The Case of Bob

The case of Bob demonstrates use of the Triage Assessment Form: Crisis Intervention in a crisis that poignantly demonstrates the need to listen to clients and not make assumptions. Initially the clinician made an assumption about the nature of Bob’s crisis, only to discover that the precipitating event was not the actual crisis. Again the first 10 to 15 minutes of the interview are reported. The setting is an urban mental health clinic that offers a walk-in crisis service to anyone who enters.

Bob, a white man in his mid-40s, entered the clinic late one afternoon. He was visibly anxious and his appearance was disheveled. His eyes were red and he spoke between sobs. He stated that he had been wandering around “all day” and needed to talk with someone as soon as possible. The on-call clinician was contacted and was available to see Bob immediately. The only information the on-call clinician had was that Bob had wan- dered into the clinic and he seemed to be in crisis.

While still in the waiting area Bob began to tell his story. His speech was slurred by his continuous sobbing, making it difficult to understand him. He kept repeating some- thing about his wife’s being ill and in the hospital. The clinician interrupted him and asked whether his wife was in the hospital. Bob put his head in his hands and began crying even harder, unable to speak. When he lifted his head he had a blank expression and said, “She’s dead, you idiot; haven’t you heard anything I’ve said?” The clinician responded by stating his sorrow about the loss. This statement seemed to calm Bob, and he said again that his wife had died last night. She had become ill quite suddenly and died within a week. He added that he had been wandering around all night not knowing what to do or whom to call. He said he had been talking to strangers on the street, anyone who would listen to him. Although Bob was dressed appropriately, his clothes looked unkempt. His personal hygiene also was poor as evidenced by body odor and bad breath.