BEHIND THE SCENES: A MOBILE CRISIS STORY

BY HEATHER GAYLORD

It’s Friday afternoon in the state’s capital, the sky is an overcast metallic grey, and mist hovers in the air above the traffic on Warren Street. In his second-floor apartment, Jonathan Doe sits on the edge of his sofa after a night of restlessness, his forehead resting in his hands. He is 38 years old with a history of Bipolar Disorder, depressive type, and at this moment, he feels the lowest he has felt in months. Jon is experiencing a mental health crisis.

He struggles to find meaning as his thoughts meander: intrusive, lonely, and relentless. The weight on his chest is making him fight to breathe. A cascade of suicidal thoughts, in waves, crashes over him. His head feels swollen in his hands. The pressure behind his eyes is unrelenting and his vision is blurred. Forcing his gaze to his right, Jon looks to his cellphone on the coffee table at the end of his sofa. More than anything, he simply wants to feel better, to feel normal again. With great effort, he reaches out, lifts his phone, and dials 988.

Within moments, a clinical phone chimes at a New Hampshire Rapid Response Access Point (NHRRAP), and a calm, kind voice greets his. A well-trained representative talks with Jon, assuring him that she is there for him, reminding him to just gently breathe. Her supportive voice offers measured directives and invites Jon to share his thoughts. Jon doesn’t notice it, but even in these few moments, the ache in his head and the heaviness pressing on his chest have decreased. He is being heard by someone who cares, and he feels safe enough to begin to describe the pain he is internalizing. He says what for too many is a shameful, stigmatizing truth: “I need help. I feel like I’m drowning. I don’t want to die, but I can’t stop hearing myself think that it might be best. I’m really scared.”

The representative knows exactly what to do next. She keeps providing Jon with a listening ear and a warm, trained voice. And not too far from Jon’s apartment on Warren Street, an alert chimes at the office of the Riverbend Mobile Crisis clinical team. Ready to deploy 24 hours a day, every day of the year, a Master’s level clinician and Peer Support Specialist (PSS) accept the request from the New Hampshire Rapid Response Access Point representative. While the PSS gathers a mobile crisis deployment bag brimming with resources and supportive information, the clinician talks to Jon to confirm his address, provide an estimated time of arrival, and reassure him that friends are on the way. For the first time in months, Jon doesn’t feel alone as the clinical team arrives. The weight on his chest — known to counselors as anxious distress — lightens enough to offer Jon measurable relief. Already, there’s a world of difference since he dialed 988 nearly an hour before.

To maintain Jon’s anonymity, the team’s car bears no symbols or signs, and the team members are in plain clothes and non-identifiable. To any outsider it would appear that Jon was being visited by a couple of friends. After knocking on the door, the team affirms their arrival, sharing again their first names which they had previously shared with Jon on the phone. Jon greets the team in with a sigh, still riddled with anxiety, beads of sweat on his brow. As they begin to talk, Jon paces, releasing more stress as his hands clench and unclench rhythmically. He is exercising a self-soothing measure that he feels comfortable using while the team listens.

After a while, Jon is relaxed enough to sink into a chair at his kitchen table, and the team joins him. They begin to explain what Jon might expect during their assessment. It will be a shared effort to bring resolution to Jon’s distress and reduce the symptoms which had culminated in his suicidal ideation. The Peer Support Specialist aids Jon in employing breathing and relaxation techniques to alleviate restlessness and bring focus to his thoughts, drawing upon their own lived experience to validate Jon’s. The clinician conducts a brief yet thorough assessment of risk with Jon, working to identify protective factors which will inform a plan of care to keep him safe. Jon denies active substance use, reports social alcohol intake, and denies any plan or intent to harm himself. He has a history of inpatient hospitalization and did have one suicide attempt eight years earlier.

The team calls his case manager at the Community Support Program (CSP) at Riverbend and together, they are able to expand upon his crisis plan by identifying specific strategies to maintain his wellbeing. One action step has Jon and the team calling his brother, Mark. This results in Jon being able to stay with his brother for the next two days until he can meet with his outpatient prescriber. As the crisis team reviews Jon’s medications with him, he is able to identify some worsening symptoms following a particular medication change. Upon clinical consult with Riverbend psychiatric providers, it’s believed this could be a contributing factor to his current experience of suicidal ideation.

With the support of the mobile crisis team, psychiatric consult, and his brother, Jon identifies a safety plan. He will employ the coping skills he has been taught and watch for warning signs and triggers to monitor how he feels and reduce risk. Jon has access to firearms in his home and Mark agrees to secure them at his home for the time being while Jon addresses his mental health symptoms.

Before the team departs, a peer follow-up call is scheduled for the next day to ensure that Jon is well supported and that the goal of maintaining his safety and monitoring symptom impact is achieved. The clinician reminds Jon and Mark that if his symptoms worsen, their supportive services are available around the clock each and every day via the NH Rapid Response Access Point.

Hours later, in the quiet of that same evening, Mark Doe looks in on his brother in his spare bedroom, ready to ask if he needs anything else for the night. He stops himself before he can speak a word. His kid brother is already sound asleep, hugging his pillow just like he did when he was a little boy.