You know how you set out to do something, and really feel strongly about its worth and the effort required, and then you just stop. Well, I suppose that’s my excuse for not attending to this blog during my travels. That and the fact that I became so ill that I had to go to the emergency room. Let’s just say that eating street food in Western Cape townships with the paramedics can be hazardous to your health. For the remainder of the trip I battled one of the worst GI illness I have had the misfortune of experiencing. It’s not an excuse, but late-night hotel room writing pretty much goes out the window when one enters nausea survival mode. So, for my one follower (hi Caroline) I am sorry. In addition, once you stop momentum, it is very difficult to reinvigorate the effort.

So, why did I choose today to take another stab? Well, I have been sufficiently motivated to speak – and this won’t be about travels or my lucky life – this is about the industry that I love, and people who don’t get mental illness.

I am sitting in a lecture today about mass causality incidents, specifically the Las Vegas concert shooting. This is an area of my field that I am passionate about, partly because its dynamic and interesting, but mostly because it is an area of emergency services that is in the process of being completely renovated. These events are a moving target, both the type of incident and the way we respond are constantly evolving. Unfortunately this nature of constant change, in addition to many structural hurdles, make efficient response very difficult. But, I am not going to write about MCIs today (I will bore you all with that topic in 6 months when I get back to this blog again).

When was the last time you heard anyone refer to a mentally ill person as a “nut job?” I would imagine it happens a lot less today than maybe it did 20 years ago, as our stigma towards the mentally ill is eroded by an understanding that mental illness is really just illness. Our society is beginning to realize that, just like cancer or heart disease, mental illness and its effects are not within the control of patients. I think this is a relatively safe assumption, if you disagree I am all ears. Ok, now that we all agree on that tidbit, would it surprise you to hear that in this lecture an emergency physician continues to use the words “nut job” to refer to a mentally ill person, before a group of paramedics and EMTs? Herein lies, in my estimation, one of the greatest problems in the medical and emergency response industries.

Ok, let’s take a perspective break, because most of you probably cannot fathom that this is true. You ask yourself, how could a doctor marginalize a patient like this? What about the hypocritic oath? How could this be a beneficial example to set for a room full of emergency responders? Let me clear it up for you, the mentally ill person he is referring to also happens to be the active shooter.

I am now ready for you to become disengaged from this blog, deem me an idiot, and move along. If you must I totally understand, my opinion is one that is on the fringe, but if you are still here, hear me out for the sake of our collective psyche.

One of the great challenges of the emergency response industry in this day and age is stress. It has even been called an epidemic, and it extends beyond EMS, or Fire and Law. We are having parallel national conversations about suicide and drug addiction. Increasing suicide rates within historically stalwart institutions like the US military and fire service are causing us to scratch our heads. Desperate people are increasingly killing other innocent people and themselves in large scale shootings. What is the common theme amongst all of these people: isolation in mental illness, that festers untreated until it volcanically erupts in violence. We ask ourselves what we can do to identify these people and get them the care that they need, prevent the destructive cycle of substance abuse and depression that contribute to the downward spiral. How can we impact the loneliness and desperation that occurs in those we know intimately, that we spend hours and hours with at work? I will tell you what we can do, we can take the first step by categorically rejecting the idea that it is ok to disparage those will mental illness, no matter what situation we may find them in, period.

Imagine for a second, sitting in a room, struggling to cope with mounting feelings of stress and isolation. Your thoughts dominated with images of trauma, sadness, and depression. Tasting the acidic aftermath of a night of self-medication, bloated, nauseous, and exhausted. Feeling as though no one else could possibly understand, and there is no escape. Dreading the next time you must go to work and stifle your growing rage. All the while listening to one of the premiant leaders in your field, a physician who you rely on to guide you professionally, disparaging the mentally ill. Painting the portrait that your feelings are wrong, that they should be hidden from the light, that your colleagues will see you as weak, incapable of enduring what they can endure. You have to start asking yourself, “what is wrong with me?” – “Am I a nut job?”

It is easy to see how this cavalier dismissal of one’s humanity, no matter their crime, has infected our responders with the idea that mental illness is equivalent to weakness and inability. The idea that those who are captured by feelings of despair and sadness, or the reliance on substances to cope, are broken. How can we deliver the message that our colleagues are safe in seeking help, when in the same breath we dehumanize mental health patients?

While this example is dramatic evidence of the problem, it is certainly not isolated. I submit that we, through our day-in-day-out dismissal of mental health and substance abuse patients are moving toward a critical juncture in our industry. Every frustrated interaction with a drunk, or compartmentalized memory of a suicide victim. The insulation we build, “how could he do this, must have been crazy – a nut job.” Or the jokes, “really – you thought that would kill you, come on.” “Can you believe they called us, for this – grow up.” On a daily basis our providers are on the front lines of mental illness and substance abuse, using the only these tools to manage the sad humanity to which they are exposed.

It is imperative that we immediately change the paradigm in our industry to dismiss the criticality and humanity of these patients, if not for them, for us. The idea that ‘gallows humor,’ insulation, and dismissal are effective strategies is not only incorrect, but may be weakening our ability to cope. Even more impactful, our tendency to minimize, marginalize, and dismiss the impact of this structure may be reducing our ability to care for our own colleague’s stress. It is high time that we make a concerted effort to remove judgement from care, setting the example for ourselves that mental illness is just that, illness.