Quiet

As I sat at my desk this morning, I heard a young woman scream, “I don’t fuckin’ care. Put me in the damn hospital. We both know that is where I belong. I am done. I don’t want to live this life anymore”. This statement was followed by a series of sounds including doors slamming, things being thrown, and a horrible scream.

Given the woman’s diagnosis, the behavior is not unexpected. The diagnosis is marked by dramatic gestures and a need for attention, amongst other things. Typically, this behavior in this situation would simply be redirected. One should not receive an excessive amount of attention for the behavior nor should those present perpetuate the behavior. Clear limitations and expectations must be given and then all involved must go on with their days.

Of course, there is more involved as well. A risk assessment must be made. One must consider the person’s access to weapons. One must consider current medications, drug abuse, and stressors. One must also consider the safety of those around the volatile person.

The fact is that it is rare that a person whom is so verbal will actually harm him or her self significantly. It is more likely that he or she would engage in a superficial gesture designed to gain attention. Yet, one must still consider what that person would to those around him or her.

Once upon a time, that was my job. I would walk into those situations. It would be my duty to assess and de-escalate. If I failed at calming the person down, I would take other measures. Sometimes, I simply petitioned to have the person detained. When I think about some of the situations I have put myself in over the years, I realize that I often compromised my safety. With that said though, I always followed my gut. It is my opinion that one’s gut feeling is the best tool a person can have when working in the mental health field.

This morning, as the woman screamed, my gut told me things were fine. I had to restrain myself from getting involved. I had an entire plan formulated in my mind before the rest of the staff even responded. Although I did emerge from my office in an effort to show staff presence, I remained silent. It was an odd experience for me. I am used to taking charge in those situations.

Yet, as I sit in my office again, I am okay with the fact that I remained quiet….