Combat as Care

NPR ran a story yesterday about mental health care on campuses. About half-way in, a woman with bi-polar disorder describes what happened when she confided in her family about the extreme emotional pain she was suffering. She felt better after talking and went to sleep, but they called 911.

“And about an hour later, there’s banging on my door,” Gelender remembers. “I go to the door, and there’s two armed police who barge in, [saying] ‘Where are your pills? Where are your pills?'” The officers ransacked her room, she says. They searched her shelves and combed through drawers, all the while yelling a steady stream of questions.

“I’m half-naked,” she remembers. “I’m dressed for bed, and you know, they’re like, ‘Are you going to kill yourself? Are you going to kill yourself?’ And I’m just like, ‘No. I’m not going to kill myself.’ And they’re threatening to take me to the psych ward, and they’ve got their handcuffs in their hands. I don’t know what you say to convince someone that you’re not going to kill yourself besides, ‘No. I’m not going to kill myself.'”
The police phoned the psychiatrist on-call, and after some back and forth, they left. But the whole experience left Gelender horribly shaken.

A moment later in the story, a professional explains that “It’s better to have someone angry and alive than dead and dead.”

Talk about missing the point. How likely is it that someone who undergoes that kind of treatment will make themselves vulnerable again by telling someone how they feel?

Police, the general public, and even mental health providers often take a “combat as care” approach to people with mental illness. As someone who has worked in the mental health field, I have known police who respond with care and kindness, but I have also known them to needlessly escalate incidences and even to beat people who failed to respond as the police wanted them to, even though they posed no threat.

Even when people voluntarily report to the psych ward with thoughts of harming themselves or others, care may be denied until the patient agrees not to leave the ward until given the permission of the psychiatrist. In many cases, the doctors in this ward are wanderers who have been unable to establish their own practice or keep a steady job. In other words, they aren’t always up to snuff, though certainly there are also many that do a good job. The power dynamics are so skewed, that if the patient and psychiatrist are a poor fit, the experience can be hell for the patient. A doctor might insist a patient go on a certain med, even if the patient has had a bad reaction to it in the past, or a patient might have to listen to a doctor’s views on things that have nothing to do with mental health, such as gender roles, religion, atheism, or politics. Only once that doctor gives the okay can the patient return to their job, family, pets, etc.

Will a patient in this situation ever again willingly seek care?

As a nation, we are doing better at demanding that our doctors treat us as partners in our health care. This needs to be true in the mental health field as elsewhere. Yes, patients that are psychotic or imminently dangerous need to be stabilized before fruitful conversations can begin. But when the professionals accept a battlefield mentality on the part of the police or staff, they should not be surprised by casualties.



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