I've been fortunate to never work with the mentally ill in a therapeutic setting. I say fortunate, because that would be a very difficult job. I mainly have dealt with the receiving end
, and in the course of my job, the crisis times. I've talked to them in suicide mode and in confused mode and just trying to keep them together in different situations while waiting to get an ambulance or police or some kind of help there, and sometimes it takes 30-45 minutes in a big city. From my experience and mine only. When mentally ill people are in a crisis state they are usually out to harm themselves. If it is a hostage situation and they want to hurt others, they are also going to take themselves along. They rarely, rarely ever want to hurt, target someone else and leave themselves whole and untouched in their mind's scenario. My ex when truly going through an episode would be suicidal or suicidal with thoughts of taking his kids (we never had any together) down with him. When lucid and playing the system it was deliberate. ""oh you told the doctor you were scared? here is something to be scared of""" that kind of thing, always directed out, never at himself. That seems to be the difference.