Danquah recalls the sense of disoriented invalidation she got from her white male psychiatrist.
“Phew,” she remembers him saying after she told him about being treated like a thief when returning a dress in a clothing store—an act of “everyday racism” all the more galling for its banality. “It must be so hard to be black. I can’t even fathom having to contend with what you must deal with on a daily basis.” A well-meaning, honest statement, sure. But that inability to fathom someone else’s experience makes therapeutic congruence just about impossible.
“I do not believe that white therapists are unable to successfully treat people of colour,” Danquah writes. “However, I do think that they should possess a certain level of cultural sensitivity, as that culture plays an important role in both the patient’s illness and treatment. I am black; I am female; I am an immigrant. Every one of these labels plays an equally significant part in my perception of myself and the world around me.”12
PART IV
IN THE MAZE
24
Who You Gonna Call?
Police are the wrong people to call when someone’s suicidal, says Susan Stefan, an author and expert on psychiatric disabilities and the law. I called her to get a better sense of the interplay of rights, legalities and first-responder imperatives when dealing with people in crisis.
“You’ll see people who call the police and they’ll say, ‘I want to commit suicide by cop; send the police.’…And what do they do? They send over eight armed police officers.”
“You’re joking.”
“No, I’m not joking. And guess what happens….When you’re in psychiatric crisis almost anything is better than calling 911.”1
I know plenty of people who would dispute that. But whether it’s the best option or not, psych crisis calls make up a growing proportion of cops’ workload.
Calling first responders or having first responders called on you when you’re in crisis is fundamentally about a loss of control: they’re there to take charge; you’re calling them because you want them to take charge. I’ve talked to people who found it reassuring—that’s the point of calling 911—but it engenders a panicky desperation when the thing they’re saving you from is yourself.
I’ve been lucky in my interactions with police and paramedics but I suspect it’s in part because I’m a short white girl and I was cowed and obedient. I don’t know what would have happened if I’d struggled or yelled or talked back when I was ordered into the back of a cop car or ambulance. Or what would have happened if I was a male of colour—in Toronto, the city where I was picked up, Black people made up 60 percent of fatal interactions with police despite only comprising 8.8 percent of the population.2
When people call 911, they do so assuming that those whose job it is to serve and protect them will serve and protect them in one of the most vulnerable points of their lives. But, too often, disclosure can ostracize, can disqualify. Calling for help can make you regret it and making people regret calling for help means they won’t seek it again when they desperately need it.
In Halifax, mental illness–related calls doubled between 2007 and 2014; Calgary’s “Million-Dollar Martin,” a sick man who cost the city about $1 million in cop calls within a year, has achieved urban-legend status among harm-reduction acolytes.3 The recently retired head of Toronto’s civilian police watchdog has suggested the prevalence of mental illness in officers’ day-to-day jobs necessitates not just changes in training, but radically different recruitment strategies—hiring officers with empathy, who won’t freak out or revert to prejudicial stereotypes when they encounter people struggling with psychiatric maladies. Maybe even giving preference to those with some psychology training.4
But often, things get ugly. Sometimes, you get tasered. In dozens of cases over an eighteen-month period in Canada’s largest city, Toronto police tasered mentally unstable, suicidal people who posed no threat to anyone but themselves. More than half of all Taser uses in 2014 were on “emotionally disturbed persons,” according to cops’ own reporting. About a third of those people were apprehended under Ontario’s Mental Health Act. Officers believe the people they’re confronting are armed 60 percent of the time, when in reality only about a third (in Toronto) are bearing anything that could be used as a weapon.
Tasers are fired more often in the west-end neighbourhood of Parkdale, where I used to live, which has a higher proportion of people with mental illness than any other area of the city. I wrote about this in an article for Global News: “Police tasered a suicidal man twice—once in the stomach and once in the back—‘to gain compliance’ as he resisted being apprehended and handcuffed by officers. In one instance, an officer tried to taser a man cutting his throat with a knife, but missed as the suicidal man backed toward his balcony. The rest of the incident report is censored: it isn’t clear whether the man killed himself….On multiple occasions, the suspect was tasered after already being forced to the ground by police. One man with mental illness, believed to be both drunk and high, was tasered three times while held on the ground by police. Another was tasered multiple times while lying on a mattress where he was apprehended.”5 Tasers are marketed as a “non-lethal” weapon and much of the public discourse around their use assumes they’re used when an officer might otherwise use a gun. That isn’t how it works. Conducted energy weapons aren’t as reliable as firearms: if you really needed the latter, you wouldn’t use the former. Tasers are a step or so down the use-of-force scale and officers use them when someone is acting violently or erratically or is resisting in some way when they’re trying to restrain them or when they have already been restrained. “My opinion is that if you really use Tasers at times when you would have otherwise used a firearm, then they’re great: I’d rather be tased than shot,” says Joel Dvoskin, a forensic psychologist who’s designed psychiatric hospitals and trained people in dealing with psych crises, whom I reach by phone. “But the problem is that a lot of departments, once they start using Tasers, their use of Tasers is way higher than their use of lethal force was before. Because it’s easier.”6
We still don’t really know what the health effects of a Taser are because the people most likely to be tasered are the least healthy and therefore the least likely to be included in any study and the most complex for divining a single cause of death. People have died after or shortly after being hit with these weapons but causation is tricky to determine. A Reuters investigation found more than 150 autopsy reports citing Tasers as a contributing factor in a person’s death; frequently, those people were unarmed and in psychological distress.7 In many cases where someone who is drunk or high or in the grips of severe mental illness dies after being tasered, their death is attributed to “excited delirium,” a medical condition not recognized by most medical associations but which keeps coming up at inquests.
Whether incapacitating a suicidal someone with a painful electric shock is a good idea depends on whom you ask. You may be saving their life. You may be doing nothing of the sort, if they stumble and fall off the roof they’ve been threatening to jump off or if they seize and slit their throat with the knife they’ve been threatening to slit their throat with. Or, more likely, in my view, you just ensure they will never call the police or tell anyone they’re feeling suicidal ever again.
“People say it’s inhumane” to taser people who only pose a danger to themselves, says Memphis Police Lt. Colonel Vincent Beasley, who coordinates the force’s pioneering Crisis Intervention Team and who talked to me by phone. “Is it really inhumane, or is it inhumane for me to sit there and watch you blow your brains out?”8
Beasley knows what he’d pick. And it isn’t watching someone die by their own hand.
Who should get to know about your mental illness–related run-in with the cops? For a while, the guards at the Canada-US border would know—and they were refusing people entry to the United States because of their one-time suicidality. After much scrutiny and criticism—and the threat of a lawsuit from Onta
rio’s privacy commissioner—Toronto Police agreed to block US Customs and Border Protection officers from seeing entries in Canada’s police database. But they still enter every suicide-related call in there.9
Joel Dvoskin argues there’s efficacy in information-sharing when it comes to people in psychological distress—but that it’s important to keep the sharing circle tight. “If I’m a resident evaluating somebody in an emergency department ’cause somebody said they were suicidal and they say, ‘Yeah, you know, I was just mad at my mother; I’m not going to kill myself. Everything’s fine,’ but I look in the database and I see he tried to grab a police officer’s gun a few days ago and the police officer cut him a break and didn’t arrest him, now all of a sudden that’s going to change my evaluation.”
What are the alternatives to calling the cops? Susan Stefan points to Massachusetts’ community crisis model as one to emulate because when someone’s suicidal, social workers and mental health practitioners show up at your door, rather than cops. Massachusetts, with its 24/7 community psychiatric crisis teams, “is basically the Valhalla of the United States, in terms of social services”—even if there, too, you’ve only got so many crisis teams. The state has centres with designated crisis beds meant as an alternative to a trip to the ER and its hours-long wait in noisy fluorescent corridors for a psych assessment. But ambulances rarely take you there, she says. Instead those beds are often used as a “step-down” program for people after they’re discharged.
She is also a fan of “recovery learning centres,” peer-run support centres where you can go in and talk with no fear of anyone freaking out at your suicidality and committing you. For a contagion-theory proponent this is a terrifying prospect: people who all want to die talking to each other about wanting to die? Perhaps it calls to mind the online message boards of people trading suicide methods. But she assures me this isn’t a room of people egging each other on to self-obliteration. “Most people feel tremendously alone and isolated and unable to talk about what they’re going through and there’s a real benefit of saying, ‘Oh my god, I am not alone. I am not super-crazy.’”
* * *
—
CALLING THE POLICE when you’re losing your mental or emotional shit doesn’t have to be a nightmarish ordeal. The most oft-cited model is the Crisis Intervention Team.
Pioneered in Memphis, the Crisis Intervention Team model was propelled into being by a wrenching act of violence: in September 1987, Memphis police shot Joseph Robinson to death. The twenty-seven-year-old Black man was stabbing himself with a knife; his mother had called police because she feared her son was suicidal. In the furor following his death at the cops’ hands, a task force was created—which is hardly unusual. But this task force created something worthwhile that’s being replicated in thousands of jurisdictions across the continent.
So far it’s the gold standard: forty hours of training in dealing with people in the grips of mental illness, plus an additional eight every year.
It gets results. Lt. Colonel Vincent Beasley tells me that in the three decades since their CIT model was put in place, officer injuries from interactions with mentally ill individuals dropped 90 percent; civilian injuries dropped 75 percent. About 3.4 percent of the 18,435 mental illness calls Memphis police got in 2016 resulted in arrests (that’s still more than 600 sick people being taken to penal facilities, though). About 30 percent of those interactions resulted in the person being taken to a health facility, such as a hospital; most of the time, officers are able to de-escalate the situation and, hopefully, address what precipitated it—by letting a person vent, by buying them a hamburger or a cigarette, by teaching their family how to cope—without carting someone off to an institution.
About a quarter of the Memphis police officers responding to calls have CIT training. There’s at least one officer in each precinct at all times. It’s key for them to be the first on the scene, he says. “The first few minutes of any situation are probably the most important ones. So if I get an officer there who doesn’t understand this person is suffering from mental illness, they can do tons of damage before I get there.” In many jurisdictions, they’re only called in after conventional officers arrive and assess the situation. Or they’re only available during certain times of day, or there’s only one crisis intervention team for an entire city.
He got crisis intervention training a quarter-century ago because he saw firsthand the skills he was missing.
“In the area I worked in there were quite a few people who were suffering from mental illnesses. And I’m thinking, ‘Hey, I’m answering these calls anyway. Why don’t I learn about this so I can better serve those individuals?’”
What did he learn about people on the brink of suicide?
“They’re fragile. And they want to commit suicide, but they don’t want to commit suicide….We just want the opportunity to talk to them.”
The need for this training was driven home when Beasley’s nephew Jacques killed himself. He was twenty-four. “He was a grand-mama’s boy, and just a great kid. Really. And I’m not just saying that. When he was five years old he memorized every page of a forty-eight-page book on Dr. Martin Luther King. And he went to every kindergarten school in the city of Memphis on a little circuit because they could not believe it.”
But when Jacques was in college the grandmother who helped raise him died. And things began to fall apart. “I noticed it, but I didn’t notice it,” Beasley says. He asked his nephew if everything was okay and when Jacques said yes, he didn’t press it.
“He taught me a lesson: to not take no for an answer….I saw some of the same things in him that I saw in other people who were suffering from mental illnesses. But I didn’t want to see that, because that was my nephew.”
Just about every urban police force in North America will probably claim to have implemented or glanced at the CIT’s principles to some degree. But there’s tremendous variation in how good or effective or compassionate they are. A few years ago I visited a Toronto Police training centre and watched a de-escalation role play in which officers armed with Tasers talked down a man sitting at a table with a knife, threatening to kill himself. In that dramatized scenario, they were successful: he surrendered the plastic knife and they exited the mock apartment. The centre’s classrooms were festooned with handwritten instructions on how to talk someone down: speak softly; ask non-aggressive questions; repeat what people have said back to them in a validating way.
But this is also a police force that tasered a woman after she dropped the knife she’d been holding to her throat; that shot to death a mentally ill man with a hammer within 120 seconds of entering the apartment hallway where he was standing. Who shot to death a man in a hospital gown holding scissors in the middle of a street. In moments of crisis, people don’t always act in the way they would in a training module. When I spoke with Toronto police officers in charge of the frontline teams dealing with the mentally ill they noted that, of the thousands of interactions they have with people in crisis, the overwhelming majority go well.10 And they’re right. Or, at least, most interactions don’t end in death.
But is that good enough? Alok Mukherjee doesn’t think so. The former chair of Toronto’s Police Services Board has argued for cop recruitment that focuses on compassion, on individuals’ ability to work with people who are different from them; on “more people who say they’re coming into policing because they want to help people, fewer who say they are here to catch the bad guys.”
Crisis intervention trains officers to go slow. But “police officers are trained to go fast, not slow,” Joel Dvoskin, the forensic psychologist, points out. “All the things police are trained to do—speak in a commanding voice; don’t ask questions, give commands—none of that helps when a person’s suicidal. So they have to kind of unlearn some things.”
He figures there are two factors in the most acute suicide-prevention situations: options and time. If suicide is an escape from intolerable pain, finding an altern
ative escape, even a shallow transient one, can help. And stall. Stall for time in the hopes the most violent self-destructive impulse will attenuate just slightly.
“[If] you can keep them alive for a while, sometimes their natural defences kick in, they start thinking of other solutions,” Dvoskin says. If nobody dies, then you win.
25
How to Talk about What We Talk about When We Talk about Wanting to Die
Imagine trying to cure cancer, or find an AIDS vaccine, or end world hunger or forcible human displacement, without ever mentioning the thing you’re tackling. For ages that’s been our approach to suicide, to the point that even the people paid to prevent it are loath to say its name.
Decades have conditioned us to avoid talking to someone about wanting to kill themselves, lest it seem like the act of discussing it is encouraging that act.
For many people, professionals and laypersons alike, the instinct is to dissuade—to plead, implore, exhort, Don’t do that! And that’s a legitimate response. And some people will want to hear that, or will at least take comfort in knowing people care about them and want them to live. “I’m glad you’re alive” or “The world is better with you in it” are, I would argue, better ways of phrasing “Enough with this suicide!” But if your first response to someone’s suicide attempt or their confession to wanting to die, is to say, “That’s bad!” it can ensure that person never brings it up with you or anyone else ever again. No one wants to be lectured on the shittiness of their desires, no matter how self-destructive. “Family members will do that all day long….Families are families. But clinicians, clinicians should be different than families,” says David Jobes, a psychologist at the Catholic University of America. “Don’t kill yourself!” is a valid emotional response to someone you care about. Clinician responses are not supposed to be fear- or emotion-driven. “You don’t talk about the weather. You talk about, you know, you’re here for a reason, and that reason is about life and death, and let’s look at that.”1
Hello I Want to Die Please Fix Me Page 25