Michael Morse: Undertrained, unarmed and overwhelmed

01:00 AM EST on Sunday, March 9, 2008

MICHAEL MORSE

THE BLINDS were separated, leaving an inch of blackness between them.

Somewhere in the darkness two eyes looked out. They saw me but I couldn’t see them.

“Rescue 1 to fire alarm, do you have a callback number?”

“Stand by.”

We stood on the snow-covered doorstep. No sounds came from inside. I knocked again. Nothing.

“Rescue 1?” my portable radio cracked the silence.

“Go ahead.”

“The person should be opening the door; I’ve got her on the phone.”

“Roger, the door is opening.”

A disheveled, intoxicated 30-year-old female opened the door widely, begging us to come in and shut the door. The place was in shambles. Dirty dishes, laundry, spent cigarette butts, animal waste and cockroaches had taken over. The patient scurried about, pretending to tidy up the place but in actuality couldn’t have tied her shoes at this point. She was too far gone.

“Rescue 1, do you need the police?” the radio blared.

“No police!” screamed the patient. “I’m sick, not a criminal!”

And so it goes.

The Fire Department is called for a variety of reasons. Nestled among the building fires, chest pain, intoxicated persons, building collapses, car accidents and other emergencies are a surprising number of calls for psychologically unstable patients. The labels vary: Emotional, Change of Mental Status, Anxious, Suicidal, but all are potentially dangerous.

Society is filled with people suffering from emotional and psychological problems. Many of these folks lead productive lives once they get help from remarkably effective treatments; medication and other therapy produce tangible results in the mentally ill. Some patients have given up on treatment, choosing to make their own way in the world unimpeded by modern medicine. Most are not successful. Many have no access to the health-care system. Whether that is their own decision or beyond their control is irrelevant, what matters is there are a lot of untreated mentally ill people living among us.

When crisis occurs, and if they are able to recognize the warning signals their damaged minds send out, a good resource is the 911 system. Highly trained personnel are waiting to take care of these patients, and get them the help they so desperately need. Or are they?

Those in emergency medical services are given rudimentary training regarding the mentally ill. They cannot solve their problems, nor do they have the qualifications to try. The best they can do is to keep patients calm and get them to the help they so desperately need. Sound simple? It’s not.

Those who decide to call for help are at the end of a long, downward spiral. Making that call is a courageous step, fraught with uncertainty. They wait by the phone, wondering if they did the right thing by calling. From the time the initial call is made to the time help arrives a lot can happen. They can change their minds. They can hear voices. They can begin to see their rescuers as threats to their independence. At times, violent struggles ensue. Sometimes the situation is diffused with care and compassion. Often, force must be used. But whose responsibility is it to use force?

The majority of calls for help concerning the mentally ill are handled by the Fire Department Emegency Medical Services, not the police. Family members and friends who call for help want to avoid a confrontation. They are at the end of their rope, helpless and afraid. They look to EMS as saviors when they arrive to take their loved one to a hospital or psychiatric facility, only to find their options limited by law and lack of training.

Patients who make the call don’t see themselves as a threat. What lucidity remained when they called for help is often gone when help arrives. These emotionally charged situations often lead to violent confrontations with would-be rescuers.

Mental-health-care professionals call 911 from their facilities looking for an “ambulance” to take a problem patient off their hands. Emergency Medical Technicians are then expected to put that volatile patient into a four-by-eight-foot space filled with glass and needles. It is a recipe for disaster.

EMS professionals cannot restrain, subdue or abduct. Doing so is a violation of a person’s civil rights. There are no “men in the white coats.” They don’t carry straitjackets. All they have is common sense, compassion and a willingness to help a person in need. Often, it is not enough.

In the tragic aftermath of one such recent call in Pawtucket, a mentally ill man was shot and killed. The police solved the crisis the only way they saw that they could at the time. The officer justifiably felt his life in danger and responded accordingly. Would the result have been different if the fire department had been called, or would there be a dead EMT in the patient’s place? We will never know.

A rapid-intervention team consisting of a psychiatrist with power to commit a patient, a law-enforcement officer with power to restrain a person against their will and a pair of EMTs to provide support and transportation in a safe environment is what is needed on these type of calls. Until that happens we are sending undertrained, unarmed and overwhelmed people into dangerous situations. There needs to be a definitive approach to handling the mentally ill who call for help.

The current lack of a system is a time bomb. You can hear it ticking if you care to listen.

“No police,” I said as softly as possible. “Get your things and come with us. We’ll get you some help.” I looked around for potential weapons, kitchen knives especially. A caseworker was stabbed in the neck on Broad Street a few years ago by an emotional patient and bled to death in the doorway, leaving a wife and two small children.

After 15 minutes of negotiations, and her crying, laughing, and a temper tantrum or two, she left her apartment with us. From the looks of things, it may be a long time before she returns.

Michael Morse, of Warwick, is a lieutenant in the Providence Fire Department working in Rescue 1 and author of Rescuing Providence.