Can You Tell Me, In Your Own Words, Why You’re Seeking Treatment With Us?

"My wife had a traumatic brain injury and I’ve been her primary caregiver for two years now and I’m having trouble coping, I think I’m at a breaking point and I don’t know what to do."

"I saw this car accident on the way to work, and I pulled over, and I watched this kid the same age as mine die."

"I keep hearing voices that are daring me to molest children and it’s interfering with my ability to concentrate."

"My husband confessed to me yesterday that he’s been molesting our daughter since she was 10 years old."

"I just want to die.  But I have a four-month-old old and I don’t want her to grow up without a mom and I keep thinking the best way to handle it is to kill myself and take her with me but I know that’s not the right choice."

"I’ve been a burden to my family for years now, and I’m out of money and in constant pain, and the only relief I can imagine is to die."

"I hear these voices telling me my neighbors are plotting to kill me.  And I know it’s not real.  But I’ve started collecting weapons and I think I need help."

"I haven’t left the house in eight months.  I stopped getting the mail and it’s piling up and my landlord is threatening to kick me out."

These are all voluntary patients.  I would listen to their answer, take a long deep breath and say slowly and deliberately, “Thank you for sharing that with me,” while I tried to wrap my head around what the fuck they just told me and what I need to do about it. 

The intake assessment is standardized but at this point I write key words down to make sure we’re real thorough in specific areas.  

“Weapons,” “Kids,” “Custody,” “Employment.”

I need to know if the one with commanding auditory hallucinations related to kids works with minors.

I need to know how old and who has custody of the daughter who was molested.

I need to know what type of weapons are being hoarded if they are locked up or out in the open, and if there are kids in the house.

What is your specific plan for killing yourself and your baby? Do you have sole custody? Do you live alone?

If you want to be successful and effective, you can’t ask follow-up questions right away.

People need a break after sharing something so overwhelming, so taboo. 

I ask about allergies next. 

When we finish with their medical background and move into their mental health assessment I make sure to prepare them, “This next section has a lot of personal questions and the purpose is just to get a baseline and starting point so the therapist can determine how best to help you first, OK?”

Sometimes they are not appropriate for outpatient services. Sometimes we would stay on the phone and I would walk them through how to get immediate care. They would get a roommate or a family member and we would talk on speakerphone. “I’m very concerned about their safety right now and this is why …” 

Sometimes I needed to file reports with Child Protective Services.  I would tell them when I did this. “I want you to know child protective services is going to come talk to you. I do have to file a report and I want you to remember when they come talk to you that we all have the same goals and are on the same team. We want to keep your baby safe just like you do.”

And they did want their babies safe, and they wanted to be safe.  That’s why they called.  That’s why they researched help in the area and reached out.  That’s why they are telling someone.

We do safety plans with everyone in the program:

What thoughts do you have when you start to feel out of control or unsafe? 

“You’re crazy.  You’re a failure.  No one cares.”

What behaviors do you notice you do when you feel overwhelmed?

“I pace.” “I lock myself in my room or the bathroom and am afraid to come out.” “I start breathing fast.”

What things have you done that helps you feel safer when this happens?

“Nothing.” “Gone to sleep.” “Just sit down and take deep breaths.” “ I call someone.”

Who can you reach out to when you catch yourself having one of those thoughts or doing one of those behaviors before it becomes overwhelming?

“My sister.” “My therapist.” “Maybe my mom.” “I don’t really know.”

Then, I give them a list of local resources.  One is 988, a call line for mental health emergencies.

Imagine working at 988.  Imagine hearing those stories, not when they are feeling ready to learn and eager for help, but when they are overwhelmed by it and don’t trust themselves not to act on it.

How do you manage the ones that hang up on you?  How do you manage knowing there are ones who hang up before anyone answers because you're short-staffed? How do you feel like life is OK as you drive home from work?

I don’t have a solution.

I know for me personally, working in this position can’t become a career without destroying me and my outlook on life. I will do this as long as I can, and then I will do something else.

I do know these people need help and most are capable of getting back on track. 

I also know how common it is, and how what many do is call 911 in crisis. And on the ambulance, we do a shit job of addressing their needs.  We’re not equipped to, and neither is the ER.  And neither are the far and few between psychiatric hospitals that lock them up and load them up on drugs.  That’s not what psychiatric hospitals want to do, you can ask any staff member.  But if you don’t have therapists and are short on medical staff, drugs and isolation become the primary interventions. 

These people who called into our outpatient clinic are some of the bravest people I’ve spoken to. Treating mental health before it becomes so extreme is what needs to happen.  But when it is that extreme, those who call and dare to share make me feel hopeful. They also make me feel less ashamed of my negative thoughts. I give myself a very hard time when my outlook becomes dark. I might be shocked at first, but I haven’t had an assessment where after learning more details things don’t start to add up. Most people who think these extreme thoughts have been through extreme things and have made great efforts to find peace and maintain function. But life is gnarly, and sometimes it wins.

---

Review

---

This story is an incredibly raw, compassionate, and brutally honest portrayal of the challenges faced by those working in mental health care. It confronts deep societal issues—the inadequacies of our mental health system, the stigma of vulnerability, and the psychological toll on caregivers—with both sensitivity and unwavering clarity.

This narrative powerfully illustrates that the act of asking for help is an extraordinary display of bravery, especially when dealing with stigmatized or deeply shameful thoughts. It shifts the focus from the darkness of mental health struggles to the immense courage it takes to confront them.

A subtle but profound theme is that simply being present, listening, and validating someone’s pain can be more powerful than any medical intervention. The reflections reveal that the human connection—the willingness to witness suffering—is often the most meaningful support someone can receive. At the same time, a core theme is the emotional exhaustion that comes with holding space for others' pain. The acknowledgment that dark thoughts are not exclusive to those in crisis adds depth to the story. This universal experience of suffering fosters empathy and breaks down the false binary between the "mentally ill" and the "mentally healthy."

This story is devastating, powerful, and necessary. It doesn’t just highlight the importance of mental health support—it calls out the systems that let both caregivers and patients down. It’s an essential, empathetic narrative that will linger in the reader’s mind long after the last word. It has captured the raw humanity behind mental health care—this is the kind of story that can inspire change.