[Hpn] MISADVENTURES OF AN ACCIDENTAL PSYCHIATRIC TOURIST

chance martin streetsheet@sf-homeless-coalition.org
Thu, 27 May 2004 18:59:04 -0700


MISADVENTURES OF AN ACCIDENTAL PSYCHIATRIC TOURIST

by chance martin

Itıs called a 5150. Itıs 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 5150ıed on May 8th, the reporting party called Mobile Crisis
before calling 911. The duty officer who answered Mobile Crisisıs 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 doesnıt 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 donıt claim to know whatıs going on with the SFPD in recent weeks,
but theyıre well established as a fairly volatile group of law enforcers on
their good days. Lately theyıve been verifiably bloodthirsty. The death
scent from Cammerin Boydıs 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 cruiserıs
trunk. 

Iım still considering requesting a transcript of that 911 call, but in the
meantime, we can safely assume the rifleman hasnıt been through the SFPDıs
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 someoneıs 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 Franciscoıs
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 Iıd 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
cruiserıs 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 Iım
sure the resisting charge still appears when the SFPD runs my name through
its computers. I hadnıt 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 Cityıs
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 doesnıt mean Mobile Crisis will begin carrying
assault rifles in their trunks.

And I canıt 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

Iım no stranger to San Franciscoıs Psychiatric Emergency Services, but it
had been over a decade since I had returned to ³the scene of the disordered
senses² known by the acronym PES.

The fetid ass-crack and alcohol-swab aroma of ten years past was long gone,
along with the PES ³smoking room² 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 patientıs 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 clockıs slow circuits as I was with observing them.

The great thing about PESıs 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 thereıs the whole
subjective aspect of what we might agree is ³normal.² But I hear poetry in
what ³the system² terms ³word salad,² and Iıll 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,
³Iım a kitty-cat in here, but I used to be a player. A Playah.²

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, ³Carlos! Leave him
alone.²

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, ³Oh.
All right,² in a detached tone that oozed sarcasm. But Carlosı antennae and
the wispy ends of his thin goatee are a-twitchinı, 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. Sheıs calling them on the phone to come and rescue her, but
now sheıs secluded. Sheıs frantic, maybe psychotic, but what I saw was
extreme anxiety. And itıs pretty damned hard not to feel that way in a place
like PES.

Giselleıs agitation isnıt 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 Giselleıs 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 Giselleıs
transgression in ensuing pitched discussions at the nurses station, but this
isnıt 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. ³We donıt need her crap here,² nurse Victoria tells
him. ³She needs to be in Jail Psych.²

Ultimately, Jude relents, and the complaint is made. Not surprising, since
nurse Victoriaıs behavior that evening is marked by imposing her will on
staff and patients alike, and the emerging MO is that whatever she canıt
accomplish with a request turns into a demand. Whatever she canıt accomplish
with a demand, she manipulates. This is what passes for ³triage² in PES.

But weıre the ones who are supposed to be dangerous to ourselves or others.

Weıre the ones who ³lack insight² 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 roomıs
psychotropic shackles. I sat there remembering first-person accounts of the
County Jailıs ³safety cells² 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 youıre 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 theyıre going to be transferred to the locked ward
upstairs. A couple of years ago, Iıd even documented one depressed homeless
guy, released from PES after only 24 hours, who then suicided on SF
Generalıs 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.
Theyıve certainly clear about their interests. And although I read it from
cover to cover, I still canıt 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
psychiatryıs fortress. Victoriaıs fortelies 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, thatıs when the PES milieu heats
up again.

Now, this is all overheard only. I didnıt 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. ³Heavenly Father!² his deep voice booms. ³Look at what
theyıve done to your Son! Look at what theyıre doing to your Grandson!²
  
³Get it ready,² grunts a male PES staffer.

³Father in Heaven!² the patient screams, ³Why have you abandoned me?²

³Youıll feel better in just a minute,² a male voice consoles.

³Father! Help me! NO, PLEASE! NOOO!²

³There we go.² Pause. ³You can let him go now.²

In the now-silent corridor, I hear a sigh so deep and visceral that itıs
only a hairıs breadth this side of a death rattle. Moments later Godıs
Grandson only snores in chemical crucifixion.

I decide I canıt 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:
³Mr. Martin? Time to get up. Youıre leaving.²

Groggily, not trusting if I was only dreaming but with swelling excitement
at the prospect of freedom, I canıt quite pronounce the words of my
question, ³Iım going home now?²

³No. The ambulance is coming to transfer you to Langley Porter.²

Itıs 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.

³Look,² says I, ³If I really wanted to hurt myself, doncha think I would
have just swallowed the milk in that carton thatıs been fermenting over
there under the drinking fountain for the last twelve hours?²

No response. 

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

Next Installment:

The Trial: Langley Porter Hospital

or

³And will you be having brain-fries with your court order, Mr. Martin?²
-- 
chance martin, Project Coordinator
STREET SHEET
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