Misadventures of an Accidental Psychiatric Tourist

MISADVENTURES OF AN ACCIDENTAL PSYCHIATRIC TOURIST

by chance martin

It’s called a 5150. It’s a law found in the California Welfare & Institutions Code granting the State authority to place people determined dangerous to self and/or others in psychiatric detention for 72 hours. It happens when someone thinks someone else is acting scary or dangerous, and calls 911. In San Francisco, we spend City money to train police officers on how to respond to this type of emergency call because so many people in psychiatric crisis wind up injured or dead after the SFPD intervenes.

When I was 5150’ed on May 8th, the reporting party called Mobile Crisis before calling 911. The duty officer who answered Mobile Crisis’s number recommended calling the cops. If Mobile Crisis had responded (between 5 and 6 pm on a Saturday), this story would have almost certainly had a different outcome.

But the SFPD doesn’t suffer the same funding or staffing woes that plague Mobile Crisis each and every budget year, so they responded within minutes of the call. I could actually hear siren after siren arriving beneath my Mission District window overlooking Bryant Street.

Now, I don’t claim to know what’s going on with the SFPD in recent weeks, but they’re well established as a fairly volatile group of law enforcers on their good days. Lately they’ve been verifiably bloodthirsty. The death scent from Cammerin Boyd’s kill still hung heavy in the atmosphere the SFPD breathed that Saturday.

I decided to present a model of calm and respectful cooperation.

I was waiting seated in a chair in the middle of the room with my hands on my knees when eight SFPD officers–one wielding an assault rifle–made their way up the stairs into our second-floor apartment. The party who originated the 911 call claims to have clearly repeated that no weapons were in the house to the operator on the phone, and in person to the police officer in the first response unit who grabbed the assault rifle from the cruiser’s trunk.

I’m still considering requesting a transcript of that 911 call, but in the meantime, we can safely assume the rifleman hasn’t been through the SFPD’s Police Crisis Intervention training yet. Or maybe SFPD officers get shift premiums for breaking out assault rifles, like the one they get for donning riot helmets.

In either case, brandishing military hardware in someone’s home, and in response to a reported psychiatric crisis, boggles the imagination. It boggled mine, anyway.

These are the basic ingredients of the 21st Century American phenomenon we term homicide by legal intervention. And I suddenly understood exactly how deadly this situation could easily become if anybody got stupid. I made it my mission not to be that person.

On the other hand, the officer who talked to me, patted me down, and ultimately handcuffed me is someone who did complete the crisis training, based on our interactions. He was very professional and very calm, and for that I owe him my gratitude. Unfortunately, when police respond to a psychiatric crisis call, they consider hauling you off to San Francisco’s ridiculously overburdened Psychiatric Emergency Services, instead of jail, to be a humane and compassionate outcome.

If the officer had offered a choice, I think I would have taken jail... because I’d probably be in front of a judge and free by the coming Monday afternoon.

For my part, I attempted to play the circumstances like any other potential arrest situation–that is, I practiced de-escalation with the cops. I kept my hands in plain sight, spoke clearly and deliberately, made no sudden or unexpected moves and generally cooperated. I even attempted to smile. But I was positively relieved when I was finally deposited into the late-model cruiser’s fiberglass back seat, the assault rifle was returned to the trunk, and all the cops abandoned our corner once more to the struggling low-level drug traders and users who live and die there.

In the interest of fairness to the SFPD, they probably had a detailed report about my identity. And I was charged with resisting arrest several years ago, along with about seven or eight other men and women seated on a floor and linking arms in passive civil disobedience. Our charges, which also included conspiracy, were later reduced to a couple of infractions, but I’m sure the resisting charge still appears when the SFPD runs my name through its computers. I hadn’t fully considered that my safety would be at elevated risk whenever I deal with the SFPD for the rest of my life when I decided to be part of that civil disobedience years ago.

One side note: the SFPD is now conducting cross training with the City’s mental health staff. The idea, as I understand it, is so mental health professionals gain a clearer understanding of just how hard it is to be a cop. I can only hope it doesn’t mean Mobile Crisis will begin carrying assault rifles in their trunks.

And I can’t help but wonder how many of those eight cops marched later that week with the lynch mob seeking to avenge Isaac Espinoza.

 

Goodbye, Blue Sky

I’m no stranger to San Francisco’s Psychiatric Emergency Services, but it had been over a decade since I had returned to "the scene of the disordered senses" known by the acronym PES.

The fetid ass-crack and alcohol-swab aroma of ten years past was long gone, along with the PES "smoking room" and its communal (and regularly replaced) can of Bugler tobacco. But trash-strewn corridors are still depressing, regardless of how new the tile beneath the trash might be. And the remodeling seemed to have swept away about half of the staff that one would once find there as well. Or perhaps the staff themselves have also been remodeled.

Which is not to say that the remaining workers were idle. But from what I observed, they were far more invested in sitting around a table removed from any patient’s casual scrutiny than in making themselves available to patients in psychiatric crisis. Perhaps this kind of neglect is employed by PES staff as a tool to determine who is really dangerous, although it seems far more likely they were understaffed and burned out... and as preoccupied with observing the clock’s slow circuits as I was with observing them.

The great thing about PES’s old smoking room was that it afforded psychiatric detainees who smoked (or wanted to) some small comfort in the vestige of nearly-normal socialization. Of course, then there’s the whole subjective aspect of what we might agree is "normal." But I hear poetry in what "the system" terms "word salad," and I’ll wager I probably have more meaningful relationships with more mentally ill homeless people than any city-funded provider in San Francisco.

Before the police left I had surrendered everything in my pockets, as well as my belt, to a psych tech, who gamely tried to fit all this into a seven- by ten-inch envelope. I was instructed to sit down on one of the chairs in the waiting area until I could be processed. A slender man with a slate-gray cotton-candy hairdo and sparse goatee saunters up and sits down next to me to talk. He points to a cartoon feline on his black t-shirt and confesses, "I’m a kitty-cat in here, but I used to be a player. A Playah."

The charge nurse at the desk, a thin-lipped, embittered individual who can only be described as wearing far more makeup than the circumstances warranted, pops up from her preoccupation and barks, "Carlos! Leave him alone."

I calmly inform the nurse that Carlos is not bothering me. She shoots a mascara-ed glare at me from over her nose-perched glasses, and says, "Oh. All right," in a detached tone that oozed sarcasm. But Carlos’ antennae and the wispy ends of his thin goatee are a-twitchin’, and he bolts for the dayroom in immediate obedience.

This is someone I need to keep an eye on, thinks I.


But a young Latina in hospital smock and black ball cap named Giselle is the star of PES that Saturday night. She wants to see her family. She wants to see her kids. She’s calling them on the phone to come and rescue her, but now she’s secluded. She’s frantic, maybe psychotic, but what I saw was extreme anxiety. And it’s pretty damned hard not to feel that way in a place like PES.

Giselle’s agitation isn’t well tolerated in the scene of the disordered senses.

Periodically, PES staff appear to demand Giselle return to an unlocked seclusion room, but then she only waits for them to retreat to their table behind a wall separating the staff area from the nurses station, and she is invariably compelled to wander back out of the seclusion room. It seems whatever it is that the staff seek to accomplish in their little sanctuary is constantly being interrupted by Giselle’s lack of compliance with their commands.

Finally, shouts and commotion in the day room and several staff bundle Giselle back into seclusion. This time a young Asian psych tech named Jude had asked her to return to the seclusion room again, and she slapped the glasses from his face.

Jude, who is uninjured, tries to minimize the gravity of Giselle’s transgression in ensuing pitched discussions at the nurses station, but this isn’t good enough for the triage nurse, whose name I learn is Victoria. After screaming at Giselle, and later cruelly mocking her cries of distress filtering out into the corridor, the nurse persistently harangues Jude into filing a police report. "We don’t need her crap here," nurse Victoria tells him. "She needs to be in Jail Psych."

Ultimately, Jude relents, and the complaint is made. Not surprising, since nurse Victoria’s behavior that evening is marked by imposing her will on staff and patients alike, and the emerging MO is that whatever she can’t accomplish with a request turns into a demand. Whatever she can’t accomplish with a demand, she manipulates. This is what passes for "triage" in PES.

But we’re the ones who are supposed to be dangerous to ourselves or others.

We’re the ones who "lack insight" into our behaviors.


The nurse made an example of Giselle for the rest of the patients who were functioning enough to be up and about and not prisoners of the day room’s psychotropic shackles. I sat there remembering first-person accounts of the County Jail’s "safety cells" that moved me to write an exposé (see A Collect Call From Jail, STREET SHEET 5/01). I can imagine that as San Francisco County Jail continues its role as the largest local mental health provider, the distinction between punishment and treatment only becomes fuzzier. Fool that I am, I always thought these terms were mutually exclusive. But then, I thought, look where you’re spending your Saturday evening.

Understanding that my personal safety had only improved marginally after the police left me in the care of PES, I pulled back into defense mode. I was going to be released, I kept telling myself. Nobody spends an entire 72 hours at PES unless they’re going to be transferred to the locked ward upstairs. A couple of years ago, I’d even documented one depressed homeless guy, released from PES after only 24 hours, who then suicided on SF General’s campus.

Finally, and in seeming afterthought following my processing and intake interviews, I was invited to make myself comfortable in the day room. I poked my head in long enough to see drugged bodies strewn across the crowded reclining chairs in the constant twilight dimness of that place, and elected instead to request something to read as I staked out a gurney in the bright corridor. The only thing they could offer me to read was a recent personal copy of Fortune magazine. PES docs must be doing pretty good, I think. They’ve certainly clear about their interests. And although I read it from cover to cover, I still can’t summon much humane perspective to extend to the capitalists this magazine champions.

Incredibly, throughout the evening, people come to the plate-glass observation window in the hospital corridor outside PES to request admission. And this is where nurse Victoria truly shines: telling them NO, sending them away into the night, guarding the gates of publicly-funded psychiatry’s fortress. Victoria’s forte lies in her ability to be a regular city-salaried asshole. How rewarding she must find her hours at PES, I reflect in silent gratitude. Because as long as she has mentally ill homeless people to fuck with, my own odds of escaping her special triage increase.

I finally start to doze... and of course, that’s when the PES milieu heats up again.

Now, this is all overheard only. I didn’t want to draw unwanted attention to myself by standing somewhere where I could get a clear view of this drama. But what I heard haunts me even as I write this.

An African-American patient arrives on the ward in the full, florid throes of religious mania. "Heavenly Father!" his deep voice booms. "Look at what they’ve done to your Son! Look at what they’re doing to your Grandson!"



"Get it ready," grunts a male PES staffer.

"Father in Heaven!" the patient screams, "Why have you abandoned me?"

"You’ll feel better in just a minute," a male voice consoles.

"Father! Help me! NO, PLEASE! NOOO!"

"There we go." Pause. "You can let him go now."

In the now-silent corridor, I hear a sigh so deep and visceral that it’s only a hair’s breadth this side of a death rattle. Moments later God’s Grandson only snores in chemical crucifixion.

I decide I can’t hang in the corridor anymore. I find an empty reclining chair in the dayroom, a male PES staffer locates clean blankets and a pillow. I lay my head on the antiseptic-smelling cotton and the world at last turns dark.

No sooner it seems that I finally find sleep, a voice intones in my ear: "Mr. Martin? Time to get up. You’re leaving."

Groggily, not trusting if I was only dreaming but with swelling excitement at the prospect of freedom, I can’t quite pronounce the words of my question, "I’m going home now?"

"No. The ambulance is coming to transfer you to Langley Porter."

It’s 6 am. My heart plummets. Ten years ago I was medically indigent, but today I have health insurance. Lucky me... PES had palmed me off on another hospital.

"Look," says I, "If I really wanted to hurt myself, doncha think I would have just swallowed the milk in that carton that’s been fermenting over there under the drinking fountain for the last twelve hours?"

No response.

And now I wonder had anyone in PES ever listened to me at all.

Next Installment:
The Trial: Langley Porter Hospital

or

"And will you be having brain-fries with your court order, Mr. Martin?"

CHANCE MARTIN
PUBLIC INTEREST SEAT, SF MENTAL HEALTH BOARD