CASPer Scenario for Discussion #1

[PrepMatch]

Dave is riding on the subway when he suddenly notices a man talking to himself in distress. The man appears as though he is talking to someone who is not there. Dave's friend, Rachel, tells him not to approach the man because he "is probably crazy."

1. What should Dave do in this situation?

2. Should Dave stop being friends with Rachel after her comment?

3. Should Dave react differently if the man appears violent?

Discuss below!

(This scenario is from PrepMatch.com, the free peer-to-peer CASPer preparation platform that allows you to practice hundreds of scenarios for free. PrepMatch is a non-profit partnered up with the SDN that aims to make the admission process more equitable)

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[jdubs1984]

1) Dave should watch from a distance to better gauge the situation and make sure to man seems to be having a delusion. If the man still appears to be having a delusion, he should keep a safe distance while calling 911. Be sure to emphasize that the man does not appear to be armed and should be treated as someone having a medical emergency.

2) No, it is normal for people to highly regard their safety and the safety of those close to them. But it should be explained to Rachel that this person could be having a medical emergency.

3) If he appears violent, the only difference would be to immediately call 911 while observing and keep them apprised of the situation.

This is my first time answering any kind of CASPer question, I wasn't sure how long it should be but I thought I'd give it a shot.

 

[RickyRic]

1) Dave should watch from a distance to better gauge the situation and make sure to man seems to be having a delusion. If the man still appears to be having a delusion, he should keep a safe distance while calling 911. Be sure to emphasize that the man does not appear to be armed and should be treated as someone having a medical emergency.

I see where you're coming from, and this is may be the answer Casper is looking for. I guess we can debate on what "distress" looks like. But, in real life, do not call 911 on someone who is simply talking to themself or "appears to be having a delusion" on the subway.

If 911 is called and you explain the situation police will also come, not a trained mental health expert. The situation will most likely escalate to an arrest or some sort of altercation. On public transport, there are all kinds of characters (I have seen many people engage in full-on conversations with themselves) who go where they intended to go and cause no trouble.

I think the best way to approach this is to observe the man to make sure he is not having a medical emergency. What we perceive as being "distressed" and talking to yourself =/= medical emergency.

 

[deleted936329]

1) Dave should watch from a distance to better gauge the situation and make sure to man seems to be having a delusion. If the man still appears to be having a delusion, he should keep a safe distance while calling 911. Be sure to emphasize that the man does not appear to be armed and should be treated as someone having a medical emergency.

2) No, it is normal for people to highly regard their safety and the safety of those close to them. But it should be explained to Rachel that this person could be having a medical emergency.

3) If he appears violent, the only difference would be to immediately call 911 while observing and keep them apprised of the situation.

This is my first time answering any kind of CASPer question, I wasn't sure how long it should be but I thought I'd give it a shot.

I see where you're coming from, and this is may be the answer Casper is looking for. I guess we can debate on what "distress" looks like. But, in real life, do not call 911 on someone who is simply talking to themself or "appears to be having a delusion" on the subway.

If 911 is called and you explain the situation police will also come, not a trained mental health expert. The situation will most likely escalate to an arrest or some sort of altercation. On public transport, there are all kinds of characters (I have seen many people engage in full-on conversations with themselves) who go where they intended to go and cause no trouble.

I think the best way to approach this is to observe the man to make sure he is not having a medical emergency. What we perceive as being "distressed" and talking to yourself =/= medical emergency.

I agree with @RickyRic and see where you're coming from but as stated if police come it could present unnecessary escalation and lead to an unwanted outcome for this person.

Imagine how traumatic it might be to experience this and all of a sudden the police have came and suddenly you're arrested.

1. I definitely agree that Dave should gauge the situation to see if the person is at risk for harming himself or others. If that's the case, call the authorities because safety is a number 1 priority (also call if this is beyond Dave's judgement that he feels comfortable with). If there doesn't appear to be any risk of violence, I don't think we should assume the person is having delusions. Yes, he could be having delusions, but he could also be going through something else, such as a medical emergency or another type of crisis. If Dave is comfortable with it, he could ask the person if everything is alright and see what happens, and try to get the proper channels involved based on that. If it appears to be an episode of crisis, calling police would end up being more traumatic as stated. If the person is not being responsive to when Dave is trying to talk to them, I would call the local crisis center and ask for help. They have proper resources to deescalate with situations like this and it would hopefully be less traumatic for the person at risk. I would explain the situation to the crisis center and listen to what they have to say.

2. No, we all say things that may be judgmental in hindsight. I would just try to bring a different perspective to Rachel and explain that we don't know what's going on and as stated before it could very well be a medical emergency.

3. If he appears violent, immediately call the authorities and try to get any other people away from danger. Gauge the situation and see what needs attention first.

 

[jdubs1984]

I agree with @RickyRic and see where you're coming from but as stated if police come it could present unnecessary escalation and lead to an unwanted outcome for this person.

Imagine how traumatic it might be to experience this and all of a sudden the police have came and suddenly you're arrested.

1. I definitely agree that Dave should gauge the situation to see if the person is at risk for harming himself or others. If that's the case, call the authorities because safety is a number 1 priority (also call if this is beyond Dave's judgement that he feels comfortable with). If there doesn't appear to be any risk of violence, I don't think we should assume the person is having delusions. Yes, he could be having delusions, but he could also be going through something else, such as a medical emergency or another type of crisis. If Dave is comfortable with it, he could ask the person if everything is alright and see what happens, and try to get the proper channels involved based on that. If it appears to be an episode of crisis, calling police would end up being more traumatic as stated. If the person is not being responsive to when Dave is trying to talk to them, I would call the local crisis center and ask for help. They have proper resources to deescalate with situations like this and it would hopefully be less traumatic for the person at risk. I would explain the situation to the crisis center and listen to what they have to say.

2. No, we all say things that may be judgmental in hindsight. I would just try to bring a different perspective to Rachel and explain that we don't know what's going on and as stated before it could very well be a medical emergency.

3. If he appears violent, immediately call the authorities and try to get any other people away from danger. Gauge the situation and see what needs attention first.

I've never heard of a crisis center....do you mean like a suicide hotline?

 

[deleted936329]

I've never heard of a crisis center....do you mean like a suicide hotline?

That's a great question!

A suicide hotline, also known as a crisis hotline has crisis counselors that are able to deal with immediate crisis by deescalating a situation by talking it out. Usually, these hotlines are successful when they are able to talk directly to the person that is having the crisis but it can still be worthwhile for a 3rd party to call on behalf of someone for any guidance. If it is a hotline funded by the government these crisis counselors are trained to assist for pretty much everything.

But it is important to remember that although they can assist, there's only so much crisis counselors can do over the phone. Sometimes a crisis team might be needed to be on site. This is where a crisis center comes in. Usually if one calls a crisis hotline, they will eventually end up being directed to a crisis center if the crisis is in need of in person help.

I imagine in Dave's position he would probably get the most help from calling the crisis center directly and seeing what can be done. The crisis center can not only help just like the crisis counselors on the hotline, but if needed they can deploy a crisis team to help the person on the subway. This team is trained in deescalation and many other techniques to deal with crisis that would be far less traumatizing than the police themselves.

Many cities have crisis centers. Here is a crisis center located in NYC: Crisis Emergency Services - NYC Health
It has more information if you would like to read more

Crisis hotlines exist to allow people in crisis talk out what they're feeling. Crisis centers provide help beyond talking.

And again, if it's an urgent emergency or someone is in danger always call 911.

I hope that helps, let me know if you have anymore questions.

 

[jdubs1984]

That's a great question!

A suicide hotline, also known as a crisis hotline has crisis counselors that are able to deal with immediate crisis by deescalating a situation by talking it out. Usually, these hotlines are successful when they are able to talk directly to the person that is having the crisis but it can still be worthwhile for a 3rd party to call on behalf of someone for any guidance. If it is a hotline funded by the government these crisis counselors are trained to assist for pretty much everything.

But it is important to remember that although they can assist, there's only so much crisis counselors can do over the phone. Sometimes a crisis team might be needed to be on site. This is where a crisis center comes in. Usually if one calls a crisis hotline, they will eventually end up being directed to a crisis center if the crisis is in need of in person help.

I imagine in Dave's position he would probably get the most help from calling the crisis center directly and seeing what can be done. The crisis center can not only help just like the crisis counselors on the hotline, but if needed they can deploy a crisis team to help the person on the subway. This team is trained in deescalation and many other techniques to deal with crisis that would be far less traumatizing than the police themselves.

Many cities have crisis centers. Here is a crisis center located in NYC: Crisis Emergency Services - NYC Health
It has more information if you would like to read more

Crisis hotlines exist to allow people in crisis talk out what they're feeling. Crisis centers provide help beyond talking.

And again, if it's an urgent emergency or someone is in danger always call 911.

I hope that helps, let me know if you have anymore questions.

Wow this is amazing information! How is this not more well known?! Is there a shortcut like 911 or 311 etc for these?

 

[deleted936329]

Wow this is amazing information! How is this not more well known?! Is there a shortcut like 911 or 311 etc for these?

I'm glad I could be of help! The information is a little niche and since mental health isn't talked about openly as other things (although this is changing), it's very likely that many people may not know that this is a resource.

Shortcut phone numbers will depend on the location because it is usually governed by state and county policy. I will say from my experience in healthcare, there isn't usually a shortcut phone number and you may just need to do a quick google search of a crisis center in whatever location that person may be in to get the appropriate contact information.

For example, if Dave was in DC he could do a quick google search of "washington dc crisis center":

washington dc crisis center - Google Search

Scroll a few links and find this crisis center: Emergency Psychiatric Services | dmh with relevant information in order to contact

Hope that helps!

Edit: I will note that some locations may not have a crisis center that is easily found on a quick google search. If this is the case it might be helpful to contact the county or state crisis hotline and ask if there is a crisis center to go to. They should be able to direct the caller in the right direction.

 

[TragicalDrFaust]

Wow this is amazing information! How is this not more well known?! Is there a shortcut like 911 or 311 etc for these?

Just because you don't know about it doesn't mean it's not well known. Casper 101.

 

[jdubs1984]

Just because you don't know about it doesn't mean it's not well known. Casper 101.

Well considering I'm almost 40 and have never heard of it, I'd say it's probably not well known... It might be well-known in the pre-med community, but I'm sure it's not in the wider community. As a non-trad I don't really interact with other pre-meds anywhere but here.

 

[RickyRic]

Well considering I'm almost 40 and have never heard of it, I'd say it's probably not well known... It might be well-known in the pre-med community, but I'm sure it's not in the wider community. As a non-trad I don't really interact with other pre-meds anywhere but here.

I'm a traditional pre-med and I also never heard of it. I assume crisis centers are more prevalent in bigger urban cities, and even then most people would not talk about it in daily life.

I have definitely heard of rape crisis centers, but never mental health or emergency crisis centers.

 

[TragicalDrFaust]

Well considering I'm almost 40 and have never heard of it, I'd say it's probably not well known... It might be well-known in the pre-med community, but I'm sure it's not in the wider community. As a non-trad I don't really interact with other pre-meds anywhere but here.

Being in your 30s doesn't mean that your perspective dictates what is well known and what is not well known.

 

[jdubs1984]

Being in your 30s doesn't mean that your perspective dictates what is well known and what is not well known.

Being older means I've had much longer to come across something. Especially considering my wide range of experience in many cities, states, countries, and civilian and military careers. Its about odds, not definitive proof of anything.

 

[TragicalDrFaust]

Being older means I've had much longer to come across something. Especially considering my wide range of experience in many cities, states, countries, and civilian and military careers. Its about odds, not definitive proof of anything.

My point isn't about any particular individual's experience, it's that one person's perspective isn't a good representative sample for what's in the public consciousness.

 

[LizzyM]

Wow! This question is so biased toward people who have had experience riding the subway.