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It was just a game, explained moderator Robert Michels, M.D., but a game with a very serious point.
The game was a role play at APA's annual meeting in Toronto in June by psychiatric patient and patient rights advocate Joseph Rogers, executive director of the National Mental Health Consumers Self-Help Clearinghouse, and a panel including several psychiatrists and National Alliance on Mental Illness (NAMI) executive director Laurie Flynn.
Michels, who is the Walsh McDermott University Professor of Medicine and University Professor of Psychiatry at Cornell Medical College, asked Rogers, who suffers from bipolar disorder and has experienced psychotic episodes, to conjure up one of his prior psychotic states. Michels asked panelist Lewis Opler, M.D., medical director for the New York City region of the State Office of Mental Health, to be the intervening psychiatrist.
The initial encounter is around a park bench. Rogers has just defecated behind the bench and been reported to local police. A crisis team arrives with the psychiatrist, a paramedic, and a policeman.
Rogers: "I don't want to be locked up in your damned hospital. What the fuck are you all doing. Leave me alone, get out of my face, this is my park bench! I bought it. Leave me the fuck alone."
Opler: "We're concerned; we were asked to come. I can understand how you would feel that way toward us."
At that point Rogers says he has AIDS and threatens to throw bloody feces at the psychiatrist, then makes a throwing motion.
Opler calls for help from the police officer and the paramedic, who move in. Rogers is on the ground with a baton across his back. Opler asks that they hold his arms and let him sit up. Rogers calms down, produces a bottle of pills, says he'll take his medication, swallows a pill, and says he just wants to go.
Opler asks about a friend or family and insists that Rogers tell him who his doctor is, but Rogers refuses. Opler won't let him go without trying to contact the doctor. Michels halts the role play here and asks Rogers what he would want done in that circumstance based on his current rational state.
It would have been better if the incident had not been treated as a crisis with a police presence, said Rogers. A street outreach worker, not a psychiatrist, would be less threatening and hence a better initial contact. An experienced outreach worker would probably know that park and its denizens, and have prior knowledge of the mentally ill person, he commented.
The goal is to enlist any social supports a mentally ill person has to avoid coercion if at all possible, said Rogers.