Psyche in the City

A couple weeks back I was up to my usual routine on a nearby street chatting with parents, while watching our kids burn their last bits of evening energy. My head was somewhere in the clouds following a night shift. But after a while I noticed some parents making odd glances towards a quiet masked man on the sidewalk. He stood fairly still while our kids flowed around him like a boulder in a stream. I thought he was maybe visiting a neighbor, but eventually I realized that was not the case. I asked him some friendly questions, but he really couldn’t answer very much. When I asked if he needed help he said “yeah.” So I started my usual ER questioning.

He admitted to being from out of town and lost. He was off his usual meds, but had no interest in hurting himself or anyone else. So I called the ER to see what mobile crisis options may exist. They gave me a number for county mental health. I called and got a friendly person, but was told I’d need to call 911 and ask for police or an ambulance. Since that seemed excessive, instead I just gave him a ride to the ER. 48 hours later I was told he was still there awaiting a psyche bed.

What made me think about this was a conversation I had a few days back with a police officer, as well as this article: California man died after police kneeled on his back for five minutes; officers claimed ‘struggle’. The officer said recruitment was way down and that officers were quitting in droves. “Would you want to be a cop these days?” he said. I wouldn’t even want to be a hall cop in school. It’s a wiring I’ll never have. That being said, I’m still extremely grateful they exist. I also hope the scrutiny officers are facing nowadays won’t amplify the behaviors we fear, while chasing their most ethical and level headed into early retirement.

In any case, I can’t change policing or people being policed. But I do know that many social problems are numbers games as well. If you send armed uniformed people with Kevlar expanded chests to every perceived mental health crisis, some fraction of those interactions will go horribly wrong. Having deescalated many psyche emergencies, of this I’m certain.

Dwindling psyche services, coupled with unemployment, street drugs, prescriptions drugs, homelessness and a pandemic, along with a profession that probably needs therapy as well, seems like a terrible combination.

Maybe a mobile crisis team could use some point of care labs and an RV to short circuit some of the madness? In New Mexico I remember “ACT” (Assertive Community Treatment) teams that roved the downtown in yellow shirts just doing routine checkins on the most fragile. (I’ve seen articles on that in SLO, but haven’t seen the implementation. Possibly it’s happening already, and I just called county mental health on the wrong day. If so, please set me straight.)

Maybe there’s opportunity for a nonprofit or for profit business to dig in? Maybe beds previously intended for COVID patients could be repurposed in some ways or other for psyche emergencies? Maybe the former Sports Authority (7+ years vacant in prime downtown) could somehow be helpful? Anyways, what do I know. I’m just another nut in the mix.

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