Well, It's A Start! (Dealing with the Mad and the Reality Challenged)

[Yarnspinner]

My immediate supervisor has finally had enough.  Yay!

As most of you who are librarians know, the library, especially the reference area, is a magnet for people who are homeless; reality challenged; special, special snowflakes with anger management issues and so on.

I am not sure what became the tipping point today (because it was a typical day) but Immediate Supervisor (we'll call him IS) sat at the reference desk and suddenly announced "I cannot deal with this C**p any more.  And I am doing something about it.  Now."

He was referring to the long list of the mentally disturbed.  On a given day, in no particular order, it is not impossible to deal in one hour with several of the following personalities:

Princess Talks Loudly And Argues With Herself
Mr. I Am Going to Prove that FDR Invented the Bank Failures (He was like a yo-yo today, leaving and coming back a dozen times in two hours)
Young Mr. I Hate the Sox Gimmee a Book on The Spirit of St. Louis and I need zombie Movies
Ninja who currently believes she is the title character from Johnny the Homicidal Maniac
Our Book Thief who stuffs the books down the front of his pants and insists that's his body (Yeah, I really don't want the books back after that)
The Lady Who Wears a Parka and Scarf in 95 degree heat
Camera Guy

I don't know what happened, but IS took the suggestion we have been making for months, called the local mental health professionals and they will start becoming a permanent presence here next week.  Hopefully some of these folks will get help and some of the others might find a new place to hang out.

I hope.

[Jocelyn]

Wow. I'm stunned that mental health professionals would agree to do such a thing.

[Jones]

So they are going to sit and observe, and ask the reality challenged if they could please come in for an evaluation?

I'm sure they will find plenty of candidates, the question is if those people can be taken against their will, or if they want help.

[HyenaInPetticoats]

What are they going to do, herd them into the local mental hospital 

[camlan]

The issue is not just that the library staff are dealing with this group of people. It is that doing this draws resources away from the primary function of the library. And if this particular group of people is disruptive enough, they can make other people avoid the library entirely. Time spent dealing with the reality-challenged is time not spent on helping other patrons, and not doing the routine tasks of the job.

While calling in the mental health professionals might not be the optimal solution, it is clearly one that is legal--both the library staff and the local mental health professionals think it is a good idea. Since this is a public library, I'm sure that all legal requirements will be met. Yarnspinnner lists seven patrons that could easily appear in the space of an hour. If the librarian on duty spends just 5 minutes with each one of them, that's 35 minutes, over half the desk hour, spent not doing his/her job.

I've worked at the circulation desk of a large library. While we did not have quite as colorful an array of patrons as Yarnspinner, there were many times we had to call Security to deal with patrons who were more or less reality-challenged. It is better that mental health professionals, with the proper training, deal with the issues that arise, instead of library staff who are trying to do their jobs and who have no training in dealing with this population. 

For those who think this is not a good solution, what would you suggest instead?

[Onyx_TKD]

I don't know what happened, but IS took the suggestion we have been making for months, called the local mental health professionals and they will start becoming a permanent presence here next week.  Hopefully some of these folks will get help and some of the others might find a new place to hang out.

I hope.

What are you expecting the mental health professionals to do?  Approach people and try to convince them to make appointments? In particular, what are you expecting them to do that will make the library so unpleasant for these people that they will hang out elsewhere? Will the mental health professionals be permitted to harass customers who are aren't interested in their services or are you hoping they'll be so offended by the initial approach that they leave? If you can't justify kicking problem customers out or calling the police over their behavior, I just don't understand how inviting mental health professionals is going to help. Unless they're intended to assist the librarians in figuring out how to effectively deal with unusual behavior? But I don't see how that would lead to "Hopefully some of these folks will get help and some of the others might find a new place to hang out."

I've worked at the circulation desk of a large library. While we did not have quite as colorful an array of patrons as Yarnspinner, there were many times we had to call Security to deal with patrons who were more or less reality-challenged. It is better that mental health professionals, with the proper training, deal with the issues that arise, instead of library staff who are trying to do their jobs and who have no training in dealing with this population. 

For those who think this is not a good solution, what would you suggest instead?

I just don't understand how it's going to be a solution at all, unless they're there to train library staff in how to handle the situation rather than dealing with the patrons directly. If the patrons need to be refused service and/or removed from the premises due to their behavior, then it seems like Security or the police are the appropriate people to handle it. Where do the mental health professionals come into the picture? They can't diagnose/treat someone for mental health issues in the middle of the library against their will!

[CuriousParty]

There are public mental health teams in many areas whose job it is to identify mentally ill individuals who are in need of services including treatment, residential placement, access to benefits, etc.  I assume this is the type of program Yarnspinner's supervisor has called, and if so then it is entirely within their purview and they are both trained and equipped for the needs of the library patrons she describes (though of course some may still decline the assistance).  It's not as if he opened up a phone book and called up the first therapist he saw (I do hope).

[demarco]

Yarnspinner, as a former librarian, I feel your pain.    I sincerely hope that something works, soon,  to make your library a little more tolerable. 

I have worked in academic and medical libraries, some with controlled access and some that were open to the public at large.  Every single library I have ever worked in had this problem.  Security was either nonexistent or ineffective.  The administration usually dealt with it by ignoring it or blaming us.  I could tell stories that would curl hair.

Let us know how it turns out, Yarnspinner.  I will be thinking about you.   

[Jones]

There are public mental health teams in many areas whose job it is to identify mentally ill individuals who are in need of services including treatment, residential placement, access to benefits, etc.  I assume this is the type of program Yarnspinner's supervisor has called, and if so then it is entirely within their purview and they are both trained and equipped for the needs of the library patrons she describes (though of course some may still decline the assistance).  It's not as if he opened up a phone book and called up the first therapist he saw (I do hope).

Oh ok. We don't have anything like that here and I was completely confuzzled as to how having mental health staff camped out would help the situation. A policeman can escort them away for anything from trespassing to suspected public intoxication; could a nurse or therapist have that power?

Hence my confusion.

[Pen^2]

What a great idea!

I don't know if the mental health professionals will be able to help very many of these people, but the point is, it certainly doesn't make anyone worse off, and the library staff simply can't be expected to deal with this kind of stuff on top of all their other duties. It is in the best interest of the disturbed people to have someone trained dealing with them rather than a frazzled librarian who, like just about everyone else on Earth, simply isn't trained to handle this kind of thing. Having someone who knows what to do can help with the more dangerous individuals, as well.

Shoving books down your trousers... ew. If it's a repeat offender, then maybe with this policy, several books will be saved as well once he realises that he's being observed directly by a trained health professional instead of by a multi-tasking staff member.

Hopefully some of these people can get the help they need, and the rest of the library will continue to improve now that more attention is available to be given to other areas.

[snappylt]

Wow. I'm stunned that mental health professionals would agree to do such a thing.

Jocelyn,

I have a genuine question to ask.  (Please - I really am curious to understand, and I am not trying to be snarky - although I'm not sure how to phrase my question well.)

I have never been a public librarian, but I have always been a frequent patron of the public libraries wherever I have lived.

When I first read the original post, my initial reaction was to think that it would be a good, sensible thing to ask for the library staff to ask for help.

Then I read your brief post about how you are shocked that a mental health professional would help, and I don't understand.  Could you please gently explain and help me understand what is shocking about this?

Thank you!

[Jocelyn]

There are public mental health teams in many areas whose job it is to identify mentally ill individuals who are in need of services including treatment, residential placement, access to benefits, etc.  I assume this is the type of program Yarnspinner's supervisor has called, and if so then it is entirely within their purview and they are both trained and equipped for the needs of the library patrons she describes (though of course some may still decline the assistance).  It's not as if he opened up a phone book and called up the first therapist he saw (I do hope).

As a former community mental health center therapist, this issue came up. It would be highly unethical to approach a person in public and suggest that they need mental health services. We could not do this unless the person was actively dangerous to himself or others. Just striking up a conversation with someone in public could be considered a breach of HIPAA, because one's identity as a mental health therapist could be well known to others in the community, so the very fact that in the middle of my workday I am sitting around having a conversation in the library might permit others to conclude that I was in the process of assessing a person I believed to be mentally ill.

[CuriousParty]

There are public mental health teams in many areas whose job it is to identify mentally ill individuals who are in need of services including treatment, residential placement, access to benefits, etc.  I assume this is the type of program Yarnspinner's supervisor has called, and if so then it is entirely within their purview and they are both trained and equipped for the needs of the library patrons she describes (though of course some may still decline the assistance).  It's not as if he opened up a phone book and called up the first therapist he saw (I do hope).

As a former community mental health center therapist, this issue came up. It would be highly unethical to approach a person in public and suggest that they need mental health services. We could not do this unless the person was actively dangerous to himself or others. Just striking up a conversation with someone in public could be considered a breach of HIPAA, because one's identity as a mental health therapist could be well known to others in the community, so the very fact that in the middle of my workday I am sitting around having a conversation in the library might permit others to conclude that I was in the process of assessing a person I believed to be mentally ill.

The programs I am speaking of are not community mental health centers, but rather programs that are specifically designed and intended to meet the needs of transient/homeless mentally ill persons, or persons in need of significant support to access public services in the first place (such as, for example, a therapist at a community mental health center). The programs I am familiar with generally function under the term "case management", but I believe the terminology varies. It does not seem as though your experience is the same as the type of support I am describing.

[Jocelyn]

Then I read your brief post about how you are shocked that a mental health professional would help, and I don't understand.  Could you please gently explain and help me understand what is shocking about this?

Thank you!

First- I'm a psychiatric social worker by training, and worked in community mental health for about 10 years. (currently I teach).
Mentally ill people have the same rights to privacy and confidentiality as anyone else. They have the right to refuse treatment. These rights are overriden only when the person is dangerous to himself or others.  In that case, the library should call 911 and the cops can notify the mental health center crisis worker to meet them at the library, if they need help (for example, if the person is on a ledge). But we had a stout rule that the cops were to secure the situation before we went in- that was after I responded on a call and the mentally ill person had over a dozen loaded guns. Our rule was that the cops were to transport the person to either the hospital or the jail, and we would respond and assess there.
I would seriously doubt that a mental status exam could be done in a library without violating HIPAA. If a person isn't dangerous to themselves or others, they have a legal right to be as mentally ill, and as loud and inappropriate, as they care to be in a public place, until they commit some other crime, when they can be taken into custody and a judge can rule on whether they are legally competent or whether they should be committed for assessment and/or treatment.
Now, it sounds like most of the patrons are going to conclude that there is something wrong with these people- but as a therapist, my presence sort of confirms the diagnosis. By even responding, I'm confirming that I have reason to believe this person is mentally ill- I wouldn't have left my office and come to the library if I didn't.
It's easy to say that a hallucinating psychotic person needs someone to step in and take control...but there's a slippery slope here. Suppose someone is having a bad day, and they yell at the library staff. Should they have to submit to a mental status exam because they might be mentally ill?  Think about all the Special Snowflakes we talk about here...some of them seem a little questionable to me, but where do we stop?  How about with state hospitals, where people were admitted with 'life sentences' because their families were embarrassed by their conduct? Or in the 19th century, when men could have their wives admitted for being poor housekeepers...since obviously any woman who didn't love to cook and clean had to be mentally ill? And how many dictatorships have admitted political dissidents to mental hospitals to silence them?

We had this exact situation (well, it was a fast food restaurant) happen when I was in practice. The CEO was furious that the psychologist on call hadn't responded, and threatened to fire her. He sent out a memo stating that we would go anywhere and assess anyone. He was stunned when the clinical director and assistant clinical director went to his office and told him that if he were serious, they were going back to their offices to prepare their letters of resignation.

I am not sure of the profession of the person who agreed to this...but my reading of the Code of Ethics for social workers is such that you could be brought up on legal charges and lose your license for going up to people who are not endangering anyone, and starting to do a mental status exam in full view of others.

I hope this makes it clearer.

[CuriousParty]

There are public mental health teams in many areas whose job it is to identify mentally ill individuals who are in need of services including treatment, residential placement, access to benefits, etc.  I assume this is the type of program Yarnspinner's supervisor has called, and if so then it is entirely within their purview and they are both trained and equipped for the needs of the library patrons she describes (though of course some may still decline the assistance).  It's not as if he opened up a phone book and called up the first therapist he saw (I do hope).

Oh ok. We don't have anything like that here and I was completely confuzzled as to how having mental health staff camped out would help the situation. A policeman can escort them away for anything from trespassing to suspected public intoxication; could a nurse or therapist have that power?

Hence my confusion.

Totally understandable!  These types of programs don't tend to be well known unless someone has had a need for them, and I can see how the original post could be misunderstood as just flipping open the Yellow Pages so a therapist can come down and hunt for clients.

Thoug when you think of it, aside from being unethical and inappropriate, that would be a terrible business model!