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    Thursday, September 17, 2015

    My Boyfriend Died Because I Failed to Make a Phone Call

      The U.S. mental health system is a sieve anyone can fall through. You are not safe—though safer—if you are middle class, have insurance, or are loved. Your loved ones are also not safe unless someone steps up.

    My story isn't especially unusual or dramatic. I'll tell it because it's mine.   

    For about a decade, my dearest love was a man I’ll call Hans, who became a suicidal alcoholic. His illness crept up slowly and in the last year of his life he rarely left his apartment. I was in touch with his psychiatrist and spoke to Hans every day, though he kept refusing to have me visit and missed appointments with his psychiatrist.

    Hans endearingly had the ability to sound kind and engaged with me, despite his own decline.  I knew a shift had occurred when he began to sound remote on the phone.

    One spring Sunday, on the chance that he'd let me in if I just showed up, I took the 45-minute trip by subway to his apartment. He didn’t answer the bell. I left a note with his super who had his keys, asking him to go in.

    When Hans answered my call that evening, he was too weak to speak. He said, "You came all the way here?" I let it sink in. Then he said, "Goodbye, Temma."  “You’re going to die if this goes on,” I said. “Good-bye,” he said, and hung up.

    I called his psychiatrist immediately and left a phone message saying, “I think he said a last goodbye to me. Please get him into the hospital.”

    This is a cautionary tale:  I learned later that the super knocked on the door and left when Hans told him to go away. His psychiatrist tried to reach Hans by phone for four days. I kept calling the psychiatrist and Hans and getting answering machines.

    On Friday, the psychiatrist finally called to tell me that the police had entered Hans’ apartment that morning and discovered him dead.

    Sometimes mental health crises come as a complete surprise to other family members, but that’s rare. A psychotic break, bipolar mania or depression, or suicidal depression usually is the latest sign of an evolving illness. If you are the main person who cares and is able to take action, it's up to you to find  the mental health services available locally.  Check the listings online (link is external) at the Substance Abuse and Mental Health Services Administration.  Should you run into a crisis, a hospital ER may not be your best choice. The waits are long and the psychiatric services limited.

    Before that day comes, also locate a psychiatrist you trust. Be in touch with the psychiatrist, but don't count on him too much, the way I did.

    If you are living with the person worrying you and have guns in the house, keep them locked up and unloaded. Keep dangerous medications out of reach, too.

    One of my mistakes: I didn't have Hans' keys. We use concerns about privacy and independence to buttress our society's emphasis on self-reliance. But the truth is dependence doesn't end when we're children. We are interdependent as adults. During a crisis, others may need to save you. This is as true in a mental health crisis as it would be if you were hit by a car and lying on the road. 

    Learn as much as you can about the illness and identify the danger signs. One myth is that a person who talks about suicide just wants attention and isn’t serious. Don’t count on it. Be alarmed if you hear someone talk about having no reason to live, being a burden to others, feeling trapped, or experiencing unbearable pain. Don't look away when you see him giving away possessions, visiting or calling people to say goodbye, withdrawing from activities, shutting out family and friends, or acting recklessly or aggressively. Drinking is a scourge for the depressed: Alcohol is estimated to be a factor in at least 25 to 30 percent of all suicides, and in one study, (link is external)heavy drinking increased the risk of a suicide attempt 16-fold.

    When should you call 911 or take your family members to a psychiatric facility or emergency room yourself? If you can say "She's an immediate danger to herself or others."

    Another mistake I made: I didn’t say the magic words, “He’s an immediate danger to himself or others.”  Many people told me later that I had to say those words to the psychiatrist or call 911 and say them myself. 

    Take fast action if you see people showing signs of psychosis that affect their functioning—delusions, or intense fear, extreme agitation, and an inability to sit still or sleep.  Behavior changes that come out of nowhere could be a sign of poisoning.

    Handling a mental health crisis will wear you down, sometimes in unpredictable ways. I am frugal. I entered a strange mental state on the day Hans wouldn’t let me in his apartment.  On my way home, I stopped to buy a pair of $300 shoes.  No, I couldn’t afford them. I mostly wear sneakers and rubber sandals.  I did other strange things, too.

    Get support from family, friends, or support groups. Mental health crises aren’t rare. In 2013, 16 percent of  females ages 12 to 17 experienced a significant depression, according to government figures. (link is external) You already know someone who has seen a family member go through one, or suffered one himself.

    Don’t be passive and trust that your loved ones as adults will seek the help they need—sadly, it’s just not true. You also can’t trust medical professionals to act quickly or decisively unless you push. You need to be the advocate.

     SAMHA estimates (link is external)that about a third of  American adults with severe mental illness in 2013 did not receive treatment. People typically go for more than two months between the onset of symptoms and treatment, if they do get it. Many people with severe mental illness don’t recognize that they have a problem and may resist treatment or medication. Most people with alcohol and drug problems don’t get treated, either.

    Persist—anti-psychotics and mood stabilizers dramatically cut the chances that your loved one will commit violence.

    After Hans’ death, many people said to me, “There was nothing you could do if he really wanted to die.” This didn’t comfort me. It also isn’t true. Hans died because the psychiatrist didn’t believe my warning was an emergency and I didn’t call 911 and say the magic words.

    Statistics and my gut tell me that but for our inaction he would be alive today, and thriving. Most suicidal people get better. Even among people who have been hospitalized because they were suicidal, according to one estimate (link is external), less than 9 percent actually die by suicide. I have a dear friend who tried hard to kill herself and was saved by her friends. She now spends her days giving to others.

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     This topic brought to you from psychologytoday.com
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