Held to answer

The woman on the phone wants to kill Robert Kennedy.

“He needs to be hooked up on life support until he has eaten every bit of his flesh,” she says slowly. She has given it serious thought.

This woman obsesses about all of the Kennedys.

“I have a theory about Karen Carpenter. She isn’t really dead. She and JFK Jr. are on a Greek island.”

Garrison Keillor is another obsession. She insists he talks about her on “Prairie Home Companion,” even uses some of her writings. That’s OK, though. He has her permission. It’s the others – the ones who use her life story on TV – they are the ones that she calls about on a 24-hour crisis hotline in Washington state.

“If I don’t get royalties, I’m going to kill myself on my 42nd birthday. I’m living in a hell. Garrison Keillor is living in hell.”

This woman, diagnosed as paranoid schizophrenic, was the most frequent caller to a crisis line where I volunteered for a year. She called so many times that the Mental Health Professionals (MHPs) put her on a restricted schedule: She could call only six times every four hours. If she exceeded the limit we had to transfer her to an MHP. She violated the restriction many times, and many times the MHPs did not want to talk to her. The volunteers always talked to her.

What made this woman’s case stand out was that she was employed as a medical professional. She was in a position to affect other people’s well-being. She also had weekend custody of her young daughter. The volunteers worried about her hurting someone; the MHPs did not, and they had master’s degrees.

Some of the police in the city where I worked knew this woman’s situation. Officers once responded to her home, and she pointed a blow dryer at them, thinking that from a distance, and in dim light, it would have the same shape as a gun and they would shoot her. They sent her to the hospital instead.

Under a new procedure in Portland, Ore., when 9-1-1 dispatchers receive calls from people like this woman, dispatchers will screen them to make sure there is no immediate threat to anyone and then transfer the calls to a crisis line.

It’s slightly different from the crisis line I worked. Portland’s crisis line is staffed by 13 MHPs and is operated by the Multnomah County’s Mental Health Call Center. According to The Oregonian newspaper, the intent is to have fewer police officers intervening where they are not needed.

“We’re definitely breaking some new ground here,” Heeseung Kang, the call center’s supervisor, told The Oregonian.

The crisis line I worked on in Washington state occasionally got referrals from 9-1-1 dispatchers. We were cautioned by the MHPs not to share any information with the police; we were not even to say if someone was enrolled in services. It was to protect the privacy of the clients, but there was also a hint of protecting turf.

Crisis lines seem uniquely American. People want their independence, but they also need help. Even with insurance coverage, help can be expensive and a crisis line is free. It’s easily accessible to the lonely and the self-absorbed, and those who are dependent on pharmaceuticals. Extortion by suicide threat is not uncommon. Neither is a family frightened and at the mercy of a child.

Some of the calls I took:

“I need two milligrams of Klonopin to get through the evening, or I’m going to kill someone!”

“My daughter is a psychotic mess. She’s been on meds, needs to be in-patient. She’s caused a huge disruption in my family. I don’t even know my other two kids anymore. I talk to them maybe five minutes. My daughter is destroying the house.”

“I lost my name. Call me Valium Risperdal Prilosec Inderal.”

“I read a book called “Purpose-Driven Life.’ I’m writing a ‘Purpose-Driven Death.’ How to overdose on heroin and a fifth and a half of vodka. Third time’s a charm.”

“Call my husband and tell him if he doesn’t apologize, I’m going to kill myself.”

“My attorneys are Seroquel and Adderall.”

“I need a place to go so I won’t kill myself, like, for the next four days … I need some place to go … I don’t need a standoff.”

“I’m holding a butcher knife to my stomach … I used to matter, then I used to sort-of matter. Now I don’t matter.”

“I took a bunch of pills a couple of years ago, and now I’m a piece of wood.”

“I’ve got full custody of my 12-year-old daughter. My stepson moved in a few months ago after being in foster care … I found my daughter’s bra in his bedroom. … He’s taken a stuffed rabbit and cut a vagina and anus into it.”

“I haven’t spoken to my dad in seven years, and we live in the same town.”

“Is this like a friendship line?”

Once you’ve worked a crisis line, you don’t look at your neighbors the same way. Does anybody really know what’s going on next door?

Portland Police Chief Mike Reese said he hopes that 9-1-1 callers having a mental health crisis, who have no weapons and pose no danger, can be taken care of without a police response.

“Sometimes just showing up in uniform can exacerbate things,” Reese said in The Oregonian.

True, but there are plainclothes police.

In September, his officers used a “go-slow” approach in handling a call involving a mentally ill man who scared his neighbors when he walked through his apartment complex armed with a rifle and shotgun. It was eventually resolved after a six-hour standoff, but there was some justifiable criticism about the police’s go-slow response. Considering the outcry from some people whenever officers use force, it’s not surprising that law enforcement is trying a different approach.

The new protocol will probably increase calls to the Multnomah County’s crisis line. The Oregonian noted that the call center stands out from other crisis lines because the call takers are not volunteers, but full-time staff who all hold master’s degrees with clinical experience.

Advanced degrees – or any degrees – do not translate into wisdom, particularly when it comes to understanding the human condition. People who routinely deal with the general public in trying situations – bartenders, bus drivers, cabbies, police officers, anyone actually – may be called on to serve as low-rent shrinks.

The only person I ever spoke to on the crisis line who wanted to know where I had gone to school and what kind of degree I had was the medical professional who wanted to kill Robert Kennedy. She asked after I pointed out that Robert Kennedy had been dead for a while, courtesy of Sirhan Sirhan.

We were told by the MHPs to never disagree with this woman, to let her say whatever she wanted. But several of the volunteers noticed that when we engaged her in real conversation, she dropped the crazy talk. She could be personable, intelligent, even witty.

At times she knew that our agreeing with her was a form of condescencion, that we were treating her that way only because she was sick. She had memories of having once been healthy, and she missed it.

I miss listening to her and wonder how she’s doing. At the same time, I wonder if it’s wise for her to be working in a job where she has responsibility for people’s health.

But what do I know? I only have a B.A. from the University of Oregon.

— Pamela Fitzsimmons