My Sojourn through Bipolar Illness – What to give up to fight stigma?

Do you feel uncomfortable when there is a news announcement of a violent crime committed by some one who is mentally unstable or mentally ill?  How can we address this stigma such that those of us who live with a mental health diagnosis largely lawfully are not readily lumped together with those people who are committing heinous acts due to their instability?

What might the typical mental health or substance use patient have to give up if there were to develop a Paranoia Hotline, a Paranormal  Institute or a Cohort Model is some level of privacy? (Please see prior posts for a discussion of these concepts.)  It is a “no brainer” to me that weapons do not belong in the hands of the mentally ill even when they are in recovery. 

I also believe we as a society should allow therapists and doctors to report clients who may be showing signs of being a danger to others. This is very tricky territory, but it seems to me that the person providing mental health care should be able to report findings to some larger group whose mission is to follow-up and investigate and intervene if the concerns raised by the therapist show that a patient is a threat to others.     At a minimum in my opinion, such notice from a therapist should ensure the patient goes on a weapon do-not-sell list.

In the past ten plus years the number of school or mass shootings in the US has sky-rocketed with the age of impacted schoolchildren often getting younger and younger.  I feel it is the responsibility of people with mental health diagnoses who know how dangerous paranoia can be and how quickly it can develop into an unsafe situation to speak up in favor of controlling and denying access to guns and other weapons for the mentally ill.  I also think the dialogue about what a therapist can reveal about his or her patient warrants more attention.  If a patient is clearly a danger to others, this fact should be communicated to a third party in charge of reconciling the account.    As people who strive day in and day out to be safe when there is often unsafety lingering around in the shadows, people with mental health diagnoses need to speak out as a group to ensure that lawmakers make weapons inaccessible to the mentally ill and provide societal intervention and/or follow-up for people who seem to be a danger to others.

It is only when we start to differentiate people who are a threat to others from people experiencing mental health symptoms but are no danger to others are we able to begin to address the stigma associated with mental illness.  The public needs to know that it is a small percentage of people with mental illness who are actually a danger to others so that we who are living with the impacts of mental illness are not lumped into that category of “danger to others”  and receive all the stigma that goes with that. These people who are a danger to others need early intervention from healthcare providers and first responders so that they do not act on these impulses to extend dangers to others.

My Sojourn through Bipolar Illness – Intermixing with Police and First Responders

I am of the mindset that police and college campus police could do well with more training as to what constitutes a paranoid episode that is largely safe and what constitutes a paranoid episode that is largely unsafe.  I feel that the police serve in a hugely defining role as to whether someone experiencing an episode of bipolar illness should go the hospital or be incarcerated.  There is no such distinction for any other type of intervention that the police are called upon to mediate.  It takes a great amount of training about paranoia and how it operates particularly in the minds of our youth.  If psychiatrists are largely unable to determine when paranoia is linked with violence or not after days or months or years of working with that person, think what a challenge it is for a police man or woman intervening with no case history on the patient while being charged with the safety of that patient and all bystanders.  It is a huge responsibility that falls on the police and college police. 

I have worked through NAMI (the National Alliance on Mental Health) in their In Our Own Voice Program to talk with these First Responders and provide more insight into the patient’s point of view when these incidents occur.  I found the reception at that event quite welcoming as if the police or campus police had never had a conversation with someone prone to paranoia when that person was outside of that paranoia event.

In any case, I find the work of police and campus police to be a gargantuan task.  It almost requires the intervening police officer to be all-knowing and to be able to size up the situation in a matter of minutes as to whether the person before them is paranoid and a danger to others or paranoid, a danger to themselves and needing hospitalization.  I feel that additional training in differentiating these behavioral health outcomes should be mandatory both for crisis interventionists as well as medical and clinical professionals.  As a person who has experienced mania and being a danger to self and perhaps others, I readily do not see a clear line for police to follow from which to determine how best to intervene.  If I am unclear on that intervention after 30 plus years of managing (or trying to) the illness, I would imagine most police and campus police feel that they are overwhelmed and alone as First Responders in assessing the case of a behavioral health incident.

I feel for the police and the campus police and their courage in this line of work and believe that greater training like that of NAMI’s In Our Own Voice Program is extremely important.  I had one first responder come up to me at that In Our Own Voice presentation and thank me.  The officer had never talked to someone with a tendency toward paranoia when they were not in a paranoid state.  All he had ever seen was the patient at the height of a paranoid event – he must have assumed through no fault of his own that that state of paranoia was the norm for that person rather than a state that comes and goes and can be managed for the most part through medications and talk therapy.   

The First Responders should have some sort of script that allows them to assess if the danger is being directed internally toward the patient or if the danger is more generalized to people external to the person experiencing the breach of reality.  I do not claim to have the content to that script in full, but my current thoughts about how questions for this script might go is something like what follows.  This script below should be vetted by a team of first responders, therapists, doctors and other professionals and is only a “strawman” from the point of view of one patient.

 I am going to ask you a series of 20 questions.  I would like for you to respond to each question to the best of your ability. OK, are you ready?  First question: 

          1) What is your name?

2) Are you a student here?

3) Are you feeling OK?

4) What is the date today?

5) Are you feeling suicidal?                

6) Have you ever felt this way before? 

7) Do you have a mood disorder illness?   Have you ever been hospitalized for a mood disorder?

8) Are you hearing voices?

9) What are the voices saying?

10) Are the voices asking you or telling you to harm yourself?

11) Are the voices asking you or telling you to hurt anyone else?

12) Do you have a weapon?  Are you intending to use it? 

13) Where did you get it?  Have you had it on you for several days or just a few hours?

14) How long has it been since you took a shower?

15) How long has it been since you had a full meal?

16) Have you been using any mind-altering, recreational or prescription drugs?

17) If so, what are they?

18) Do you feel safer now that the paramedics are here and we are talking?

19) Is there someone in particular you would like to talk to? Your parent? Your friend? Your psychiatrist? Your therapist?

20) What do you need to feel more calm?    

If there had been such a script available for use by First Responders at the West Ferry airport back in 1985, perhaps my first episode would not have been so cataclysmic.  Perhaps I would not have been plagued by security concerns for several years after this first episode if that episode had been less threatening and less dramatic.