"So, what brings you here tonight?"
This is my favorite part of the assessment--the story, the why that has led our paths to cross. I never know what will follow those six words. Sometimes it's an unfocused flight of psychosis with delusions and hallucinations both auditory and visual. People like Phillip with nonsensical ramblings about God and the government, who could not answer the simplest of questions--what is your name, when is your birthday. People like Paul who sees dead people and Rebecca who's struggle with depression is complicated by the voices telling her to "do it, do it, do it."
In my first solo outings as a crisis worker, I hesitated to ask the person in front of me if they heard voices or saw things other people didn't. "Of course this perfectly calm, logical individual in front of me isn't hearing voices," I thought foolishly. I carried that bias until I met Michael who said "yes, I hear gospel music," and John who said "yes, I see shadows" and Charlotte who said "yes, I see my dead father standing at the foot of my bed shaking his head."
"Why is he shaking his head," I probe.
"Because he's so disappointed in me."
These cases, the ones that fulfill stereotypes of mental illness are surprisingly easy. A man walking in the middle of the road, not eating, and wearing a coat on a 100 degree day is an easy assessment with a clear solution--inpatient admission by way of temporary detention order or TDO. I find a bed at a psychiatric facility and go before the magistrate who issues the TDO ordering the person to the found facility for a minimum of 72 hours. A clear need meets a clear answer.
But these cases are fairly few. What is far more likely is the everyday illness that dances at the edges of us all: depression and anxiety often with a dose of substance abuse for good measure. A bad marriage, job loss, molestation, physical illness, the death of a grandparent--God awful events, sometimes layered, that hit a person so hard and fast they just can't get back up. How do you cope when you lose the one person who's ever truly loved you? How do you bounce back from years of mental abuse that's stripped away your sense of self and strength? So often my heart breaks for the person they are...and the one I could have easily become. A different uncle here a different choice there and the roles could so easily be reversed.
"Did you want to die, " I ask Ana. A cheating boyfriend, a bad fight, and a fistful of pills have led her to me. Of course the alcohol she had earlier didn't help matters.
"At the time, yes but I don't any more. I feel so stupid."
"If you go home tonight, what will happen?"
What I don't want to hear is "I don't know...or I'll try again...or next time I'm gonna do it the right way."
"I just want to go to bed and get some sleep," she says.
I've been assessing her the whole time and that answer confirms what my gut has been saying--she made a really poor choice in the heat of the moment but she'll be alright to go home. No prior psychiatric history or suicide attempts, no current suicidal thoughts or ideas, upbeat mood, and positive outlook. She's sobered up some too and the difference sobriety brings never ceases to amaze me. We talk about the benefits of counseling and I refer her to outpatient treatment. I hope she'll follow up but I have my doubts. I know the pull for help will weaken as she moves further and further away from this night and this crisis.
She signs my form, I wish her good luck and I walk out of her room. I hope she follows through with outpatient treatment so she never needs to be seen in crisis again. Best case scenario for anyone I've seen is that we never meet, professionally, again. Only time will tell.
I inform Ana's ER physician that I'm clearing her. She has no medical problems so she'll be discharged within minutes. I go to my designated work area to create the digital version of my assessment and wrap the case. I have a superstition that makes me work quickly because if I don't another case will walk through the door.
Walking out of the ER the moon is still shining brightly. Since Ana didn't need to be transferred to a psychiatric facility the case is resolved within 2 1/2 hours, and I put this in the good night column.
I get into my van, pull off my name badge, and head home.
Author's Note: I started working as an on call emergency services worker July 2013. I was five months pregnant with my 3rd daughter--clearly my judgement should have been called into question. Today is July 27th and tonight I will work my last shift as a crisis worker. The work has been challenging and immensely satisfying. I am honored and deeply grateful to have played a small part in helping citizens in my region access the mental health services they needed. This work is bigger than me and continues. Please keep my (now former) colleagues in your prayers.
