Breaking Someone Out of the Behavioral Health Unit


By Chris Hirsch

She came to us like a breath of fresh air; cheerful, passionate, beautiful, and always looking out for others to her own detriment. We had conversations. “Be a little selfish” I said, “It’s OK to look after yourself” – and this was before I knew of the pain in her past. Tragedies, both personal and familial were scattered through her life – more than most could bear, more than many could survive. There is a tangible energy to her, a will to live, a drive to get the most that she can out of every moment. Not surprising from someone who is, so far, a cancer survivor. Very surprising for someone who has been abandoned so frequently.

Everyone makes mistakes, they say. These days I don’t think of them as mistakes anymore – better to call them learning experiences, you try something, it fails, you try something else. Over and over until it succeeds – learning is important, and having the room to learn is even more so. We didn’t really get any kind of instructions on what to do, where to go, who to see, or why we are here – maybe if we had we wouldn’t have to try so hard to learn – we could all be perfect, or at least we would know when and where to blame people (“If only they’d followed the instructions in “The Manual” we could say). Or maybe we should just follow the “rules” handed down to us by our “elders and betters”. It would be more helpful if the rules actually worked, or even if they were things that we felt a little like doing or saying – maybe that is the source of our madness: we don’t want to do the things that a “normal” person wants to do. It doesn’t really make me feel like I want to be “normal” very much. “Just follow the rules” my mother would say “then everything will be OK”. I tried, and it wasn’t. “Try harder” she’d say, eventually I said a mental “Fuck you” to my mother’s methods, and stopped paying attention, and tried to work out my own way to stay afloat until I died.

I came to work one day and found out that she had ended up in the BHU. I didn’t really understand why or what had happened (it later turned out that Mr. Miscommunication and his children Assumption and Trigger had entered the fray and exacted their toll). Except, the night before she had texted me – reaching out. But it was my birthday and I was out celebrating. It’s a good thing I know how to batter my conscience down. Better it than me.

Then she called. “I’m glad it’s you.” I had earlier bragged that the reason the major crises happened on my shift was because I was the one who could handle it. Guess I was about to have to put my mouth around the money.  “I was vulnerable with the wrong people.” “I need to get out of here”. Slowly I dragged the story out of her.  An episodic night.  A scared boyfriend. A visit to the ER. The “wrong” word said to a nurse and a sneaky 5150 to the Behavioral Health Unit. Locked away and lost in the mechanism; scared, lonely, traumatized and desperate. “Help.” “I need to get out of here.” “I don’t feel safe here.” “I’ll see what I can do.”

I build guitar amplifiers with vacuum tubes (They can set off an electromagnetic pulse and they’ll still work. There will be no power to work them, but if there was, they would). Doing something new and different is always attractive to me. Something that no one knows or remembers how to do. Tilting at windmills those who know me often call it. Breaking new ground and learning is how I see it. I had no idea how to get someone out of a 5150, was not even sure that it could be done, but had some ideas.

I called my boss and culled approval from her, and for continuing the stay at the house. I called BHU and talked to a nurse there, probably breaking all kinds of confidentiality rules, but he didn’t seem too worried. He said he needed to “evaluate” her, and then he’d call me back. (“Was she worth enough to keep there?” Popped into my head. “Do people understand what evaluate means?” Look it up). I let it slide, realizing at that moment that connection might be the first step in Intentional Peer Support, but it is also the first step in a con, or manipulation.

I don’t know if he remembered me, but he was the nurse who evaluated me the first time I was there (I was valuable enough to keep for 11 days. Despite having no insurance). I remember him running to get me two valium right after he had taken my blood pressure. At the time it made me feel looked after, cared for. In hindsight, I probably should have started worrying then, but I was so desperate, and so lonely, and (I thought) so incapable of caring for myself, that I felt reassured – someone cared whether I lived or died. That’s nice.

I tend to leave everything to the last minute. So overall, both of my visits were “good” for me personally, I got fed (I hadn’t been eating). I got “good” rather than “self” medications. I slept – All of which had been eluding me; but I was unable to keep my caretaking under control even in that state, and watched in horror as a charming old man (I wonder whatever happened to him? He had incredible stories of travel, photography, and cultures) was first tied to bed, isolated, conserved and then forcefully medicated. I tried to help. I tried calling the Ombudsman repeatedly, and repeatedly got an answering machine. Eventually I was told that if I didn’t stop I would be asked to leave (I think “they” thought I was calling to complain about my own treatment). I didn’t realize the extent of the conspiracy until much later. Over time I have come to accept that I was the exception rather than the rule.

She called me after the evaluation. I could hear traumatics in her voice. I knew her well enough to know that this was WRONG (with a capital everything). “They can’t do anything unless my boyfriend calls and says I wasn’t suicidal” she said. “What would you like me to do?” said I, “would it be better if you or I called him?” We muddled around conversationally, trying to make the decision, she unsure of the repercussions or reception for either of us. I asked about him, looking for tools and trying to evaluate a total stranger using someone else’s observations and relationship. “I’ll call him” I said, thinking in the back of my head that if everything went screwy, she would have someone else to blame and could use that to persuade him (as I said, connection is also the first step towards manipulation, too).

I called. He was worried. Scared for her. Scared for himself. Scared as to how this would affect them. I ignored the fact that she was in the midst of breaking up with him, jollied him along and explained the situation. “I was so scared” he said, “she used the ‘S’ word”. I reassured him, explained the stages of suicidality that I and many others seem to go through, the questions that “they” ask us when worried. “Would you call them” I asked “and say that she wasn’t?” “Yes” he said. I didn’t really pay much attention to the rest of the conversation.

My mother (again with the mother, I guess she was/is a major influence) had the wonderful ability to be able to be able to go on automatic pilot conversationally during a dinner party. Horrendous things would be happening in the kitchen – pots exploding, cream curdling, frying oil catching fire – and she would sit having a deep meaningful conversation with the person next to her. “What were you talking about?” I’d ask, as she reappeared in the kitchen to try and salvage some kind of appetizing concoction from the debris (usually successfully, a talent I have somewhat either learned or inherited from her). “I don’t remember,” she’d say, “I was thinking about how to make something tasty out of this mess. I was on auto pilot.”

It is another skill I have inherited from her, often useful, sometimes dangerous (one can find oneself having agreed to do or say all kinds of things, when one thinks one is just making agreeable noises). Along the way this time I heard myself offering to educate him on the in’s and out’s of being with someone who is “abnormal”. Consciousness caught up and I managed to add “if that is OK with her.” Potential crisis averted, I returned to auto pilot and thought a little about what I was doing, the wisdom of it, in terms of my career, the reputation of the House, and what I would feel like if she came out and did commit suicide. “Trust your gut” I heard Yana say, and did.

He ended up calling her at the BHU, I am not really sure what happened during that conversation, but he soon called me back. “What do I say,” he asked “she told me to call you for help.” “I am surreptitiously engineering a breakout” I thought to myself as I prompted him with the words and emoting what “they” wanted to hear… I hoped. We chatted a little more, nursing him through the fear and nervousness that challenging authority inevitably entails, I think I gave some good advice, mostly about how to reframe from what is the most logical, to what is the most beneficial, way to perceive with the ups and downs that accompany a relationship with someone who is not “normal”.

“It has nothing to do with you.” I heard myself saying “try not to take it personally” “Maybe you could try the suicide hotline training” “I’ll see if I can dig up some support groups for you.” Stock phrases wrapped around minimal brainstorming. I watched helplessly as I saw myself trying to wriggle out of the helper/fixer role with him, trying to pass the buck onto someone else, anyone else; “Do it gracefully and trust the system,” “You cannot fix everyone,” “This is likely to get ugly and complicated.” The ‘excuses’ bounced around, trying to obscure the raw and naked nobility that is at my core.

“I fix,” I’d say, “people, computers, systems, situations. I just fix”. An overwhelming gift and burden that has given me many moments of true joy (fixed), while also bringing many disasters (broken, sometimes more so), as life tries to teach me the impracticality of unconditional love and radical acceptance for all.

The conversation ended and I realized how truly tired I was: a celebration ‘till three followed by a 14 hr work day (only 8 at the house) and “this” were pushing the limits of this 50 year old. And thrown into the mix was an interview that I had conducted somewhere in the midst of “this” that made me feel more like a servant in a county mansion than a counselor – “I want to stay at the house because I have no money to do laundry or feed myself, and cigarettes are cheaper near you” (maybe a parent?) “Bathtubbing laundry? Food banks? Buses? Friends?” “It’s too hard, I can’t”.

The contrast in scale and perception of need eventually got to be too much for me and I invisibly lost my temper with the interviewee. “Can I stay ‘till midnight?” “Can I eat some of the meal you just cooked?” For some reason things that I would normally offer, push on, anyone who walked through our front door became resentments when they were ‘demanded’, seemingly as an entitlement that evening. I finally allowed my self to express it a little “I’m feeling used” and tried to explain a little. At the end of my mild diatribe he reached into a pocket and pulled out and handed me my lighter (he’d borrowed it earlier). “Is this what you mean. I’m sorry.” Missed by several light years. “It’ll have to wait until another day” I told myself as I watched him eat, quietly, coldly, and a little disgusted with myself, waiting for him leave, muttering reassurances into the phone as they were needed.

Either I called her or she called, I was so tired and so involved in the situation that the details I saw as useless were dropping out of focus. “How is it going?” I asked. “I don’t know” she replied. It had been about an hour since he was supposed to have called ‘them’, and neither she nor I had any idea of what, when or how ‘they’ were going to process this, or even if we’d be notified when they had. Trust was clearly an issue for both of us. “What happens if you have to spend the night there?” I asked, “I don’t know, I don’t think I can.” I started to talk about the “good” side of BHU. Trying to reassure her that the worst wasn’t that bad. As the emotions became more intense, so did the fogginess of details. At best the conversation left me feeling as if I had failed. As I  once wrote:

And somewhere someone screams in pain
As the jailor turned the key
And somewhere someone has found a way
To act and do no deed

I tried to push aside the feelings of failure ‘till I got home. Luckily the house was not very full and the other guest had been asleep my entire shift. I struggled with my guilt until the next shift arrived. I briefed them on the situation and they walked me downstairs. “She might just turn up” I told them. As I pulled my motorized bicycle out of the garage, I got a text. She’d gotten her phone back. Did this mean?. I dialed her number, she was out and had just arrived at her car and would be back at the house in about 10 mins. She sounded so much better. “Would you like me to wait for you?” “You don’t have to”. I chatted and put lights on my bike for the next 10 mins, not really consciously waiting, a little afraid that if I didn’t, something else could go wrong.

She turned up as I was beginning to get on the bike. My co-workers went upstairs “I feel weird with all three of us standing here,” he said. “see you on Friday”. I walked up the street and made sure that she made it from there to the front door. “I’m not usually a touchy feely person, but can I give you a hug?” “Of course, you can hug me any time you want.” I sent her off to bed, her physical and emotional exhaustion was tangible, wishing her sweet dreams and drove home, allowing my self to stop and get a beer. I’d earned it. Walking into my apartment (about as messy as my mind) I texted her “if you feel up to it, you might want to let him know that you’re out (text?)”. She was already on top of it and sent me a grateful text for all my efforts.

I am not very good at endings, or letting things go. I sat up too late thinking things through. The previous doubts surfaced in my head, reverberating and multiplying for a time, and then slowly echoing off into the distance. It was time for me to get some rest. “What happens if she does commit suicide in the next few days?” I mused as my head hit the pillow, and I drifted off to sleep, grateful for the meds I had just taken – else it would have been a sleepless night.

I stumbled out of bed the next morning and somehow found myself a way to therapy. “I broke someone out of BHU last night” I said in greeting (she is used to my extreme reframing, after a few panics as we got to know each other) and, after an explanation. “I’ve never heard of that happening before.” She said. That part of me which is pride stuck its head up and started to get dressed and make itself presentable. I bumped into a fairly senior therapist of long standing for “The County” and repeated my story. “I’ve never even heard of that happening.” She quipped as we laughed our way through the pain of ‘their’ rules. Pride put the finishing touches on his outfit and sat and waited until it was OK to come out. I put some hours in at the computer lab and then went to the house. I checked in with some friends/co-workers and got very positive feedback. “That was a good thing.” I expressed a few doubts and was reassured, one was almost angry with the insecure me. Very passionate. Then the boss came, I expected at least a recrimination about not keeping her well enough informed – which may have been deserved (it certainly has been in the past…I’m working on it), but wasn’t. Pride stood up impatiently and started pacing back and forth.

A little later she called. “It got late without me noticing. Am I too late for dinner?” “No. Probably ½ hour to 45 mins.” “Oh. OK. I’ll be back by then”. Somehow the lightness of the conversation, contrasted with the intensity of the night before, felt disconnecting. She soon returned, we ate and talked about the night before, filling in gaps and letting each other know what we’d felt we had to do (or at least I did). Connection returning and feeling more stable. Pride started banging on his door. Eventually I couldn’t resist “my therapist and one at the county both say they’ve never heard of that happening before.” “Wow”. She said (or something like that, foggy details) “Thank you.” I finally let myself hear it – she’d said it many, many times. I let Pride out and tried not to let the tears from one of those really joyful and satisfying moments flow. I always get embarrassed by them.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Thanks Chris for your honest story telling, it made me feel as if I was there with you. And told me something of what it’s like to work in a peer respite, and rescue, house. A home from home, just what we all need. Being a mother, your mention of your mother touched me, and your revealing of emotions was brave.

    All the best and I look forward to reading your next chapter, regards, Chrys

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  2. Well done Chris. I almost forgot how terrifying it can be when you are taken into custody “for your own safety.” I remember how the private hospital I was in would handle those who ran out their insurance policy’s allotment of days and were still not quite “safe” to discharge. A van would show up from the state hospital and handcuff the person, strap them down and take them on a body board over to Madden or Elgin State. Mostly they had been somewhat anxious but in pretty decent spirits the day before, and mostly by that time they were weeping hysterically, and the rest of us were shaken up pretty good as well. Oh, the art of healing.

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