As a peer experiencing a mental health crisis, that wonderful event where my bipolar symptoms and/or PTSD symptoms and/or anxiety symptoms hold an unavoidable detrimental sway upon my mood, my thoughts, and my behavior, the suddenness of the onset of a severe episode can be just as sudden as the offset of a severe episode. Thus is the quality of mental illness.

For me, I can go from suddenly wanting to power-swallow a gallon of rusty screws and then throw myself in front of an industrial electromagnet (for no apparent reason) to suddenly wanting to power-pet my rabbits whilst sharing a bag of organic caffeine-marinated baby carrots running infinity laps together around the base of Mount Erebus (for no apparent reason), to suddenly wanting to find that gallon of hardware once again (for no apparent reason). All in the space of an hour or two. For no apparent reason. It’s fun having bipolar.

It’s on the suicidal end of the bipolar spectrum where I am of the most danger to myself. One might argue hypomaniacally jumping from moving train car to moving train car a la opening scenes of The Last Crusade is equally dangerous to myself (I did this for a number of days back in 1989 before it got boring), although the difference is the suicidal symptoms veer towards purposely destroying myself and the hypomanic symptoms veer towards accidentally destroying myself. So, it is on the suicidal end member where I’ll take myself to the hospital, particularly if “I want to harm/kill myself” and “I have a plan to harm/kill myself.”

If you’ve ever been to an emergency room, you’re well-versed in the “luck of the draw” nature of how long you’ll be sitting in the lobby waiting to be seen. And if it just happens the tour bus for Nickelback is traversing Albuquerque via I-40 and said bus just happens to veer off the highway into a waiting heap of depleted uranium bricks because every motorist on the highway working in tandem rams into Nickelback’s bus because Duke City’s residents can’t pass up this unique humanitarian opportunity to rid of the world of Nickelback but somehow they live because Nickelback’s contract with the Desolate One has a specific rider protecting them from Albuquerqueans, bus-ramming, and piles of depleted uranium bricks so now Nickelback and all of their tour bus entourage are ahead of you at the ER…

Look, sometimes you get to the ER and sometimes your wait can be hours and hours before being seen. I know with my rapid cycling, I can go in ready to listen to Nickelback (this is a suicidal ideation at its worst) and by the time I’m seen by the ER staff my symptoms have diminished and throw up a little bit in the back of my throat thinking about listening to Nickelback, so at this point I have to answer these criteria of:

“Do you feel like hurting yourself or others, do you want to kill yourself, do you have a plan?”, the answer would be “No, at this precise moment I don’t meet any of these criteria…”

And so I’m sent on my way by ER staff, and driving home I get the unholy urge once again to listen to Nickelback… this is the quality of rapid cycling for me. What is the problem with this scenario?

  • I got suicidal and have a plan to off myself.
  • I take myself (or a friend/family member takes me) to the ER.
  • I am a peer who contends with rapid cycling and can launch from suicidal to not suicidal several times in an hour.
  • When the ER staff sees me, I can be either suicidal or not suicidal, based upon where I am in my unpredictable rapid cycling.
  • And if not “suicidal with a plan” I cannot be admitted inpatient to the hospital.
  • I’m still a risk to myself (suicide), regardless of where my symptoms happen to be in the ten minutes I present to the ER staff.
  • The choice by ER staff not admitting me for critical inpatient services has now put me at serious risk of… harming myself and having a plan to carry it out.

That’s the problem peers face. We can go in suicidal with great need for inpatient services and still be turned away because when asked “Do you want to harm yourself or others and do you have a plan?” we answer (truthfully) “At this very moment I no longer feel like harming myself or others and by extension at this very moment I no longer have a plan.”

I can count so many numerous numerous numerous numerous numerous times in this exact repeated scenario where I’ve been turned away when I absolutely knew I needed to be inpatient. It’s frustrating. And dangerous to peers.

There’s got to be a way for peers to get around this irresponsible inpatient admittance criteria. And I’ve got just that way for peers to get around this irresponsible inpatient admittance criteria. Steve-tested and loved ones-approved. Shall I share this? You bet!

When asked “Do you feel like harming yourself or others and do you have a plan?”, regardless of how you feel at that precise moment, and especially if you absolutely know you need to go inpatient, repeat this over and over and over:

“If I go home, if I leave this ER, I won’t be safe.”

You may be told, “That doesn’t answer my question.” And your answer is, “If I go home, if I leave this ER, I won’t be safe.” And they may counter, “Do you not understand the question?” And you may answer, “Yes, I understand your question. If I go home, if I leave this ER, I won’t be safe.” This can go on for quite a spell. Batten down for the frustration of the ER staff not understanding your answer.

It’s the all-purpose answer I’ve used when in this situation, and it’s the perfect workaround for an imperfect system. If I go home, if I leave this ER, I won’t be safe. It is not a lie. It is the real answer to why I’m at the ER.

There are many providers who have scolded me for sharing this with peers. They feel it is dishonest and provides a way in to the hospital for peers who don’t require inpatient services (by their admittance criteria). We have limited inpatient services in New Mexico (this is true) and inpatient services, for now, must be reserved for only those peers who meet their rigid, limited admittance criteria. Here’s how I feel about this:

If I’m in the ER because I’m in crisis that means I need to be admitted for inpatient services.

I’ve been accused of oversimplifying things, I’ve been scolded for providing peers with inaccurate information, and I’ve been told that I’m irresponsible. That’s fine, and that’s honest from the point of view of Muggles who work in the psychiatric services industry. But I’m not a Muggle. I’m a peer, and only I know what’s best for my wellness and recovery, and only I know when I need inpatient services. If I’m in the ER, I’m there for inpatient services. I’m not there for the ER staff to judge if I’m actually in crisis. I’m there. I’m in crisis. I need inpatient services.

In DBSA support groups, in NAMI support groups, when holding peer focus groups, giving public presentations, and all the other places where peers are amongst peers, I’ve shared this (for me) very helpful pointer. And if you think it’s oversimplified, inaccurate, and irresponsible, chew on this important peer feedback:

Many peers have shared that this ER workaround saved their lives.

They got the inpatient services they knew they needed. They got the inpatient services they might have only suspected they needed. Point is, they went to the ER for help with their mental health crisis, and they got the exact help they went for.

If I go home, if I leave this ER, I won’t be safe. It’s honest and accurate. It allows peers to advocate for themselves when in crisis, rather than allowing a canned ten minute Q&A decide if they need inpatient help. And this simple phrase saves lives. How can this be a bad thing? It’s not. And if it flies in the face of current convention, like ignorance, current convention is temporary and remains current only until replaced by what works right.

Disagree? Then I invite you to listen to some Nickelback and share in my peer experience. I promise you, by the end of track 2 you’ll be planning how to take a permanent vacation under the rain and roses or you’ll be launching a full-scale total-destruction nuclear strike on Canada.