E.240 When Systems Fail: First Responders, Crisis Work, And The Cost Of Care Part 2

[music] Welcome to Resilience Development in Action with Steve Bisson. This is the podcast dedicated to first responder mental health, helping police, fire, EMS, dispatchers, and paramedics create better growth environments for themselves and their teams. Let's get started. [music] Get free.ai. You heard me talk about it. I'm going to keep on talking about it because I love it. I've had about a year and a half, 18 months practice with it. And I still enjoy it. And it saves me time and it saves me energy. Free.ai thinks your note makes a transition from what you're talking with a client, just press record. And it does either transcript, it does a subjective, and an objective. With a letter if needed for your client and for whoever might need it. So for $99 a month, it saves me so much time that it's worthwhile. And if you do it for a whole year, yes what, you get 10% off. More importantly, this is what you got. Because you are my audience that listens to Resilience Development in Action. If you do listen to this and you want to use free.ai, put in the code Steve15 in the promo code area, Steve50, and you will get $50 off in addition to everything we just talked about. Get free from writing your notes, get free from even writing your transcripts. Use that to your advantage. Free.ai, a great service. Go to getfree.ai and you will get one of the best services that will save you time and money. And I highly encourage you to do so. And by magic, we're already back. Thank you again for continuing with me. I really enjoy our conversation. So if I hope you're enjoying it too. It's okay. Well Morgan Yaskas. I want to do so in case people then catch the first part. This is part two. I know that you worked on a mobile crisis team. You are now in the private practice. You work with first responders. I think it's all important stuff. I wonder how your career as a crisis clinician or that's what I called us when I was a crisis clinician shaped how now you treat first responders, how you treat your clients in general, but particularly first responders nowadays. And knowing about things like the systematic factors that go through a lot of things, including administration, betrayal for some of those guys because they can't really talk to anyone in their department. So I think it's something. Yeah. I think Elgast it's really a loaded question. Oh, I know. That's what I think. That's why you pay me a lot of money to be on here. So I can send you a lot of loaded questions. Then pay me folks. She did not. You know, I think on paper, crisis work looks very noble, heroic. Right. And in practice, it's. And I think it's not a lot for lack of a matter of word. I think it's, it's, we're often being a buffer between suffering and a system that's not built to hold it. At least that, and you know, this is all speaking from my experience here in Alaska. And so in Alaska, I think that that's really magnified by the lack of infrastructure and the isolation that we're working with geographically speaking. And I think one of the most frustrating and heartbreaking realities was, was how few real options exist, right? So we had our first responders and then we created mobile crisis team and we're like, this is going to be so great. We're going to solve all of the Alaska's problems. And then we didn't not just say we did too great work. That's where you told me to wait a minute. This is false. And I know that's on the rest of it. But you know, in the Matt's to bro, which we talked about earlier, it's a, it's a huge area. And we have, we have one homeless filter. One. Wow. And it's women's only domestic violence shelter. That's it for a burrow that's larger than some states. No kidding. So there, there often isn't a clear or available next step for a lot of the individuals that we were interacting with. And so we were experiencing that as mobile crisis. And I, all I could think about was like, good God, what did these people do before we existed? Because at least once we were there, they were able to hand off to us and we could problem solve this. And they could get back to what their actual jobs were, which wasn't this, right? It's not case management or resource referral. And so I think that that was a big piece of it was, was I had that question in mind of like, what, what did they do? And you know, obviously I asked because I'm curious and I like to talk. And, and they were like, well, we, we didn't. And it, but really it wasn't that we didn't it was that they couldn't, what could they do? So these first responders are being called to these scenes that are not medical or not criminal related. Right. And being told to fix it and then, you know, getting shit out on Facebook two hours later when they don't. And it's just this like toilet bowl effect. It's just so cyclical. And the reality is like that's not a problem that they could solve. And I think that the public was often missing that this isn't about willpower. You know, and that goes for the, okay, I'm going to paint a picture here as I like to do. It goes for the people, these individuals too, because I remember hearing all the time, like, why don't they just stop using? Why don't these people just get a job? Why don't they just get clean? Why don't they just find housing? But they're asking the wrong question. And because what they're really asking whether they realize it or not is why doesn't someone with no ID transportation or support system or place asleep. Navigate this bureaucratic labyrinth that would frustrate even a fully researched person. That's what we're really asking. And so please come me off at any point, because I get really heated about this actually. But to humor me, right? I want to hear it. That's why I'm letting you talk. Yeah, someone experiencing homelessness in Wastilla, which is where I am. They want to get a job, but they need an ID. Well, it was lost their stolen. So now they need to go to DMV. Well, guess what? We don't have one here. The next one's like 15 to 20 miles away in a neighboring town. So they have to walk or find transportation. But also to get that, they need a social security card. We don't have that here either. So now you have to go to Anchorage, which is 40 mile over 48 miles away. Again, assuming they can find transportation and get the security card. But also you need a birth certificate to do that. I'm pretty sure. So you're going to have to order that from by the statistics. We also don't have one of those here, which costs money that you probably don't have. Takes several weeks and requires mailing address. So where exactly is that going to be mailed to? Right. And I probably got the order of this all makes up somewhere. But I think you got the point, right? Like this is a systemic issue. And it's horrible for the people that, you know, the system's really working against. But it's also horrible for those first responders that, you know, are trying to help these people. But it's so much bigger than that. It's so much bigger than that. It's a system that's broken. I mean, I remember I'm here in Massachusetts. They would be like, we can't send you social security or disability or social security assistance or even unemployment because you don't have an address. So get an address. But to get an address, you got to have revenue. And if you don't have revenue, they don't want to give you an address. So you're fucking over your people. And that's not the cops fault. No, that's the way to issue. Right. And then those first responders that are seeing these same people over and over again. And know that there's really nothing they can do to help. It's not a lack of desire, at least not for my experience. And I think that's where that moral injury really takes root is responders are asked to carry problems that are literally unsolvable within their scope. And then, and then they're the ones who are blamed when it doesn't work. Why are these people still in the streets? Why is this still happening? This is their job. It's not. It's literally not. And I think over time, I've seen that create and I felt it. This like internal conflict, but I'm trying to help because they think the reality is is anybody that steps into these first responder roles that they were trying to help. And then we became a part of the machine that keeps hurting people. Right. And so what do you do? Right. And you know as much as I do, you didn't even mention the hospitals in your area when I'm assuming they're between. You know, like the other part too is the hospital system is a slave to the crappy healthcare management stuff. So basically like, oh, so you're not suicidal anymore. You're meds having kicked in. We don't care about that. You're no longer suicidal. Oh, we'll give you a list of therapists that may or may not have openings. And you don't have a phone to call any, but I can go on it on myself about these things. Yeah, I mean, for us, we have one, I mean technically, I think we have like two hospitals, but one ER and it's again 15 miles from where I live. And I mean, when mobile crisis, it still exists. I'm just not on the peak anymore, but with mobile crisis, if somebody was experiencing an acute mental behavioral health emergency, whether it was like psychosis, suicide, or maybe whatever it may be before we existed, the only option was to call law enforcement or EMS to transport that person to the hospital. That's it. That was the protocol, right? And then we thought this was going to get better once mobile crisis team existed. And it did in terms of we were able to do that. to leave. I want to say I don't remember the numbers for sure, but it was like 87 somewhere around their percent of calls were resolved within the community. But there was still a chunk that needed additional care that we would transport to the hospital and we were hoping that by our presence of being there through the triage and really sitting next to these individuals that whole process that it would work better and it just didn't. And again, like you were saying earlier, like this it's actually it's a systemic issue and it's a policy issue because we were doing for us it's a title 47 that's our involuntary commitment. But Alaska law doesn't even guarantee a 24-hour psychiatric hold if we do that. So there are several times that I would bring an individual in and I'd be sitting with them and I would go to fill up paperwork and give it to the right person and by the time I came back which this doesn't take very long, they'd be getting discharged. And I'm like, "Well, not. What do you mean?" And that happened more times than I can count. And what was worse is when they would you know they would triage them and they would do like an intake whatever their process was and we would leave because we'd have another call and they would discharge these people back to the exact same circumstances with no connection to care, no follow-up plan. It's like 1am in the middle of winter and now they're 20 miles from where they were to begin with. What are we doing? So then what do they do? They call 911 again or if they don't somebody else does because they see this person on the side of the road in the middle of winter at 2am and they call 911 and then it's the same responders coming again. And so it's like as the responders you're just feeling like you're resetting the cycle knowing full well you're going to see the same person again in a couple hours or a couple days maybe in a worse shape or now more mistrust mistrusting mistrustful whatever the right word is. And essentially moving further away from any kind of stability even though your only goal was to create stability by doing this in the first place. And so it's frustrating and it's heartbreaking and I think like you know when you talk about moral injury that paints the picture right there because it's not that they don't care the system ties their hands. I mean you talk about distance sometimes it's just lack of a lack of resources period. I know in our area here in the Metro S of Boston if you don't get into a shelter when it's cold or even warm it doesn't really matter by 7pm ish. Luckily love them are 9pm but that's the latest. If it's 11pm in your homeless and they want you to resolve that as a police officer crisis clinician usually both you're like I don't know there's a laundry mat over there you can sleep in there for until tomorrow morning it's open 24 hours but we have lack of resources too because we've also come to a point as a government where we don't trust to give people the resources they need and that's a whole different ball of wax and I don't want to get into too much of that because people say oh you're blaming one party you know I blame both parties I don't give a crap I'm not I don't favor anyone but the bottom line is you're right and then the police officer is still dealing with it I mean like how many guys come in here and say I really wanted to help this homeless woman this homeless man this suicidal man suicidal woman and they were able to and then two years down the road two months down the road whatever the case may be they're they hung themselves or they were found you know dead on the side of the road because it was like 10 degrees the night before it's it's a systematic issue I don't I think Alaska has a little harder I don't I'm not trying to compare apples to oranges here but nonetheless I don't think it's that different across the country no I don't think it is and I think like when we were kind of talking about what are the unique challenges to Alaska and I was trying to think of my answer and I was like they're not unique to Alaska and actually that's the problem I think that's what I wanted to talk about is like it's not unique because I think any people from any state could listen to this and relate to a part of it and that's the problem right like it it's just so much bigger than than I think we sometimes want to admit that it is I mean I've worked with therapists from everywhere in the country name it I probably worked with one of them from one of the states and the same I was talking to someone from Iowa recently and the same thing as you just described there's parts of Iowa where you got to drive 15 miles to get to the hospital in the hospital says well you know what it's been like 10 minutes they're in the ambulance they're not suicidal anymore let's prepare their discharge papers you're like wait wait wait wait wait now they're far away from their home they don't have any resources and now they're pissed yeah yeah I think that there's so much that we can do in this country to change things but I don't want at the risk of being called a socialist I just think that we need to do something for the community at some point in time yeah you know I something about what you said just reminded me too of you know mobile crisis team was created to bridge the gaps that was our that was our goal and you know not sure exactly what it was that you said that reminded me of this but I remember having a conversation with the first responder and they were like mobile crisis team is the best thing that that could have happened to us and I was like oh I'm so glad do you think that but they had a very specific example which I thought was so interesting because I would have never thought of like this having been our role but they're saying when they called us for loss of life calls that it was so life-changing for them to know that when they walked away from the scene that these individuals were still going to be cared for and I was like mind blown because I never really I have been very lucky to not experience that kind of loss in my life and so the little naive to it but I'm like what did you guys do before like this was mind blowing to me and then once everything thought about it they were like yeah we would just have to we'd be doing CPR on this individual with their whole family around all the time of death pack up and leave because we have more calls to go on and I was like that is horrible for the family of course but also these responders like they never the loop was never closed and that's like where I was like how do you live like that because I'm like I need answers to everything all the time like all of the time and that was a big piece of it was like we were able to not complete the scene I don't know what you would say but just be there longer and provide real long-term resources and you know to stay with people until their family showed up things like that it's a big state people are driving for hours sometimes and that gave a sense of peace to these first responders in a way where I'm like that's not what we were created for that's not why our role existed but it became such a beautiful piece of the role that I think is worth highlighting for because like yeah when we're talking about moral injury like mobile crisis was absolutely able to bridge that gap a little bit it didn't go away entirely but I'm like there's so much so many parts and pieces to being a first responder that people don't think about like that and I mean this was like a year into me working in that role and I hadn't thought about it because I had an experience so why would I right and it's just there's just so many things like that that I think yes what they do is it is heroic absolutely but what we're not seeing are there's just so much that we're not seeing that's a part of this too. I mean I had someone who was dispatched and that's recently on my podcast that's what we talked about is like you know you get a from 911 call you take care of the call and then oh yeah officers here then they hang up and you don't know what's happening because guess what phone's still ringing still need that what next phone call the other part two day really struck me in what you said is that you know police officers sometimes do want some sort of closure we do get some closure by you know sending someone home someone getting help in the hospital getting arrested whatever there's always some closure but it's not full closure sometimes and I think about particularly again not only Alaska and like I said we talked about earlier probably across the country I know that some of the smaller departments around here and there's like sometimes two or three officers for the whole towners that were in and it's those two or three guys who end up like going to all these calls but they don't have time for closure they don't have time for that they just move on and the calls don't stop because oh wait wait no Johnny's at the 27 Hollis Street okay we'll wait to have our crisis until he's done with 27 Hollis Street it doesn't right and so I think that's the other part too I'm sure is a challenge for your guys now these there's moral injury and stuff like that I think the guys also go like from call the call and it's like if they start breaking down that's not like they can tag someone in right yeah exactly I think too that you know exactly what you just said it there's I think there is grief of being fully conscious inside a structure like this right that that really only functions a while if you're like not paying attention to it because when you're paying attention to you realize that it's not functioning very well and so when you refuse to like dissociate from that and when you're staying awake and you're connected it starts to take pieces of you I think it really does I mean we talked about it earlier it's a small community you probably know someone and then it starts like [BLANK_AUDIO] getting under your skin. You go to the same call, you've helped Johnny a couple of times or Jane. And Jane two years later is found dead because of purposeful or, you know, similarity. So I am not very good at saying nice things there. That messes up you, be like, oh, what did I do wrong? Or what could I have done more? Or like we forget how personal, sometimes these police officers take these things. - It doesn't go away when the call ends. - No. - Especially not in smaller towns. I mean, I think this is true everywhere, but definitely in smaller towns. 'Cause like you said, there's, there's a family relations here. There's Aero and Natia's go together. Like there's so much connectedness, which is really beautiful and also makes it out much harder sometimes. And now we're in this area of social media. So everything is posted out and out. I don't know how it is for you guys, but I know like our law enforcement radio channels are private, but our fire and EMS ones aren't. So that gets published to Facebook so quick, so quick. Like you can't escape it even if you want it to. - No, only that. I mean around here, this is what my biggest pet peeve, there's sirens going down Mullins Street. Do you know what I'm saying? - Oh my God. - No, I'm not a police officer. That's what. - Yeah. - I'm not a police officer. I'm not a firefighter. I don't know what the fuck's going on. How about you wait a little bit? - You'll find out when everyone else finds out. It's going to be okay. - In Massachusetts, there's something called the police logs you can look at. Look at the police the next day. - Yeah. - But yeah, no, those are the ones that drive me nuts. I hear sirens on Mullins Street. Yeah, that's probably because there's an emergency. But you know what the emergency is? Yes, I do know, but I will not share it with you. Thank you. I mean, that's the other part of the-- - Yeah, even if I knew I'm not going to share it, so why this is a silly question? I want you to think about that. - Yeah, social media has made people not only selfish, but they made them ignorant sometimes. And yes, I saw. And if you want to fight me on it, please send me a message. But I think that that's what it is. Like when ambulance goes by my office, do you think I go, oh my God, I wonder where they're going? I don't know where they're going. I don't care if I need to really know I'll look tomorrow on the paper at the next day when the police logs come out. - And if it's relevant to me, I'll find out. - I will. - They then come into my building, so I should be fine. - Yeah. - I think that that's the other part too, is that the scrutiny that they go through. I think that you talk about moral injury, not only about even what's that saying in business. If you have a good experience, you may tell two to three people. If you have a bad experience, you're going to tell nine to 11 people. And so the cop is tired or is trying to get to the next call. And this wasn't their priority. And they kind of cut you short and say, hey, listen, you can go to court magistrate. Here's how you do it. And they, he didn't pay attention, didn't seem to care about my problem. Yeah, because the other one was a murder just for the record. Yeah, your little court thing is not as important. But you don't think about that. You only think about your own self-centered world. I think that's the other moral injury that happens with a lot of police officers. And I forget to mention my firefighters, EMTs, and paramedics here, but they're the same vote. Yeah. Well, I think, you know, you said it earlier, like the one bad thing happens and it's held times everywhere. And I think that's even a bigger issue in the smaller towns because everybody knows everybody. As soon as one person even catches one and it's on Facebook and outshared a hundred times and you can't escape it. And you're seeing these people again. You're going to see them again. You can almost do them. You're going to do that. And yes, it's like constant state of having to defend yourself. And like these are the last people that should have to do that. Not to say there's not bad apples sometimes. Sure. Sure, but you can say that about any profession. And you don't come after the rest of them the way that you do these guys. So, or girls. And I think, yeah, it's just, it's so, it's hard to watch. It's really hard to watch. Let alone, I'm sure experiencing it. Right. I mean, like it's the argument, if you listen to my podcast, you've heard me make this argument. You know, 95% of therapists want to do their job, help people and hopefully go home and everything goes hunky-dory. The baker wants to make 95% of them want to make their bread not hurt anyone and kind of move on. But I forgot 5% on both of those because 5% are assholes. And guess what? Police is the same thing. Fire is the same thing. But we concentrate on the 5% in those particular jobs. While in therapy, I can tell you horrible stories about therapists doing absolutely unethical things. Yeah. And that doesn't make it to the back page of anything. And somehow that's okay. But if a cop coughs the wrong way, let's put it on the front page. And again, not saying that they're all good cops. There's about 5% on the other. They're not good people. That's not what I'm saying. But it's like why are we always emphasizing the negative for other people while we, the emphasizing in pretty much every other population. And that's another moral injury that they face. Because you're happy to see the cop when you're in trouble. But when you do something wrong, you're not happy to see the cop. How the hell did they win? Right. So anyway, that's my little stuff. Myself, I can go on it on about that. But I would rather hear a little more about what you do. I mean, before the interview we were talking, fellow I move in desensitization and reprocessing therapists EMDR for those who, I don't like to use acronyms because that just makes it too, to I know better than you shit. But I know you're an EMDR person. I know you do some wellness workshops. So can you share a little bit about all that? Yeah. Yeah, I do, I do EMDR in my, in my typical practice, but I also do some EMDR intensive, which they are intense. They are, but they're just, they're longer, right? And so these sessions are ideal for people who maybe don't want to commit to like long term weekly therapy. And they're, they're more focused and more efficient. They're more tailored, really, to, to more like single incident helmets, things like that. And so I do offer those. I also offer, yeah, wellness trainings. I'm partnered with our EMS department out here. So next month, actually, I'll be there for a week doing some wellness workshops and trainings. And my, my doctorate, I talked a little bit about and I think it was in the last episode, but it's in community prevention, intervention and advocacy. And so my research and my dissertation and capstone are all around creating family wellness for first responders, family wellness programs and initiatives. Because, you know, we've talked a lot about first responders and what they experience. But what we haven't touched on at all, actually, is what the family experience is also, right? And so I think that's something that I've just noticed that there's a gap that I really, really want to work to fill. And I have these relationships built with our first responders here. And so I think it's just an opportunity that I don't want to pass up. And so hopefully that'll be coming soon in the future too. Well, I agree with you. And if you go back to a few of my podcasts, we talk about the impact on partners and families in general because they're so important in having that regular communication, particularly when you have two people who are both first responders who live in the same house, that communication is key. So I definitely support the family stuff. How do we reach you though? How do we find you? Yeah, I can have you link my website, which is be wild and readin.com. And then I am on Instagram as well. And it's wild and readin. So wildness. And so those are the two best ways. Well, I'll definitely put that in the show notes. And I'll definitely be part of your following on those things. But I wanted to thank you. I know that you have someone in your life. I don't share people's stories because it's not mine to share. We have someone who's in the Massachusetts area and the families around here. So if you ever think about it, if you are ever around here and you reach me out and write a chat, I'll leave you my phone number. Please come and see me. Love to talk to you face to face. It'd be great. Yeah, I'll be in the area in like a couple of weeks actually, which it'll be during the holidays. It might be a crazy time, but it's not done in the summer. I think it'd be great. Thank you so much. And I will not ask you to go do the touristy shit in Boston. I promise. Oh, yeah. Thank you. I'll bring you to the Stirbridge Village or something a little more rustic. I'll give you a lot more. Oh, I don't know what that is, but it sounds cool. So I'll take you up on it. Yeah. Well, I, and it's a sincere invitation, by the way, love would love to meet you and your love one that has family around here. It'd be great. Yeah. I want to thank you for being part of Resilience Development and Action. And I will talk to you soon. Thank you. And for those of you who are listening still looking forward to seeing you for episode 241 and I hope you join us. Like, subscribe, and follow this podcast on your favorite platform. A glowing review is always helpful. And as a reminder, this podcast is for informational, educational, and entertainment purposes only. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor for consultation. If you are in a mental health crisis, call 988 for assistance. This number is available in the United States and Canada.