On July 6, 2024, Sonya Massey, 36, called 911 to report a potential home intruder at her home in Springfield, Ill. “Don’t hurt me,” were her first words to the two officers who responded. Deputy Sean Grayson reassured her, “Why would I hurt you? You called us.” When Massey was questioned about her mental well-being, she confirmed taking her medicine. Minutes later, Grayson shot and killed her. After the shooting, Grayson labeled her as “crazy” and not deserving of first aid. Video of the killing of Massey was released this week, and chillingly conveys how yet another defenseless Black woman was seen as a threat by armed police officers.
Between 2019 and 2021, approximately 180 calls for help resulted in law enforcement shooting and killing the very people in need. A majority of these individuals had a history of a mental health crisis or were in an active mental health crisis that they or a family member were reporting.
Emergency physicians liked us are trained and expected to respond to high-risk, potentially violent situations every shift. Emergency department staff experience high rates of verbal and physical assault. Triggers of escalation may be related to mental health crises, illicit substance use, personality disorder, or spontaneous and unpredictable outbursts in other otherwise emotionally stable people. When a patient appears agitated, we attempt to de-escalate the situation by lowering our voices, speaking slowly, and offering reassurance. At times, we negotiate their needs with services we can provide. We try to avoid speaking loudly, crowding the patient, and cursing at the patient, as Grayson did. If possible, we slowly peel back security in the room to remove any sense of threat the patient may perceive.
If verbal de-escalation is unsuccessful and if a patient remains agitated, medications and restraints are then used. Oral medications, versus intramuscular injections, are preferred, when safe to administer, as they are less traumatic for patients. No matter the cause, clinicians desire to practice controlled and safe de-escalation using verbal redirection as a first line, followed by mechanical restraints and the use of medications.
Massey’s family has confirmed her diagnosis of paranoid schizophrenia. Individuals living with paranoid schizophrenia may report home intruders and may struggle with focus and organization. In the released body cam footage, Massey was distracted, unsettled, and frightened. She required both redirection and reassurance. These behaviors suggest to us, as emergency physicians, that a patient may have a mental health issue that needs further attention. Given Massey’s medical history and suspicion of an intruder, her unease and fear in front of the officers seem reasonable. Regardless of her mental health status, being alone with armed officers, especially after hearing a potential intruder outside, could be disorienting and intimidating for anyone. Nothing about her behavior in the footage appeared to be difficult to control or redirect when compared to the behaviors of similarly distressed patients in the emergency department.
Controlling distressed individuals can require specific skills and pose challenges. However, when errors occur, clinicians are ethically bound to disclose the truth. Massey’s father was told that she had been killed by an intruder. Another person on the scene called the cause of death “self-inflicted,” implying she committed suicide. These inaccuracies, along with Grayson calling Massey “crazy,” weaponized her mental health condition and minimized Grayson’s actions. That the truth can be concealed or be completely subverted by law enforcement is gravely concerning for us as physicians and Black women.
There is another critical moment that needs to be addressed, and that is the speed with which Massey’s interaction with police quickly went from routine to deadly. As two academic, Black women physicians, we have become familiar with the same speed at which we can turn from “pet to threat.” The “pet to threat” phenomenon, coined by Dr. Kecia Thomas, describes how Black women are treated in the workplace and academia when they demonstrate ambition and assertiveness. The classic example is of a Black woman who is seen as a “pet project,” someone who needs support and guidance. And yet, a shattering change occurs when this person shows growth, authority, passion, fear, confusion, or empowerment.
Throughout our medical education, training, and careers, when expressing emotions such as fear, confusion, anger or even disappointment, we were not afforded the same grace, compassion, or resources as our peers. Massey’s killing is a significant example of the ways the “pet to threat” phenomenon transcends the workplace. Even in her most vulnerable moment, retreating to her kitchen floor, hands in the air, apologizing for her actions, she swiftly shifted from “in need” to threatening.
Massey’s tragic story highlights the importance of officers being compassionate to those seeking support, being trained on safe de-escalation tactics, and the need for accessible and specialized mental health crisis response teams. Only 15-17% of police agencies have Crisis Intervention Trainings (CIT) that train officers on how to respond to mental health crises. CIT programs have been shown to decrease mental health stigma, reduce the force used by officers, and reroute people to mental health facilities instead of jail. However, these trainings are not universally mandated.
CIT training should be mandatory for all police officers. However, police officers should not be expected to replace a trained mental health professional. In the emergency department, we work in teams with our nursing staff, social workers, and psychiatry team. States should also invest in programs and the use of mental health professionals similar to Oregon’s CAHOOTS program, San Francisco’s Crisis Response Unit, and Massachusetts’ Community Assistance Response and Engagement, which incorporate social workers and mental health professionals during responses to mental health crises. These programs have demonstrated not only a reduction in hospital and public safety costs but also provide a safer environment for individuals experiencing a mental health crisis, allowing them to receive the care they need.
In a society that has repeatedly failed Black women, Sonya Massey’s final words, “Okay, I’m sorry,” have left us unsettled that she felt responsible for a system that failed her.
Onyeka T. Otugo is an emergency medicine physician at Brigham and Women’s Hospital in Boston and an instructor in emergency medicine at Harvard Medical School. Adaira I. Landry is an emergency medicine physician at Brigham and Women’s Hospital and an assistant professor of emergency medicine at Harvard Medical School.