The dispatch call from the Concord, N.H., police department is brief. A woman returning to her truck spotted a man underneath. She confronted him. The man fled. Now the woman wants a police officer to make sure her truck is OK.

“Here we go,” mutters Officer Brian Cregg as he steps on the gas. In less than three minutes, he’s driving across the back of a Walmart parking lot, looking for a man on the run.

“There he is,” says Cregg. The officer pulls to a stop and approaches a man who fits the caller’s description. Cregg frisks the man, whose name is Kerry. NPR has agreed to only use Kerry’s first name because he may have serious mental health and substance use problems.

“Why were you lying on the ground under a truck?” Cregg demands.

Kerry, head hanging, rocks back and forth, offering quiet one-line answers to Cregg’s questions. There’s a contest, Kerry says. The prize is a new pick-up truck, and he just has to find the truck with a key hidden underneath. He says he’s searched three so far.

“Kerry did you take anything today?” Cregg asks. “You’re not acting right.”

“No, no,” says Kerry, shaking his head forcefully. “I’m just stressed out.”

Cregg watches Kerry, looking for signs — is this meth or a mental health problem? Over the past three or so years, as meth has surged in New Hampshire and across the U.S., it’s become hard to tell. Police in many areas of the country where meth has maintained a steady presence have more experience making an assessment, but in Concord and many parts of the Northeast, the onslaught of meth is new.

Concord police say they need to know whether they’re dealing with a mental health issue or drugs — or both — because it can make a difference in determining the best response.

Concord may send six to eight officers to subdue someone darting through traffic who is high on meth. The calming techniques these officers learned during training for a mental health crisis intervention don’t seem to work as well when someone is out of control on methamphetamine. Several officers are recovering from injuries sustained during meth-related calls.

“Stay right there for me, all right?” Cregg tells Kerry. “I like you too much — stay right there.”

Cregg walks a few steps away from Kerry to speak to one of two other officers called to this scene. It turns out this is the third time in the past few months that alarmed drivers have reported finding Kerry under their car. Cregg decides Kerry’s delusions are mental health issues, and doesn’t call for more backup.

Kerry, now cuffed, climbs into the back of Cregg’s cruiser and they head for the station. Kerry’s suspected crime: prowling.

“Hey, uh, Kerry — man, you feel like you want to go up to the hospital to speak to somebody?” Cregg asks a version of this question four times.

“No, no,” Kerry says repeatedly, “I’ve been through that route years ago; don’t want to do it again.”

Kerry says later that getting stuck in a hospital emergency room — waiting days, maybe weeks for an opening in a psych treatment program — makes his anxiety much worse.

At the station, Cregg finds something that changes his view of the day’s events.

“What is that, Kerry?” Cregg asks, pulling a tiny plastic bag of glistening white shards out of Kerry’s coin pocket. It appears to be meth. “This explains a lot.”

Cregg says what he thought was psychotic behavior likely had more to do with meth.

But “on that call, they mimicked each other. I wasn’t able to tell at first,” Cregg says.

That may be because Kerry is one of the 9.2 million Americans coping with both a mental health problem and a substance use disorder. In this particular case, not being able to tell what fueled Kerry’s delusions didn’t cause any problems for him or the police. Things never got out of hand. But Concord Police Chief Brad Osgood says calls triggered by meth are often more challenging than this one.

“With somebody that’s high on methamphetamine, you want to treat them a little firmer and control them,” Osgood says, “because they often are very volatile and aggressive and you just want to treat that hostility, differently.”

With meth now accounting for 60% of drug seizures in Concord, police say they often default to that firmer approach. Some mental health advocates worry that may mean police are using too much force with their clients. Sam Cochran, a retired major in the Memphis police department who co-founded and now helps lead the crisis intervention police training program, CIT International, says officers aren’t making a diagnosis.

“The officer’s foremost is ‘how do I open up communications?How do I get compliance in order to accomplish safety?’ ” Cochran says.

There are visual signs of longer-term meth use that are less likely to show up among mental health patients: skin wounds and scabs, rotting teeth, dilated pupils. But addiction medicine specialists agree that it is difficult to determine what’s going on, at first glance, with someone who appears extremely agitated.

“The possession of methamphetamine may be a clue, but teasing out the acute effects of methamphetamine versus a long-standing mental illness may take a longer period of time, says Dr. Melissa Weimer, an assistant professor of medicine at Yale School of Medicine. She notes that the effects of meth can last for 72 hours or longer.

Surging meth use is relatively new in New England. Cochran, a veteran of the Memphis police department, has dealt for years with this issue of meth’s effects mimicking mental health issues. He says slowing things down and diffusing fear can work when dealing with people who are high on meth.

“But let’s be real, there are some individuals that are so sick,” Cochran says, that “officers find themselves having to act immediately to protect safety. Sometimes that may mean a hands-on approach.”

Cochran and another mental health advocate, Dr. Margie Balfour, an associate professor of psychiatry at the University of Arizona, say the goal is to only use force as a last resort.

“And then, ideally,” Balfour says, “whether it’s meth or mental health or both … you’re going to be able to take that person to somewhere where they are going to get treatment — and not to jail.”

Balfour is also chief of Quality and Clinical Innovation at Connections Health Solutions. The organization operates a network of psychiatric crisis centers in Arizona where, instead of making an arrest, police can drop off anyone 24 hours a day who is out of control on meth or who has a mental health condition. Balfour says 20% of adults seen at Connections test positive for meth.

Kerry was due in a New Hampshire court last week, where a judge could have ordered drug treatment or an evaluation. Kerry didn’t show up for that arraignment — but says he is trying to reschedule.

This story is part of a reporting partnership that includes WBUR, NPR and Kaiser Health News.

Let’s block ads! (Why?)

October marks the start of a new flu season, with a rise in likely cases already showing up in Louisiana and other spots, federal statistics show.

The advice from federal health officials remains clear and consistent: Get the flu vaccine as soon as possible, especially if you’re pregnant or have asthma or another underlying condition that makes you more likely to catch a bad case.

Make no mistake: Complications from the flu are scary, says Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tenn., who is part of a committee that advises federal health officials on immunization practices.

“As we get older, more of us get heart disease, lung disease, diabetes, asthma,” Schaffner says. “Those diseases predispose us to complications of flu — pneumonia, hospitalization or death. We need to make vaccination a routine part of chronic health management.”

Federal recommendations, he says, are that “anyone and everyone 6 months old and older in the United States should get vaccinated each and every year.” People 65 and above and pregnant women, along with patients who have underlying medical issues, should make haste to get that shot, if they haven’t already, Schaffner says.

Within a typical year, about two-thirds of people over 65 get vaccinated against the flu, studies show, compared with 45% of adults overall and 55% to 60% of children. But only about half of pregnant women get vaccinated, and immunization rates for people with chronic diseases hovers around 30% to 40%.

Take the case of JoJo O’Neal, a 55-year-old radio personality and music show host in Orlando, Fla., who was diagnosed with adult onset asthma in 2004 at age 40. For years she didn’t get the flu vaccine, figuring her healthful diet, intense exercise and overall fitness would be protective enough.

“I skated along for a lot of years,” O’Neal says, “and then, finally, in 2018 — boom! It hit me, and it hit me hard.” She was out of work for nearly two weeks and could barely move. She was extremely nauseated and had an excruciating headache and aching body, she says. “I spent a lot of time just sitting on my couch feeling miserable.”

O’Neal says it takes a lot to “shut her down,” but this bout with the flu certainly did. Even more upsetting, she says, she passed the virus on to her sister who has chronic obstructive pulmonary disease. Fortunately, neither she nor her sister had to be hospitalized, but they certainly worried about it.

“We have lung issues and worry about breathing, so having the flu created lots of anxiety,” O’Neal says. This year, she’s not taking any chances: She has already gotten her flu shot.

That’s absolutely the right decision, says Dr. MeiLan Han, professor of internal medicine in the division of pulmonary and critical care medicine at the University of Michigan Health System and a national spokesperson for the American Lung Association.

If generally healthy people contract the flu, they may feel sick for a week or more, she says. But for someone with underlying lung conditions, it can take longer to recover from the flu — three to four weeks. “What I worry about most with these patients,” Han says, “is hospitalization and respiratory failure.”

In fact, Han says, 92% of adults hospitalized for the flu have at least one underlying chronic condition such as diabetes, asthma, or kidney or liver disorders.

When people with underlying lung conditions contract the flu, she says, “the virus goes right to the lung, and it can make a situation where it’s hard to breathe even harder.”

Other chronic health conditions — diabetes, HIV and cancer, among them — impair the immune system, Han explains, making people with those conditions unable to mount a robust response to the flu virus without the immunization boost of a flu shot.

That means the inflammation and infection when they get the flu can become more severe, she says.

Even many of her own patients don’t realize how bad a case of the flu can be, Han says.

“People often tell me, ‘That’s not me. I’ve never had the flu. I’m not at risk, and I’m not around people who might give me the flu.’ “

O’Neal says she’d always figured she wasn’t at risk either — until the flu flattened her.

Healthy pregnant women, too, are more prone to complications and hospitalization if they contract the flu and are strongly urged by the Centers for Disease Control and Prevention and OB-GYNs to get vaccinated against both influenza and pertussis. Yet the majority of mothers-to-be surveyed in the United States — 65% — have not been immunized against those two illnesses, according to a recent CDC Vital Signs report.

Some women mistakenly worry that the flu vaccine isn’t safe for them or their babies. “I think some of the fears about safety are certainly understandable, but they’re misinformed,” says Dr. Alicia Fry, chief of the epidemiology and prevention branch of the CDC’s Influenza Division.

The evidence is clear, Fry says: The vaccine is extremely safe. And she points to a recent study showing that immunization against flu reduces the risk of flu hospitalization among pregnant women by 40%.

As for worries that the woman’s vaccination might not be safe for her developing fetus, Fry says the opposite is true. When a pregnant woman is immunized, antibodies that fight the flu virus cross the placenta and can protect her baby in those critical months before and after birth.

“It can prevent 70% of the illness associated with flu viruses in the baby,” Fry says. “So it’s a double protection: Mom is protected, and the baby’s protected.” Infants can’t get the flu vaccine themselves until they are 6 months old.

Now, the vaccine won’t protect against all strains of the flu virus that may be circulating. But Schaffner says the shot is still very much worth getting this year and every year.

“Although it’s not perfect, the vaccine we have today actually prevents a lot of disease completely,” he says. “And even if you do get the flu, it’s likely to be less severe, and you’ll be less likely to develop complications.”

Let’s block ads! (Why?)