Tony Mantor: Why Not Me the World
Lynn Nanos: Navigating Psychosis: A Mobile Crisis Worker's Perspective
Wed, 28 May 2025
Send us a textLynn Nanos, a mobile psychiatric emergency social worker with 15+ years experience, shares insights on evaluating and helping people with serious mental illness in crisis situations. Her work bridges the gap between law enforcement and mental healthcare, providing crucial interventions for individuals experiencing psychosis and other mental health emergencies.• Conducts psychiatric evaluations in various settings including homes, police stations, nursing homes, and even public spaces• Assesses whether individuals need hospitalization or can be referred to outpatient treatment• Works with police to divert people from the criminal justice system when possible• Explains the "revolving door" problem with brief hospital stays leading to recurring crises• Advocates for Assisted Outpatient Treatment (AOT) to reduce homelessness, hospitalization, and incarceration• Discusses anosognosia (lack of awareness of illness) affecting up to 97% of untreated schizophrenia patients• Clarifies that most people with mental illness are not violent and are more likely to be victims• Highlights the difference between psychosis and borderline personality disorder interventions• Emphasizes that mental illnesses are brain disorders that shouldn't be stigmatizedContact us at TonyMantor.com if you would like to share your story on our show. Tell everyone everywhere about Why Not Me, the conversations we're having, and the inspiration our guests give to everyone that you are not alone in this world.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)
Chapter 1: What is the main focus of Lynn Nanos's work?
And if they don't need to be hospitalized, I can refer them to outpatient treatment programs or give them self-help material. I'm an LICSW, which is Licensed Independent Clinical Social Worker, and that gives me the ability to authorize involuntary transfers to the hospital for people who are unsafe.
Do you work with the police alongside them, or lots of times do you work without them?
Some cases involve referrals from police officers, and other cases don't involve the police. So it really varies.
So when you are involved with the police, what's the criteria for you to work with them so you can get everything you need under control and create a better situation for everyone involved?
Well, I do a psychiatric evaluation with the police and I try to divert them away from the criminal justice system from being arrested. I can authorize involuntary holds. which in Massachusetts is called a Section 12. And if the person in crisis is out of control and uncooperative and not willing to go to the hospital, the police can help to, along with me, persuade them
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Chapter 2: How does Lynn Nanos assess individuals in crisis?
the person to agree to hospitalization. They use restraint as a last resort, and I typically don't see people being restrained because we can usually persuade them to agree to the hospitalization, but occasionally they have to be forcibly restrained.
So if it does get out of control where they have to be restrained and they need medication, is that done there or at a different time?
I don't have anything to do with medication. The medication occurs at the hospital setting, like after they're transported to the hospital.
Okay, that makes sense. So what led you to get into this business? It's not your everyday nine-to-five job that people think of. So what drew you to doing this profession?
Well, I've always been most invigorated by helping the sickest of the sick, the people who are least functional. I really enjoy helping people. I always found it really, you know, tragically ironic that the people who are most sick seem to be the least helped by the government. They seem to be the most underserved people. And this motivates me to want to help them.
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Chapter 3: What role do police officers play in mental health interventions?
And so I've always felt most comfortable dealing with people who are very sick with psychosis usually.
I think that's great. So what's your first approach when you first come onto the scene? How do you handle this with the person that you're going to be looking at and ultimately trying to help out? So what's the first thing that you do?
Well, I begin with telling them that I want to get to know them a little bit, ask them a few questions to try to figure out how to best help them out. And I ask some background questions. And then, of course, there are the safety questions, which are critical. There are questions involving history of past suicide attempts.
history of hallucinations, whether the person is suicidal or having any thoughts of wanting to harm others right now. I use my instinct and my gut a lot because I've been doing this work for many years. I can tell if someone needs to be hospitalized usually pretty quickly.
Sometimes it takes longer than other times, but I think my instinct has been well-developed at this point so that I can determine pretty quickly if someone needs to be involuntarily transferred to the hospital or voluntarily hospitalized. They usually go voluntarily. So like I said, seeing people being restrained and going against their will is not very common. I mean, it does happen.
So if you're in a situation where someone just does not want to go to the hospital at all, and you know they need help, they might be in a situation where they may not realize they need the help, but they do need the help. So what's your approach? How do you get them to settle down, calm down, and get them to a point of where you can actually help them?
Well, oftentimes I say that, you know, you're not acting like your true self. You're not yourself these days. Or I haven't said this often, but I have on occasion come right out and said, you're not in touch with reality. You're not yourself. You're having a hard time taking care of yourself. And they've been down this road many times in the past.
The presence of police officers and security guards, usually just their presence is enough for them to cooperate.
That's good. You kind of caught me off guard a little. I thought the presence of the police might be a little more intimidating for them. So that's really good that it worked out. Now, if you've seen a person a couple of times and you've gone through all these situations, how is that handled? Has that created a relationship, so to speak, with them so they understand you and trust you?
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Chapter 4: What is anosognosia and how does it affect treatment?
And AOT oftentimes uses the black robe effect, which is People, they're more likely to follow treatment plans and they're more likely to follow through with treatment when there's a judge ordering them to do the treatment because of the judge's power and influence. And that's called the black robe effect.
And there have been lots of studies showing that AOT reduces rates of homelessness, hospitalization and incarcerations. It also prevents violence, prevents suicides. It's a tool that Massachusetts and Connecticut really need to adopt if we want to see a decrease in these horrible markers.
Okay, you just brought up anosognosia. Can you explain that to the listeners so they can understand what it is compared to other serious mental illnesses?
Well, psychosis involves the most anosognosia among the serious mental illnesses. I can usually tell if there's lack of insight or anosognosia involved when there's lack of adherence to taking medications. and not attending outpatient appointments. These are some red flags and signs that there's some anosognosia going on.
And a few studies have shown that the rate of anosognosia in schizophrenia spectrum disorders can be up to even 97% for those who are not treated.
So if they're being treated, then that gives them the opportunity to lead a fulfilling life and it gets rid of all that noise that's going on in their head. Is that correct?
Right, absolutely. They'll be able to have more organized thought process. Hallucinations will lessen. Delusions will hopefully dissipate. As a result, less tragedy is likely to occur.
So if Massachusetts was to get and pass AOT, that would help everything that you're trying to do, correct?
Definitely. It would decrease the revolving door. It would prevent tragedies from occurring. And it would just overall improve the functioning of those with serious mental illness, especially those with psychosis. And when I say psychosis, psychosis can be medically caused, but I'm just referring to psychosis in the context of serious mental illness.
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Chapter 5: How can Assisted Outpatient Treatment (AOT) improve mental health outcomes?
When someone is clearly suicidal with planned means intent, that is a very straightforward case. A lot of cases involving psychosis can be really tricky and involve a lot of gray areas because there are varying degrees of psychosis. And someone can be very psychotic with the ability to take care of herself and even have a job. clean herself, eat, sleep, do basic functions.
And just because someone is psychotic doesn't necessarily mean that they qualify for hospitalization. Someone can be psychotic and very high functioning. A straightforward case would be if someone tells me that he has nothing to live for. There's nothing going on in his life that gives him hope or motivation to continue living.
And he has a plan to hang himself and, you know, go to Home Depot and buy the tools for it. And he knows exactly where he's going to do it. And that's a case that's like, for lack of a better word, easy.
So how do you talk them down off that cliff? I mean, from what I understand, the ones that are talking about it are the ones that, I'm not going to say less likely, but sometimes will not follow through. But the ones that don't talk about it much, they're the ones that might just go ahead and do it because they've kind of pre-planned it.
So what do you do to help them so that way you can talk them down off that cliff and
Well, I think praising strengths is really important. So reminding them of some light, even though they're only seeing darkness, and making sure that the right questions are asked. I found that... Secretiveness when it comes to suicidality is a big red flag for me.
So if someone is dodging my questions, someone is not answering me directly when I ask about the questions pertaining to suicide, then I get really concerned.
What happens when you have some that are thinking about it, they don't follow through, but yet they're thinking about it. They go back and forth. Is that a situation to where you get concerned?
That's very common with borderline personality disorder. People with borderline personality disorder have oftentimes chronic daily thoughts of suicide at baseline.
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Chapter 6: What are the challenges of diagnosing mental health issues in emergency settings?
So it's very important that people know the differences between everything so that the understanding is there for them to at least have a little empathy for them.
Right. And it's really important to understand and tell the audience that most people with mental illness are not violent and they're more likely to be victimized. But a small subset of the population with untreated, serious mental illness, mostly involving psychosis, can be more violent.
Right. One of the things that I have heard is the ones that are not violent can oftentimes be the victims. And many people think that they are creating victims when they really aren't.
Yes. Yeah.
Yeah. It's a very tough subject. Not a lot of people want to do it because there's so much stigma attached to it. Then a lot of people don't want to talk about it for that same reason. There's a lot of stigma attached to it.
Yes, unfortunately, there is still stigma associated with mental illness, but there really shouldn't be because these are brain disorders and the brain is part of the physical body and it's organic. You know, these are brain-based disorders that really shouldn't be stigmatized.
Yeah, unfortunately, it's very sad. People that think about psychosis tend to go to the very worst case scenarios. The news media, unfortunately, carries a lot of the worst parts of it where people kill somebody or something bad happens. But as you said, a lot of people can actually thrive in life.
Yeah, absolutely, with proper treatment. Yeah.
Well, this has been great. Great conversation, great information. I really appreciate you taking the time to come on.
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