A night in the life of a mental health crisis counselor

By Debbie Moore-Black, RN in collaboration with a licensed masters social worker, LMSW

It was my turn again to sit for the next 8 hours in the middle of the night at the mental health crisis center. Run by a team of therapists and social workers with the community mental health center. We regularly collaborated with the local police department and EMS for people who were experiencing a mental heath crisis.

We never knew what to expect and every day was something different. We were a good hardworking team, and we couldn’t do our job without law enforcement by our side.

This night was different. This call came from a grandfather. Scared and nervous, he called the mental health crisis call center. “My granddaughter Kiesha. She’s 24 years old. She stopped taking her medicine. She has a 3 month old baby she holds onto tightly. She hasn’t taken the baby or herself to the doctors for wellness checks. She’s screams at the TV. She slams doors, paces all night long. I have to tell her to change the babies diapers.”

“She tried feeding her baby 2 pieces of bread with toilet paper neatly folded in between!! She put it up to the babies lips, not realizing what she was doing”.

Her Grandfather continued: “She screams at me and her grandma that we are the FBI. She washes her hands continuously saying she defies the Rona (corona virus).”
“She’s out of control. Pulling the tv plugs out of the wall, saying it’s the FBI, Jesus is watching, the chip in your brain is the devil…she’s talking out her head”.

The grandfather was frantic. His granddaughter held on tightly to her baby. We had to help them. Stat.

My partner and I agreed to meet the grandfather at the home. We notified the police and asked them to accompany us for a mental health assessment. This may be a tricky situation.

We arrived at her grandparents house. Keisha was already in treatment but had stopped taking her medication once pregnant. We found out that Keisha lost her mom a year ago. Her boyfriend left her when he found out she was pregnant. She lost control due to the stress and trauma and isolation.

She moved in with her grandparents.
Diagnosed as schizoaffective bipolar type, in the past, she was compliant with her medications. This time she quit taking her medications saying she could “do it on her own”. And as she decompensated, the psychosis came out.

We knocked on the door. Gently talking to Keisha. Keisha stared at the tv, and didn’t even look our way when we walked into her room. Keisha had her baby snuggled up to her but she seemed in a daze. “How many radio channels in Florence county?”, she said to no one in particular. Keisha then laughed out loud. “So many cameras outside and inside, what does it have to do with me?” “They said I could do whatever I please so long as the custodians have already cleaned and withdrew on the mantle place” “hey officer, when was the last time you had to track down a stolen cat who ran away and ended up on the east side of Columbus, Ohio” “Haha!”

We asked Kiesha a series of questions. She wasn’t alert or oriented. Her speech was disorganized, tangential, nonsensical. And still, she held her sleeping baby close to her as any mother would.

We walked back outside to consult with the officer and our supervisor. “She needs to go to the hospital; she is very sick.” There was no doubt that she needed to be involuntarily committed, but how would we separate a mother from her newborn?

We went back inside and tried to engage with Keisha again asking if she would stand up and show us around some.

As I calmly talked to Keisha, a female officer swiftly and gently gathered the baby in her arms while another officer helped Keisha to her feet. The police officer took the baby from her. That’s when I quickly took the baby from the officer and went with my partner to the other room. My partner and I stared at this beautiful little boy knowing we were getting his mommy some help.

The officers let Keisha know they were taking her to the hospital and that she wasn’t in trouble or under arrest. She attempted to fight, but gave in. She was in such a state that she didn’t even acknowledge that her baby was no longer in her presence.

We handed off the baby to the grandfather and grandmother. They said they would care for the baby and keep this little one safe while their granddaughter got help. Keisha was escorted to an emergency department that had the best mental health care in the area. My colleague and I called to give a report to the ER charge nurse. We later found out a routine admit urine drug screen was completely negative.

After several weeks at the inpatient mental health facility, Keisha took her medications daily. She was compliant with medications again, started showering, eating, and going to group therapy during the day and got restful sleep at night.

With a clear head, she was taught that this was a lifelong diagnosis. Schizophrenia and bipolar. And she would need to diligently take her medications every day without fail. And continue with a therapist to gain coping skills, learn warning signs and know when to ask for help.
After one month, Keisha was able to go home to live with her grandparents and get back to raising her little boy. This was not a situation of abuse or neglect and DSS was not called. This was a mother with mental illness postpartum in need of mental health treatment.

Kiesha eventually finished her GED, enrolled in a technical college, and decided that one day she too may become a social worker, a policewoman, a nurse. The sky had no limit.

As I think back to this event, sometimes this job is filled with anxiety, and unpredictable events. But sometimes we have a success story, that makes it all worth my pledge of being the best social worker and crisis clinician I can be to help my community.

The Nurses Revolt

(Google photo stock)

By Debbie Moore-Black, RN

Where do I begin?
Maybe at the beginning.
Let’s start with the degradation and devaluation of nurses across this country.

For decades, I lived the devaluing of nurses. Daily huddles from our nurse managers, to the ER nurses, ICU nurses, even Behavioral Health nurses. Emails and huddles about downsizing. Nurse- patient ratios. Decreasing nursing staff and increasing patients. ICU nurses typically had a 2:1 ratio and depending on the acuity of the patient, a 1:1 ratio. But as years went by, we watched our nursing world become increasingly unsafe. Decreasing our staff because we were told “for the sake of the budget.”

We watched the much needed and valued CNA’s and technicians disappear. Our EKG/secretaries disappear with less than a 2 week notice.

The degradation and devaluation of nurses.
We also watched the increase in CEO salaries… in the $millions/year not including their perks. The secrecy of “bonus checks” to our managers. The hospital board members receiving their financial bonus perks also. Every upper management padding their pockets as they rode on the backs of us nurses.

While we worked to keep patients alive. 12-14 hours a day. Rarely a 30 minute break. And rarely even a 15 minute break. The “tripling up” assignments. The dangerously unsafe assignments. The badgering and micromanage of managers. No matter what we did, how long we worked, Tripling our assignments… we were bad and awful and had to do better…. Better ….. or else we would pay the consequences. The threats.

The degradation.
The devaluation. Of us.

And then Covid happened. And then Delta/Covid happened. And with the mass refusal of receiving Covid vaccinations across our country, our ER’s and ICU’s filled up. Overfilled. Massive admissions of unvaccinated Covid patients desperately seeking to breathe. Desperately seeking ER and ICU admission.

And throughout these next two years, our ICU beds became scarce. It has become a vicious cycle. No ICU beds. No ICU/ER nurses. Ambulances and medics and paramedics backed up. 4 hour waits for a 911 call. Our healthcare system has become clogged, and failing.
And along with this crisis comes the emerging need for ICU nurses. For ER nurses. For Respiratory Therapists. Suddenly we are valued. And needed. And in high demand.
Suddenly, an ICU/ER nurse can make $5000- $10,000/ week with a travel agency.
And throughout years of physical and verbal abuse trickled down from CEO’s to our managers…. We fled for higher ground.

The staff members that stayed on board with their hospitals (without going to travel nursing) have not been compensated.

And a new degradation has begun.
ICU or ER staff nurse making $30-$40/hour standing and working next to a travel nurse making $5000 or more per week.
And hospitals not honoring the nurses that stayed on board but rewarding the travel nurses.
Is there an end in sight?

When this Covid potentially winds down… will we teach CEO’s, board members, upper management that we demand respect?
That we are college educated professionals?
Will Covid change the face of nurses throughout our country?

Time will only tell if lessons will be learned.
The greed of CEO’s and upper management is catching up with them.
And nurses are realizing and demanding their worth.

And I stand tall for all of the nurses who demand their respect and their worth.

By now, you know

By Debbie Moore-Black, RN

You know that if you don’t get vaccinated and you don’t wear a mask, you potentially will die.
You go to super spreader events, big groups at beaches, football games, baseball games… loads of people laughing and clapping and shoulder to shoulder.

Your refusal of the mask and Covid vaccination almost seems like a passage. Beating your chest. The survivor. It won’t happen to me.

Until you can’t breathe anymore. Delta, doesn’t care about your rights.
Delta could care less if you call the others “sheep”. Delta could care less that you refuse to wear what you call a “muzzle.”

Delta cares about you not having any vaccination protection and no masks and it jumps from one host to the next. Lodging in your lungs, heart, kidney and brain. Your lungs stop working. Delta throws clots to your lungs and heart, your brain.
It’s a virus. A deadly virus. It’s not a Republican and it’s not a Democrat.

So when you come gasping into any ER, begging to breathe because delta attacks your lungs first, we try to fix you if we have room in the ER or in the ICU. But now you’ve overcrowded ERs and ICU’s.
Now you’ve shut down elective surgeries even emergent surgeries because there’s no more room left in the hospitals.

You refuse a vaccine in your body. But when you come to the hospital everything will be forced into your body. An ETT (endotracheal tube), a central line, an arterial line, IV drips for low BP’s, a paralytic, steroids, Ativan drip and morphine.
A Nasal gastric tube through your nose and into your stomach. A sheath to introduce dialysis for your damaged non-functioning kidneys. Weeks to months on a ventilator and we can’t wean your oxygenation down.

You’ve seen the pictures. You see us nurses and doctors begging you all to social distance, wear a mask and get the vaccine.
But you refuse.
Is it your badge of honor to refuse the vaccine but choose to die?
You’ve refused the vaccination infecting your children and your children infecting other children.
Because of your self righteousness
You’ve played jeopardy on many lives.
No mask and no vaccinations

Picture what you’ll look like in a body bag.
Because this is your “the end.”