bystander intervention in crisis: personal experience on either side?
June 8, 2020 9:25 AM Subscribe
I live in a big city where it is very frequent to encounter strangers having mental health crises. Based on your personal experience trying this or having someone do this with you, is it helpful for someone to approach and ask what's wrong? What are the pros and cons of bystander intervention?
Obviously no one should ever be calling the cops on someone in this position but I am also wary of calling 'street teams' or similar because of the possibility of that just being cops in better outfits, leading to institutionalization. My current standard MO is therefore just to give people their space. I know there are training programs out there directed at making sure neighbors help neighbors and don't just stop at minding their own business; I just don't have any sense of whether or not that's like, a good helpful thing to do or super invasive and shitty to experience. I've read some training materials but haven't been able to attend a session and I am looking for people's practical insight. Have any of you ever been a bystander intervening in a crisis with someone having an episode of severe mental illness, or have you ever had a bystander intervene in such a crisis? Was it helpful? How did it go?
Obviously no one should ever be calling the cops on someone in this position but I am also wary of calling 'street teams' or similar because of the possibility of that just being cops in better outfits, leading to institutionalization. My current standard MO is therefore just to give people their space. I know there are training programs out there directed at making sure neighbors help neighbors and don't just stop at minding their own business; I just don't have any sense of whether or not that's like, a good helpful thing to do or super invasive and shitty to experience. I've read some training materials but haven't been able to attend a session and I am looking for people's practical insight. Have any of you ever been a bystander intervening in a crisis with someone having an episode of severe mental illness, or have you ever had a bystander intervene in such a crisis? Was it helpful? How did it go?
Best answer: I went through Mental Health First Aid Training. I highly recommend attending MHFA training, especially if this is your entreé into behavioral health interventions.
As a trained behavioral heath professional providing direct service to people who are my peers*, I would not intervene unless I already knew the person and had a relationship to them, or if harmful behavior was directed at others. (I worked as a peer recovery specialist, although I recently transitioned to research and advocacy rather than direct care.)
I have had severe episodes, including mental health breakdowns, in public. I don't know what people may be envisioning; I isolated myself in public parks and engage in heavy crying/wailing due to extreme suicidal ideation. I strongly preferred to be given my space by anyone who couldn't establish rapport. 80%+ of the time, bystander intervention did not happen. The few times it did, they did not help and half the time made things much worse.
My training in MHFA and Intentional Peer Support would support that these interventions became negative especially because the bystander had no training, I had no previous relationship with them AND they did not know how to form a connection. Furthermore, even if they had created a rapport, based on my experience working with people who are new to my profession: without good boundaries and excellent sense of how to help, the well-intentioned would have made my experience worse.
I choose to support those who may experience crisis in two ways: I greet anyone in my neighborhood while I walk my dog multiple times a day, and previous to pandemic often had short conversations. Research shows that these local acquaintances serve a valuable social purpose to people who may be more isolated than we knew even before COVID19. I also have a serious volunteer commitment to an advisory council for behavioral health in my local area, and we have a robust suicide prevention plan. These are ways I personally find sustainable of building a strong community that serve my values, as opposed to a quick fix for one person. I know that a strong community that has mutual support and caring is the only way to stop the crises before they start, because that's what I needed to recover and how I've seen many others begin their recovery journey.
posted by saveyoursanity at 11:32 AM on June 8, 2020 [11 favorites]
As a trained behavioral heath professional providing direct service to people who are my peers*, I would not intervene unless I already knew the person and had a relationship to them, or if harmful behavior was directed at others. (I worked as a peer recovery specialist, although I recently transitioned to research and advocacy rather than direct care.)
I have had severe episodes, including mental health breakdowns, in public. I don't know what people may be envisioning; I isolated myself in public parks and engage in heavy crying/wailing due to extreme suicidal ideation. I strongly preferred to be given my space by anyone who couldn't establish rapport. 80%+ of the time, bystander intervention did not happen. The few times it did, they did not help and half the time made things much worse.
My training in MHFA and Intentional Peer Support would support that these interventions became negative especially because the bystander had no training, I had no previous relationship with them AND they did not know how to form a connection. Furthermore, even if they had created a rapport, based on my experience working with people who are new to my profession: without good boundaries and excellent sense of how to help, the well-intentioned would have made my experience worse.
I choose to support those who may experience crisis in two ways: I greet anyone in my neighborhood while I walk my dog multiple times a day, and previous to pandemic often had short conversations. Research shows that these local acquaintances serve a valuable social purpose to people who may be more isolated than we knew even before COVID19. I also have a serious volunteer commitment to an advisory council for behavioral health in my local area, and we have a robust suicide prevention plan. These are ways I personally find sustainable of building a strong community that serve my values, as opposed to a quick fix for one person. I know that a strong community that has mutual support and caring is the only way to stop the crises before they start, because that's what I needed to recover and how I've seen many others begin their recovery journey.
posted by saveyoursanity at 11:32 AM on June 8, 2020 [11 favorites]
Best answer: since you say "episode of severe mental illness" and not "emotional distress" I am tentatively assuming you mean behavior that looks & sounds like psychosis?
I do not have a good answer but I do have a thought, which is: before you ask someone if they need help, be clear on what you will do if they ask for help you are not willing or able to give. Or offer something specific you're sure you can do if they take you up on it (can I call someone for you, can I bring you a cup of coffee, do you want to talk for a few minutes, do you need a doctor, do you need help getting to a clinic.)
likewise, if you approach someone respectfully and say Hey, are you doing ok? think about what you can say if they answer No, I'm not ok, I'm ill and homeless and uninsured? or just NO, OBVIOUSLY NOT?
But I think sometimes people just can't take being invisible. a couple of times I've seen someone sit down dead center in a busy sidewalk and start yelling at passers-by. the feeling of talking to people who look real, look human, but who act like they can't hear you and like you aren't there, is not the same experience as talking to voices that only you can perceive. but I think the ways in which both experiences are alienating and distressing can overlap, even if only one of them is "mental illness" per se. This is the kind of situation where I think it would do most potential good to approach and speak to someone, but it is also the kind of situation where you ought to be prepared for a very hostile response. Letting someone know that you can see and hear them is often a good thing to do. but part of that is noticing when they aren't inviting interaction, even if they are quietly talking to themselves or crying.
posted by queenofbithynia at 12:35 PM on June 8, 2020 [5 favorites]
I do not have a good answer but I do have a thought, which is: before you ask someone if they need help, be clear on what you will do if they ask for help you are not willing or able to give. Or offer something specific you're sure you can do if they take you up on it (can I call someone for you, can I bring you a cup of coffee, do you want to talk for a few minutes, do you need a doctor, do you need help getting to a clinic.)
likewise, if you approach someone respectfully and say Hey, are you doing ok? think about what you can say if they answer No, I'm not ok, I'm ill and homeless and uninsured? or just NO, OBVIOUSLY NOT?
But I think sometimes people just can't take being invisible. a couple of times I've seen someone sit down dead center in a busy sidewalk and start yelling at passers-by. the feeling of talking to people who look real, look human, but who act like they can't hear you and like you aren't there, is not the same experience as talking to voices that only you can perceive. but I think the ways in which both experiences are alienating and distressing can overlap, even if only one of them is "mental illness" per se. This is the kind of situation where I think it would do most potential good to approach and speak to someone, but it is also the kind of situation where you ought to be prepared for a very hostile response. Letting someone know that you can see and hear them is often a good thing to do. but part of that is noticing when they aren't inviting interaction, even if they are quietly talking to themselves or crying.
posted by queenofbithynia at 12:35 PM on June 8, 2020 [5 favorites]
Response by poster: Thank you for everyone's comments so far, I really appreciate people's thoughts.
posted by peppercorn at 2:04 PM on June 8, 2020
since you say "episode of severe mental illness" and not "emotional distress" I am tentatively assuming you mean behavior that looks & sounds like psychosis?Good question and I was struggling to think of how to define what I'm describing. I didn't want to specify psychosis because I am definitely also looking for answers like saveyoursanity's above in re: being not-helpfully intruded on during a depressive crisis and also just, as you say queenofbythinia, situations like someone who's just having an incredibly shitty day and rationally-not-delusively believes they're invisible to the people around them. But "behavior that looks and sounds like psychosis" is I guess the basic use case I'm looking for. Thanks again.
posted by peppercorn at 2:04 PM on June 8, 2020
Best answer: A friend of mine tried to help a stranger in crisis - not exactly sure what was going on in the stranger's head, most likely they were on some illegal substance, and possibly some other mental illness. Like queenofbithynia suggests, my friend was willing to help to a certain extent but had some boundaries. When my friend tried to enforce those boundaries, the stranger's behavior turned violent, they broke some windows out of the cars parked along the street (the whole scene took place on a sidewalk, in the evening). They ranted about how they had a knife and would use it. My friend had to hide for hours until they were sure the stranger was not around and would follow them home.
You say "severe mental illness" and "psychosis". That's some very heavy stuff, and people in those situations do not act predictably. If you're encountering a stranger, you do not know what is going on or how violent they will get. Cops and mental health practitioners with years of training and experience sometimes do not react well. While a random bystander with two hours of online training may mean well, it's ridiculous to think they'll be any better.
Now, if you're referring to someone who is having a shitty day (or month) and needs a hand up, that is an entirely different conversation and a kind gesture by a stranger can make a valuable difference. But again, sometimes you don't know what you're getting into until you're in it.
posted by sdrawkcaSSAb at 3:55 PM on June 8, 2020 [2 favorites]
You say "severe mental illness" and "psychosis". That's some very heavy stuff, and people in those situations do not act predictably. If you're encountering a stranger, you do not know what is going on or how violent they will get. Cops and mental health practitioners with years of training and experience sometimes do not react well. While a random bystander with two hours of online training may mean well, it's ridiculous to think they'll be any better.
Now, if you're referring to someone who is having a shitty day (or month) and needs a hand up, that is an entirely different conversation and a kind gesture by a stranger can make a valuable difference. But again, sometimes you don't know what you're getting into until you're in it.
posted by sdrawkcaSSAb at 3:55 PM on June 8, 2020 [2 favorites]
I want to very gently push back on your wariness of calling street teams. I work closely with psychiatric emergency teams, and most of them are wonderful people who are very well trained to work with people in acute psychiatric crisis and perform an incredibly valuable social need. They have signed up to work with a population that the vast majority of society cannot bear to look at. And "instutionalization"--ie hospitalization--may be warranted in some cases, especially if the person is a danger to himself/herself, someone else, or is so psychiatrically ill they cannot secure food, shelter, or clothing.
I am a psychiatrist. I work with severely mentally ill people in the hospital or in my clinic all the time. But when I see a person with florid psychosis on the street, I do not intervene. (Not sure what you are planning to offer them? Psychosis requires pharmacotherapy for treatment. And of course psychosis can be aided with therapy (including supportive), but not in the street and not by a stranger.)
If I saw a floridly psychotic person on the street and I had enough information from my brief observation to be concerned about the above (danger to self/others, cannot make basic needs met), I would reach out to the psychiatric emergency team. Because that is a medical and psychiatric emergency that requires further evaluation. If you saw a person drop to the ground with chest pain, wouldn't you reach out to the proper medical providers (call 911) for further care?
posted by namemeansgazelle at 4:24 PM on June 8, 2020 [5 favorites]
I am a psychiatrist. I work with severely mentally ill people in the hospital or in my clinic all the time. But when I see a person with florid psychosis on the street, I do not intervene. (Not sure what you are planning to offer them? Psychosis requires pharmacotherapy for treatment. And of course psychosis can be aided with therapy (including supportive), but not in the street and not by a stranger.)
If I saw a floridly psychotic person on the street and I had enough information from my brief observation to be concerned about the above (danger to self/others, cannot make basic needs met), I would reach out to the psychiatric emergency team. Because that is a medical and psychiatric emergency that requires further evaluation. If you saw a person drop to the ground with chest pain, wouldn't you reach out to the proper medical providers (call 911) for further care?
posted by namemeansgazelle at 4:24 PM on June 8, 2020 [5 favorites]
What, exactly, are you trying to accomplish here? I am trying to say this gently but, as someone who has dealt with family members in extreme psychotic break, there is NOTHING that a stranger could do to help unless they were willing to call in a professional team - which, by the way, very possibly does not exist or is already so overwhelmed that they can do nothing anyway. When someone is in the ranting on the street level of psychosis, not tracking, unable to be coherent, you are not going to be able to have a friendly chat. The best case scenario is they may ignore you. The worst is going to be attack. If they are indeed your neighbor and you can reach a family member, please please do that. If you don’t know family, then your next best bet is to give them the information to contact a local mental health agency. You could try calling that agency yourself but they are very likely to tell you the individual must call themselves. It is not, actually, a crime to be mentally ill in public. People have to ask for help themselves or they will not be helped.
The most helpful thing you can do is to familiarize yourself with what resources exist in your community and be able to direct people to them.
The other thing - and this is hard and sad - is you need to realize that there is no or very little help out there. The US has been dealing with mental health by shunting people into jails and/or onto the streets for many many years now. Mental health is not a priority. It is crazy underfunded. There is no magic team of counselors who will ride in and save people. Probably there is not even a 24 hour mental health response team. There is no social safety net. Once somebody calls 911 (and they will, probably, depending on the neighborhood) the best you can hope for is they have an empty bed in the psych ward (unlikely!) and they can stabilize the person with meds and keep them for a couple weeks so that at least they get fed and clean and a bit rested - and then they dump them back out on the street, lather rinse repeat. Worst is they get shot or go to jail, yes. And the jail will toss them back out sooner rather than later.
posted by mygothlaundry at 7:25 PM on June 8, 2020 [1 favorite]
The most helpful thing you can do is to familiarize yourself with what resources exist in your community and be able to direct people to them.
The other thing - and this is hard and sad - is you need to realize that there is no or very little help out there. The US has been dealing with mental health by shunting people into jails and/or onto the streets for many many years now. Mental health is not a priority. It is crazy underfunded. There is no magic team of counselors who will ride in and save people. Probably there is not even a 24 hour mental health response team. There is no social safety net. Once somebody calls 911 (and they will, probably, depending on the neighborhood) the best you can hope for is they have an empty bed in the psych ward (unlikely!) and they can stabilize the person with meds and keep them for a couple weeks so that at least they get fed and clean and a bit rested - and then they dump them back out on the street, lather rinse repeat. Worst is they get shot or go to jail, yes. And the jail will toss them back out sooner rather than later.
posted by mygothlaundry at 7:25 PM on June 8, 2020 [1 favorite]
Response by poster: I didn't want to post this up front because, well, it's kind of personal, but I am already someone who frequently has interactions with people in psychotic or other type of mental health crisis and directs them to the wildly inadequate resources which exist in our community; that is already part of my day job. I am asking about personal experiences of a particular method of bystander intervention. It's fine if those experiences are "I hated it and it sucks" and I am appreciative of those comments.
If you're not speaking to your personal experience with bystander intervention, please feel free to memail me your thoughts so I can respond to them which I can't do in the comment section of an Ask without sort of breaking the rules of Ask.
posted by peppercorn at 8:26 PM on June 8, 2020
If you're not speaking to your personal experience with bystander intervention, please feel free to memail me your thoughts so I can respond to them which I can't do in the comment section of an Ask without sort of breaking the rules of Ask.
posted by peppercorn at 8:26 PM on June 8, 2020
Best answer: I was woken up early one morning by a man screaming for help. I went outside and found him and he told me that someone was trying to kill him. It was almost immediately apparent that this was a homeless man having a mental health crisis.
I invited him to come "hide" on my porch, which was hidden by trees. He insisted on calling police (IMO not a good idea, but it was his choice) and borrowed my phone to do so.
The police showed up and said they'd already had three calls from him that night. They were VERY crabby about it. I just stood there as a middle-aged, middle-class white woman being a witness, holding my phone and obviously ready to start recording if things escalated. The police didn't do anything to him, but offered to take him to the hospital because apparently he was coming down from a multi-day meth binge. He refused. The police left.
I spent a few hours on the porch with him. His lucidity came and went. I tried to get him to hydrate and eat something, since he said he hadn't eaten for three days. I reassured him that his paranoid delusions were not true, e.g., the construction workers across the street had nothing to do with him, their radio was not talking about him, etc. When he was more lucid, we talked about possible options of places he could go, etc.
However, the increase in car traffic around 8am of people dropping their kids off at the school across the street really agitated him because he thought every white van or black truck was there to kill him. So he insisted on calling the police again.
There must have been a shift change, because a different and much nicer batch of officers showed up. They called in a couple of social workers who talked with him for a while and finally got him to agree to go to the hospital for inpatient psychiatric treatment. I gave him a coloring book and some fresh markers because based on my own experiences in the nut hut, coloring is one of the only forms of entertainment but the supplies are usually pretty used up.
It took several hours of my life and was very stressful, but I'm glad I did it. I think if he'd continued to run around the city screaming and having paranoid delusions that he might have hurt himself or been shot by the police or a scared civilian. Whereas just having someone sit with him and try to calm him down and push fluids and food I'm sure was a lot better for him than however else he might have spent that time.
The social workers who came the second time said that they're actually on call 24/7 for mental health crises and that the first batch of police should have called them. So I tucked that away for future reference -- if I end up adjacent to another police-involved mental health crises, I will ask them to call the mental health team.
posted by Jacqueline at 9:03 PM on June 8, 2020 [5 favorites]
I invited him to come "hide" on my porch, which was hidden by trees. He insisted on calling police (IMO not a good idea, but it was his choice) and borrowed my phone to do so.
The police showed up and said they'd already had three calls from him that night. They were VERY crabby about it. I just stood there as a middle-aged, middle-class white woman being a witness, holding my phone and obviously ready to start recording if things escalated. The police didn't do anything to him, but offered to take him to the hospital because apparently he was coming down from a multi-day meth binge. He refused. The police left.
I spent a few hours on the porch with him. His lucidity came and went. I tried to get him to hydrate and eat something, since he said he hadn't eaten for three days. I reassured him that his paranoid delusions were not true, e.g., the construction workers across the street had nothing to do with him, their radio was not talking about him, etc. When he was more lucid, we talked about possible options of places he could go, etc.
However, the increase in car traffic around 8am of people dropping their kids off at the school across the street really agitated him because he thought every white van or black truck was there to kill him. So he insisted on calling the police again.
There must have been a shift change, because a different and much nicer batch of officers showed up. They called in a couple of social workers who talked with him for a while and finally got him to agree to go to the hospital for inpatient psychiatric treatment. I gave him a coloring book and some fresh markers because based on my own experiences in the nut hut, coloring is one of the only forms of entertainment but the supplies are usually pretty used up.
It took several hours of my life and was very stressful, but I'm glad I did it. I think if he'd continued to run around the city screaming and having paranoid delusions that he might have hurt himself or been shot by the police or a scared civilian. Whereas just having someone sit with him and try to calm him down and push fluids and food I'm sure was a lot better for him than however else he might have spent that time.
The social workers who came the second time said that they're actually on call 24/7 for mental health crises and that the first batch of police should have called them. So I tucked that away for future reference -- if I end up adjacent to another police-involved mental health crises, I will ask them to call the mental health team.
posted by Jacqueline at 9:03 PM on June 8, 2020 [5 favorites]
Best answer: Oh, that's just the incident that took the most of my time. I've since moved to the homeless epicenter of my city and thus have frequent encounters with the mentally ill.
I generally follow the same approach -- gently discourage paranoid delusions, offer water and food, be friendly and talk with them like an equal who respects their agency, etc.
There's only been a couple of bad incidents since then but someone else had already called the cops or was otherwise handling it so I didn't stick around.
I do take a break while I'm at home, and have a brown noise generator running almost 24/7 to drown out the voices of the homeless people who like to have arguments etc right outside our window. Otherwise I would have to go deal with mental health problems literally every day and I'm not getting paid for that.
There was one lady who kept drunkenly knocking on our window (but would say "nevermind" and walk away when I answered) and when I'd see her elsewhere I'd tease her "If I win the lottery, I'm going to buy you a house and then come knock on YOUR window every night" and she'd laugh. She was pretty well known for being belligerent and had been arrested and fought the cops multiple times, but I found that treating her with respect and humor kept her calm. Someone eventually got her to go to rehab so it's been several months since we last heard from her.
posted by Jacqueline at 9:21 PM on June 8, 2020 [1 favorite]
I generally follow the same approach -- gently discourage paranoid delusions, offer water and food, be friendly and talk with them like an equal who respects their agency, etc.
There's only been a couple of bad incidents since then but someone else had already called the cops or was otherwise handling it so I didn't stick around.
I do take a break while I'm at home, and have a brown noise generator running almost 24/7 to drown out the voices of the homeless people who like to have arguments etc right outside our window. Otherwise I would have to go deal with mental health problems literally every day and I'm not getting paid for that.
There was one lady who kept drunkenly knocking on our window (but would say "nevermind" and walk away when I answered) and when I'd see her elsewhere I'd tease her "If I win the lottery, I'm going to buy you a house and then come knock on YOUR window every night" and she'd laugh. She was pretty well known for being belligerent and had been arrested and fought the cops multiple times, but I found that treating her with respect and humor kept her calm. Someone eventually got her to go to rehab so it's been several months since we last heard from her.
posted by Jacqueline at 9:21 PM on June 8, 2020 [1 favorite]
This thread is closed to new comments.
As for anecdotes, I've been on both sides of bystander intervention at various levels of crisis. Once while staying in a hotel, a bystander knocked on my door to try to interrupt what he thought was a domestic dispute, but was instead my infant son crying. This pretty much elicited a "Thanks" and an eye roll between me and my wife.
On the other side, as an intervening bystander, I've had all manner of experience. Some have been intense and traumatic (like, with people pulling out guns). Other times it's been to intervene in mundane workplace (but very real) aggression from one colleague (with more power) against another (with a lot less power). I would like to believe that all such interventions were helpful, but having now gone through Green Dot Training I know that some of the stuff I did was not so great.
I would feel happy and lucky to never intervene as a bystander again. It never makes me feel good, even when things work out okay in the end.
posted by El_Marto at 10:25 AM on June 8, 2020 [7 favorites]