Is calling 911 really the best thing?

[VIDEO: "What is parental alienation?"]

Mod Note:  this thread was split from another as it warrants it's own discussion https://bpdfamily.com/message_board/index.php?topic=335933.0

There are some stark realities that I "see".  I hope others can reflect some and "see" if they have common memories.

I'm not aware of any story on bpdfamily where SI has been present and "gotten better" without professional intervention.  

That's very different than saying there are stories on here where SI was present and 911 was NOT called (or some other method used to get professionals involved).  Maybe there were breakups or the relationship took some other pathway.  

I also have the personal/professional experience of the Navy where I personally referred a handful of Sailors to medical so professionals could evaluate their SI.  100% of those (I'm thinking the number is between 5-10) were alive after.

I'm also aware of  a few situations (2-3) where a deliberate decision was made by the chain of command NOT to involve medical professionals.  100% of those resulted in death of a service member (successful suicide).  

One of those was a guy I flew with for 10 years or so.  He was a far better pilot, calmer under pressure etc etc than I was, yet something got off track for him and he carried out his threat.

I wish I could honestly say there would be no chance if I was put in the situation of deciding to call for him or not, that I would call 100%...(after all...I "knew" him and he would never...)

I realize these observations sound stark, perhaps black and white, but the data is what it is.

I'm also painfully aware there are no do overs..

How does this issue look to you now that you have considered things for a day?..slept on it...if you will.

FF

Are there stories here where someone did call 911 for suicidal ideation/threats, and that made things better? Links? I would love to read them.

Obviously I struggle with this issue, but it is hard to find any actual data to support the claim that this is an effective route for pwBPD, and there's plenty of published research that seems to suggest that it's not particularly effective.

[stolencrumbs]

Mod Note:  this thread was split from another as it warrants it's own discussion https://bpdfamily.com/message_board/index.php?topic=335933.0

There are some stark realities that I "see".  I hope others can reflect some and "see" if they have common memories.

I'm not aware of any story on bpdfamily where SI has been present and "gotten better" without professional intervention.  

That's very different than saying there are stories on here where SI was present and 911 was NOT called (or some other method used to get professionals involved).  Maybe there were breakups or the relationship took some other pathway.  

I also have the personal/professional experience of the Navy where I personally referred a handful of Sailors to medical so professionals could evaluate their SI.  100% of those (I'm thinking the number is between 5-10) were alive after.

I'm also aware of  a few situations (2-3) where a deliberate decision was made by the chain of command NOT to involve medical professionals.  100% of those resulted in death of a service member (successful suicide).  

One of those was a guy I flew with for 10 years or so.  He was a far better pilot, calmer under pressure etc etc than I was, yet something got off track for him and he carried out his threat.

I wish I could honestly say there would be no chance if I was put in the situation of deciding to call for him or not, that I would call 100%...(after all...I "knew" him and he would never...)

I realize these observations sound stark, perhaps black and white, but the data is what it is.

I'm also painfully aware there are no do overs..

How does this issue look to you now that you have considered things for a day?..slept on it...if you will.

FF

Are there stories here where someone did call 911 for suicidal ideation/threats, and that made things better? Links? I would love to read them.

Obviously I struggle with this issue, but it is hard to find any actual data to support the claim that this is an effective route for pwBPD, and there's plenty of published research that seems to suggest that it's not particularly effective.

[formflier]

 there's plenty of published research that seems to suggest that it's not particularly effective.

Can you share this published research?

Particularly effective to do what?

I'll certainly try to think some about names, stories and that kind of thing.

My point and what I'm referring to is a lessening of SI over time and a more stable relationship with a pwBPD.

I can't think of any stories where SI was present, and it got better without "outside intervention" or "outside visibility".

Circle back to some of the points Babyducks  mentioned.  In this case SI appears to have bee used to "gain control back" of the relationship.  To get the OP reacting to the pwBPD, vice have the pwBPD react to the OP.  

And...in this thread, that worked for the pwBPD.  He got the "breathless" phone call..the engagement...the outrage...the emotional energy (etc etc) that the pwBPD likely saw was "missing".

So...next time there is a perceived "need" it is likely for this particular pwBPD to "cross that line again".  The "consequences" to doing it this time were actually likely what the pwBPD was looking for...the calls..the talks..the outrage.  

However, if things shift and a non-emotionally involved professional is now involved in the situation there is no "payoff" for the pwBPD.  Once the pwBPD understands that SI gets no "payoff", and in fact it actually gets attention the pwBPD DOES NOT want..it's very likely SI will go away.

Of course involving professionals creates a pathway to potential real healing as well.

FF

[stolencrumbs]

Can you share this published research?

Particularly effective to do what?

This is from Managing Suicidality in Patients With Borderline Personality Disorder,
Joel Paris, MD. https://www.psychiatrictimes.com/managing-suicidality-patients-borderline-personality-disorder

There are lots of links/citations in the references. There is more recent research that suggests the same. There is also some newer research that suggests it can be effective. It is, at the very least, controversial whether hospitalizations and emergency services are the way to go with pwBPD.

Active interventions designed to prevent suicide have a tendency to be counterproductive in patients with BPD because they reinforce the very behaviors they are designed to treat.9 Most BPD experts have advised therapists to tolerate suicidality and focus on the problems that cause it. Kernberg31 recommends that therapists inform patients and their families that they cannot take responsibility for, or ultimately prevent, completed suicide; and Maltsberger32 argues that one must accept a calculated risk to effectively treat patients with BPD.

Many believe that, if possible, hospitalization should be avoided. Linehan9 sees hospitalization as interfering with effective treatment and is only willing to tolerate an overnight hospital stay. Livesley33 advises keeping hospitalization to a rarity. Dawson and MacMillan34 suggest that hospitalization should almost never be used for patients with BPD. Gunderson,25 while not excluding admission, tries to avoid it by informing patients that it will not be helpful. The American Psychiatric Association guideline for the treatment of borderline personality disorder represent a committee consensus and take a different point of view.35 The guideline (page 8) states, "When the patient's safety is judged to be a serious risk, hospitalization may be indicated." Yet there is no evidence that such interventions actually increase safety or reduce mortality. Moreover, when suicidality is chronic, hospitalization tends to become recurrent.36 Thus while hospital admission may provide temporary relief, most patients continue to have suicidal ideas after discharge. Hospitalization can also be harmful when recurrent admissions disrupt the patient's life.3 There is a good evidence-based alternative. Clinical trials of outpatient treatment support its use for patients with BPD in crisis.37 Day hospitals have the advantages of intensive treatment by an experienced team without the disadvantages of a full inpatient admission.

Most patients with BPD are managed as outpatients with psychotherapy.38 It is also common to use pharmacotherapy as an adjunct to reduce impulsivity, 14 but there is no evidence that drugs can prevent suicide. The key to effective psychotherapy in BPD may be to address the life issues that make patients consider ending their lives rather than making an endless cycle of attempts to prevent suicide.39 Dialectical behavior therapy (DBT) is an effective method for reducing levels of parasuicidal behavior.9 DBT uses specific strategies to manage suicidality: therapists conduct a behavioral analysis in which they validate the distress behind suicidal ideas, identify the problems leading to that distress, and work to develop alternative solutions to these problems. Instead of reinforcing suicidality through increased therapist contact (a common problem in other therapies), DBT offers brief coaching through telephone contact when patients communicate thoughts but provides negative reinforcement (temporary loss of sessions) of suicidal actions. Recently, several other promising forms of therapy, including mentalization- based treatment, transferencefocused therapy, and schema therapy have undergone clinical trials.14 Suicidality in BPD remits when patients attain meaningful work and establish a network of relationships.40 The long-term follow-up studies reviewed above show that most recovered patients are working, about half achieve some kind of stable relationship, and about a quarter raise children, although formal research has not determined whether the offspring of patients with BPD are also at risk.6

[formflier]

OK...this is a "professional" article for people who are otherwise qualified to make these kind of judgments.

I think this actually reinforces my point.  There are people out there qualified to make these judgments, my point is to let the system work to get qualified people/professionals involved.

I'll take a stab at an analogy.  

Just because you can go online and read about a medical procedure and from reading the article and looking at the pictures it appears you have the tools needed and the article says the procedure is quick and easy...it would be unwise to practice this at home

That's essentially what "we" (non-professionals) are doing by reading this particular article and trying to carry out this advice...without professional supervision

Now..if the OP has a therapist and that particular therapist expresses that it is ethical, proper "treatment" for the OP to ignore SI, then I would change my tune.

Same for you Stolencrumbs.  Involve professionals and if they "prescribe" or "direct" you on a certain course of action, I can't imagine advising you not to follow that advice.

Back to point 1.

Involve those with the training to evaluate these things.  The consequences of alternate pathways can't be fixed.

FF

[stolencrumbs]

I take your point. I think one difference is that you seem to have way way way way way way way way more confidence in the ability of a “professional’ to handle things in the best, most helpful way.

[formflier]

Can you expand on your point some.

What experiences have you had with "professionals" that have led you to NOT or to have less confidence in them.

If professionals are not as appropriate in your world to handle this..who should handle it?

I'm not suggesting a professional will get you "the best" way.  I'm suggesting involving a professional has a much better chance of getting professional results.  As you can see from the literature, there are debates among professionals about "the best" or "most effective" ways to "treat" these type of things.

That's why it's called "the practice" of medicine and that's why there are strict laws and ethical guidelines AGAINST those without the appropriate credentials from practicing medicine.

So...since the topic is so important.

I have confidence in the average medical professional to approach SI in an ethical and medically appropriate way.  I have confidence that the results from professional involvement will be VASTLY better than for people like you and I (and others) who read professional literature and try to specifically apply those ideas.

Yes..I have lots of confidence in professional certification processes, schooling...etc etc.  That confidence does not extend to confidence in perfect results.

Another analogy...

Why is it that local governments won't spend money on school projects that do NOT have the stamp on it from a professional engineer (I used to be a county manager...so..up my alley)?

Yet...every once in a while structural failures still happen in school buildings.

So...since there is no guarantee of the best result with an engineer stamp...why not save the money, read the book and draw the plans ourselves.?..doesn't look that hard and I have a ruler and can make nice straight lines.

Seriously...answer the last question.  Is the analogy valid?

FF

[stolencrumbs]

Can you expand on your point some.

What experiences have you had with "professionals" that have led you to NOT or to have less confidence in them.

If professionals are not as appropriate in your world to handle this..who should handle it?

I'm not suggesting a professional will get you "the best" way.  I'm suggesting involving a professional has a much better chance of getting professional results.  As you can see from the literature, there are debates among professionals about "the best" or "most effective" ways to "treat" these type of things.

That's why it's called "the practice" of medicine and that's why there are strict laws and ethical guidelines AGAINST those without the appropriate credentials from practicing medicine.

So...since the topic is so important.

I have confidence in the average medical professional to approach SI in an ethical and medically appropriate way.  I have confidence that the results from professional involvement will be VASTLY better than for people like you and I (and others) who read professional literature and try to specifically apply those ideas.

Yes..I have lots of confidence in professional certification processes, schooling...etc etc.  That confidence does not extend to confidence in perfect results.

Another analogy...

Why is it that local governments won't spend money on school projects that do NOT have the stamp on it from a professional engineer (I used to be a county manager...so..up my alley)?

Yet...every once in a while structural failures still happen in school buildings.

So...since there is no guarantee of the best result with an engineer stamp...why not save the money, read the book and draw the plans ourselves.?..doesn't look that hard and I have a ruler and can make nice straight lines.

Seriously...answer the last question.  Is the analogy valid?

FF

No, I'd say there are significant differences. For one, our bodies, and especially our minds, are not buildings. Psychology ain't engineering. It ain't physics.

I do think professionals are the appropriate ones to handle it. I think it is important to find the "right" professional, and whoever is on duty at the ER when the call is made doesn't seem like a great way to find the right one.

I do have some personal experience to support my general skepticism, but I don't want to derail the conversation here any more than I already have. There is a lot for WEW to think about. I think there is good advice here. It's a very hard situation to be in. I don't think it's obvious what the right thing to do is in cases like this.

[boatingwoman]

The studies stolencrumbs posted are strictly for pwBPD who are *in treatment* for their BPD.

That is not the case for most (all?) here.

Apples and oranges, etc.

Does not apply.

[formflier]

No, I'd say there are significant differences. For one, our bodies, and especially our minds, are not buildings. Psychology ain't engineering. It ain't physics.

Hmmm..the analogy is that there are professional standards, a process to achieve those standards, to maintain those standards...etc etc.

I was hoping the thought would go towards our bodies (dare I say our lives?) being "more important" than a school building, therefore lending to my assertion that professional is the way to go.

I do think professionals are the appropriate ones to handle it. I think it is important to find the "right" professional, and whoever is on duty at the ER when the call is made doesn't seem like a great way to find the right one.

That very well may be.  For some issues it starts and ends at the ER...for some a process is started.  Let all the professionals involved "do their thing" and find the best process for what presents in the ER (even if the ER doc on duty isn't the one that takes the issue to the finish line...they still have a part to play)

I would also encourage WEW and others to let go of the notion that it must be done "right" (with the unspoken "or not at all").  

Doctors consult with each other all the time, especially on complex issues.  If the way to "start the system" is presenting in the ER and going with whoever is there...I would suggest that is better than waiting on finding the "right" one.

 I don't think it's obvious what the right thing to do is in cases like this.

Exactly...so let those trained to do so make those judgments...or refer to those that can make better judgments.

FF

[stolencrumbs]

Exactly...so let those trained to do so make those judgments...or refer to those that can make better judgments.

FF

You first have to make the judgment to force a professional evaluation/treatment on someone in order for "those trained to do so" to "make those judgments". That's the decision, and it is not obvious to me that's the right decision.  "Let the professionals decide" doesn't at all speak to that decision, and that's the decision we face.

Look, I'm in the middle of it, so I'm sure my judgment is compromised, and I obviously may be completely wrong here. I just don't think the decision is obvious. I think there are real risks in both directions. I'll leave it at that.

[formflier]

You first have to make the judgment to force a professional evaluation/treatment on someone in order for "those trained to do so" to "make those judgments".  

I'm not aware that this decision has to or should be made?  Forcing someone into evaluation/treatment is very different from a welfare check, whether or not that welfare check is precipitated from a 911 call or a regular call to authorities.

True...those showing up for the welfare check will "evaluate" what they see, so I suppose that is somewhat accurate to say it is "forced".  The people (likely deputies) that would show up for such a welfare check will have professional training to determine the appropriate next steps.

There are very very important points and discussions in this thread.  However I wouldn't want someone breezing by this to miss the "main point".

When someone presents with Suicidal Ideations that's best left to professionals to sort out.  Calling 911 is usually the best route to start that process.

FF

[sweetheart]

stolencrumbs, I have just read your most recent thread. It must be a terribly conflicted place to be to no longer know what to do for the best; for either person in the wake of such dysregulated behaviours.

Threats of suicide, suicide attempts, DSH, SI, is a truly terrible place for a relationship to be. I know, my dBPDh cycled in and out of all these things for years.

In order to break free of the hold it has over us, those who write here, to stop the bleeding, it becomes important, whatever the motivation behind the behaviour, to hand it over to professionals.

Ultimately this protects us just as much as it protects our SO. Professionals, as I think I can hear from you, don't always make things better, or stop it happening again, but they can take the feeling of having to carry the responsibility of this burden away from us for short periods of time.

[empath]

In my state, we have a pretty high rate of suicide, so there are some training programs for the community in which I live. It's something that we talk about fairly regularly around here.

The general recommendation is if someone expresses thoughts, one needs to find out if the person has specific plans and how far they can go with those plans. IF there are plans, it's an emergency situation. Also, if there are plans, there is a possibility of harm to others who are close.

It's a scary situation, even if the person is using it to get attention. Responding from a place of calm is difficult in these kinds of situations.

[babyducks]

it's interesting how this thread moved into other territory and other ideas.    I hope WitzEndWife, will indulge some further discussion.

First I should say I have read the study stolencrumbs   mentioned several times and long before it came up here today.     Second I should say I have personal experience with the implementation of that study in my past relationship.   In my opinion that study and ones like it are outside the context of the topic here today.   It is also my experience that this is not zero sum game theory.    Threats of suicide, suicide attempts, DSH, SI, are complex, different, nuanced.    We can all deadlock in our personal positions and reinforce our own opinions.     That doesn't help either the original poster or anyone reading along but refraining from comment.    One size does not fit all.    One response does not fit all circumstance.   The topic is broader than that.

Are there stories here where someone did call 911 for suicidal ideation/threats, and that made things better? Links? I would love to read them.

Obviously I struggle with this issue, but it is hard to find any actual data to support the claim that this is an effective route for pwBPD, and there's plenty of published research that seems to suggest that it's not particularly effective.

Yes there are success stories here.    Predominately on the parent with children board, less so on the relationship board, almost never on the tolerating or conflicted board.     It matters where you read.   I will also say that no data will ever empirically support one position or another.    There is a difference between logic and theory and practice and experience.

You first have to make the judgment to force a professional evaluation/treatment on someone in order for "those trained to do so" to "make those judgments". That's the decision, and it is not obvious to me that's the right decision.  "Let the professionals decide" doesn't at all speak to that decision, and that's the decision we face.

I am going to return to sweetheart   because I think she nailed it.    We all bring our own personal bias to these decisions.   Our own unique fears, worries.   We have skin in this game.   We are involved.    Being willing, in certain circumstances, to remove our selves, our bias, frees us from the hold it has over us.   There are no perfect solutions.    There are no easy answers.   There is no response that is guaranteed for success.    

Yes,   you have to make the decision to force a judgment by professionals if you accept responsibility to act on the obligations of the relationship you assumed.

No, you don't have to make a decision to force a judgment if there is no ethical, or moral fortitude behind it.

'ducks

[stolencrumbs]

One size does not fit all.    One response does not fit all circumstance.   The topic is broader than that.

I agree with this 100%.

Yes,   you have to make the decision to force a judgment by professionals if you accept responsibility to act on the obligations of the relationship you assumed.

No, you don't have to make a decision to force a judgment if there is no ethical, or moral fortitude behind it.

This, to me, seems to run counter to the first quote above. I do not think that I assumed an obligation to call 911 anytime my wife talked about suicide. I don't think not doing that is failing to accept responsibility to act on obligations I assumed.

Maybe I'm reading this wrong, in which case I apologize. But this seems like one-size-fits-all, and it seems very black/white. You either accept your moral responsibility and show "fortitude", or you don't. I just don't think that's accurate.

[formflier]

Perhaps this will be a good way to look at things...an analogy to use.

If you become aware of someone breaking into a neighbors house you have the option of calling 911 or getting your own weapon (or going unarmed) and trying to deal with it yourself.  I certainly don't recommend people dealing with it themselves, because most people don't have the training for that type of a crisis situation.

When you become aware of a loved one (or even someone you don't like very much) "playing around", suggesting...whatever you want to call it, that they are going to take their life, or even thinking about taking their life...that's a crisis situation.

Call people that are trained to deal with a crisis situation.

There is another "axiom" that I use.  If you are standing around asking yourself "is this a crisis"...it's a crisis and you should call.  Unless you are absolutely...absolutely sure that whatever situation you are looking at is not a crisis..consider it one. 

Why "lean" that direction?  Well...a mistaken crisis can lead to embarrassment.  I crisis that is mistakenly looked at as "normal" can lead to a death. 

So...if you are going to make a mistake, which way should you "lean"?

FF

[sweetheart]

stolencrumb, you ask somewhere if calling 911 made things better, like a success story.

I came to this forum years ago when my life was in chaos and my dBPDh was out of control. Before I found the forum I used to cover up, minimise, enable, control, do anything to try and hide my h's behaviours from everyone. I also had no life and no friends, I was isolated with a baby and a mentally ill husband. My choice.

His behaviours ran the full gamut of the BPD profile. He would smash things up, go missing, threaten to kill himself over and over again. Self-medicate, by over medicating, he took overdoses, self-harmed. And so much more. Yes I tried to micro manage all of this things until one day he threatened to kill me because I attempted to take a knife from him as he was self-harming. I called the police who took him to a 'place of safety' overnight. He came back the next day sorrowful and apologetic and off we went again. Calmer, but struggling.

I didn't come to these boards for another three years when a house moved triggered a period of dysregulated behaviour and crises for my h that lasted five years with him eventually being hospitalised for 18 months, for a year of that time he was detained under the Mental Health Act.

At every point throughout those 5 years of dysregulation I involved whatever service was appropriate for the behaviour at the time. Mostly it was the police for Welfare Checks, Missing Persons, or just to help my h calm down if he was smashing things up, or hurting himself. Sometimes he was arrested.
I also contacted the local Out of Hours Mental Health Crisis Team, in hours I would contact my h's psychiatrist, his doctor, his mental health nurse, all who would give me advice, maybe an appointment for my h to be seen for assessment, or a review. Sometimes an appointment just for me.

Most times he would be sent home again after being seen, sometimes he was given medication, sometimes he would be admitted briefly to hospital, he also spent three months in prison albeit in the hospital wing but nonetheless.

I must have called the police more times than I called my mother over those five years.
Was it successful? Yes it was, every single time, because it meant that I was not having to deal with the dysregulation and chaos. Was it easy? No it was awful.
Did it make things better? No not the short-term it absolutely made everything worse because my h didn't want his behaviours seen and documented by others.
Eventually though it did change the behaviour dynamic and the extreme dysregulations reduced in frequency and intensity. It took a while though.

It was me that had my husband sectioned in 2017 and it is without doubt the best decision I ever made. He would be dead now I'm sure if I had just stood back and allowed his behaviour to continue unchecked.

My h is home now, not psychotic, emotionally regulated, but functions at a fairly impaired level. We are managing. If he feels he cannot manage he now has the option of going to live permanently in supported housing. I suspect this will be the outcome for him. He finds life hard and overwhelming, he finds living in his own skin a daily challenge.
He is using the support available to him in his own way. I am not involved in any part of his therapy.

I have a life today with lovely friends, and we are managing to raise our beautiful talented son. I am happy, but it took me the best part of ten years to get to this point. And I still use the tools I learnt here everyday.

I suppose the end result is a positive outcome of sorts, but I'm not sure that any of this is about positive outcomes.
For me this whole process has been about understanding that my husband had no chance at life without professional intervention, whilst also accepting that even with professional intervention there are still no guarantees.