The handcuffs.
But I'll come back to them in a minute. First, a little background to understand how we got to the point of handcuffing depressed people.
Mental health caseworkers or clinicians used to go out into the community to assess and transport clients to the psychiatric hospital. Outpatient mental health services also used to be more accessible. But the administrators of our local mental health authority are more interested in redecorating their offices than in treating people so they cut services to keep more money for themselves. The result?
First, they made outpatient services less accessible. If fewer people are able to access treatment less money is spent on them. And this was the problem with my client. She spent two months trying to access psychiatric treatment to get her medications. But she could not get through the barriers they erected. Secondly, people trained to handle mental health issues are no longer provided to transport clients to the hospital. This job now falls to the police department.
So people are unable to get their medications. They "decompensate" (which means they get sicker and sicker) until they are no longer functioning and have to be hospitalized. In step the police.
The police department has made an admirable attempt to meet this need. As police officers they try very hard to be compassionate, kind and gentle. But they're still police officers, not caseworkers or clinicians. So they show up in police cars and police uniforms complete with stun guns, billy clubs, badges and guns and sit down to talk to the client who is so depressed and tortured she is actively suicidal. This very tiny, soft spoken, tearful Black woman is in a small room with two huge, burly, White cops. It is so intimidating it breaks my heart. They are kind and try to be reassuring, but it's difficult. At one point I realized she was becoming more distressed and I interrupted, asking if she had questions. Yes, she did. Was she being arrested? Oh dear. I was afraid of that. The police reassured her, but it didn't change how the situation felt. In the end they agreed she needed treatment and agreed to transport her to the hospital.
Being the police, they have to follow police procedure, which is designed for transporting criminals, not suicidal people. They explained as gently as they could that they would have to handcuff her to transport her. I hate this part. It's so humiliating to be treated like a criminal and taken out to the car in handcuffs. The police car draws attention. People stop to watch what is happening. Spectators don't know she is being taken to the hospital. It looks like she is being arrested.
But which is worse? The stigma of appearing to be a criminal? Or the stigma of being labeled "crazy" and being carted off the "nuthouse" as one person put it? It differs depending on the client.
When are we going to make it a priority to provide proper mental health services for people in this country? Not any time soon it seems. But I have to realize that we've only recently made it a priority that everyone receives adequate medical treatment. I guess mental health will have to wait its turn.