Crisis Scenario

Sherry, a Caucasian human services professional working in a hospital, was called to the emergency room because a patient was threatening to kill himself. The patient was claiming that someone at the hospital had not made the right diagnosis, and he was in extreme pain. That was all the professional knew before going to the ER.

When she arrived, she saw an African-American man (probably in his 50s) threatening to go get a gun if someone did not help him. She also saw security guards watching the man. She spoke to the security guards to find out more information. They told her that the man had been to the hospital before, was treated, and then released. They did not yet know who the doctor was or what the man's condition was. She asked the guards to take the man into a private room where she and the man could talk. Since the man didn't seem to have a weapon on him, she felt safe enough talking to him alone. She also asked the guards to contact her supervisor, as well as the chief of the hospital, since that was a component of the policy and procedure in dealing with situations like this one. Also as policy, at least one guard would remain outside the door during their conversation.

The guards were able to get the man into the private room where the professional was waiting. She asked the man if he wanted anything to drink or eat, as he looked shaky and unwell. He declined, saying that he believed someone would put something to knock him out in whatever he was given. Sherry asked the man if he would be willing to tell her his name; she told him her name and her role at the hospital. He was reluctant, but finally told her his name was Albert. Sherry thanked him and asked him to tell her what was going on. Albert wanted to not be in pain and he was mad at the doctor who sent him home even though he told the doctor that he was still in pain. Sherry said she would talk to the doctor about this and see if the doctor could provide any additional treatments. Sherry made a note about this to remember later. But, for now, she wanted to talk to Albert about his threat to commit suicide.

First she asked him if he had any family she could contact. Albert said his mother had Alzheimer's disease, his wife left him, and his children did not talk to him anymore. So, no, there was no family for Sherry to contact. Sherry asked him if he had had suicidal thoughts in the past. Albert said no, that this was the first time. He had never been in this much pain for so long in his life, and he was very frustrated about it. He had been trying to deal with it by going to church and talking to his pastor and other supportive people, as well as praying about it, because he did not really trust doctors or hospitals. But the pain was just so bad and lasted all the time that he did not know what else to do but go see a doctor. Sherry acknowledged that Albert had really gone out of his way to find support, and that it was great that he had friends and a pastor at his church to talk to. Sherry asked Albert if he had anyone else he could talk to about his pain and his feelings about it. Albert replied that he did not really have anyone else he felt like he could talk to about that sort of thing. Sherry asked him how he came to have a gun, and how long he had it. Albert told her that he had the gun for years, for self-defense purposes, but never thought about using it on himself before. Sherry mentioned to Albert that it was great that he never thought about using the gun on himself before. Sherry asked Albert how long he had been thinking about coming to the hospital and threatening to kill himself if his pain was not treated. Albert said that he had been seriously thinking about doing this for about a week or so. He had been feeling hopeless and helpless, and he figured if no one could help get rid of his pain, then he might as well die. He did not know anywhere else to go or whom he could turn to.

Sherry then asked Albert to share a little bit about his medical history to get an idea of how long he has been seeing doctors or other medical practitioners. Albert said the pain in his body had started about 10 years ago. He has been prescribed various medications, and for a time some of them worked. Then, about three months ago, he started coming to this hospital, having been referred by the clinic he was going to, as they said that a particular doctor specialized in pain treatment. He saw the doctor about a month ago, was given another prescription and some exercises to do, but the pain just seemed to be getting worse. He spoke to the doctor's nurse, but he was not helpful. Albert just got so fed up with it all that he decided to come to the hospital with his gun in his car and see what happened when threatening to kill himself.

Sherry thanked Albert. She requested that she call the police so that they could safely remove his gun from his car and take it to a safe holding place. Albert was not happy about this, but he realized he needed to do this for his own safety; otherwise, he would be arrested for not having a concealed weapon permit. The police were called, they obtained Albert's car key, and removed his gun from the car.

Sherry talked to Albert about his options at this point. Albert could make another appointment with the doctor, he could go see another doctor, he could get admitted for a full workup, or leave and not return. Albert would also need to see a psychiatrist; Sherry gave him a referral for a good local psychiatrist. Sherry also gave Albert several other resources:

• A group for those dealing with chronic pain
• A community clinic where Albert might feel safer
• A group for those who have family members with Alzheimer's disease
• Sherry's own contact information

Sherry also asked Albert for his phone number so that she could call in a day or two to ask him how he was doing and if she could be of further assistance. She asked Albert if he got an appointment to see a doctor, the guards to take the man into a private room where she and the man could talk. Since the man didn't seem to have a weapon on him, she felt safe enough talking to him alone. She also asked the guards to contact her supervisor, as well as the chief of the hospital, since that was a component of the policy and procedure in dealing with situations like this one. Also as policy, at least one guard would remain outside the door during their conversation.

The guards were able to get the man into the private room where the professional was waiting. She asked the man if he wanted anything to drink or eat, as he looked shaky and unwell. He declined, saying that he believed someone would put something to knock him out in whatever he was given. Sherry asked the man if he would be willing to tell her his name; she told him her name and her role at the hospital. He was reluctant, but finally told her his name was Albert. Sherry thanked him and asked him to tell her what was going on. Albert wanted to not be in pain and he was mad at the doctor who sent him home even though he told the doctor that he was still in pain. Sherry said she would talk to the doctor about this and see if the doctor could provide any additional treatments. Sherry made a note about this to remember later. But, for now, she wanted to talk to Albert about his threat to commit suicide.

First she asked him if he had any family she could contact. Albert said his mother had Alzheimer's disease, his wife left him, and his children did not talk to him anymore. So, no, there was no family for Sherry to contact. Sherry asked him if he had had suicidal thoughts in the past. Albert said no, that this was the first time. He had never been in this much pain for so long in his life, and he was very frustrated about it. He had been trying to deal with it by going to church and talking to his pastor and other supportive people, as well as praying about it, because he did not really trust doctors or hospitals. But the pain was just so bad and lasted all the time that he did not know what else to do but go see a doctor. Sherry acknowledged that Albert had really gone out of his way to find support, and that it was great that he had friends and a pastor at his church to talk to. Sherry asked Albert if he had anyone else he could talk to about his pain and his feelings about it. Albert replied that he did not really have anyone else he felt like he could talk to about that sort of thing. Sherry asked him how he came to have a gun, and how long he had it. Albert told her that he had the gun for years, for self-defense purposes, but never thought about using it on himself before. Sherry mentioned to Albert that it was great that he never thought about using the gun on himself before. Sherry asked Albert how long he had been thinking about coming to the hospital and threatening to kill himself if his pain was not treated. Albert said that he had been seriously thinking about doing this for about a week or so. He had been feeling hopeless and helpless, and he figured if no one could help get rid of his pain, then he might as well die. He did not know anywhere else to go or whom he could turn to.

Sherry then asked Albert to share a little bit about his medical history to get an idea of how long he has been seeing doctors or other medical practitioners. Albert said the pain in his body had started about 10 years ago. He has been prescribed various medications, and for a time some of them worked. Then, about three months ago, he started coming to this hospital, having been referred by the clinic he was going to, as they said that a particular doctor specialized in pain treatment. He saw the doctor about a month ago, was given another prescription and some exercises to do, but the pain just seemed to be getting worse. He spoke to the doctor's nurse, but he was not helpful. Albert just got so fed up with it all that he decided to come to the hospital with his gun in his car and see what happened when threatening to kill himself.

Sherry thanked Albert. She requested that she call the police so that they could safely remove his gun from his car and take it to a safe holding place. Albert was not happy about this, but he realized he needed to do this for his own safety; otherwise, he would be arrested for not having a concealed weapon permit. The police were called, they obtained Albert's car key, and removed his gun from the car.

Sherry talked to Albert about his options at this point. Albert could make another appointment with the doctor, he could go see another doctor, he could get admitted for a full workup, or leave and not return. Albert would also need to see a psychiatrist; Sherry gave him a referral for a good local psychiatrist. Sherry also gave Albert several other resources:

• A group for those dealing with chronic pain
• A community clinic where Albert might feel safer
• A group for those who have family members with Alzheimer's disease
• Sherry's own contact information

Sherry also asked Albert for his phone number so that she could call in a day or two to ask him how he was doing and if she could be of further assistance. She asked Albert if he got an appointment to see a doctor, would he still be considering suicide? Albert responded that if he got some help or relief with his pain, then probably not. The security guards escorted Albert out of the hospital. Sherry waved goodbye.

The following are case notes from Sherry's files:

• "Talked with supervisor to debrief and discuss what could have been done differently, if anything"
• "Two days later, I called Albert to see how he was doing. He said he had called a couple of the referrals she had given him and was doing better"
• "Two days later, I called Albert to see how he was doing. He said he had called a couple of the referrals she had given him and was doing better"

1. Was theproblemidentified accurately based on the precipitating events? What were the protocols that were followed?
2. Were the appropriatepeople(i.e., agency staff, client friends/family, community stakeholders) for resolving the crisis quickly identified? Was there anyone else that should have been included?
3. Wereethical codesfollowed in the intervention stage? Support your claims with examples from the scenario. What could have been done differently, if anything?