You don’t need to have a seriously mentally ill loved one to brush up against madness every time you go out in public, right New Yorkers? Correct me if I’m wrong. I’d like to be wrong.
Who among us hasn’t had the heart-pounding, palm-sweating, prayer-inducing experience of finding yourself in the same subway car as someone yelling violent nonsense between stops?
And yet – believe it or not – NYC enjoys big bragging rights for allocating substantial funds for mental health programmes under the current Mayor and First Lady. NYC Thrive, our billion-dollar initiative describes itself as ‘an unprecedented commitment across 12 City agencies to implement over 30 innovative programmes that reach hundreds of thousands of New Yorkers every year’.
So when you find yourself in month six of the pandemic, working full-time from home and feeling pretty fragile yourself (it’s been six months!), listening to the downstairs neighbour yelling aggressive nonsense from his apartment, you’d feel reassured you don’t live in Texas, right? Those 30 Innovative Programs should come in handy now that it’s a full-blown emergency that requires immediate psychiatric intervention, shouldn’t it?
My close friend would shake her head and think you are impossibly naive for making that assertion after living the above scenario for four months. And honestly, couldn’t it have been any of us, either suffering a breakdown or reporting one? Not hard to imagine if you’re living in a rational world. I got involved in Philadelphia, hoping to help – preventing this sort of crisis is why I do my advocacy work, after all. One day I hope to live in a country where this didn’t happen so much.
But for now, my knowledge of how these things unfold helps only if you define ‘help’ as identifying grave structural, systemic failures to your friend who’s panicked someone’s about to get seriously hurt, die or sent to jail. But I try anyway, always hoping the system’s improved since my last interaction.
I wish I could tell a different story this time. Trigger warning: this will sound disturbingly familiar if you’ve been a central player in a mental health emergency. I’m writing about it for those of you who haven’t and/or will feel compelled to join me in working for reform. We’ll call my friend Frieda and her neighbour Mr X.
Phase 1: NYCWell to EMS to NYPD
Since May Frieda and her partner, John (fun picking out fake names!) have been listening intermittently to aggravated shouting from Mr X, their downstairs neighbour. It’s been getting steadily worse, finally reaching a fever pitch three weeks ago when the yelling became non-stop. She had no idea where to turn; calling the police could result in unnecessary violence and Mr X didn’t belong in jail. A google search produced info about NYCWell so she began there.
Frieda’s cell has an upstate area code so she was connected to services there and then routed to staff in Brooklyn, who were helpful and responsive. She learned of an option that sounded appropriate; the ‘mental health check’ which sends EMS out to make an initial judgement of the situation and decide whether cops are necessary. They arrived and found Mr X barricaded in his apartment, refusing medical treatment. He was so agitated it took the police, called in for much-needed support, hours to get him into an ambulance. He still had some fight in him on the way out of the building because he stopped to spit on people sitting outside at a bar. It’s hard to imagine a clearer case of a person being plainly ill. The only consolation in seeing someone in this state taken into custody is that you can feel confident they’ll be heading straight to a psychiatric ward and not prison. There’s nothing like it in the world if the sick person is someone you love and it’s pretty singular even when it’s a neighbour you don’t really know. The whole building, staff and patrons at the restaurant watched the ambulance drive off and stood around in absolute shock.
Phase 2: Where is Mr X and how long will he be there?
Now we come to the part where I got involved. As I said earlier, I’ve been through it with a loved one and know a thing or two. I started by calling the local ER rooms to see if he’d been admitted. Five hospitals had no record of recent admission but one said he’d been there before. I moved on to the local police precinct. Frieda’s street is divided by side and I was given to the appropriate office. Whoever picked up the phone looked it up and told me where he’d been taken. Success! I knew this was about all I could do since HIPPA laws would prevent hospital staff from giving information to anyone except those Mr X named. I called the hospital and got the number of the psych ward and social worker he’d been assigned. I left her a voicemail knowing I wouldn’t get a callback.
As straightforward as that all sounds, it’s anything but and took me about two hours. But the resulting relief was well worth the effort and I hoped Frieda could relax a bit now. She and her partner were deeply shaken up and worried that Mr X would either never make it to a hospital in the first place or be discharged in a day or two.
Frieda was not especially relieved and also stunned that no further information could be shared (who could blame her?). How would they prepare for his homecoming if they didn’t know, even vaguely, when he’d be discharged? More importantly, would he be stabilised when allowed to return? And might he know it was her who’d gotten the authorities involved?
She started making her own calls and got the social worker who said there was nothing they could do if he refused treatment, no information could be given regarding a release date or discharge plan and that they weren’t responsible in any way for his care once released. I reassured her that someone who put up a fight for hours and exhibited such clear symptoms of psychosis would be held for at least 14 days. Maybe he’d get a 60-day hold even but definitely no less than two weeks. I backed it up with information I found about NY State legal holds on the city’s Office of Mental Health site.
I was wrong.
One week later he was back in his apartment, only slightly less loud and persistent with the yelling. Now it was my turn to be stunned. Frieda told me other neighbours were trying to locate friends or family through social media and coming up empty.
Phase 3: Here we go again
To be clear, no one involved wanted anything for him but long term treatment. The residents nervously wondered what to do over the next four days as he got worse and worse and began burning enough incense to set off all the fire alarms in the building. It had taken about a week for Mr X to be as out of control of his mind as he was before the last hospitalisation. He was spending more time in the halls and residents took copious iPhone video footage. Once again it was my friend’s household that made the call, but this time it was her partner John. He was seriously worried the building would burn down.
Frieda had been paralysed for days after being given contradictory information from NYCWell and the Mobile Crisis Team who would be making the visit. The Mobile Crisis Team member she spoke with was adversarial and suspicious of her motives.
Why was she so hung up on being anonymous? Why would she want him to lie to her neighbour about who’d made the call? And no, the landlord couldn’t make the call either because they weren’t on site. Video footage meant nothing.
She wondered why all involved parties, now including the psych ward, social worker from the hospital, responding precinct, NYCWell, and Mobile Crisis Unit were not communicating? What was the subcontracting arrangement? How could there literally be zero coordination happening in real-time?
Because she couldn’t remain anonymous, Frieda had to cancel the Mobile Crisis Team visit, which would have provided a social worker, psychiatric nurse or psychiatrist for on-site counselling that would determine his need for intensive services. Maybe they could have offered an intervention more substantial than once-weekly outpatient care but less frightening than hospitalisation.
The one 911 call, made in a panicked state as the fire alarm, triggered by Mr X’s manic incense use, rang ear-splittingly through the building wasn’t enough. It took 3 different households and 5 calls before residents could convince EMS to take him into custody. When Mr X was led out of the building for the second time in under three weeks he was crying and deferential. No consolation to cling to this time that he’d even make it to a hospital, let alone be kept long enough to stabilise.
It’s been 72 hours and he’s still gone.
Calls would be futile. No friends and family are around. The landlord and prior social worker say all they can do is call 911 if this happens a third time. Or a fifth time. Or a fiftieth.
The central issue here is the lack of community resources and long term custodial care that began with the deinstitutionalisation movement in 1963. The only two options for people with serious mental illness cannot continue to only be jail or homelessness, peppered with occasional short hospitalisations.
We should also be able to ensure that those suffering from severe mental health issues in our communities are receiving the long term mental health care that they need while remaining anonymous and safe. The requirement to give your name surely inhibits neighbours, friends and colleagues from making appropriate referrals.
You don’t need to be concerned with the well being of ill people to support these reforms. Like it or not, your tax dollars are being spent to chip away at this problem, and it’s only a matter of time before you and your family suffer as a direct result of these local failures.
Phase 4: My cry for help
I write this as a last-ditch effort to get help for Mr X, his community and all of us. We’re all vulnerable, each and every one of us.
I’m not a policymaker but this is not what a billion dollars should have bought New York.
Mayor DeBlasio, where are you? Please get on this.
Image credit: Freepik
Elsie Ramsey was born in California and moved all around the country growing up. She runs the website, What’s Your Story?