Helpful hints about what to do in a crisis, and a Post editorial

Happy Fourth of July!

A new Psychiatric Crisis Resource Kit that can help families if someone they love develops a mental disorder is scheduled to be unveiled this week in Chicago at the national convention of the National Alliance on Mental Illness. It’s been developed by the Treatment Advocacy Center.    

Of course, the first thing that comes to mind whenever someone mentions TAC  is its aggressive and relentless campaign to promote Assisted Outpatient Treatment laws. But whether you support AOT laws or oppose them really doesn’t matter. All of us with loved ones who have a mental disorder need to be prepared and from what I have seen so far, TAC has done a real service by putting together a mental health first aid kit.

When my son first became ill, I was completely at a loss about what to do. And based on the emails and letters that I receive weekly, other parents, families and friends find themselves in the same situation.

For instance, the kit recommends that families compile a list of telephone numbers for key people, agencies and organizations that should be contacted if there is an emergency. While that sounds like a no-brainer, how many of us have the telephone number of a mobile crisis team, a psychiatric case manager, or an Assertive Community Treatment (PACT or ACT team) handy? Do you know the emergency numbers for your community mental health provider? How about your local suicide hotline? Do you know if your community has a Crisis Intervention Team and, if so, how to contact it. What’s the number of a public defender who knows mental health laws? Or a private attorney? Is there a mental health court in your jurisdiction and, if  there is, do you know what sort of cases it will hear?

How about the telephone numbers for homeless shelters, a clubhouse or a peer to peer specialist? How about a contact at your local NAMI or Mental Health America?

The kit recommends that you have a complete psychiatric and medical history on hand during a crisis. Has your loved one filled out an advance directive? Do you know what medications your family member does and doesn’t want to take and why?

The kit spells out exactly what sort of medication information you might need, including such simple things as the age of your loved one when they were first diagnosed, any medications that have or have not helped in the past, dates and locations of previous hospitalizations, a list of current medications.

Of course, TAC also has included each state’s standards for involuntary civil commitment and information about AOT laws.  But there is also information about HIPPA laws and how to deal with doctors who don’t think they need to listen to parents or family members.

It’s important for all of us who have a loved one with a mental disorder to have thought about what to do if there is a crisis. Have you talked over an emergency action plan with the family member who has a mental disorder when he/she has the symptoms of his/her illness under control so that you can make sure that their wishes, when possible, can be carried out?

As I looked through a preview of the TAC kit, I realized that I had not done many of the common sense steps that I’ve just listed. Yes, I carry the name of my son’s case manager, psychiatrist and emergency numbers for CIT, a mobile crisis response team, and the local community mental health treatment center in my billfold.

But I’ve not got a folder with other vital information in it, including a signed advance directive or history of my son’s previous hospitalizations and medications.

Again, even if you are against AOT, it strikes me that this kit would be extremely valuable for family members and consumers to obtain. In addition to making the kits available in Chicago, you can get information about them by visiting the TAC webpage.

One item that caught my eye when I read about the kit is called IN A CRISIS GENERAL GUIDELINES.  I’m reprinting it exactly as TAC has listed it on its website and in its publication, The Catalyst,  because I wish that I would have had this list the first time that my son became ill.

Here is what TAC recommends.

IN ANY CRISIS: Your goal in an emergency is to stabilize the situation and get the person to professional help as quickly as possible.  

• Do not try to manage the situation alone – Sometimes just having another party present or on the phone with your loved one will defuse a situation.
• Start at the top of your Emergency Contacts list and work your way down – If it is an evening or weekend and you cannot reach providers or agencies, call the most appropriate hot-line.
• Speak to your loved one in a calm, quiet voice – If it seems he/she isn’t listening or can’t hear you, it is possible that auditory hallucinations (“voices”) may be interfering. Don’t shout; raising your voice won’t help and may escalate tensions.
• Keep instructions and explanations simple and clear – Say, “We’re going to the car now,” not, “After we get in the car, we’ll drive to your doctor’s office so she can examine you.”
• Respond to delusions by talking about the person’s feelings, not about the delusions – Say, “This must be frightening,” not “You shouldn’t be frightened – nobody’s going to hurt you.”  
• Don’t stare – Direct eye contact may be perceived as confrontational or threatening.
• Don’t touch unless absolutely necessary – Touch may be perceived as a threat and trigger a violent reaction.
• Don’t stand over the person – If the person is seated, seat yourself to avoid being perceived as trying to control or intimidate. 
• Don’t give multiple choices or ask multi-part questions – Choices will increase confusion. Say, “Would you like me to call your psychiatrist?” not “Would you rather I called your psychiatrist or your therapist?”
• Don’t threaten or criticize – Acute mental illness is a medical emergency. Suggesting that the person has chosen to be in this condition won’t help and may escalate tension.
• Don’t argue with others on the scene – Conduct all discussion of the situation quietly and out of the person’s hearing. 
• Don’t whisper, joke or laugh – This may increase agitation and/or trigger paranoia. 

Please distribute these helpful hints to folks who you think might benefit. You might also suggest that they read my friend, Dr. Xavier Amador’s book, I’m Not Sick, I Don’t Need Your Help which I turned to for advice when my son became ill. It stressed many of the same points.

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Two weeks ago, I reported on this blog that the Fairfax County Police Department had fired the police officer who fatally shot David Masters in November 2009 while he was sitting in his truck at a stop light. He was being pursued because he had taken flowers from a local business. He also had a history of mental illness.

Eight days after my blog appeared, Tom Jackman at The Washington Post confirmed that the police had fired the officer. Jackman identified him as David Scott Ziants, age 28.

Jackman reported:

No civil suit has been filed in the Masters case, but David Masters’s sister and brother-in-law have filed notice of intent to sue. David Masters, 52, named his ex-wife and stepdaughter as executors of his estate, but under Virginia law only family members are entitled to recover damages in a wrongful death case. Ziants declined comment Tuesday when a reporter knocked on the door of his Prince William County home.

The Post followed up that story on Saturday with an editorial that criticized the Fairfax Police Department for taking so long to investigate the case. One specific criticism that the newspaper lodged was that more information about the shooting had been released by the Fairfax County Commonwealth Attorney than by the police.

“Tellingly, most of the details about the case were disclosed by the chief prosecutor in Fairfax, Raymond F. Morrogh, not by police.”

While I appreciate the editorial, I was surprised that the Post seemed to be praising Morrogh. Yes, he did act more swiftly than the police and he did reveal more information, but his explanation for why he had decided to not purse any criminal charges — even a minor offense — against the officer struck many in the mental health community as being pusillanimous.  It didn’t help when Morrogh made this comment to reporter Jackman:

 “Unfortunately, we had a mentally ill man who was behaving bizarrely,” Morrogh said. “His family indicated he was behaving under delusions, that he might feel he was under attack if approached by the police. I think that’s the explanation for his actions.”

That comment implied that Masters, somehow, was to blame for his own death.

The editorial also pointed out that despite lip service, little has been done by Fairfax officials to implement a citizens backed police review board.

I’m just thankful that Fairfax County has now formalized its Crisis Intervention Training program for police.

Hopefully, with better training, there will be fewer of these preventable tragedies.