How to better handle mental health crises

This entry contains mentions of suicidal thoughts, mental health crises situations, self-harm, and traumatic hospital experiences. If you are not in a good place mentally, please seek out help. A great place to start is 7 Cups, where you can find free peer support and low-cost therapy. If you are in crisis, please consider calling your local crisis line, or the National Suicide Prevention Line at 800-273-8255. If it’s possible, reach out to a close friend or family member who will be understanding as an alternative. Your life is important, and the world is better with you in it. I promise.

“Have you recently thought about killing yourself?”

“Have you made plans to kill yourself?”

“Have you had an urge to act upon them?”

“What would your friends and family think if you went through with killing yourself?”

“Have you harmed yourself? How?”

“Name two reasons for living.”

The list of questions becomes longer the more at risk you are, and although I understand a certain level of bluntness is needed to determine the safety of the person in crisis, this could be handled so much better. In my case today, I had difficulty answering several of these questions, felt ashamed, embarrassed, and extremely irritated. It didn’t really help me at all.

I haven’t accomplished much in my life. I have quite a bit of experience with being told I’m too much, overwhelming, or just horrible. I have years of trauma resulting in BPD, PTSD, a panic disorder, OCD, and other issues. I’m autistic. I keep to myself and often worry if people truly like me or are just being polite. I’m always concerned that I’m a burden.

When the above questions were asked to me, among many others as they built off of my answers over the phone, I recoiled. I experienced very real physical sensations of my skin crawling, jolts of anxiety, and burning irritation. I have always found the questions intrusive, although that’s not necessarily the professional’s fault.

When asked what caused my crisis I’m currently in, my head spun. I became annoyed. It would take hours to explain. There has been a ridiculous amount of trauma in my life and when I’m feeling suicidal, that’s the last thing I want to go into detail about with my case manager. Again, that’s my issue, not theirs. They’re not doing anything wrong. I should be able to be open because I truly do want help, and I seek it out when I can as I need it.

I feel there could be better tact in the way required questionnaires are worded, though. Such blunt terminology, and open-ended questions I can’t possibly know the answer to (hello, autism), bring me more stress than comfort. I don’t know what my friends and family would feel if I died. Personally speaking, I often feel as if it’d be a weight off their shoulders. They may be relieved. They may be distraught. I can’t answer that question. Thinking about it just reinforces the negative feelings I had because it brings on guilt, and then I feel selfish for being in crisis. That’s not the intended effect, but this has been a part of the conversation around suicide for a while now.

Centering a suicidal person’s struggles on how others would handle it, or be hurt by it, isn’t helpful.

Likewise, using such blunt language can be a huge trigger. “Are you currently suicidal?” “Have you thought about taking your life?” While still blunt, there’s a huge difference in wording that sounds a lot easier on the ears, and it doesn’t make me feel like I’ve been hit with a battering ram.

“What are two reasons to live for?” is another question I struggle with. I truly don’t have a lot in my life to name. I stick to myself, I don’t have anything going on, and the only reason that pulls me back from the edge every time is that my cats need me. They can’t take care of themselves, and I love them too much to let them go without.

All of the questions are delivered in a formal manner. I feel like I’m at a job interview rather than trying to keep myself safe. Again, I’m not harping on anyone trying to do their job. I just wish there was something more to this whole crisis prevention thing.

Instead of asking me to name things, or asking me to figure out how other people would struggle due to my problems, why not just… give me hope? The most important thing a suicidal person can hear in the moment isn’t anything they tell themselves. It’s what they hear from others.

Often, when suicidal, it’s important for someone else to say, ‘I would miss you’ or ‘be sad if you died.’ ‘You’re not a burden.’ ‘Think of (this thing) and (this thing) you may not have thought of that you’ve accomplished!’ Often, others see things we’ve done in ways we can’t, especially in crisis. Having to answer these things myself just makes me irritated and want to withdraw even more because I can’t think of anything, which furthers the reinforcement of the initial feelings that put me in crisis.

The questions are for clinical purposes, but in the end, the way mental health crises are handled in America still needs a lot of work. It’s a very blunt, and often traumatizing, experience for the already traumatized. Often, we will say we are safe at home when we really aren’t due to the poor quality of treatment in hospitals.

We also may fear emergency help at our door, which could take the form of a crisis prevention police officer or an ambulance, which adds loads of stress to what we’re already experiencing, and then we have to hope they have training and don’t hurt us, put us in handcuffs, or force us to do something we don’t want to, such as being involuntarily committed.

Thankfully, I’ve never had to face a crisis intervention on that level because I’m aware of the possibility. I don’t lie, but I certainly skirt the truth. I’ve been in the psych ward a few times, and while it kept me from dying from a suicide attempt or from even going through with one, it is a cold and sterile place with nurses that may get frustrated with patients. I watched a helpless old man, who had been homeless, have food thrown on the table by a nurse who got frustrated, yelled at him, and left after he kept dropping things.

If I needed my PRN (as-needed) medication for anxiety because I was shaking like a leaf and terrified, I was handed one through a window guard and sent to bed alone. I spent a few nights crying by myself in the dark with no one to check on me, only to be woken up at the crack of dawn and threatened with the reality that if I didn’t get up, eat, and go to group, I couldn’t go home.

When first admitted, I had to strip down into a backless gown so a team of nurses could come in and look at my naked body to make sure I didn’t have injuries anywhere else, and the entire time I felt ashamed and embarrassed because complete strangers were looking at my nakedness. No one bandaged the wounds on my arms. They left me to redress and head out into the community room while I had to ask for my sweater so I didn’t bleed on the table.

The first or second time I’d been admitted (brain fog makes it hard to remember things), it was late at night. I had medications in my bag in a pill box because I had to take my medication to work at night, and I was met with policemen — two of them — who walked into the community room while I tried to eat a snack. They stood over me and questioned me, and I said the medication was mine prescribed by my doctor. I simply took it to work because I worked at the same time I had to take it.

One remained with me with his hands clasped over the table, sitting across from me and staring me down. The other went to the nurse’s station to confirm what I said was true. The entire time I was terrified. I’d never done anything illegal in my life. I’d never been in trouble with the cops and was as straight-laced as they came. I had no record of any kind.

Finally, they left and I remained in the dimly lit community room. I felt less than human. In a matter of minutes, after the nurses scoped my naked body and left my injuries unattended, and police officers coldly interrogated me, I felt institutionalized in every sense of the word. There was no love. No care. It was all quick and cold, and merely to be sure there were no problems.

Don’t get me started on group therapy, in which religion was forced on me that I didn’t want, and the art therapist argued with me about the meaning of my drawing. And the sexism. Women weren’t allowed to shave, but men were. If one floor of the psych ward did something bad, we were all punished. We had our coffee machine taken away because someone on the floor below us threw theirs across the room.

I’m not trying to discourage anyone from going to the hospital if they are a danger to themselves or others. The hospital truly did keep me from going through with the inevitable. Despite how awful my experience was, that was one place. There are far better hospitals I’m sure, but since I’m low-income and on state insurance due to being disabled, my choices are limited.

If you are in crisis, please get help. Do what you can to protect yourself. That’s far more important than the current imperfections in the system. Surviving is key.

But many of these reasons are why people don’t seek out help. The whole process is cold and controlled, and very institutional. It’s a system. And I understand the need for a system, but in reality, what someone in crisis really needs is someone who cares — or at least acts like they care.

In the case of being transgender, the process can be doubly bad. Not only do we have to fear discrimination, but the act of being forced to strip and be looked over, which will out us and possibly open up awkward questioning, is traumatizing in itself.

If it must happen, it would be better handled by well-informing the patient of the intentions and the necessity, asking if there is anyone they preferred to do the inspection, and simply just letting us wear a pair of fucking underwear during it.

Things need to change. In times of crisis people have to respond quickly, but it should also be possible to be humane and compassionate while responding quickly.

If we want people to continue to seek out help, we have to make help a non-threatening thing.

Word questions in a way that are sensitive to the person who may be moments away from taking their life. Give us reasons to continue instead of asking us to figure that out ourselves, since we obviously feel we don’t have reasons or we wouldn’t be in that position. Don’t make our struggles about other people and what they feel or would have to say about it.

Treat us like humans who are in pain. A lot of people with trauma have a serious lack of love — or a sense that they are not loved. Going through the motions and being blunt, distant, and cold may enforce that we feel like a burden, are in some kind of system, and that no one cares.

To the doctors, hospitals, and crisis prevention people who are doing it right and are compassionate, thank you. Ultimately, a person in crisis is someone who needs love and handled with care, even if they may not want it. It’s far better than the alternative, which will lead to less people seeking help, and will end in more lost lives than there needed to be.

©2021 Shane Blackheart

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