Why It Can Be a Very Bad Idea to Call the Police on a Suicidal Person

The police in America have killed mentally ill suicidal people after breaking into their homes, and this latest case where it could have happened to whistleblower Chelsea Manning is another reminder of this. It’s better to try to contact friends or family that care instead.

Shortly after Chelsea Manning posted what appeared to be two suicidal tweets on May 27, police broke into her home with their weapons drawn as if conducting a raid, in what is known as a “wellness” or “welfare check” on a person experiencing a mental health crisis. Manning, a former Army intelligence analyst turned whistleblower and U.S. Senate candidate, was not at home, but video obtained by The Intercept shows officers pointing their guns as they searched her empty apartment.

The footage, captured by a security camera, shows an officer with the Montgomery County Police Department in Bethesda, Maryland, knocking on Manning’s door. When no one responds, the officer pops the lock, and three officers enter the home with their guns drawn, while a fourth points a Taser. The Intercept is publishing this video with Manning’s permission.

“This is what a police state looks like,” Manning said. “Guns drawn during a ‘wellness’ check.”

Welfare checks like this, usually prompted by calls placed to 911 by concerned friends or family, too often end with police harming — or even killing — the person they were dispatched to check on.

Manning was out of the country at the time of the incident, said Janus Cassandra, a close friend who was on the phone with her that night. “If Chelsea had been home when these cops arrived with guns drawn, she would be dead.”

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The problem, mental health experts say, is that police should not be the ones to check on suicidal people in the first place. In 2017, mental illness played a role in a quarter of 987 police killings, according to a tally by the Washington Post. People of color experiencing mental health crises are particularly at risk.

In 2018 alone, police have shot and killed at least 64 people who were suicidal or had other mental health issues, according to the American Civil Liberties Union. “This January, Alejandro Valdez was suicidal and threatening to kill himself. The police shot and killed him,” Susan Mizner, the group’s disability counsel, wrote in a recent post. “In February, Orbel Nazarians was suicidal and threatening himself with a knife. The police shot and killed him. In March, Jihad Merrick was suicidal and pointing a gun at his head. The police shot and killed him. In April, Benjamin Evans was making suicidal comments. Police shot and killed him.”

“There is absolutely no excuse for sending armed police to the home of someone who is having a suicidal episode,” said Cassandra. “As we’ve seen countless times, cops know that no matter what happens, they will be shielded from any accountability whatsoever.”

“It’s not necessary for police to be the first responders when somebody calls 911 and says they’re suicidal,” said Carl Takei, a senior ACLU attorney focusing on policing, in an interview. “In the same way that if I were to call 911 and say I’m having a heart attack, I would expect a medical response. As a society, we should expect a mental health response when somebody calls 911 and says they are suicidal, rather than dispatching somebody who is armed with a pistol and most of whose training is directed at enforcing criminal law and how to use force with people whom they suspect are breaking the law.”

When police do become the first responders in mental health crises, Takei added, the ways in which they handle them vary greatly between departments.

“Some have specially trained crisis intervention teams that are dispatched when there’s a call involving a mental health crisis; some departments provide some level of crisis intervention training to all officers; some departments provide no training at all,” said Takei. “And, of course, if a department provides no training or very little training on how to deal with situations involving a person in a mental health crisis, the officers are going to default to the training they received, which is very much based on a command-and-control culture.”

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Ketamine Nasal Spray Shows Effectiveness at Treating Major Depression and Suicidal Thoughts

There’s definitely something to be said about ketamine’s apparent effectiveness at immediately making many suicidal people no longer want to end their lives. The importance of caution in using it should be noted though.

A nasal spray formulation of ketamine shows promise in the rapid treatment of symptoms of major depression and suicidal thoughts, according to a new study published online today in The American Journal of Psychiatry (AJP).

The double-blind study compared the standard treatment plus an intranasal formulation of esketamine, part of the ketamine molecule, to standard treatment plus a placebo for rapid treatment of symptoms of major depression, including suicidality, among individuals at imminent suicide risk. The study involved 68 participants randomly assigned to one of two groups — either receiving esketamine or placebo twice a week for four weeks. All participants continued to receive treatment with antidepressants throughout. The researchers looked at effects at four hours after first treatment, at 24 hours and at 25 days.

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The results of the study support nasal spray esketamine as a possible effective rapid treatment for depressive symptoms in patients assessed to be at imminent risk for suicide, according to the authors. Esketamine could be an important treatment to bridge the gap that exists because of the delayed effect of most common antidepressants. Most antidepressants take four to six weeks to become fully effective.

This study was a proof-of-concept, phase 2, study for esketamine; it must still go through a phase 3 study before possible FDA approval. It was funded by Janssen Research and Development, LLC.

The authors caution that more research is needed on the potential for abuse of ketamine. That caution is also the focus of an accompanying AJP editorial also published online today. In the editorial, AJP Editor Robert Freedman, M.D., along with members of the AJP Editorial Board, note the known potential for abuse and existing reports of abuse of prescribed ketamine. They discuss the need for additional research relating to the abuse potential of ketamine during phase 3 trials, such as monitoring of patients’ craving and potential ketamine use from other sources.

While it is the responsibility of physicians to provide a suicidal patient with the fullest range of effective interventions, the AJP Editor’s note, “protection of the public’s health is part of our responsibility as well, and as physicians, we are responsible for preventing new drug epidemics.” The Editors suggest the need for broad input in the development of effective controls on the distribution and use of ketamine.