When we cannot feel, we become desperate for connection and shit happens. A discussion of when it hits the fan. Who get’s hit?
This past week I was on the periphery of several situations where it hit the fan. These were unexpected, public and assaultive behaviors. Public events that involve an alleged miscreant, the participants, witnesses and eventually law-enforcement. The specific details are not important, yet folks are increasingly experiencing, witnessing, and being involved in these bizarre, crazy, and potentially dangerous incidents.
Desperation in the Isles
I was at a grocery store shopping, mindlessly minding my own business, when suddenly a person started knocking over shelves of various grocery products. A homeless and mentally ill man swept off shelves of products into the isles. Store employees yelled at him to “stop” and “to get out.” One employed was uncontrollably screaming at this man. The man ran out of the store after pushing over displays and wrecking several isles.
My immediate response was an instant situational awareness of being a witness (not my job, no reason to insert myself). “Ok he ran out. Apparently no one harmed… all good… I’ll continue my grocery shopping.” Immediately, thought “ahh the good old days of it hitting the fan. Been there, done that, ain’t going back.” A few minutes later, my wife notes “those poor store employees.” This jogged my memory of her being a witness of a similar incident the week before. While at her work, a middle school student was randomly and significantly assaulted.
Ok now I observed the residual behavior of several store employees who had been directly involved in the incident. It was immediately clear that they were untrained on dealing with such an incident as it was happening. Nor how to recognize, deal, and process the residual effects of this (or any crisis) incident. In fact, a couple of employees were clearly quite distressed by the incident. Reflecting on my observations of the incident, there were several opportunities where things could have turned much more violent for both the person and the store’s staff.
This is nothing new and in fact I would be surprised if they were trained to handle similar events and how to debrief the residual effects. Ah… the story of my life, a crisis mental health evaluator and consultant often witnessing some level of distress on all parties. It is very rare that folks have any formal training, experience and debriefing skills… this includes medical staff, security, medics, and law enforcement.
On the way home, my wife suggested writing a post.
The Devil is in the Details
Was this some random unexpected outburst or were there signs and symptoms prior to the incident? Was this a random (disorganized) outburst or a willful predatory behavior? What was the effect on folks involved and how were they handling their emotional aftermath?
Inevitable, is some type of investigation: Questioning builds the picture of what, when, where, why, and how of the event. Which also includes the profiling of the miscreant. Criminal cases centers on the facts of the incident and resulting evidence. Whereas in civil mental health cases the investigation focuses on the causes and contributing factors of the behavior. And what could be done to avoid continued and repeated incidents? Of course, there is overlap. However, what is to be done is a rat’s nest of between and involving both the community’s and the individual’s wills, capacity, and resources prior to, during and after the event. The presumption is, it is the person acting out… or is it? It is an evaluation of if the individual at the time of the incident that their behavior was willful or disorganized? Also if they have insight into their need for treatment? What can be done either by the person and/or by the community? What connections and relationships are available? At the heart, it is a form of advocacy.
A Can of Worms
The determination, i.e., interpretation of why, is largely based on perspective. Perspectives often involving education/experience and the persons’ associated “duties and responsibilities.” For example, in the above grocery store incident. The immediate store employees versus the owner of the grocery store. The presumption is that police, other law enforcement (jail) and courts have a duty via social contract “to maintain public safety.” Various community agencies, via bureaucratic contracts have the duty to provide access to services for those unable to care for themselves. And the political officials and the un-elected administrators have the duty to coordinate and ensure the coordination of health and safety in and of the community.
The 8 Blind Men and the Elephant
The elephant in the room is not the elephant. But that of the 8 blind persons. Each person has their perspective and understanding of the elephant. But each one has difficulty seeing and understanding one another’s perspective. Invariably, there is a host of opinions, offerings and resources. All are blind. Yet if all the blinded can open their eyes, seeing one another’s perspectives, then they might see the invisible elephant and discover it is gigantic. The problem is that if these blind men open their eyes, they no longer have “plausible deniability” that it is in fact they are the elephant. Thus, remaining blind, they can abrogate their duty while appearing to be doing all kinds of alleged effective and meaningful things.
The Understanding
Ultimately, the miscreant holds the key to understanding the puzzle. Yet may not understand nor have the capacity of what, why and how the incident occurred. Factors could be from lack of psycho-social development, lack of skills, conditions of stress, intoxication, physical pain and innumerable contributing factors. This is nothing new. The miscreant needs to be asked and offered the opportunity to tell their story. However, there are different processes in whether the incident is criminal investigation versus a mental health evaluation.
Time Frame
There are four time frames that help to get a better picture of the incident.
First is the culture of the environment and the history of the miscreant. Which is considered fact and unchanged. Second are the medium-term dynamic contributing factors (both risk and protective factors). Such as personality, relationship, work, education and family/SO relationships, living arrangements and functioning of life. Third are the short-term environment or contextual access to food, shelter, care and community supports, daily functioning. And access to drugs, alcohol, weapons, etc. Last are the immediate or fluid factors of the individual’s “mental status,” i.e., mental (cognitive) and emotional processing and their perception, interpretation, and perspective of what is going on in their immediate internal (thoughts and feelings) and external environment that either contributes or lessen the likelihood of the person acting in a bizarre and disorganized and dangerous manner.
The Players
Beside the time frames, there are also the “players” involved, including the individual, persons in the immediate environment, the recent interactions with family and/or significant others, co-workers, etc. Other systems that are involved such as law-enforcement, medics, hospital ER, social workers, mental health and detox/recovery services, etc. And then community players such as advocacy, housing, crisis respite, homeless organizations, churches, community/political levels of bureaucracy, etc.
The Roles of the Players
The participants are the ones that who are directly trying to deal with the situation.
The witness are the ones who are randomly in the vicinity yet are not directly involved.
And the others who were not there but have a duty to insert themselves, e.g., medics, police, hospital ER. These are the folks that for various reasons become involved usually via community roles and responsibilities. Folks such as police, family members, attorneys, courts, insurance companies, medical services, jails, etc.
What to do? It depends on the community’s will, standards, resources and means. Which often come down to the details, time of day, available staff and condition of the miscreant, other things happening in the community which is highly fluid and difficult to expect.
Debriefing, It’s What to Do?
Perhaps the most effective, simple, immediate and empowering tool is to debrief every incident. The simple format is:
What happened, what went well, and what did not go well?
What can we do better next time?
How can we improve or do differently next time?
Identification of needed resources, training and skills.
AND allowing a safe place to release the energy of the incident.
Such as anxiety, literally the physical shakes, time and space to get grounded and re-centered.
And offers/access/support so that things do not become a rather “complex PTSD” syndrome. Which results is compassion, integrity and grace fatigue, burnout, loss of hope and motivation, loss of competent folks who have the education, experience, and skills, etc.
Just to note in the grocery store incident. I realized two young women were suffering and a few of the men were usually doing the “man thing.” The first, the woman was the employee what was practically uncontrollably screaming at the offender and was quite close. She could have been easily and attacked because of her lack of being aware of her behaviors that could have escalated the offender. Also, this young woman, a few minutes later, was overly apologetic to customers. Which showed to me a probable history of PTSD evidenced by her screaming and now a lack of relationship boundaries by being over apologetic. It was clearly not her fault and there was absolutely no reason for her being over apologetic.
The second young woman was in the back loading area, crying… clearly her coping skills were overwhelmed. And several of the men were just acting as if barely anything had happened, except for the inconvenience of having to clean up the mess.
The issue is that these employees had no opportunity to express their feelings, i.e., to acknowledge and release their physical and emotional energy. When this energy gets bottled or blocked up, it will come out in different ways. And if a person has some level of PTSD, it often triggers a cascade of detrimental reactions affecting other areas of their life.
The Problem of Debriefing… is the lack thereof.
My first job in the mental health was working as a “psych tech” at a 50-bed state hospital “admissions” unit. That is 50 patients, “raw” and right off the streets on one contained unit… truly a powder keg. It was rodeo time! It was not in frequent to have four to six escorts, takedowns, restraints, and seclusion incidents in an eight-hour shift. The crew was tight, efficient, and effective. Able to get someone on the ground, medicated, and in restraints within two-minutes. By far, the only injuries being to a patient’s “sense of reality”… or so we thought.
Eventually, the state noted the frequency of these types of interventions were unacceptable. All were required to do “de-escalation” training and practices. Of course, all of us (techs, RNs, docs, etc.), thought “impossible… this is the rodeo!” The core tool was “debriefing” every incident. Debriefing required all who were involved. Debriefing is usually a mere 5-15 minutes of sharing and discussion. In the course of 1-2 years, our “rodeo” events dropped from 15 to 25 per week (mostly on the evening shift). To 1-3 incidents in three months’ time including all three shifts. Unbelievable!
Yet all, including patients, were much happier about their living conditions and our working conditions. We moved from being highly reactive and over responding to a patient’s behavior to being able to see and read cues of impending agitated/assaultive behavior. Thus, pre-emptively offering support thus avoiding the whole train wreck. Eventually, we developed to establish healthier relationships with patients and a healthier environment for all. Therefore, avoiding patients even needing to feel that they had to act out to get their needs met. Sure, there were incidents of verbal and infrequent physical acting out, but staff no longer felt the need to over-react. And instead learned to feel, anticipate, and listen to a person who was suffering. No longer was it a rodeo but relationships.
WHAT?
Guess what? Staff felt more effective, empowered and able to work humanely and with a sense of comradery and community on the unit. Besides, there was much less paperwork, much less risk of harm for both patients and staff. We all were much happier. I am sure that this simple ongoing technique of debriefing can significantly reduce the cost of doing business.
In the intervening years, I’ve sat in many discussions amongst community partners. It was extremely rare, (well I can’t remember a single time) to have any as semblance of a process of a community debriefing. Which at its heart is openly sharing feelings and thoughts without judgement or criticism. And yet in sharing is where meaningful and purposeful relationships and solutions form. Community are collaborative relationships that are beyond the mere mission driven/bureaucratic/contractual constraints of the parties involved.
Horrifying are the past 20-30 years. I’ve been a witness to seeing organizations and agencies letting go of and encouraging very skilled, seasoned and connected individuals to leave and walk out the door. In at least 90+% cases, seasoned professionals with their competence and relationships are rarely recognized until after they walked out the door and the shit hits the fan. Clearly a failure of not noticing and allowing the opportunity for these seasoned experts to mentor less experienced persons. For the past 20 years, I have been watching and predicting the implosion of public mental health. Have we accomplished this yet? The contributing factors are many, to which I will not offer a boorish accounting of the details. But it is no wonder we are in dire straits.
The Victims of Feelings
Unfortunately, in our current dire straits, these types of events are becoming commonplace. Thus, if we do not want to become a crippled mess of being overwhelmed, stressed out and hitting the fan. We need to have a process that supports all the parties involved. Where we can release the emotional and psychological after-effects so that we don’t become a pile of poo. Whether the miscreant, the involved, witness, or community; we are all victims.
The key is the feelings! Feelings… expressions of desperation and loss if not confronted become hopelessness. The danger of hopelessness is that it turns into the beast of rage or nihilism. Screaming in pain from lack. The lack of meaningful answers of why, meaning, purpose, and what can be done. Feelings are also the great motivator that inspires our search to find meaning and purpose. Eventually resolving and releasing the creative and collaborative purpose that empowers new realities.
Blessings,
Tim