How can bystanders address mental health crises?

Training from a Brattleboro insurance agency lets people develop compassionate strategy for responding to those experiencing a psychiatric emergency and to discern when such incidents can be dangerous

BRATTLEBORO — Imagine walking downtown through the Harmony Lot in broad daylight when a young man approaches and asks you for some money. You refuse. He passes by you and then starts shouting and howling into the wind. He's not even looking at you as he shouts.

Disconcerting? Yes, of course. Threatening? Could be.

Did you cause the incident? You'll never know.

Is there anything you can do about it? Well, maybe.

One person who knows how to handle events like these is Shannon Prescott, 40, who works for The Richards Group as the insurance agency's director of risk control services, assisting clients with complying with state and federal workplace regulations and helping them evaluate and implement safety programs.

Prescott has been trained in Mental Health First Aid by the National Council for Mental Wellbeing and has been teaching courses in it since 2019.

"I've experienced this myself in downtown Brattleboro," she said. "There's a gentleman who is often downtown throughout the day, and normally, he just keeps to himself. He doesn't look at anybody. He looks down to the ground. He sometimes is talking to himself, but he doesn't pay any attention to anybody else. And he's not bothering anybody. So I've never felt threatened by this man."

One day, however, as Prescott was walking down Main Street, she saw this man actually out in the crosswalk, yelling and shaking his fist and getting in front of cars and pointing at cars.

"He was clearly agitated," Prescott said. "He wasn't throwing anything. He didn't have weapons. He wasn't hitting the cars. But he was going to scare other people."

She said she was concerned for him at the moment, "because he was in a dangerous situation and he might not understand fully what's happening. Also, it's putting himself and others in danger."

Prescott immediately called 911.

"I told them there's a gentleman here and I think he's having some psychosis," Prescott said. "He's jumping in front of cars and yelling at cars, and I'm afraid someone's going to get hurt."

Then Prescott found a safe spot and waited for the police.

"The great thing about Brattleboro PD is that we have social workers attached to the police department who can respond with them," Prescott said. "So if you let them know that this is a mental health crisis, they can [provide] the correct mental health response."

She called Brattleboro "a really lucky community to have something like that."

"Not every community does," Prescott said. "And that's really what we're trying to move towards, so that we can have the right response for our police. It's for their protection as well."

A nation's vicious cycle

The country, as a whole, is experiencing a mental health crisis - just ask the people in Lewiston, Maine. Their recent mass shooter may have had a home but, according to various news accounts, he was also hearing voices and his mental instability was known by local police well before he took up his rifle and shot up a bunch of innocent people on Oct. 25.

To exacerbate the problem, the U.S. has an ever-increasing population of people who are unsheltered, living on the streets, and who are badly in need of support services.

These people have multiple issues, including mental health, physical health, and substance use, all of which can be exacerbated by - and exacerbate - the stress of living with housing insecurity.

And they're interfacing with a housed population also walking around with its own mental health problems and anxiety.

It appears as if our whole society is living in a vicious cycle of deaths from overdoses, from drug deals gone wrong, from suicides, from home, auto, and retail store theft. It feeds the general anxiety. It's not good for the community or the country.

How do we help while staying safe ourselves?

How best to help

Mental Health First Aid teaches participants what they need to know about mental health and substance-use issues.

"When a person is struggling with any kind of recovery or kind of mental health challenge, that's where the Mental Health First Aid comes in," Prescott said. "The class is really focused on helping people feel more competent about approaching when something happens or when they recognize that something's going on."

The program seeks to make the idea as common as offering physical first aid in an emergency. If a person is bleeding, we might offer them a bandage or a tissue. If a person appears to be having a heart attack, we can try CPR - if we know how to do it. If a person is struggling with dehydration, we can offer them a bottle of water.

But what do we do when we see someone standing in the middle of a busy roadway, trying to fight a car?

That is where Prescott comes in.

First of all, she says, we must acknowledge that at one time or another, most of us have struggled with a mental health issue. She uses herself as an example.

"My daughter was diagnosed with Type 1 diabetes in 2021," Prescott said. "And it was an emergent situation. She was near coma. Watching this happen was the most traumatic thing I've ever been through in my life. And then learning that our entire life [would be] completely different now. And having to figure out: How are we going to afford this?"

It changed her.

"I wasn't even able to teach my Mental Health First Aid classes for a time. I tried, and I really struggled through a class, because I just had too many raw emotions," Prescott said. "I'm very thankful to my employer because they understood that I needed time to step back."

Mental health issues can present themselves in younger workers as well as in older ones; employers need to be sensitive and aware.

"People can be one way in the beginning and slowly deteriorate or start developing situations," Prescott said.

"And certainly everybody right now is struggling with recovering from trauma from the pandemic, or anything else that happened over these last few years that maybe was traumatic for them," she added. "Maybe people of color are going through extreme trauma. There's lots of things going on right now. We all just need to be patient with each other."

Mental health issues can be frightening. There are hazards right now that are beyond our control, Prescott said.

"This isn't like something that we can throw a guard on or put a shield up in front of, or something we can put safety glasses on for," she said. "It's beyond what people are used to dealing with. And it's been building for a long time."

The issues are widespread. Over the past few months, Prescott said, every single commercial insurance client of hers is dealing with substance abuse issues touching their workforce or having an employee struggling with mental health.

"It comes up all the time," she said. "And in addition, with the closing down of the pandemic housing program, lots of people don't have places to go. So they are on the streets, or in the parking garages."

As a result, "that brings mental health out into the open and exposes its challenges to the general public, who are just going about their day," Prescott said. "Some of these challenges are really extreme. And they make people uncomfortable."

Prescott emphasized that people who are having episodes of psychosis on the street, as frightening as they may appear to strangers, are also simply struggling human beings.

"We're trying to remind people that these are humans that we're talking about," she said. "Sometimes it can be scary. Maybe somebody's getting aggressive or violent, which are two different things. Or it's scary because I don't know what to do and I feel for this person. Or sometimes I don't know if I should say anything."

Violence versus aggression

"The debate about addressing mental illness and violence often ignores key facts. Many people experience mental illnesses, so having had a diagnosed illness is not a very specific predictor of violent behavior," says the abstract for a 2014 paper, "Mental Illness and Violence: Lessons from the Evidence," in the American Journal of Public Health.

"This means that many proposed policy approaches, from expanded screening to more institutionalization, are unlikely to be effective," its authors continue. "Expanded access to effective treatments, although desirable, will have only modest impacts on violence rates. Most people with mental health problems do not commit violent acts, and most violent acts are not committed by people with diagnosed mental disorders."

That means that the vast majority of the time, mental illness has nothing to do with violent crime, and people with psychiatric disorders often suffer from the stigma and stereotyping.

In her trainings, Prescott notes the difference between aggression, which often comes from a state of fear when people are feeling they need to defend themselves, and violence, which is more calculated and planned.

"The statistic I use in the class is that 4% of violent crime is driven by somebody in an active mental health crisis," Prescott said.

But within that 4%, those mental health crises can account for deadly and heartbreaking results.

Prescott referred to the April murder of Leah Rosin-Pritchard, the manager of Morningside House shelter, operated by Groundworks Collaborative.

"The community is still trying to move forward from the horrific event at Groundworks," she said. "It was violence, for sure. But those of us outside of the situation don't know exactly what happened in the interactions that drove the violent act."

The event "could have been a form of aggression that went to violence," she added.

Zaaina Mahvish-Jammeh, who has been charged with first degree murder in Rosin-Pritchard's death, has been found not competent to stand trial and is in the custody of the Vermont Department of Mental Health under a one-year involuntary hospitalization order.

Groundworks, and its residence, Morningside House, are prime examples of places that have exposure to violence, Prescott said.

"Unfortunately, it just kind of comes with the territory of the job," she noted. "So every now and then we'll have a shocking event that we can't account for. How do we prepare people? And how do we take care of people if stuff does happen?"

Prescott said she has empathy "for people on both sides of this."

"The individual that did the act was struggling, and they're ill," she said. "But the entire community was affected by the loss of this person. It's a very hard situation."

Recently, Groundworks Collaborative was fined by the Vermont Occupational Safety and Health Administration for serious workplace violations that resulted in Rosin-Pritchard's death.

Uncomfortable on the street

Given the Groundworks death, plus the number of homeless people and panhandlers, many residents of Windham County say they now feel unsafe on the streets of Brattleboro. Many refuse to come downtown anymore.

"There's no one solution to solving the problem of what's going on downtown right now, unfortunately, because there are multiple issues," Prescott said. "Each individual is going to have their own set of needs that we need to try and address."

The first example: "Just finding someplace to have a shelter is complicated," she said.

"A lot of shelters require you to be sober to stay the night. And if somebody can't stay sober that day, they can't do that. So where does that person go?" Prescott said. "There's a lot to work through."

For people who want to grab lunch downtown, or shop, or maybe work in a downtown office, perhaps taking a self-defense class is an option.

"I think it's also important to take a Mental Health First Aid class so that you can have a better understanding if you happen to get into a crisis situation," Prescott said. "We talk about when safety becomes a concern. We talk about how to approach somebody who may be feeling aggressive or scary to you. When do I call 911? When do I call 988, the mental health crisis hotline?"

Once the national suicide prevention hotline, 988 is now a national mental health phone-in system. Each state, including Vermont, has its own volunteers who respond. When you call, a trained volunteer can talk you through whatever the crisis is.

"It's still very much meant for suicide prevention," Prescott said. "But anybody can call. I've even had friends call because they had a spouse that was making suicidal statements, and they didn't know what to do or how to approach it. In many communities, 988 can also connect you to emergency services if you need them."

What to do

Using Mental Health First Aid is not so different from common sense medical assistance.

"If you've ever taken a physical first aid class, it's the same thing," Prescott said. "The first thing you look for is the extreme things that we might need to call 911. If it's excessive bleeding, if they're not breathing, or they're not responding, we want to call 911."

In mental health, "that's a little bit harder, right?" she said. "We're not always sure. So we talk about how to assess somebody, what is a crisis situation, and when do we call 911."

Say, for example, that someone is self-harming and accidentally cuts themselves too deeply.

"Somebody who's self-harming is not intending to die by suicide," Prescott said. "Somebody who's self-harming is just intending to release emotions at that point. But sometimes accidents happen, and that's the 911 call.

"We look at early symptoms. We look at how to recognize when somebody might be struggling early on, because early intervention is key to recovery. So if we can get them in early stages, we're much more likely to get somebody into the right systems and through recovery."

Prescott remembers seeing two clearly intoxicated people walking down Putney Road.

"I don't know what they were on," she said. "They would weave themselves out into the road and then back and then they would yell at the cars if the cars got too close. So I pulled off over to the side and called 911. The operator let me know that others had already called it in. So people were on their way."

Calling for professional help is the least we can do for someone in that predicament, Prescott said.

"It's not safe for me to go and try to stop this man from jumping into traffic," she said. "It's absolutely not. But it is possible for me to step to the side, keep an eye on things, and call 911. Only approach if you feel it's safe for you to approach. If you don't feel like it's safe, or you feel like it's it's going to cause harm, then you should call 911."

Prescott has been trained to deal with people with schizophrenia, who may be hearing voices in their head.

"We do an audio hallucination exercise, where you get to experience what it's like to have an audio hallucination happen while you're just trying to do a normal day," Prescott said. "It can be a lot. I needed to step away, because it was too much. It got me."

But the exercise builds empathy, she said.

"I can understand why this disease is so difficult for somebody, because I couldn't do 20 seconds of it. You can't differentiate when the voice is speaking to you versus the person who is in front of you. You're trying to pay attention to the person in front of you, but this voice is saying really negative things in your ear. And really, all you can focus on is what they're saying," Prescott continued.

"Even though I know it's not true, and I know it's not a real thing, it's my brain trying to decipher what was happening, what just created chaos in my body," she said. "And I can't imagine having to live like that all the time."

How do you help someone in that situation?

"The idea is to connect to how they're feeling, not necessarily with what they're seeing or hearing," Prescott said. "So we don't want to validate the delusions or hallucinations. But we do want to connect."

So, she suggested: "Say something like, 'You seem really scared right now. What can I do to help you?' Try to de-escalate them to a point where maybe they can get calmed down, and then you could call for help. Ask, 'Is there somebody I could call for you?'"

Prescott recounted an experience she had in Massachusetts when she was teaching an early-morning class in a homeless shelter and found "a gentleman sleeping in his sleeping bag with all his belongings" in the entryway.

"I know that this man is dealing with mental health challenges because he just spent the night outside sleeping," she said. "There's no way that this person isn't traumatized by that in some way."

The safest way to handle the situation would have been to go back to her car and call for help.

"And then, actually, a worker showed up who was taking the class," she continued. "And she knew who he was. She woke him up. And he clearly was not on his medication. He has schizophrenia - I found that out after the fact because they know him very well. He'd been camping out there for the last few nights.

"They are never sure when he's going to show up. And he's been clearly unmedicated for a few days now. So somebody with schizophrenia who has been off their medication for days is going to start showing a lot of symptoms. He thought she was his sister, and that's part of his struggle right now - he's having some issues with his sister."

The man got upset and started throwing shoes at the worker.

"She had to remove herself from from the space," Prescott said. "He came out throwing shoes in the parking lot. And he was getting very upset and he was yelling, but not at us.

"Again, when I've experienced this stuff in public, it has never been an aggressive state towards anybody. This person is just upset in their own space right now. And he didn't know who we were or what was going on. And he had just woken up. I can relate - if I had just got woken up and was a little confused."

The worker called the man's counselor.

"Then we kept him in our peripheral vision and made sure he was safe, and that everybody else who came was safe," Prescott said.

"But we were allowing him to do what he needed to do," she continued. "And then he saw his counselor, and I saw his whole body relax. This was his trusted person."

Prescott said she uses this example in her class constantly, "because that staff executed perfectly what they should do in those situations. They handled him perfectly and with empathy and compassion. And had I been the one to try to wake him up, that could have turned into a 911 call."

The unthinkable becomes thinkable

It has not yet happened in Brattleboro, but after Lewiston, Maine, the town cannot discount the possibility that it might some day have to confront a public shooter.

"I can give my personal perspective here," Prescott said. "The best things we can do are to stay aware of our surroundings, listen to our instincts, and take an active shooter training course to learn how to protect yourselves in these rare situations.

"I do believe we need to continue to move towards making real changes in our support of individuals seeking help when the mental health challenge has become a crisis," Prescott said.

"But my heart goes out to all involved in Lewiston," she added. "It's a tragic event."

* * *

The best way to take a course with Prescott is to follow her on Facebook, check out, or email her at sprescott@therichardsgrp.

"We provide these trainings at no cost to our business insurance clients and we work on a fee base for all others," she said.

This News item by Joyce Marcel was written for The Commons.

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