct feeling that if he’d come in here bleeding all over the floor you’d be paying more attention. Can you prescribe him any medication to calm him down? Is there any counselling available? Can he be supervised over the next few days until he’s feeling safer?”
Suddenly, we start hearing the word “yes”, and my friend – much to my surprise – opens up about further damaging events in his life involving grief and loss that stretch back at least a decade. Now Head Dean shuts up and listens. It’s blatantly obvious now that my friend has been a pressure cooker, bottling crap up inside for years until today it finally exploded.
There’s promises of counselling referrals, and temporary prescriptions for anxiety medication, but he doesn’t get his overnight stay in the ward. When I saw that things were going south, I offered – in front of the crisis team – for my friend to come and stay with us for the night. They leapt on that opportunity like a Frenchman on cheese.
The ordeal was long and humiliating for my friend. Despite clear signs of distress (including the clearest sign of all – an interrupted suicide attempt), he was treated like a middle-aged, middle-class drunk who just needed to get his act together and sort his shit out. The phrases “harden up” and “get over it” were not used, but they may as well have been.
The follow-up care over the next few days was even worse. Called by different staff members who seemed to have little knowledge of my friend’s case, and one who expressed surprise that he didn’t know where the counselling centre they’d referred him to was, and asked him to look it up in the phone book because she didn’t have the details.
The nail in the coffin was a follow-up call after the weekend from Head Dean, after my friend had managed to get himself in touch with a GP and a counsellor (all on our own organising, without any help or referrals from the crisis team).
Head Dean’s softening in attitude disappeared on the follow-up call, which ended with my friend hanging up. Why did he hang up? Because when he said to Head Dean, “I get the feeling that you don’t actually care whether I kill myself or not”, he answered: “I don’t.”
My friend is on the road to recovery now, and has started to address the melting pot of issues that have gone untouched for many years, but it’s no thanks to our experience with this particular crisis team.
Head Dean had volunteered while we were at the hospital that he’d been working in this field for nearly twenty years. I’d venture that’s been about nineteen years too long.
Compassion fatigue (I’m assuming he had some in the first place) is the most insidious illness that a mental health crisis worker can have. Those who don’t care about what happens to the wounded people that come through their doors have no place working in an emergency room.
This isn’t an episode of “House” where we can laugh at the funny quips from the rude doctor. It’s real life. And death.