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.