Disclaimer: This post discusses the very sensitive topic of suicide and mental illness and may not be suitable for all readers. If you are having thoughts of suicide, please call the Lifeline at 1-800-273-TALK (8255).
The bells went off at 1:38 am. This was an outside alarm, not an inside one. That means instead of just heading down the hall in cartoon slippers to listen to someone’s dilusions, I actually had to leave the building for action. I was the counseling member of the Comprehensive Psychiatric Emergency Program (CPEP) team. It was time to be mobile.
Awoken from a dead sleep, I was disoriented at finding myself in the on-call room of the hospital. It was hard to believe I had only been passed out on my cot for 15 minutes. As I raced down the hall, the other three members of the team were with me.
We quickly loaded into two vehicles. I rode shotgun in a plain sedan driven by a plainclothes police officer. The officer was just there for my protection in case the person had a weapon. In over 90% of cases, the person had a weapon. Granted they were usually using it on themselves, but occasionally, it was pointed at me. I’m just a therapist who weighs 100 pounds soaking wet.
They plainclothes police officer often just watched. The other two members of the team were EMTs. The both went in the ambulance. We raced through the city streets with lights flashing, but sirens silent. We never used sirens on these calls. It may spook someone into doing something rash. Besides, what they were doing wasn’t a crime. They just needed help.
Over half of our calls took us to the gorges. The gorges were where people went to jump. We were averaging four jumpers a month. The city is home to a popular ivy league university that is well known for it’s high suicide rate. It has one of the highest suicide rates of all colleges and universities in the entire country.
We make it to the gorges in record time. The 911 call came from a bystander. Someone had gone beyond the safety fence to stand dangerously close to the top of the gorge. They were threatening to jump.
I opened the door and was out of the car before we even stopped. I hit the ground running to the spot that was mentioned to us by the bystander. I could just see the person at the top of the gorge through the foliage.
Almost at the exact moment I came within speaking distance of the person, I watched them fall. I didn’t get the chance to say anything to them.
It was silent. One moment they were there, the next moment they were gone. You always see in movies or imagine someone screaming when they fall. There was no scream, just silence. There was no slow-motion like the movies either. Bodies drop hard and fast.
Our suicide prevention mission just changed to body recovery. We put a call into the fire department to let them know they would need to bring the helicopter and the propelling team. They were now looking for a body at the bottom of the gorge. No one has ever jumped and come out alive.
I walked back to the three other members of my team stunned. It was not often that we witnessed the loss of life. We had saved literally thousands of lives over the past few years. In debriefing, we talked about how we did everything we could. We got there as fast as was humanly possible. You just can’t stop a person who truly wants to die. They didn’t even reach out for help – the call had come in from a bystander.
Oh yes, you can do a psychological autopsy and find the signs of suicide the person exhibited before their death. You can go through all the coulda, shoulda, wouldas. The person is gone. There is no way to bring them back. The only thing we can do is to talk about suicide to remove the stigma. Let people know the signs of suicide so that they are comfortable asking others if they are having thoughts of taking their own life. It is all about normalizing the thoughts, talking about it, and educating others about suicide.
The other members of the CPEP Team and I returned to the hospital. It was still the early hours of the morning. I returned to the on-call room to go back to sleep. I was exhausted, but needed to be prepared for the next call.
It felt like only 15 minutes since I laid down when the bells went off again. This was an internal call. It was one brief bell followed by a page. I was being summoned to talk to one of the residents in wing 1-B. This was the locked in-patient psychiatric ward of the hospital. When the bells go off, I never know if I will be paged to someone who is in-patient or someone who just came through the emergency room and is on their way to being admitted for in-patient. If it’s an external call, we could be going into the field.
This call is internal. The technician had me paged because they cannot get the patient to calm down. They need to calm down before they wake up everyone else on the unit.
“What’s going on?” I ask the agitated person. Their shoulders relax. They’ve seen me and spoken with me before. They know I will listen to them and help them work through what they are experiencing. That’s what I am here for. This particular person has had a schizophrenic diagnosis for over 20 years. Every once in awhile, they need a hospital stay, like now. That’s why we are here. I’m here to listen and talk you through this moment.
It’s going to be a long night.
I finish with the person who is in the in-patient unit. I return to the on-call room to go to sleep once again. I barely lay down when the bells go off. It is now 5:24 am. This is an external call. The CPEP Team springs into action once again.
This call comes from the person themself. They called 911 on themself because they were sitting in their garage with a loaded gun in their mouth. They were going to pull the trigger. But, they called 911. They obviously wanted to live.
We pulled up to the house and I jumped out of the car. I walked towards the garage, the person, and the loaded gun. The rest of the team stayed back. They took their queue off me.
I walked over to the person while maintaining a respectable distance. I did not want them to get antsy or trigger happy if I got too close. I was surprised to see that I knew this person. It was someone I had grown up with as a child. I don’t mention that fact. I blatantly ignore our prior association. I’m here to try to save their life, not to make small talk.
We do talk. In fact, we spend about an hour talking. We do all of this with the rest of the team hanging back and watching to see what we need. We talk about why this person wants to die. We talk about why they want to live. Eventually, I get the person to take the bullets out of the gun.
The person sits there with the gun in one hand. The other hand is massaging the bullets. I listen to the sound of metal clanking. We keep talking about why this person wants to live and how important it is. There is a future. We should not make a permanent action based on a temporary situation. I get the person to put the gun down.
The EMTs move in and assist the person onto the stretcher. We are transporting the person to the hospital for advanced psychiatric care.
When we arrive at the hospital, I will not be doing the intake. I will be handing the person off to other staff in the psychiatric unit. My job is only to respond to the immediate crisis, defuse the crisis, and transfer the person to more advanced care.
It was the last call of the shift, and I have a lot of paperwork to do. There will be no more sleep tonight. I have to fill out paperwork on every case I work and every person to whom I respond.
Since over 50% of our external CPEP calls were to the gorges, we did a lot of advocacy around those gorges. How do we prevent people from jumping? We can talk about suicide, we can post the Lifeline number, 1-800-273-TALK. We installed fencing to try to block access to the gorges. People simply climb the fences. If you truly want to die, you will find a way.
Many people jump from the Golden Gate bridge in San Francisco too. They put up netting under the bridge to catch people who jump so they have a better chance of saving their life. We decided to try to do the same with the gorges. We kicked off this massive fundraising effort to try to raise money to purchase nets for the gorges.
We wanted to be able to prevent people from reaching the bottom of the gorges. The fall was always lethal.
The nets were installed. There was actually a lot of technology involved with them. The tension was set so that if a body landed in the nets, it would set off the alarm for the CPEP team. We knew we needed to respond to a live person in the net. The person was in need of emergency psychiatric care.
When the nets were first installed, the tension settings were too sensitive. We had squirrels that would land in the net and set off the sensors. Personally, I didn’t mind. I was happy to respond to a confused squirrel caught in the net. At least it wasn’t a person trying to take their own life.
Eventually, we got a handle on the technology so that now the nets only react if there is an actual human there.
I performed my duties as a mental health first responder for about four years before I stopped. As you can probably imagine, burnout is extremely high in the field of suicide prevention. I needed a break. Self-care is important in any psychiatric profession. If you do not take care of yourself, you cannot take care of others. You cannot pour water from an empty pitcher.
Last month I lost my job. I have been applying for new jobs. I reached out to my former employers to let them know I was job searching and to confirm that they were still able to give me a reference.
In this process, I reached out to the agency I worked with when I was providing suicide prevention services. They asked me if I would want to pick up a shift.
Even though I really need the money, and I KNOW I am not supposed to “turn down work,” I said no. I have had over 10 friends and family members die of COVID this past year. I have been on the phone with some of them as they died. There is no way I can go back to working with people who are actively trying to take their own life ON PURPOSE right now. I have lost so much to COVID. Life is so precious. I don’t think I can handle working in the field of suicide prevention right now.
If I were to go back out into the field to do this work, and break down, that would be horrible. It wouldn’t be fair to the person whose life I am trying to save and it would not be fair to me. I just can’t do it right now.
I’m sure I’m going to get a lot of backlash for turning down work when I’m unemployed, but after what I have experienced in the pandemic this past year, I just can’t anymore. I have nothing more to give.
Please remember that if you are having thoughts of suicide to call the Lifeline at 1-800-273-8255. There are trained counselors on the line able to talk to you 24/7. They will not respond in-person like I did on the CPEP team. You can talk to them by phone. I also answered the suicide prevention lifeline when I was not actively responding to CPEP calls.
Someone is there to listen. Always. Call 1-800-273-8255