How a psychiatrist rebuilt trust with a patient in crisis

I was trained in my first month of residency, during onboarding, to always position myself closest to the door when interviewing a patient, as situations can escalate quickly and become potentially dangerous. “If a patient stands, you stand,” my preceptor said to me during safety training. Her words came back to me in that moment.

I stood.

“Adetola, I can see that you’re feeling very concerned right now. Can you tell me more about how you’re feeling?” I said, in my most calm voice, while my heart began to race. I wasn’t scared, per se, it was just one of my first times encountering a Black patient in the psychiatry ward, and I knew that his intense distrust was not undue; Black patients have historically been treated differentially in psychiatry, especially in the emergency departments. Black men, moreover, are more likely to have physical restraints used, and higher doses of tranquilizing medications administered, driven partly by a subconscious fear that they will be more aggressive and require more sedatives. I wanted to not only “do no harm” but also reinforce the most positive experience he could have in the emergency room, as this often dictates whether patients will return when in crisis or continue with follow-up.

“You are going to lock me up like an animal again, aren’t you?” said Adetola, with eyes that looked more terrified than threatening.

“We are only here to help you, Adetola, and I can’t be certain what that help may look like while you’re here. But I promise that we will do our best to make you feel better, and less scared.” I kept my eyes on him, soft and fixed, as he paced the back perimeter of the room.

“Would you be OK taking a seat?” I asked. He did.

Demi continued to reassure his father, and shared with us more details of prior hospitalizations, visits to the emergency department, prior medication trials, and stories of how his mother was able to ground Adetola in moments of distress.

Gathering collateral information is one of the most important parts of the psychiatric assessment, as patients with psychosis or altered realities may not always remember details, or will have limited insight into the initial symptoms and course of their disease.

“Demi!” Adetola cried out. “Enough! Enough! Enough!” he screamed, before bursting into wails and calling out for [his deceased wife] Tolu. He stood up and threw the notebook across the room.

“Papa,” said Demi, with jagged breathing and a shaky voice, “I will take you to go and see Mama soon, but remember how she would remind you to breathe? Breathe with me, Papa.”

Adetola looked at his son through tears. He fell back into the chair and began to slow his breathing through deep, protracted breaths. Demi released an audible sigh, reflecting the collective relief the nurse and I hid behind a wall of professional composure.

“He’s not always like this, Doctor,” said Demi.

Adetola was a vibrant, intelligent man and loving father, he shared, who was kind and helpful toward his neighbours, and had great rapport in his business. He stressed, above all else, that he wouldn’t hurt anyone, even when he was “like this.”

“He was restrained and heavily medicated during his last hospitalization,” Demi continued. This had caused him to become distrustful of the doctors (in Canada) and the medical system more broadly.

“I’m so sorry that you experienced that, Adetola. I can only imagine how unsafe and terrified you must have felt,” I said, knowing my words of comfort fell woefully short of imparting a sense of ease.

“Please, just don’t hurt my father, Doctor. Please. I know he might look like he could hurt someone when he’s like this, but he won’t. He is a good person, very loving. He just hasn’t been well since Mama died. Just please don’t hurt him. Treat him like the other patients you’re taking care of.” He broke down in sobs.

I understood, through his coded language, that, as a Black man, Adetola might face differential treatment in the emergency department, like undue force from security and other excessive treatment measures. Within recent years, media headlines surfaced about Black people experiencing mental illness and dying in the process of getting help. Demi surely also understood that racist stereotypes portray Black men as more violent and aggressive, especially when experiencing mental illness.

It was clear that he was building a case for his father that served more than to inform his treatment course—it was to protect him.

“I understand your concerns, and I want you to know that I will do everything to ensure that your father is safe here, as will the other doctors, nursing staff and support team,” I responded, as Demi grew more emotional.

“I can see that it would be hard to believe me, given everything you’ve both been through, but as a Black physician I can appreciate why you and your father are scared about him being in the psychiatry department with a mental health crisis, and possibly being treated differently.” Demi looked forlornly at his father, while I further tried to placate his concerns.

The role reversal of son protecting father struck a chord with me, as a daughter often called to protect and advocate for her mother in medical settings and beyond.

“Doctor,” Demi said. “Thank you, truly. You have no idea how grateful I am to know that there is someone like you here who is helping taking care of my dad,” he continued, sniffling through his gratitude.

“Can you please make sure that the other ones understand, as you do, that he is just like the other patients, and should be treated the same way as everyone else? Please, Doctor, you know how they can treat us in here.”

I didn’t think my heart could sink any further, but it did. I discreetly turned my head toward the ceiling, averting tears. His voice, though heavily accented with a Nigerian lilt, reminded me of my own brother’s: soft but hurting. Adetola was all he had left, and he would never give up on his father. I reassured them both once more, explaining the developing assessment and plan, and promised to relay their concerns to the rest of his care team.

Adetola agreed to take a small dose of Ativan, and soon he began to doze off in the assessment room.

Chika Oriuwa is a psychiatrist and author of Unlike the Rest: A Doctor’s Story.