ACIS is our Mental Health Crisis service in SA, and whilst they have an incredibly important job, they can at times be difficult to interact with. Sometimes this is just determined by who you get on the other end of the phone and how bad a night they’ve had so far. I’ve had to call ACIS as a carer or friend on many occasions now, and I’ve learned a few strategies that seem to make things a bit easier for me. Here’s my tips:
1. Have a clear goal in mind
Before you start the call, work out why you are calling them. I know this can be difficult when things are in crisis, but if you don’t know what you want, you’re not all that likely to get it. Are you updating them with important information? Do you need them to speak to the person you’re worried about? Are you hoping for a visit from their staff? Do you think the person urgently needs hospital? Do you need police support? Work this out before picking up the phone if you can.
2. Gather the person’s information
I can never remember everything I was going to say once I’m on the phone. Write down a list, and tick them off as you go. Having everything in the one spot means less fuss running about the house to check the name of the current treating doctor or what dosage of meds they’re on this week. The more chaos and change in the person’s life, the more important it is you take a few moments to check all your information. You may need to know the person’s current diagnosis, medications, treating doctors, hospital ID numbers, full name, address, date of birth, phone number, and dates of important events (eg. she was last in hospital on…, he stopped taking his medication on…) You can still call if you don’t have these – eg you’ve just stepped in to help a stranger in crisis on the train – but if you can put this information together first it will help.
3. Lay out the situation really clearly and simply
ACIS get millions of phone calls from desperate, incoherent, stressed out people. Assume for a moment they have no files whatsoever on your person, even if they do. Give them the dot-point version (that you’ve already written down) of what’s going on and explain very, very clearly why you are concerned. For example:
I’m calling on behalf of my friend Lauren. She has schizophrenia and becomes suicidal when she is unwell. She’s not very good at taking her medication and I’ve just discovered she stopped her antipsychotics on Tuesday. She’s also not eaten in several days. She’s just called me in a very distressed state, she’s having delusions that the neighbours are trying to kill her and has barricaded herself in her apartment, armed with a carving knife. I’m concerned that she is a danger to herself and unable to care for herself at the moment. Can you please speak with her or send someone to her apartment.
Don’t assume anything. Don’t assume that it’s obvious you would want the police to come, or that the person clearly needs hospital. Don’t assume that saying something like “He’s becoming very withdrawn and won’t speak to me” will ring the kind of alarm bells for them that it does for you. You need to tell them that the last time he did that, x happened. Tell them what you need and explain why.
4. Cry some place else
That sounds pretty harsh, but I’ve found that if I keep really clear in my mind that ACIS are a crisis response service, not a counselling one, I have an easier time in conversations with them. Very occasionally perhaps a lovely person will look out for you and let you talk for a moment about how you’re feeling and coping. But going in, I assume that they are not there to meet my emotional needs. I am as calm, clear, and professional as possible. That doesn’t mean your emotional needs aren’t important! If you need to follow or precede a call to ACIS with one to Lifeline, a good friend, your Mum, whoever, then do it. But in all crises, there’s a time to cry and shake and feel things, and a time to call the police and clearly tell them your address – or whatever. Don’t get them mixed up if you can.
5. Recruit help
Sometimes in a developing crisis you have your hands so full with the person you don’t have the energy or time to call ACIS as well. If a couple of you can work as a team that can take a lot of the pressure off. I’ve done this quite a bit, someone sits with and calms down the person, someone else makes the important calls. Doing it all yourself is a recipe for burnout. Also use this technique if for some reason ACIS aren’t taking you seriously. I’m sorry to say that as the carer/family/friend your experience and opinion often count for very little. If you are looking out for someone high risk such as a person with Borderline Personality Disorder, there will be times when you really struggle to get the help that’s needed. Persistence is the key. Keep calling them, and get everyone else who’s worried to call them too. There are resources and supports out there, but unfortunately they tend to go to the squeaky wheels. Don’t suffer in silence, squeak as loud as you can.
6. Do without them wherever you can
Especially if your person if in chronic distress, try not to escalate a situation by jumping for ACIS every time they wobble. Look at the patterns – eg issues with medications etc. and expect more of the same. Try to take as much of it in your stride as you can. There isn’t a magic fix for these kinds of issues, and a lot of the help and healing your person needs is probably not going to be found in the crisis services. They can hospitalise or medicate, but that’s about it really. Concentrate your energy whenever you can on the other supports – finding a good doctor, a therapist, social support, maintaining stable housing etc. Be aware of the limitations of crisis services.
7. Give them feedback when you can
Crisis services are frankly a horrible place to work. Any kind of front-line work like this has a lot of people having the worst days of their lives, feeling totally overwhelmed and miserable. If you have a positive experience, be sure to let that person or the service know that what they’ve done has made a difference. We need to look after the good folks in these kinds of roles so they stay around and look after the next person. On the flipside, if you have a terrible experience and have the time/energy, make a complaint. Be clear about what you wanted and what you didn’t like. It wont change the world, but it can be part of culture changes in the mental health system.
8. Maintain credibility
As a friend, family member, or carer, you may be quite surprised to find how little your opinion counts. This holds true in my experience, even if you have extensive experience and qualifications in mental health. If ACIS or any other service decides that you are jumpy and overly anxious, it will be next to impossible to get them to take you seriously. The heart-wrenching thing is that there is basically no accountability in mental health. If your person kills themselves after you spent days arguing they should be in hospital, it is extremely unlikely anyone will be held to account for it. Additionally, we are in a no-win situation where suicide is often considered to be proof the person was beyond assistance anyway. This means you are far more invested in the outcome then nearly anyone else you will speak to – often including the person you’re worried about. This is incredibly distressing and you may find yourself feeling more and more overwhelmed with intense feelings and justifiable frustration. If you let these reactions show too much to services like ACIS, they may take them as indicators that you are over emotional, overly involved, and unreliable as a reporter of what is going on. You need to do whatever you can to retain what little credibility you have. That means working with the system and accepting it as it is, instead of being fooled by the packaging into thinking it’s going to adapt to you. The more you can behave and speak in a detached, professional, calm, and courteous way, the better chance you have of being taken seriously. Don’t let them write you off as emotionally unbalanced when the stakes are this high.
9. Ignore useless advice
As a carer/friend/whatever, you will get a lot of contradictory, useless and unhelpful advice. The crisis services are really good at this in my experience. Boiled down most of the bad kind turns out to be something like this: “If you were less involved, no one would be ringing me about this difficult person and my job would be easier”. There’s often a conflict between your perception of the person’s value and that of the services. People do get written off in many different ways, it’s ‘just behavioural’, they’re ‘doing it for attention’, he’s ‘a hopeless case’. I’ve had the bizarre experience of being told off by one staff member for being over-involved and not involved enough in someone’s care – within the same conversation. If it can be made to be your fault somehow you will probably hear about it at some point. A lot of people who know nothing about you or your caree will tell you how to care for them and let you know they think you’re doing a pretty lousy job. I’ve also had experiences of emotional blackmail from crisis services, including ACIS; “But what if someone else dies tonight because your (person) was in the last hospital bed?” Some people find it difficult to work in a service and acknowledge its limitations. When things fall apart that means they will turn out to be the person’s fault, or your fault. Expect this and learn to tune it out as much as possible when picking them up on it would only distract from your goal. Find somewhere safe to rage or cry about it later. Don’t take it on board or let people undermine you.
Most of that isn’t fair at all. You’re already working hard to support the person, probably exhausted and scared out of your mind, and feeling all the intense feelings that crisisgenerates. Services like ACIS should get that and accommodate you and your needs too. I couldn’t agree more – and occasionally it may happen that way. But that’s not been the norm in my experience. Take good care of yourself, it’s phenomenally exhausting supporting someone in crisis. Hang onto your sense of their value even if services such as ACIS are not treating them that way. Hang onto your sense of your own value even if services such as ACIS aren’t treating you that way. If it all goes belly-up and you can’t follow a single one of these tips, call ACIS anyway.
If your person is dealing with dissociation, you may not get any support from ACIS at all I’m sorry to say. The level of discrimination against dissociative conditions is extreme and many crisis staff consider all dissociation to be faked for attention. Your best route is to stay out of crisis as much as possible, and get good support staff on board. You may need to get private hospital cover and look for a psychiatrist with admitting rights instead of risking the public system. I’m sorry about this disgusting state of affairs and I hope we can improve things fast. But this is roughly how things stand at the moment.
Good luck, take care, and get some support.
ACIS: 13 14 65
Lifeline: 13 11 14