It takes a certain personality type work with people in crisis. You arrive at the beginning of each shift with no knowledge of who you’ll work with, where you’ll see them, what they’re dealing with, and whether or not you’ll be able to connect them with the services and support that they need. The pay is a lot less that what you’d expect a licensed clinician would earn, and people in crisis and their loved ones are not ordinarily at their calmest and best-mannered.

You might work with someone who is having a psychotic episode and thinks you work for the CIA. You might be summoned to a school to assess a child in distress. Often, you spend hours at the local emergency room, talking with someone who is desperate for help or has been seen as a danger to himself or others. That patient may be intoxicated. They may have attempted suicide.

And while you’re tasked with doing an evaluation, in many instances, you are not figuring out what the problem is, as the problem has risen to such a level as to be obvious to everyone. What you are determining, instead, is whether the person needs mental health or substance use services, and if so, at what level of intensity.

The continuum ranges from a referral to outpatient therapy to admission to a psychiatric unit or hospital.

Some people are not just eager, but desperate, to talk to someone. To try to have their story heard and understood, or to have someone point them in the direction of help.

Some people are outraged about a crisis clinician being summoned at all.

Sometimes, a person has just been assaulted and needs someone to process it with or just to be there with them, for them.

Some people have lengthy histories of mental health services. Often, they have trauma histories and substance misuse in addition to one or more mental health conditions. They are usually also dealing with serious situational problems such as homelessness or threatened homelessness.

It is sometimes tragic, sometimes extremely inspiring and moving, to see people with such odds stacked against them reach out yet again for help. Try yet again to rebuild their life.

Almost always, you are working with the disheartening matter of supply and demand. Which is to say, many, many people need help, and the small number of resources such as shelters and social service programs often have long waiting lists.

It is especially sad with a child or teenager is in the emergency room with a mental health crisis and needs hospital level care. The resources for this population are particularly scarce, and it is not unusual for a child or teen to “board” in the emergency room for days waiting for help to become available.

Which brings me to the subject of emergency rooms as settings for people in psychological or emotional distress. It would be an understatement to say that the setting is not optimal. You have a space full of people in terrible pain or incredibly ill, family members milling around anxiously, shifts changing, medical equipment noise. Often, there is minimal elbow room, and I always feel a little absurd when I pull the curtain for “privacy”.

There is also the phone work. People call the crisis number at all hours. Sometimes, they are familiar to us, people who use crisis services often to get the brief emotional support they need to help them get through that particular day. Sometimes, they are first time callers dealing with a situational crisis or a serious problem about which they don’t know where to turn.

Sometimes family members call wanting us to evaluate someone who does not show signs of imminent dangerousness and does not want to be seen. We have to say no in these cases, as our services are voluntary. But try explaining this to the weeping mother who is watching her son destroy his life with drugs, or the man who is feeling increasingly frantic as his depressed wife becomes more and more withdrawn.

Why, then, do people sign on for this kind of work?

Because it’s an incredible honor to listen to someone in need.

Because it’s rewarding on those times when you can help someone navigate the complicated social service, mental health, or substance abuse systems.

Because it’s a mental health job that does not require turning someone away for inability to pay.

Because the other clinicians have similar personalities: kindred, quirky spirits.

Because there is rarely a dull moment.

Because many of us have been on the receiving end of help, once or more than once, when we have desperately needed it.

Because you see something of humanity, of whatever it is that connects us.

Because rare are the opportunities to connect with someone so meaningfully.

Because crisis is equal opportunity, and should we need someone, we’d want someone to be there for ourselves, our loved ones, reachable 24/7.

Because it matters, and what other quality is more important in a job?

Because it’s a fascinating gig.

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