“I’m trying not to kill myself.”

I was walking toward a staircase in the Danforth University Center Monday afternoon when a middle-aged black man missing his two front teeth and wearing a typical black Missouri Tigers sweatshirt asked me to talk to him. As I prepared to shrug him off as I do the Bible peddlers near the Underpass or the student groups selling donuts at lunch, the man uttered that line and stopped me in my tracks: “I’m trying not to kill myself.”

“I just want someone to talk to,” he continued and kept repeating throughout our ensuing 20-minute interaction, which left me feeling scared, upset and ultimately helpless as this suicidal man failed to receive the help he clearly needed from Student Health Services.

SHS is a frequent source of anecdotal criticism on campus. But this incident went beyond the usual complaints of being interrogated about a possible pregnancy or immediately diagnosed with mono—this incident involved a life-threatening situation and a series of communication failures and protocol contradictions that reflect quite poorly on our chief source of medical care on campus.

If SHS learns about any hint of suicidal ideation from either a member of the University community or an outsider, “we would most definitely want to meet with that individual so that we’re laying eyes and ears on the situation, so we can independently make that assessment,” Dr. Thomas Brounk, director of Mental Health Services within SHS, told me in a later interview. “Any time we hear that there is mention of suicide, we’re going to want to assess that individual face to face.”

But nobody assessed this man face to face. No trained mental health professional ever laid eyes on him.

ARRIVAL AT SHS

The idea for this column arose at SHS, but we first had to get there, so I’ll rewind a bit to when I stopped at the striking line the man—I’ll call him Robert—uttered. He followed by telling me he had nothing—no mom, no dad, no house—to live for but reiterated his desire not to commit suicide; he then shoved two pieces of paper in my hand, one the record of a hospital visit he had made that morning, the other a list of at least eight medications he had been prescribed.

I told Robert that I felt unqualified to help, and despite his claims that he only wanted “someone to talk to,” he agreed to accompany me on a walk toward the South 40. Over the course of our walk from the DUC to SHS, I learned that Robert couldn’t remember the last time he had eaten and was, in his words, a “bipolar schizophrenic.” He asked what I was studying, and I instinctively responded that I was a psychology major before realizing how nothing I learned in Abnormal Psychology class had remotely prepared me to handle this sort of real-world situation.

We arrived at SHS without incident, and I told Robert to take a seat as I approached the front desk. “Ma’am, this man approached me and said he was thinking about killing himself,” I said. “He says he’s a bipolar schizophrenic.” I didn’t know what to do, so I brought him here, to the center of health services on campus, I said.

“He needs to go to a hospital,” she responded—a reasonable assessment, to be sure, but one that I was entirely incapable of accommodating. Instead, she told me that she would be out to talk to Robert in a few minutes and that he should stay seated in the meantime.

Here’s where SHS’s system began to fail him.

INTAKE

What should have happened here was simple: the SHS website promises, “Mental Health Services are available to help with urgent situations seven days a week, 24 hours a day. Same-day appointments are available for students experiencing a crisis.”

Brounk, who said he was the organizer of the team preparing to deal with Robert, similarly laid out a plan for determining who would best respond and how quickly, which would in turn have helped Robert get access to the type of care he needed.

But that’s not what happened, and here’s when the first contradiction arose. Brounk said that having a student (read: me) bring in a stranger indicated that the situation was “obviously urgent…we needed to be putting together quickly a response.” Both the receptionist in the moment and Brounk in my interview also told me that Robert could have been dangerous. The receptionist called me to speak with her privately to express her concern that I would be situated close to someone I didn’t know, and Brounk said when I spoke with him, “There was concern about your safety, that you were telling us that this is somebody that was unknown to you, that was potentially schizophrenic or bipolar. At that point, no professional had laid eyes on this individual, so we didn’t know—could’ve had a weapon, we had no idea.”

Yet no trained professional was dispatched to deal with this potential patient. Brounk told me that Forrest Ceballos, Mental Health Services coordinator, was busy with a scheduled appointment at the time and therefore couldn’t fulfill his normal role of handling the intake process—despite Brounk also saying that if “it sounded like we were concerned about imminent harm, then we would be clearing schedule, if nobody was available…[the] last thing is we try to interrupt an actual appointment with a student, but sometimes that is necessary.”

Apparently the explicit mention of suicide, combined with a high likelihood of mental illness, did not constitute “imminent harm” or warrant tasking someone trained in the triage process. (Ceballos declined comment on any matter of mental health policy.)

I don’t know what more I could have told the receptionist that would have spurred her to interrupt Ceballos’ session, but this certainly seems like an instance when that would have been necessary.

“GET PROFESSIONAL HELP, EVEN IF THE PERSON RESISTS”

Instead, a few minutes later, which seemed like an eternity as Robert and I ran out of small-talk topics, the receptionist emerged from the back. “Are you a student here?” she asked. He replied that no, he wasn’t a student; he was just looking for someone to talk to and didn’t want to cause any trouble. Perceptions of what happened here diverge: I observed the receptionist tell him he needed to leave whereas Brounk—who, to be clear, wasn’t present—maintains that protocol was followed and that Robert turned down help.

I was incredibly upset following this exchange chiefly because it didn’t appear to me as if Robert had been offered help. But even if he had and had responded by saying he would rather not cause any trouble, it shouldn’t have mattered. SHS’s website explains that someone contemplating suicide should “get professional help, even if the person resists.” And remember, Brounk said at another point in our conversation that any possibly suicidal individual should be assessed face to face. Robert saying he “was hungry and didn’t want to cause a problem and just wanted to go get something to eat”—as Brounk said the receptionist informed him—shouldn’t have been a legitimate excuse to let him leave, nor should it have superseded the practice and promise of professional help.

Further, “suicide ideation can fluctuate up and down,” Brounk said, agreeing with the possibility that a person would willingly be taken to SHS but refuse help once there. In such a situation, he told me, the person should still receive care.

Maybe the receptionist didn’t know these details; maybe it was all a misunderstanding. But then she shouldn’t have been the one charged with dealing with a suicidal, potentially bipolar or schizophrenic man waiting in the lobby.

COMMUNICATION BREAKDOWN

The communication problems that plagued this entire incident are no more obvious than in the uncertainty surrounding what the receptionist actually told her supervisor. Brounk said he formed his response plan thinking that Robert “might be schizophrenic, delusional, potentially hearing voices, and people that are schizophrenic—they might be hearing command hallucinations or command voices that are telling them to do things. The red flags went up so that we were equally concerned.”

It’s important to note here that Robert never told me, and I never told the receptionist, anything about hearing voices or hallucinating. Rather, the very first, most vital point I emphasized with the receptionist was that Robert was thinking about killing himself, but that knowledge apparently never made it to a trained professional.

To this end, I asked Brounk directly whether he knew that Robert was possibly suicidal. “That’s not information that I knew,” he replied. Considering the fact that Brounk spent the first 15 minutes of our interview discussing SHS’s suicide policy, and considering that he only agreed to this interview after I told him I was writing about a matter of suicide, it makes little sense that he was entirely unaware of Robert’s suicidal ideation.

Brounk went on to clarify that the steps he took wouldn’t have changed had he known Robert was suicidal in addition to mentally ill, but I find that hard to believe. There are two possibilities: first, that nothing would have differed and that SHS truly failed to follow its own protocol; or second, that the transfer of information from the receptionist to the man in charge of overseeing the help process left out the most pertinent detail in this entire story, which in turn ruined the ensuing process of setting up help.

Whatever the case, there’s no excuse for the end result, regardless of the process that led to it.

FALLOUT

Robert was visibly spooked when we left SHS. He apologized for causing me any problems, despite my protests to the contrary, and just asked the quickest way off campus; he left walking west on Shepley Avenue toward Big Bend Boulevard. I don’t know if he was able to scrounge up a meal that day or where he curled up in the cold to sleep that night. I don’t even know if he’s still alive.

Brounk told me that the optimal course of action when I initially stopped back at the DUC would have been to call the Washington University Police Department. “They are highly trained to be able to compassionately intervene with individuals that are experiencing some sort of mental-health-related crisis, and I’m consistently impressed with their ability to do so,” he said.

Discounting the issue of potentially scaring Robert off by calling the police on him, I didn’t know what to do at the time—I followed my instincts to take him to SHS, whose website seems to support my decision.

“In the course of your college career, you may find yourself in a situation where someone’s health is in danger,” the site describes. “In the case of a serious emergency, you may contact Medical Services and/or Mental Health Services, which are open and prepared to assist you at all times.” Included as an example of a life-threatening or emergent situation: “threatened or attempted suicide.”

WUPD might have been a better choice, but SHS certainly should not have been a wrong one. And while the skeleton of a reasonable assessment and treatment plan might have been in place, the way it was carried out was wrong.

Mine was a rare situation, but SHS has a poor reputation among students, and now I have a negative story of my own. My experience Monday only confirms the need for an improved intake process and far better communication within our campus’ health care provider. Particularly when it comes to dealing with potential suicide, whether involving a student or not, the flaws I observed in the system cannot remain so pervasive.