Wednesday, June 22, 2011

Danger to self in the real world

In over twenty years of providing mental health crisis services in Tompkins County, New York, I signed hundreds of orders for people to be taken into custody and brought to the hospital against their will. The order I signed is referred to in NY as a 9:45 order. It was not for hospitalization, but for custody and transport to the emergency room for evaluation. It is a huge responsibility to have the power to take people's rights away, even for a brief time.  I was always very thoughtful and intentional when I was called upon to sign an order. Individuals had to meet the letter of the law, to truly be "...likely to cause harm or come to harm.." and the danger be" imminent".  I always wanted to be in a position to be able to defend my actions in court, if need be.


All stories on this blog are edited to ensure confidentiality or are part of the public record in police reports and are my recollections. My hope is that they will have us think about the policy. The following incident took place in 1991.

The Story

The first time I got a call about Dan was from the president of a Cornell fraternity that had rented him a room for the summer.  Dan had paid for the entire summer and according to the caller was "acting weird".  He'd  been making strange grunting noises in his room that were loud enough to bother others on the hall.  Someone had knocked on his door to see if he was OK and Dan had not opened the door, but yelled through it that he was alright and he'd try to be quiet. When it continued, another person banged on the door and  told him to cut it out.  Dan responded by coming into the hall in his underwear and screaming, " The torture has got to stop, I had nothing to do with it and all of you are going to have to learn that lesson."  The young man who had banged on the door was so shocked by Dan's reaction that he quietly returned to his room and wrote down what he'd said. The grunting continued as did some yelling and banging around. Most of the fraternity brothers left for the summer and the few renters moved away from the hallway where Dan resided.  When they encountered him in the shared spaces, he'd  avoid eye contact or scowl. "He's not normal and he's scaring everyone," the caller said and informed me he was leaving town the next day so "no one is in charge."

     My policy was to respond to every call.  I arranged to meet the fraternity president at the house and to see Dan. The building was a rambling mansion with huge common spaces with beautiful woodwork and fireplaces on the first floor and about twenty rooms divided into two wings on the second floor.  I knocked on Dan's door softly and stepped back. I heard movement behind the door.  I knocked a little louder and called his name.  "What! What do you want?" came from behind the door.  "I need to talk to you, could you please open the door."  I heard more movement, things being moved away from the door.  It opened 5 inches and I saw a white man about thirty with bushy hair and beard.  "My name is Terry, I need to talk to you."  He obviously knew that he'd been causing problems and having someone else visit was not unexpected. "Folks here are worried about you and they asked me to come see you."  "Where are you from?" he asked.  "I do outreach for the county,"  I responded. "Do I have to talk to you?" he asked.  I suggested that it would be better if he did talk to me.  I wanted to let him know that if things didn't change he might be evicted.  He was as cooperative as anyone would be in that situation.  In fact, he even came out in the hall to talk, a thin man just under six feet dressed in dirty jeans and tee shirt, he smelled unwashed and his room gave out an unpleasant odor. When I at last gave him my business card, explaining my outreach was for the Department of Mental Health, he became angry again. "You people made my life miserable in Binghamton and now you're doing it again."  I explained that in fact I was trying to help by being his advocate with the fraternity."  If there are any more problems, let me know."  I left him knowing I'd see him again.

     The next week I got a call from a police officer from college town.  He'd worked 3-11 and the previous night had responded to a dispute at a fraternity.  A housemate had thrown away things that Dan had stored in the refrigerator and Dan had come to his room screaming at him and acting in a threatening manner.  The housemate was scared and called the police.  By the time they arrived, Dan had calmed and returned to his room.  He'd given the cops my card when they arrived and said I was helping him.  Scott, the police officer, told me the place smelled really bad, but since things were calm he'd not insisted on entering the room, but felt obligated to return.  When we arrived at the house, we were met by two other renters who were scared and angry.  "You have to do something." they said.  Not a week went by during my whole professional career that I did not hear that phrase.  When we got to the room and I knocked, identifying myself, Dan opened the door.  When he saw Scott, he asked, "What's he doing here. I didn't do anything."  I responded that we were following up to make sure there were not further incidents.  "We need to come in your room," Scott said.  "I don't want you to," Dan responded.  Scott said that the smell was so bad that there may be health or safety violations and if need be he'd get the building department and seek the landlords permission to enter.  Dan reluctantly let us enter.  I noted that his jeans were inches bigger than his thin waist and he'd tied a rope around them as a belt.  The smell was staggering.  Jars filled with a yellow liquid lined the shelves.  Filled plastic ziplock bags were piled on the desk.  The bed and floor were filled with dirty clothing and books.  "What's in there?" Scott asked, pointing to the jars, us both knowing the answer.  After further examination I asked Dan to join us downstairs to talk. When he hesitated, I assured him we were just going to talk, nothing else.

     "Why?" I asked, referring to the jars of urine and bags of feces in his room.  He explained that he had certain knowledge that he had aquired as a graduate student at Princeton that made him a national security risk.  "Some people know what I know and they don't want me to know it. Several times they have tried to brainwash me using basic techniques that were easy to spot.  Now they seem to be poisoning me.  I've been testing what I eliminate to find out how they are doing it."  Scott stood up asking if I needed him any more.  "You've got to clean that up and not have fights with the housemates!"  Dan agreed and continued to tell me his reasons for his actions.  Given his belief system, delusions that are symptoms of schizophrenia, everything he did made perfect sense.  I told him I'd be back in two days to make sure things were cleaned up.

     Back at my office I consulted with collegues including our staff psychiatrist.  Not much we can do, was what we all decided.  Two days later I returned and Dan reluctantly let me in his room. The smell remained, but the jars and bags were gone.  Dan had on a pair of scrubs he said he got from the Psychiatric unit in Binghamton Hospital.  They didn't show how thin he'd become, but I could see it in his face and hands. "Are you eating?  Do you need some food or help shopping?"  He shook his head and spread his arms indicating the missing objects. "Satisfied?"  I wasn't, but I then left at his request.

     The next week I got a call from the fraternity president.  "All the other renters want him gone.  We'll give him all his money back, even the deposit.  There were jars of piss and bags of shit in the basement.  The whole place stinks.  You have to do something."  I drove to the house and when I got there, no one else was around.  I went to Dan's room and knocked on his door and called his name. There was no answer. Testing the door to see if it was unlocked, I slowly entered, "Dan, it's me Terry, can we talk?"  I saw the piles of clothes on the floor and bed and wondered what to do. I got my notepad from my jacket to leave a note and noticed movement from the bed.  One of the pile of clothes was Dan.  He was lying on his side, legs pulled up, his head bowed toward his chest. His arms were crossed, his hands curled on themselves. Dried spittle was on his mouth, his eyes closed.  Only the scrubs kept him appearing as a man not an infant.  Initially, I couldn't detect breathing.  I touched his shoulder and he moved. I gathered him in my arms and took him down to my county car, placing him in the back seat.  I knew I should have found a phone and called an ambulance, but it seemed to me that moments counted.  I parked in front of the Emergency Room door and entered with Dan in my arms.  The nurses and doctors knew me very well and directed me to a room. They'd never seen me in tears before and were taken aback by my behavior.  When I got a call from the head nurse a few hours later, she'd said, "He only weighed sixty four pounds, when they get to that stage, they rarely survive."

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