HOSPITAL-articleLarge

By Jonathan

The phone rings and the familiar voice on the other end of the phone tells me I need to call for assistance and get back to the room where our new “friend” is being held. I run back there and find that a man I had searched and restrained approximately fifteen minutes ago has already managed to pull a knife out of an orifice that (spoiler alert) doesn’t smell like roses, cut through his restraints, and threaten to kill everyone. But more on that later . . .

I’ve been employed as an armed security officer at an emergency trauma center in my state’s favorite ghetto for a few years now. I took the job after I didn’t get hired by my law enforcement agency of choice out of college. I can honestly say it’s been good experience, albeit stressful at times, but I don’t look forward to doing it much longer. What I want to share is my unique perspective on being put into a shoot/don’t shoot scenario, the politics and pitfalls of working contract armed security, as well as how the public mental health system affects us all. Through my time I’ve seen all this wrap together in a way that I believe is unique and should provoke some thought.

First, let’s talk about budgets. I love guns. Despite what some would say about me, guns are not the reason I do what I do, that passion is separate. Anyway, imagine the smile on my face when I show up for the first time at my new job for training and a brand spanking new gun box is put in front of me that has the red letters H&K on it. Then I read the words on the handle, “Pistol USP 9mm Tactical.” Anyone else getting a little too excited?

Now, imagine my face as I open the box and what I actually find occupying that space is a police trade-in Smith and Wesson 10-6 with wooden grips, covered in surface rust. “That’ll rub right off,” is what I’m told. I didn’t know what to say as I was then issued an awful snap holster, two of the worst speed loaders I have ever seen, and exactly 18 rounds of mixed .38 special ball that looked like it had been handed down for a decade or more. Only one had a copper jacket and I couldn’t read the head stamp because it was so dirty.

My issued pepper spray had expired three years ago and felt almost empty. When I asked where to pick up my vest, my new boss chuckled. We don’t wear them. I was warned if I wanted to buy my own that was fine, but I should know I would technically be in violation of policy, using unauthorized equipment. I still don’t wear one because now my budget won’t allow it. Unfortunately, this also meant that my GLOCK 17 and Safariland 6360 duty holster from my previous job were out of the question. It’s apparently better policy to make someone use what I would argue is antiquated and substandard equipment than to allow them to qualify with a more modern setup that they are used to. The argument I was given is that it’s a “department standard.” There are only seven of us total.

Back to the man with the knife. This is where things get cloudy. Now, can you imagine the fallout for shooting someone inside a hospital? A patient? Physically restraining combative patients and in general dealing with some of the rudest and most disgusting people you can imagine is a daily experience for me. This particular individual had been picked up by police for assaulting someone else on the street, searched, and then dropped off at the hospital because that’s what they do with people that have mental illnesses.

I am sad to report from at least my perspective they are rarely arrested. Once I even had a conversation with a patient who was there in the winter admittedly because he had been kicked out of every shelter and church in town for starting fights. He wandered over to my hospital and said he wanted to kill himself because he knew it would mean a place to stay the night and a sandwich or two. His advice to me was that I should quit my job and just “be crazy.” I sat there and listened to him brag about how he gets two government checks a month and a food card that he uses to buy liquor and cigarettes because of his disability. And the best partm according to him, is that you can do whatever you want and never get in any real trouble because you’re crazy.

Again, back to that knife. My unarmed backup arrives and we get to go play a game called “get the knife from the crazy person,” a game we’ve both played a few times. To a regular concealed carrier, crazy man with a knife saying he’s going to slice you up is pretty cut and dry. Getting away is your number one priority. If you can’t get away take the shot and call for help.

For us, there’s no avoiding it or getting away. This is where a lot of people will jump in and tell me to quit whining and do my job. Some even tell me that the police also have a duty to act, so why am I worried? Well remember the difference between me and the police is that the police are better equipped, have real authority, and are unionized and protected. I have been told by people above me on numerous occasions that in the event one of us were to have to use deadly force, even if it was clearly justified and saved lives, we would likely be fired immediately for public relations reasons.

Don’t get me wrong, the last thing I want is to use deadly force, but what I am getting at here is, if I feel like I can’t use it and screw up, I could get hurt. Also remember we’re always one snap holster away from a gun grab. So, despite the fact that he has a deadly weapon and is threatening lives, I don’t even consider drawing my pistol because I know what kind of a shitstorm would result from that action.

As soon as we were close enough we avoided his first swing and took control of his arm and broke the knife free. The struggle was quick and nobody ended up cut or with anything broken. My backup officer got spit on, but we were able to re-restrain the man safely with the help of the other staff once they knew the knife was out of play.

During the rest of his stay I would occasionally go see him to check the restraints were secure. Every time I did so he would tell me that he’d be out in a day and would be back “with his piece to pop pop, take care of me.” This is something I take seriously because aside from my interest in keeping myself alive and intact, as I said earlier there is no real retreat option for me. If someone were to come looking for me with a weapon they know where to find me and I am there 12 hours a day.

The real message here, aside from wanting others to learn from my experiences, is that we really do need to find better ways to deal with mental health. The recent shootings/stabbings in California involved someone who had a support network of family and therapists. There were large glaring signs pointing to something bad happening and still nobody did anything to prevent that tragedy.

About a week after the man with the knife left my hospital, he showed up again, this time with a gun in his waistband. We were fifteen yards or so from him, and if he had reached for it before the police arrived there would have been a bad outcome. He was arrested in possession of a firearm after threatening to shoot people outside of a hospital. I’m thinking, “Good, the police will finally be able to deal with this.” Think again.

We were good for about a month after that, then he’s back. I found out later that he had been again taken for mental evaluation and released. He shows up again, this time using a toy gun with the orange tip painted black, and threatened to kill a group of employees on their way out to the parking lot.

Since then I have attempted to use the freedom of information act to retrieve the police reports, which have been denied due to “pending court outcome.” This man I have been writing about is not our only regular with mental illness that causes problems for us and the community. If we won’t lock up or find a real solution for someone like this who has no oversight or family network and a history of threatening and violent behavior, how are we going to lock up or intervene in the cases of potential spree killers who often have no prior record?

I am very confident in saying at this point that there is not enough being done to treat people with serious mental illness. In the one example I shared here, thankfully nobody was killed or seriously hurt. But when you combine the quick turnaround of mental health cases with what is happening with the court system, it seems obvious that you are going to have problems. Being reactive is not going to help keep people safe but it seems as long as budgets are tight and nobody is stepping up to get creative that’s all we’re getting.

For those who are wondering I finally got new ammunition (still lead ball) and pepper spray, but only after one of my co-workers was injured detaining someone who was hearing voices and armed with a metal pipe. The police arrived finally and ended up tasing him to get the cuffs on. We were supposed to get tasers after that as well, but when it came time to buy, the budget wouldn’t allow it.

I can’t help but see the same theme all around me now. We shouldn’t be happy just doing something, what we need is to work together to do the right thing. As long as our politicians and representatives aren’t called out for throwing up the safety smokescreen, nothing with change. Get out and be loud, be proactive and don’t be afraid to improvise. If we are going to do something let’s make it count. Feeling safe is not as important as being safe, which is why simply blaming the guns and hoping for the best doesn’t work.

46 Responses to P320 Entry: Scenes From America’s Mental Health System

  1. Some anti-psychology radicals helped dismantle our mental health system in the 1970’s and set a lot of mentally ill people loose on society. A lot of those radicals were themselves diagnosed with serious mental illnesses. One of them was Kate Millett, who subverted feminism in the 70’s and was able to turn it into what it is today. She was herself diagnosed with severe mental illnesses and her family attempted to have her committed. She was credited with changing Minnesota’s commitment laws but likely just made the whole situation worse.

    I’ve seen the other side of your wonderful journey working in a jail. We didn’t keep crazies for long, they usually got bounced to MHMR. We did get to keep them in iso until the proper constable or deputy could show up. Usually they were just taken to a different facility that had a special wing for them. They would stay as guests of the county until they had their hearing, would usually get declared incompetent to stand trial, and would be released back to the street. If they were charged, they usually just don’t show up for court. So they do a few months in lock up and generally got released back to the street. A lot of them work as trustees because once they are in jail they are forced to take their meds and suddenly become model citizens. Go figure. Either they were out within 24 hours or out within a few months, but the reality is a constant rotation of genuine mentally ill individuals who were not getting any kind of real help other than a disability check which was usually spent on cheap booze and beer. You see these people often enough you get to know them by name.

    In the jail we don’t have firearms, so there is no shoot/don’t shoot scenario. Fights do not go down like they do in the movies. I was usually working as an over-glorified clerk, running warrant checks, taking booking sheets, or working the public information desk. Actually, I’d wrestle with crazies for an entire shift if it meant not having to work that damn info desk. Nothing like trying to explain complex legal terms to people who couldn’t graduate high school. Even with my usual duty rotation, I’d been involuntarily involved with enough scuffles to know those people don’t hold back, generally don’t care if they get hurt, and don’t know how to “fight proper”. Martial arts or other civilized training usually does not help when your opponent does not care about the rules of the match. I’m not bashing martial arts, I took Tae Kwon Do for many years, but a street fight is not a sparring match.

    My roundabout point is that our system is horribly broken and it was broken by some of the people it was intended to help. We as a society seem to have turned a blind eye to the whole problem. Now, thanks to smartphones and other distractions, it is easier than ever to ignore a problem right in front of our face. Sadly, few of these people are as “harmless” as many claim. Most of them could get violent in the blink of an eye and with little provocation.

    • Unfortunately, you are right. Hand to hand training is hard to use against people who you can’t beat within an inch of their life without severe repercussions. In real life, you take out joints and render the attacker unable to move or fight. Quite often, a person with martial arts training will do nigh irreparable damage in self defense. (Rolling arm bars are a personal favorite of mine from my MCMAP days.) Sadly, when you are a public servant, you are unlikely to have good results when a fistfight ends with the assailant with two broken elbows and a fractured knee.

      • I’m a big fan of arm and wrist locks, but you actually have to be able to get ahold of an arm to pull off either. The Sheriff’s Office was also fond of what is popularly known as a “dead leg” though they called it an “upper leg takedown”. Most of these techniques means a willingness of the person executing them to get within bad breath distance of their opponent. The only time I didn’t get bruises was the time I did so against someone who wasn’t crazy.

        • That’s because your training emphasized getting your opponent to comply. My training emphasized getting your opponent to stop breathing.

    • dismantle our mental health system

      This happened because of abuses. Our anti-gun friend in Chuck Schumer lead the charge. The system was suppose to be replaced with a new system setup with local, regional and state level facilities. Instead, we let all the mentally ill onto the street and did nothing to build a new system.

      The system is complete under funded and there are not enough beds or treatment centers for many and in states like NY, they use prisons to treat the mental patients.

      Nobody wants to get involved in solving the problem.

      • “This happened because of abuses.”

        Bullsh1t. This happened, as you kindly pointed out subsequently, because of politics and craven politicians stealing funds and resources for their own selfish ends. But you are right – the pipeline is so twisted and warped that calling it a system is a huge compliment.

    • I had written a long post that got eaten when the system locked up on me. Getting harder and harder to post here every day, it seems. anyway, In California, the “radical” we have to thank for dismantling the state mental health system was governor Ronald Reagan, for budgetary reasons. Most state facilities were closed, excepting the penal mental institutions for the dangerously criminally insane, and a few others. The burden was shifted to the counties, and it did not take long for them to run out of money. Currently, there is a single in patient mental health facility in the nine northernmost California counties, and it has a single staff psychiatrist and only twenty beds. The vast majority of patients have to be transferred to the Sacramento area.
      Apart from budgets, the statutes for involuntary holds ( Welfare & Institutions Code 5150, 5152) are intentionally slanted to provide for release at the earliest possible time, a recognition that even people with mental health issues have a constitutionally guaranteed interest in personal freedom. Perhaps this was due to the abuses of patients in ties past, many of whom were the involuntary subjects of experimental procedures, from very hot/very cold baths,, electroshock, new experimental medications, and prefrontal lobotomies, sensory deprivation, straight jackets and isolation units (padded cells), and just plain old abuse by their keepers. I tend to believe that this is the right balance, since most mentally ill are more of a threat to themselves than to anyone else.

    • Part of the problem with the system lies in the fact that there’s a stupid huge stigma around mental illness.

      Back in the 70s before it got dismantled, it was too easy to send away someone that really wasn’t a problem, but you didn’t want to have to take care of them anymore. Someone who wasn’t a danger but couldn’t live alone. The mentally retarded were locked up as if they were looney cases, and the solution to all mental health problems was “lock them up”. No therapy, no drugs, nothing but lock them up and treat them as prisoners.

      We needed reform. Not a total throw out of the system.

      Now we have problems like this all and the response will just turn it right back to where we were before. Oh had problems before and got help and you’re fine and dandy now? Nope! You’re a ticking time bomb just waiting to happen and we need to lock you up and take all your rights for safety reasons…

      It’s bullshit. No one wants to deal with it so they let them run free.

    • ” radicals helped dismantle our mental health system in the 1970′s and set a lot of mentally ill people loose on society. A lot of those radicals were themselves diagnosed with serious mental illnesses.”
      Which is why we’re dealing with issues like gay “marriage”.

  2. You’re working for the wrong company. Businesses generally market themselves as either being the best and worth more, or the cheapest. I think I can peg which one you currently work for.

  3. Given how rationally the guy you described is manipulating the system, I question how mentally ill he really is.

    Someone who is violently out of control in a hospital is a threat to other patients. He is a direct threat because of what he may do to them himself. He is also an indirect threat in that he may incapacitate a care giver who will no longer be able to look after other patients. Sacrificing the other patients to minimize injury to violent ones is unacceptable.

    • Mentally ill does not mean stupid or incapable of intelligent thought. Some people I used to deal with were wickedly smart. Combine wickedly smart with mentally ill and you have one seriously dangerous individual.

    • Most schizophrenics have an above-average IQ, and can play the existing system like a violin. Crack a book or talk to someone who has dealt with one.

      As far as facilities, there are two HUGE mental health treatment facilities (i.e., hospitals) within 30 minutes of DC that have completely shut down and are rotting away (DHS is building their DC Palace on the St. Elizabeth grounds [irony alert]) and a third in the northern part of Baltimore has shut down 90% of its facilities. All this due to lack of funding and a political spine. So some 3,000 beds disappeared in ten years, and the occupants turned out on the street. The totally dysfunctional/criminal just sit in the ER until a bed opens up somewhere close. They’re kept until they’re stable and then dumped back on the street with a scrip or meds that they’ll never use.

      They should instead be treated and cared for in the spare rooms of the Congresscritters’ DC estates and mansions.

  4. I wonder what they would do in Russia? Or China? Or Saudi Arabia? Just saying. Mad dogs stay mad.

  5. Terrific article Jonathan. Many years ago I worked in a mental health facility. To say it was a crappy job would be a huge understatement. And we were unarmed. Hope you get a better gig.

  6. If we can’t trust him on the street because he’s too dangerous, than he should be locked up.

    -Half the commenters on TTAG.

    The reality is that people who are arrested in major metropolitan areas get released from arrest or 5150 (mental case)holds in a few days. Those who do time typically serve less than half of their sentences due to prison and jail over crowding. We simply do not as a society have the resources to house all the sh!theads and criminals in this nation. Many other nations have similar problems.

    The solution is to respect the rights of the responsible citizen to be armed. Cost to taxpayers: 0$. I’ll buy my own stuff (other than what my current department has supplied me with). If I could choose my own duty gun, it would probably be the Sig 226 Tac Ops with a 20-round 9mm mag and a 300 BLK AR.

    As a former Dunbar Armored employee circa 2000-01, I can speak a bit to substandard equipment loaded with ancient ammo. We did, however, have the freedom to upgrade to better guns and ammo (Glock 35 with .40 cal Hydrashoks for me). Of course, we didn’t train with our guns whatsoever until a few months before I left. Its a good thing we didn’t have any shootings, since half of the guys flat out missed the 18″ target at 50 feet.

    You seem to have a good head on your shoulders. I hope you get picked up by the agency of your choosing sometime soon.

    • You are sadly correct. The cry to “lock them all up” does not work well with the same people who complain about out of control government spending.

      I have often questioned if it is cheaper to have outsourced the cost of mental health facilities to county lock-ups. At least the old mental hospitals had the mission of trying to help the mentally ill. While our Sheriff’s Office had a dedicated MHMR unit, the goal of the jail is nothing more than a temporary holding facility. Even for a State Jail Felony, the maximum time served is a year or two, otherwise convicts get shipped to an actual prison. The mentally ill are not usually going to prison and will get released early because they are usually model citizens while locked up. Even those that still display mental illness (We had one guy who was REALLY into self mutilation) they will get released as soon as we could avoid liability simply because we were not set-up for the long term care of the mentally ill.

      If you want to drastically reduce violent crime and decrease the jail and prison population, then it’s time to reassess the War on Drugs. Then we would have plenty of room, but still would not be set-up for taking care of those with psychological problems.

      There really is no winning here. At the point you’ve increased the budget of your local law enforcement agency to deal with these people, you can’t easily take that budget back because those agencies will then declare you are making their essential mission more difficult. In some cases I almost think law enforcement administrators like this system because it justifies the need for a large force to deal with locating crazies and another large force to keep them locked up.

      • Outsourcing to the county doesn’t help if there’s not enough beds. My son was in and out of several private hospitals on the county’s dime, and pretty much enjoyed his stay each time. Then he went to the county hospital where the criminally insane and drug-induced disorders wound up – he begged us to get him out (wouldn’t say why).

  7. I work for a contract security an emergency rescue company. I have been told explicitly, by upper management, that my job is to be a mobile meat shield in the event of an active shooter or workplace violence situation. I have been further told that I am NOT allowed to carry a baton, pepper spray, or any other tool of self defense because that would violate the workplace weapons policy. i feel your pain

  8. The title of this excellent post is somewhat misleading. America doesn’t have a mental health system. It has bedlam.

  9. Thanks Jonathan and also Rob for those posts. Jonathan I would never tell you to “quit whining and do your job”… you have one hell of a job to do and you deserve a little whining time!

  10. I will disagree slightly with Accur81 to say that indeed we do have the resources, we just misallocate them. The government, both federal and state, does a lot that is not in its purview or jurisdiction, and does not do, or pays lip service and does not do well, much that it ought.

    Great story, and thanks for sharing. Also, if you’ll allow me the liberty of assessing your motives – thanks for caring.

  11. Actually it is all Bushs fault.!!!

    This just about says it all:

    “Once I even had a conversation with a patient who was there in the winter admittedly because he had been kicked out of every shelter and church in town for starting fights. He wandered over to my hospital and said he wanted to kill himself because he knew it would mean a place to stay the night and a sandwich or two. His advice to me was that I should quit my job and just “be crazy.” I sat there and listened to him brag about how he gets two government checks a month and a food card that he uses to buy liquor and cigarettes because of his disability. And the best partm according to him, is that you can do whatever you want and never get in any real trouble because you’re crazy.”

    Amazing isn’t it? I work in EMS, have for years. Never had anyone pull a knife on me but have had contact with violent people who have threatened me and partners. Most of the people we “serve” are on the government dole, don’t have any ambition, drop out of high school, menial work, poor diet/personal habits leading to major medical problems in their 50s. Diabetes, COPD, heart problems, all run rampant as a result of GMO foods, smoking, drinking to excess, use of street pharmaceuticals with the former leading to overmedication and the last leading to, well nowhere. Profound lack of personal responsibility for themselves enabled by government. We have elected, and reelected the people who have brought us this tragedy with our complicity. We need to look in the mirror.

  12. “The real message here, aside from wanting others to learn from my experiences, is that we really do need to find better ways to deal with mental health.”

    The attitude toward mental health treatment in this country is scandalous and shameful. And once again the “conversation” seems to be controlled by the Left.

  13. I would have told them I’m using my own gun and gear on duty or I’m walking on day 1. I would much rather work at home depot or take unemployment than literally risk my life with no safety net and sub par equipment.

  14. You have worked in EMS and never had a knife pulled on you? You have been fortunate That was a rookie thing for me. Recently my mistake was assuming the distraught person only had one ruger lcp on their person. My next mistake was clearing the second one in the ER. That got all sorts of folks upset.

    We routinely take folks to the ER to get them off the street because of intoxication or mental problems or both. Usually they go voluntarily with the PD declining to do a mental hold. So the patient is held till they are sober, offered outpt resources
    and turned loose til the next time.

    have the pd pat down the customers before you transport
    yep something should be done, am not holding my breath

  15. It’s the unionization of the police that has led them to stop policing the way you are securing your hospital. The trend of shooting at the slightest provocation is not what was expected before the zero risk mentality was adopted at the urging of unions.

  16. Real World stuff….its all about the coin folks. If it requires coin, you go paperwork and call it good, but its not good, its easier to release than work reality.

  17. Pretend you are a politician. Crazy people go off and kill or injure others and the public demands you do something to prevent this from happening again. Your choices are:

    1. Push for mental health commitment laws that protect the public from mentally ill people.
    2. Ban weapons used by the mentally ill.

    As tough as a ban on weapons seems it has more traction than the expensive process of getting the ill into a facility. Coupled with family members who won’t go along and certainly won’t pay for treatment and option 2 looks appealing. Stripping people of self defense costs very little and you get awards for caring. And in some places re-elected. No one gets a second term establishing a mental health facility and authoring bills on involuntary commitments.

    Now the mentally ill end up among us and we are defenseless. But at least Joe Politico gets to stay in office.

    • If there were an easy solution, the problem never would have happened. A difficult solution is just impossible for Washington to do. That’s why Washington doesn’t solve the problem – they know that the way Congress works right now, they can’t solve a problem this complex.

      Congress needs to give the necessary money to an independent Department that contains the brains needed to find the solution, then let them send a bill back to Congress that would give the Department the authority they need to fix the problem. An oversight committee should keep a close watch on the Department to prevent unnecessary over-reaches, while still letting them do what needs to be done.

      Even I don’t like the above idea (sounds a lot like the way Obamacare was created, doesn’t it), but I can’t see any other way to solve this problem. We’ve got to let the experts solve this one.

  18. The guy is constantly in trouble with the law and still, allegedly, gets two government checks a month? Sounds like the government is funding domestic criminals.

    I wonder how many domestic criminals are being funded?

    Of course this mad man is only saying that so who knows. He may actually get his money somewhere else.

    I think we over diagnose what is mental illness in this country. Having a bad month? All of a sudden they label you depressed.

    This crazy guy certainly isn’t mentally ill enough to the point where it got in the way of his plan to kill that security officer. Sounds like he has a bad attitude towards life and is simply being labeled mentally ill.

    Too many criminals try to play the mental illness game because they get off easier with the law, which is just what the antagonist in the above article stated.

    He may not mentally ill … He just might be evil. But let’s say he actually does have some bonafide diagnosis and not some easy to procure diagnosis, which it appears psychologists are want to give these days. I doubt it plays a role in his criminality, meaning if you cure his mental illness he’ll still be criminal.

    Actually, if you cure him, depending on his diagnosis, you might say, as he’ll have more of his faculties in place for longer periods of time, it may very well make it easier for him to plan and execute crimes.

    There are many mentally ill people in this country, but only a small percentage of them are criminals.

    Maybe we should look at criminality and mentally as not being correlated and as distinct from one another because in my experience, they appear to be. I would wager mental illness does not cause criminality anywhere near the level we think it does.

    • I guess you never found out that mental illness that prevents you from holding a job is grounds for getting a disability check from Social Security. At any age. And if you’re a vet, you go through the paper maze again and get another check from VA for the same reason. And if those two checks keep your income below the poverty line, you can get a SNAP card. It’s a safety net of sorts, but inpatient treatment would be MUCH better.

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