From 2016 to 2018, I experienced a long period of mental health crisis, with multiple experiences of contact with police officers and paramedics, including being detained under the Mental Health Act and on one occasion receiving CPR from police. This article is based on a blog post I developed to share some thoughts on what can help from the emergency services attending to a person in mental health crisis.
“We’re here to help”
Firstly, even if you are with an individual who has been in crisis before, emergency service involvement is terrifying. I fear being in trouble, I am terrified that you think I am attention-seeking or wasting your time. Please reassure me that you are here to help me. Remind me that I am not well. This may seem obvious, especially if someone is diagnosed with a mental health problem, if you ‘know’ somebody who you see regularly, or if somebody is clearly distressed. But in crisis, we can lose insight. Please keep reminding me that this is my illness talking, and that I need some help to get well again. I may need to be told the same thing multiple times in order to take it in, but it does stick with me later.
Self-harm and suicidal thoughts
Self-harm and suicidal thoughts/acts are generally not attention-seeking or ‘cries for help’. For many, they are deeply private and shameful, and even for those cases which are ‘attention-seeking,’ serious help is still needed if someone is turning to harming themselves. ‘Attention-seeking’ is not in itself necessarily a bad thing. We all desire human contact and interaction. Whilst many can communicate effectively with words, others may not be able to do so and may communicate their distress in other ways. We never know what has brought a person to that point, and those who need medical treatment as a result of a mental health problem deserve the same care, empathy and treatment as anyone else.
Suicide may seem objectively ‘selfish,’ but to a person in that state of mind, it often seems like the only option. Please do not try to make me feel guilty. Having said that, talking about the impacts on others – including the police or paramedics who are called out to deal with this – can be a very effective way of halting the intention to act on these immediate urges for some.
And thirdly, please do not ever tell somebody that ‘If you really wanted to die, you’d have done it.’ It is not the case, just as it is not true that ‘Truly suicidal people don’t talk about it.’ Sometimes it simply means that somebody is taking every step to help themselves. I have always promised that I will do everything I can to avoid acting on my thoughts. It doesn’t mean I didn’t want to die at those times. But I didn’t want to want to die.
What it can help to say
In emergency situations it can be tempting to deal with things as quickly as possible and move on. But in mental health crisis, adopting a slower pace, being patient, taking the time to listen, understand and build up trust helps. That rapport is so important. Use that rapport as much as possible: for example, allowing the person who has got that rapport to accompany the individual in the back of an ambulance or to explain decisions.
One thing that can really help to build a rapport is just to talk about ‘normal’ things. We all have likes and dislikes, hobbies, interests, a sense of humour. These are the things that make us who we are, but sometimes it is hard to remember them in crisis point. Where appropriate, use your sense of humour. If you can make me smile, you have got me engaged. Remind me that there is hope, that I have a future and am a worthwhile person. Where appropriate, self-disclosure can also be beneficial. A lot of people suffer from mental health problems at some point, and it is so reassuring to know that people can get through these and find something they love in life.
Two of the most helpful phrases I have heard from police officers are ‘Focus on my voice’ and ‘I’m not going to let you hurt yourself.’ The sound of a calm, caring, firm and direct voice can help me to feel safe and grounded, to listen to your voice and to know that someone is in control of the situation.
Please try to give me options where appropriate and try to guide me towards making the ‘best’ choice. However, please also be aware that at times I am so consumed by my illness that I need you to take control away from me and make the best decision, even if I can’t see it at the time.
And finally, always remember the difference you make
The impact you have will stay with someone forever. I know at times it is frustrating for you, particularly if there are repeated incidences and nothing seems to be happening as a result, and particularly where the system is clearly failing. It may take time for me to get well. It is likely to be a slow journey with many ups and downs. But you are making a difference. I will remember the care you provide to me, be that good or bad. The words you say will stay with me forever. And I cannot put into words how grateful I am to you.