E Krebs, PhD 🧂
@SaltySicky
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Asst prof of health & culture @FordhamNYC . Research on suicide, disability, mad justice. Dog's best friend. 🧗🏼🚲🌲
Asleep, probably.
Joined November 2018
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Pinned Tweet
It's
#WorldSuicidePreventionDay
!
As a suicidologist and someone who has experienced chronic suicidality since age 9, I want to offer some insights that mainstream prevention orgs don't often share. 🧵
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A resource for anyone spending Thanksgiving with extended family:
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I learned by age 9 that I couldn't talk about suicidal thoughts because I would end up locked in a psych ward. We can't expect people to just "speak up" or "tell someone" in a country where discrimination, institutionalization, & incarceration of suicidal folks is 100% legal.
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One way to be a disability justice ally right now:
Keep wearing your mask.
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Thoughts from a suicidologist on the new 988 crisis hotline:
1. Having a simple number is good.
2. Having more trained crisis teams is good.
2. It's still linked to nonconsensual active rescue which means they can & will trace your call & send police if they deem it necessary.
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A student just used the phrase "as we normalize the pandemic" instead of "as we return to normal" and I love it.
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Reporting someone for being suicidal can get them kicked out of college & fired from jobs. It can even cause them to lose custody of their kids. Mandatory reporting policies are dangerous & are aimed at protecting businesses and organizations from liability, not helping people.
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A real life
#NYC
horror story. 🧵
I was watching Netflix with my cat laying on the couch. All of a sudden he got up, eyes wide and ears forward, and ran over to the wall. 1/
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And yes, Hopper is a very good, smart kitty. He got plenty of extra treats and love yesterday, plus some nasty wet food today. He purred while eating it.
Hopper has wobbly cat syndrome (cerebellar hypoplasia) so he doesn't really catch critters, but he's good at locating them.
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There are many ways to handle mental health crises that don't involve cops or involuntary psychiatric care. Access to childcare, meals, emergency funds, and affordable medical care can go a long way. Being in a community where people can talk openly about suicidality is huge.
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My research as a critical suicidologist means I often critique nonconsensual (carceral) psychiatric care. Lots of people have asked what I recommend as an alternative. 🧵
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Suicidal ideation does not mean a person needs to be immediately hospitalized against their will. A significant portion of the population experiences suicidal ideation and never acts on it. I'd argue that it's a "normal" response to many difficult life situations.
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Suicidality isn't always episodic. That means that for some people, the desire to die never goes away. We wake up, think about it, and carry on with our day. I've seen this called "grey suicidality" online and it's fairly common. Again, not an emergency.
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The United Nations has called involuntary psychiatric care a form of torture but it's still regularly practiced on suicidal patients in the US. Involuntary 72-hour ("5150") holds are the norm for people deemed a threat to themselves. During this time, consent goes out the window.
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Chronically ill culture is having symptoms that would send most people to the ER, then saying "idk maybe it'll go away" and laying on the couch instead.
#NEISvoid
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If your accessibility system requires “proof” of disability, then it’s not accessible.
#DisabilityTwitter
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There are crisis hotlines that don't engage with police or nonconsensual active rescue. 988 is NOT one of these safe hotlines. Instead, check out
@TransLifeline
,
@CallBlackLine
, &
@SamaritansNYC
.
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This is hugely problematic & a barrier for folks who want help. They won't call if they know it's not truly confidential. This is for a good reason, as people can & do get fired from jobs, lose housing, lose access to their kids, etc. after being deemed a danger to themselves.
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Second, police kill people with actual or assumed mental illnesses at very high rates, and they're rarely trained for mental health crisis intervention. They're also an organization based on containment and punishment, not care or healing.
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Suicide risk following involuntary psychiatric hospitalization skyrockets. While 5150 holds may prevent a person from dying in one moment of crisis, they don't protect people long term.
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If you want to learn about anti-carceral mental healthcare practices (meaning care where patients don't lose their rights or autonomy), check out
@projectlets
,
@fireweedHJ
,
@idha_nyc
,
@Mad_In_America
, and
@TransLifeline
.
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We took the bat across the street to the park and let it go.
It flew into a tree.
I'm not sleeping tonight.
The end.
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5150 holds are one of the only legal circumstances in the USA where people can be forced to undergo medical treatments and ingest food or liquids against their will.
(The other circumstances include treatment of minors, intellectually disabled adults, and incarcerated people.)
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Nonconsensual active rescue often leads to nonconsensual treatment (being locked in a psych ward without consent). This type of "carceral care" is an incredibly violent and dehumanizing process, and suicide risk skyrockets after release.
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#988Lifeline
openly engages in nonconsensual active rescue despite its harms and lack of effectiveness. Callers seeking phone support can end up being escorted by police to a psychiatric hospital against their will--sometimes at gunpoint if the officers deem the person dangerous.
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Writing a dissertation that heavily critiqued suicide prevention efforts & theorized the desire to die as a queer desire, I didn't think many people would be onboard.
BUT, I just received Dissertation of the Year awards from 2 NCA divisions: GLBTQ & Critical Cultural Studies. 🎉
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Watching Mormon missionaries try to convert people while
@kanyewest
and the
#SundayService
choir belt gospel... Classic.
#justUtahthings
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I know we’re almost 2 years in, but it still stuns me how many people I consider[ed] very loving, caring humans are refusing to take basic precautions and refusing even harder to acknowledge that their actions are harming others.
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On unsolicited advice for chronically ill folks: Why do we get so upset when you recommend a book, diet, vitamin, exercise, essential oil, tea, meditation, etc?
THREAD. 🧵
#NEISvoid
#ChronicPain
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These issues with police violence are even more prevalent when the person in crisis is a person of color, a trans person, an immigrant, and/or a member of other marginalized groups often facing violence at the hands of police.
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If you want to read more about suicide and helping suicidal people from social justice perspectives, I highly recommend this book:
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If you're looking to understand the perspectives of suicide survivors,
@lttphoto
has an incredible collection of narratives shared by these people. It's publicly available online. Definite content warnings though! They often discuss methods and other triggering concepts in depth.
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Folks still on this train: I assessed my risk in line with medical guidance & based on additional info not shared in this Twitter thread. I have a full healthcare team. We've got it. Continued unsolicited medical advice from strangers on the internet is unhelpful & unwelcome. ✌🏼
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And voilà! We got it! (Note the one glove, one sock combo.) 15/
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Here's a great article by
@TransLifeline
about why they never engage if you nonconsensual active rescue:
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We could do something very similar for people in mental health crises. If they disclose that they're struggling to a mandated reporter, they should be presented with transparent resources that clearly outline multiple paths forward. That choice and agency is crucial.
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To everyone talking about rabies: I'm not worried since the bat was never loose in my apartment. It was in a utility closet that is sealed from the rest of the unit. No bites or exposed skin during the capture.
NY Health guidelines:
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People love to make a meal for a temporarily sick or pinjured person, but the difficulty of chronic illness is that it doesn't fit the "get well soon" narrative. It's scary bc we have to confront that independence isn't possible for everyone--& might one day be impossible for us.
People’s capacity for sustained care is extremely limited. We are really good when we know something is time limited, that we can show up and provide or offer something and it will be helpful or useful at the time; and then the person will get better. That we can handle.
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Someone in a Tesla just honked to hurry me out of my parking spot. Now I have to sit here until both of us are dead.
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1. When it comes to mandated reporting in schools, we can follow the lead of recent shifts in sexual violence reporting procedures. Instead of always involving police or formal reports, most colleges now simply reach out to the student with a list of potential resources.
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Pushing for more mental health facilities instead of more policing isn’t the social justice move many people think it is. Those facilities function on the same carceral logics and systems as prisons, and they often partner with cops when it comes to involuntary containment. (1/4)
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P.S. Please don't be a jerk in the replies. Take time to figure out how to share your thoughts without denying other people's experiences or dunking on them.
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Video description: Me, a white person in checkered boxer shorts and a sweatshirt, standing in the open doorway and shutting the door promptly after screaming. 13/
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First of all, this is a fantastic question! While we critique oppressive systems, we also need to build and support better alternatives. Here are some ideas:
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Now this cat is not a playful guy. He's a couch potato. So I paused the TV and followed him. He was staring at a spot on the wall, then up slowly moved his gaze toward the ceiling. Then he started walking around my apartment, looking up and chirping. 2/
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Here's an op-ed about 988 and its downfalls:
And a bit more about nonconsensual active rescue from
@Mad_In_America
:
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Now, my super is absolutely not going to deal with this at 9pm. He wouldn't deal with it at 9am if we're being honest. I waited 4 months for him to fix a light.
So we went for it. 10/
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If you have differing perspectives, feel free to share. Psychiatric care has helped many people and it's not my goal to deny that. Instead, I want to have conversations about shifting conditions & policies that would enable more people to find helpful, non-carceral crisis care.
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These include easy to discern info about confidentiality and precisely what each resource can do for the student, as well as the potential ramifications of those resources. This includes engaging hospitals, police, housing departments, counseling, LGBTQ centers, and more.
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2. For folks with known mental health issues, having a psychiatric advanced directive is a great idea. You can work with a friend or trusted professional to create a plan for what types of treatment you want and don't want in a time of crisis.
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1. Because it’s condescending. It suggests that we haven’t done our own research, or aren’t smart enough to consider these ideas. (Anyone recommending yoga or veganism, this is for you. It’s not like we haven’t heard of these things.)
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Making it simple for
#SuicidePreventionMonth
:
People need to be able to talk about suicide & suicidality without fear of being locked up.
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Those resources should also be presented to all students/staff/faculty as part of training, just like sexual violence resources. We should have an awareness of our options as early as possible. Then we also know options for supporting others.
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I was fully prepared to move out at this point.
I gathered a neighbor and we went onto the roof to see if rats were scurrying around up there. They're all over the sidewalks and streets outside my building, so this seemed plausible. 5/
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2. Because it feels like victim blaming. It insinuates that it’s our choice to be sick because we don’t want to try new ideas, or we’re just too lazy or closed-minded to do so.
(Truly, if our conditions had easy & accessible cures, we wouldn’t be sick!)
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Something was clanking around on the inside of my metal light fixtures and walking around inside the ceiling. (It's important to note that I live on the top floor, so no one is above me.) 4/
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We switched to a bowl and piece of cardboard technique. 14/
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We need to dismantle legal systems that make this violence possible. And for the time being, share resources that DON'T engage in police interventions or involuntary hospitalization. Some of them include:
@CallBlackLine
,
@TransLifeline
,
@SamaritansNYC
. 988 is NOT a safe resource.
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No one should have to call a suicide hotline trying to edit what they say to avoid police and other nonconsensual interventions.
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4. Because it erases our reality. Chronic illnesses are, as the name suggests, chronic. They aren’t going away. When you refuse to acknowledge that, you’re refusing to see our lives as they are. That compounds the isolation we experience.
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3. We need more crisis lines that are *truly confidential* like
@TransLifeline
and
@SamaritansNYC
. If people can be truly honest with someone over the phone without fear of nonconsensual interventions, that's a huge step.
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This format could be applied to suicide crisis websites (government & otherwise), as well as hotlines. For example, callers could be emailed or texted transparent resource lists w/info on consent & ramifications. And there should be webpages with this info easily accessible.
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Nothing was up there, but we noticed a bunch of vents that had no mesh or grates on them. Not a good sign. 6/
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If you're interested in learning more about suicide, crisis care, and mad justice, I recommend following
@projectlets
&
@Mad_In_America
to start.
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So we came back into my apartment and stood silently to see if we could hear the noise again.
I heard it and said, "RIGHT HERE. Can you hear that?!" The neighbor couldn't, but we were right next to my furnace closet so he opened the door. 7/
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3. Because it’s not what most of us want from our friends: Support. Offering a quick [non]fix derails conversations and gets you off the hook from being truly present with us and our experiences.
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There are so many options. Suicidality often stems from feeling trapped in mental anguish, and having multiple doorways out--down on paper--can help many people. The key to these plans is to have many possibilities and as much transparency as possible. Agency is crucial.
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Huge
#accessibility
news: Google Chrome now offers live auto-captioning for ANY video/audio anywhere on the internet.
Because they’re auto-generated, it’s still important to add your own captions when making a video. BUT this is a massive leap for web access.
#DisabilityTwitter
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Overall, we need more funding in anti-carceral care systems, more consent & agency in mental healthcare, & more resources for changing the conditions that drive people toward suicide. We need to build more habitable worlds for suicidal people, not punish them for wanting to die.
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@SuperNurseRN
He was much cuter flying away and into the night than he was inside my wall, that's for sure.
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Someday I will proofread before clicking Tweet. But for now, here's one more great resource for folks interested in anti-carceral community practices:
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5. Because if we wanted advice, we’d ask for it!
Truly. I have asked friends **who are also chronically ill** for advice many times. It’s been hugely helpful! But if we don’t ask, don’t try to backseat drive our medical care or lifestyle choices.
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I could only find one glove so I put it on one hand and put a sock on the other, then tried to gently grab the bat using some old t-shirts. 11/
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Note: This doesn't mean all colleges are doing sexual violence resource sharing perfectly. But some have produced a model that I believe has powerful potential for mental health resources.
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I think it's great for most people to have one of these plans! We can create them when not in crisis so we can understand our options before a crisis comes. It's also a great space to have open conversations with loved ones about our values & concerns with treatment.
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Similar plans can involve things outside medical care as well. For example, a list of loved ones to call, a list of activities that make you feel grounded, travel funding to get to loved ones, a list of people who can watch your kids or pets for a few days...
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Academic job market horror story:
My friend just interviewed for her first TT position. A few days later they called & offered her the job via phone. They said they would email official paperwork later that day. 🍾🎉💃🏼
30min later they called back & said "oops, wrong person." 🙃
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He’s going to stutter. Don’t mock it. Don’t make dementia jokes.
If you’re upset that he won, find another point to critique.
#CripTheVote
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.
@stefkaufman
(founder of
@projectlets
) is another fantastic Mad justice human to follow.
I don’t think people understand the reality of what happens when police show up to your house for a wellness check or “safety”intervention. If you survive, it’s enough to traumatize you + stop you from *ever* sharing your truth again. Forced into a life of emotional isolation.
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The pandemic of the “The Unvaccinated” isn’t just about anti-vaxxers. It’s also immune-compromised folks who can’t make antibodies, kids under vaccination age, and folks around the world without vaccine access.
#CripTheVote
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In addition to being a compassionate witness, trained crisis workers can help people find resources for things like housing, food insecurity, safe disposal of drugs or firearms, rehab programs, intimate partner violence, financial support, abortion resources, and more.
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As Omicron data comes out, remember: Mild COVID still produces
#LongCOVID
.
I had an infection in 2016 that created a neurological disability. Now I feel sick every day, my body doesn't regulate heart rate or digestion, & my income is drained by med bills.
I really think most people's conception of Long Covid is "I'll get a little winded walking up stairs" and not "I'll get an incurable neurological disease worthy of an Oliver Sacks book" and that's a communication problem
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6. 💀💀
@SaltySicky
@ChronicSalt
Usually I find those offering essential oils, supplements, etc are just trying to sell them to me. They see me as a target and that is hurtful, not helpful.
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Most of these resources can help a suicidal person out of a crisis far better than police showing up at the caller's home/work without their consent.
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And these hotline volunteers/workers would still be able to call emergency services for a person IF (and only if) that person requests it. But if they caller doesn't, there are tons of other supports the hotline can provide. Many already do this.
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The diss analyzed 140 attempt survivors' stories about their experiences w/crisis care.
2 sentence summary:
Forcing someone to live isn't the same as saving their lives or making those lives livable. We need to be able to talk about suicide without fear of being locked up.
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Those are my 5 reasons. If you’re also chronically ill and/or disabled, feel free to add your own reasons in the replies. I’ll add them to the list and highlight any differing perspectives!
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They can help people figure out what kinds of mental healthcare their insurance covers and where to go for it, or help people find free clinics and centers for pro-bono services if needed.
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Just a note: Online teaching often requires WAY more working hours and zero extra pay. For me, it’s about double.
#AcademicChatter
WHY ARE SCHOOLS CHARGING FULL TUITION FOR ONLINE CLASSES AND WHY ARE WE AGREEING
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Another great resource: @/Dandelion.Hill on Instagram has crowdsourced and collected a list of mental healthcare providers invested in abolition and anti-carceral care:
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The fact that they added alt-text that's not really alt-text is just icing on the cake.
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This means 988 callers can't be sure whether or not their calls are confidential. There's no clarity on whether or not carceral care is on the table. For a crisis line to be most effective, transparency & consent are key.
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If you have more ideas, please feel free to share! And follow some of the following for great mad justice content:
@Mad_In_America
@fireweedHJ
@projectlets
@idha_nyc
@TransLifeline
@SamaritansNYC
@WldflwrAlliance
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Before anyone says this is irresponsible: Most ER docs aren't trained to treat chronic/complex patients so they typically can't help anyway. Also, $$.
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2. The infrastructure for all of these local crisis centers just isn't there yet. If they aren't present or are currently at capacity, 988 is acting as a shortcut to the National Suicide Prevention Lifeline, which openly uses geolocation & engages nonconsensual active rescue.
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Twitter,
@Dysautonomia
, &
#NEISvoid
rightfully jumped on this one & I'm going to unpack why this study is so harmful.
Obviously, saying that
#POTS
stems from a fear of standing up is preposterous. But that published conclusion isn't even supported by the study's data. 🧵
Norcliffe et al. show that in patients with postural tachycardia syndrome, the increase in heart rate that occurs upon standing is associated with a fear-conditioned response involving sympatho-adrenal activation.
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