The nurse and the cop were nearing the end of another shift when they knocked on a door of an extended-stay motel.
The door inched open, and out stepped a gaunt, unshaven man wearing boxer shorts and a grin that revealed several missing teeth.
The man said he was sleeping in three-hour shifts and surviving on French fries and Ovaltine. Nurse Vicki Jacobs knows the man as a gifted mathematician and writer whose career was derailed by schizophrenia, and she gently suggested he take his medicine.
Each weekday, from about 1 to 9 p.m., a police officer and a nurse patrol DeKalb County in a squad car marked "Crisis Intervention."
The unit is jointly run by the DeKalb County Police Department and the DeKalb Community Service Board, a mental health agency. And it's one of only a few such collaborations in the Southeast.
A dozen officers take turns riding for a week with one of a handful of nurses trained in psychiatric care. On any given day, they may be summoned to a suicide or standoff or to crime scenes involving the mentally ill.
When they're not racing to an emergency, they make house calls to monitor whether people take their medicine, and refer grieving parents or drug addicts to support groups and treatment centers. "We can have 10 hours of sheer boredom and 10 seconds of sheer terror," Officer Cindy Fausel said.
Push toward care
One of the program's goals is to steer the mentally
ill toward medical care as opposed to taking them to
jail, as officers sometimes do for lack of a better
option.
"These people do not choose to be mentally ill," said Fausel, a 24-year police veteran who shifts seamlessly from tough cop with a booming voice to compassionate stranger who calls people "honey" or "darling" to show she cares.
"Sometimes, people need a hug, OK?"
Recently, the crisis unit visited a 68-year-old woman who calls 911 often to say strangers live in her basement and steal her power. She says she smells their cooking, even though officers have shown her that there are only cobwebs in the crawlspace.
Another time, the unit coaxed a woman into treatment after she said she worried she'd be hurt if she stepped off a bathroom rug.
Jacobs, a nurse for 30 years, remembers the woman who insisted that her sister-in-law played the harp with 50 ghosts who were living in her attic. "Bless her heart, she would say, ‘Can you hear it?' " Jacobs recalled.
She and Fausel see people in desperate moments and return later to check up on them.
A couple of months ago, they went to the apartment of a 53-year-old substitute teacher who suffers from bipolar disorder. She had gone into a manic phase after failing to take her medicine. Police and paramedics held her down while a nurse injected her with medication.
When Jacobs and Fausel returned last month, the woman talked with them as if they were long-lost friends.
"Guess who came to see us?" she asked her daughter in a phone call. "Remember the nurse? The nurse in the police car?"
The woman talked loud and fast - she had not been taking her medicine - but was nowhere near the crisis of a few weeks before. Jacobs said she would call the woman's psychiatrist to talk about switching to a more effective medication.
Assessing situations
One afternoon, Jacobs and Fausel arrived at a
house in a middle-class subdivision after a woman
called a mental health hotline to say her 13-year-old
grandson had threatened her with a knife.
They met the woman as she sat in her living room, livid and afraid. Jacobs held a pink clipboard and asked softly whether the boy had trouble at school.
"Yes. Oh, my God," the woman said. "He went from straight A's to straight F's. He's been suspended. He's been getting into fights."
A few minutes later, after Jacobs asked to talk with the boy, he walked into the living room in baggy jeans and a shiny blue athletic jersey, a handsome kid with braces. Doctors had diagnosed him with an adjustment disorder after a failed suicide attempt.
Jacobs asked what he did when he skipped school that day (sat in an abandoned car reading) and why he pulled a knife (he thought his grandmother was going to beat him). They talked about his mother leaving years ago and about a friend who was shot to death while he and the boy walked down the street. After talking with the grandmother and grandson, Jacobs decided a doctor should evaluate the boy. She arranged for a private mental hospital to evaluate him that day.
Jacobs sometimes sends people directly to hospitals, but she will have fewer options after July. That's when state budget cuts force the closure of an assessment area at the DeKalb Crisis Center, a kind of psychiatric emergency room run by the DeKalb Community Service Board. It evaluates and treats many mentally ill people who lack health insurance. As they prepared to leave, Fausel stopped to talk with the grandmother.
"You take care, sweetie. OK?" she said, and the women hugged.
"It'll get better."
- This article was reprinted from The Atlanta Journal- Constitution.