Suicide: What Will Happen To You When You Ask For Help?

The Triage Process

Whether you end up at the ER or the office of a mental health professional, you can expect to be interviewed in order to establish the acuteness and lethality of your present suicide risk. In a hospital environment this entrance interview is typically known as triage. If your risk of harming yourself is judged to be severe, you will likely be asked to enter the hospital as a psychiatric patient on an inpatient unit. If your suicide risk is judged to be lower than severe, you will likely be given some names of local mental health professionals and sent home.

You can expect a similar introductory interview to be part of your first interactions with any psychiatrists or psychotherapists you may work with on an outpatient basis. Those professionals also must establish your level of suicide risk and the type of care necessary to reasonably ensure your safety. See the section below concerning the Initial Treatment Interview, for a list of some of the questions you may be asked that help professionals to understand your current level of suicide risk. Even if you start off in a clinician's office, if you are judged to be acutely suicidal, you may be asked to enter the hospital for a while. If you are not judged to be an acute risk, you will likely be offered psychiatric and/or psychotherapeutic care consistent with your presenting symptoms, and your suicidality risk will be monitored on an ongoing basis.

Please be as open and honest as you can during this triage process. Try to let go of any shame you may experience at feeling suicidal and focus on describing what you are thinking and feeling as accurately as possible. Suicidality is often a response to overwhelming stress; it does not mean you are "crazy". Many people feel at least vaguely suicidal at some point in their lives, and a substantial minority of them will experience a true suicidal crisis. Most of those people recover, and recovery is a strong possibility for you as well if you allow helpers to know what is happening so that they can respond appropriately.

Inpatient Treatment

If the doctor or therapist performing triage on you determines that you are not safe to return home, he or she will discuss more intensive levels of help that might benefit you, including voluntary and involuntary forms of hospitalization.

Voluntary psychiatric or substance abuse hospitalization (or similar crisis treatment facilities) are often recommended if you are judged to be at high risk for suicide and are willing to be admitted for treatment. If you are judged to be a high risk for suicide and refuse your therapist's recommendation for voluntary hospitalization, or if you are intoxicated, you may be lawfully hospitalized against your will for several days. In many states, involuntary substance abuse and psychiatric systems are separate, so whether you are intoxicated will determine which type of involuntary hospitalization will be used.

Voluntary and involuntary hospitalization processes differ from state to state (sometimes even within states). Someone's need for involuntary hospitalization is usually determined by two court-appointed medical specialists. As a result, you may be interviewed multiple times; first by a triage doctor, and then later by one or more mental health professionals who will determine whether you require commitment (as the process of involuntary hospitalization is commonly known).

Be as open and honest and as accurate as you can be when discussing your condition with such specialist doctors. It may be annoying and irritating to have to repeat yourself multiple times, but this repetition is actually for your benefit so that you are not railroaded into an unnecessary hospitalization. The process is typically designed such that separate doctors must speak with you directly and arrive independently at the same opinion that hospitalization is necessary to keep you safe before you can be restrained against your will.

Many people fear involuntary commitment and are resistant to the idea of seeking help for their suicidal feelings purely on the basis of this fear. In addition to fears of being restrained (in a locked hospital unit), many people fear that they may be hospitalized indefinitely. While you might indeed be admitted to a locked unit for a few days, any fears you have of indefinite hospitalization should be put to rest now. In today's modern world, you probably would not be hospitalized indefinitely even if you really needed it. It's too expensive to keep people in the hospital for long periods of time. Financial and other societal factors work together to minimize the duration of all hospital stays.

A typical involuntary hospitalization scenario in the U.S. works like this. Your initial commitment period lasts at most three days, after which it must be reviewed by two court-appointed mental health specialists (typically psychiatrists) who can re-certify it for perhaps an additional three days. All the while, insurance companies (and the courts) are reviewing your progress closely with an eye to ordering your discharge as soon as possible so that their costs are kept to a minimum. It is the rare and very ill patient who is kept hospitalized on an indefinite basis these days. In fact, in many cases today, patients are discharged before they feel they are ready to go home, while they are still feeling somewhat overwhelmed and suicidal.

If you enter the hospital on a voluntary basis, you are typically free to leave the hospital once your level of suicidality has decreased. However, if it seems to your doctors that you continue to be an acute risk for suicide and you decide to leave the hospital against medical advice, your doctors may be allowed by law to ask for involuntary commitment at that point (i.e., you started off as a voluntary patient, but then become an involuntary one). Involuntary hospitalization may also be extended while your suicide risk remains high, but such extensions require additional assessment procedures and certification by a court or a mental health court, depending on the laws in your area.

Unfortunately, there may not be any available hospital beds in your area at the particular time you need one. In such a case, the mental health professional who is in charge of the triage procedure will work to find another crisis facility that you can go to. If a suitable placement cannot be found for you when you need it, do what you can do to set up a circumstance for yourself that will help keep you safe. Call your psychotherapist (if you have one), local crisis lines and supportive friends and family as necessary. Ask a reliable family member or friend to stay with you until you are feeling safer.

Regardless of the circumstances of your hospitalization, it is okay to ask questions about the nature of your treatment. Questions such as how long you will be hospitalized, and what you can expect to occur while you're hospitalized are very reasonable and should be answered by hospital staff to the best of their abilities.

While in the hospital, you will likely be interviewed at least once by a psychiatrist, who may prescribe various medications. You will also generally be asked to participate in individual and group therapy sessions. The more you cooperate with your treatment recommendations and requirements, the better you are likely to feel.

If you believe that your care plan is not helpful or appropriate, it is okay to say so. Offering alternative treatment ideas may prove more successful than simply expressing dissatisfaction. You can also ask for help from your psychotherapist, a family member, a friend, a legal advocate or an advocacy organization such a local NAMI (National Association for the Mentally Ill) chapter. It is best to discuss your objections and ideas in as calm and rational a manner as possible, so as to best be listened to and taken seriously. Hospital staff members must maintain an orderly environment for all patients under their care, and they may restrain patients who throw fits or temper tantrums in order to keep the general peace. Restraint techniques used by hospital staff members are designed and regulated so as to be as non-harmful as possible for the individuals being restrained, but they still suck. It is always best to avoid the need for restraint in the first place.

Comments
  • Anonymous-1

    My wife is in the hospital now for suicide but she was on medicine and that was one of the side effects of it, she's good on nothing but they want her to be on something. They say its a crap shoot anyways the medicines and now I think they want to keep her for insurance reasons only. I need help with this, we have been married for 13 years this is the first time ever

  • Patient X

    I think it is good that this article lets people know about the possibility that they will be forcibly committed to a hospital if they seek treatment for suicidal thoughts or attempts. When I went to a psychiatric emergency room to apply for entrance to an outpatient therapy program, I had no idea that I was at risk of being involuntarily committed. The doctors who committed me were not compassionate and respectful as this article claims they will be. I was completely unprepared and shocked at how they used force to remove me from all the things that provided me with comfort at that difficult time in my life - my home, freedom, the community that I had been painstakingly working to integrate myself into for months, and the respect of my friends and family. On the psych ward I was bullied, humiliated and treated as sub-human by the doctors and staff. After they released me, I spent the first 24 hours at home hiding and shaking in my basement trying to feel safe. It was not long before the after-effects of the involuntary commitment experience triggered my first uncontrollable bout of self-directed violence. The whole experience sent me on a downward spiral that has not abated, and I do not expect to live through the end of the year. I would like people considering seeking help for suicidal thoughts to understand that the system is not always competent or caring. In the end, if you choose to seek help from the mental health system, you will have to live with consequences or die by them.

  • Anonymous-2

    Patient X,

    I regret your having had such negative experiences when you were hospitalized for suicidality. However, I do want to both correct one thing you mention in the hope of clarifying the issue:

    People are not hospitalized for suicidal ideation or thinking. If that were the case half the world population would be hospitalized.

    People are hospitalized if, upon the review of the attending psychiatrist along with the rest of the emergency team, find that the patient is in real danger of attempting suicide. It's the "intention" that is assessed, or, the level of danger. Their job is to protect and help the patient.

    I have no explanation for how you were treated but, based on my experience working in the psych E.R., staff does their best to be kind and helpful to a person who is fragile. However, there always exceptions to the rule.

    Dr. Schwartz

  • The Truth

    "People are not hospitalized for suicidal ideation or thinking"


    That is not true at all if you so much say anything about thinking about suicide you are imediatly involventarily hospitalized. Maybe you should tell people the truth instead of just making an already bad situation worse.

  • Anonymous-3

    A friend called 911 after a bout of self injury when I was drinking and I was taken to my local ER, treated, had all of my things taken from me, and told I had to stay. The next morning I recovered from the alcohol but was still transferred to the county psychiatric hospital where I was evaluated, and was committed. I did not express any suicidal plans. Even though my therapist was affiliated with the hospital (she worked for the same community mental health company), I still had to stay. I know that my therapist knew I was there because the social worker told me she had called her.

    Why didn't my therapist stick up for me when it was SI that started things?

  • Patricia

    After I was told they would "help" me I found I was being taken to jail where I stayed for 3 days. I went to a hearing where they paternalistically decided to commit me. There is no "treatment" unless you call the weekly 10 minute talk with the psychatrist who only says "suicide should never be an option." The focus is always on going through the motions so you can "get out of the hospital." That's what they talk about all the time, not any treatment. I was there a month, and we maybe had 2 group times that I would call useful. Otherwise it was just fluff and filler. Worst of all, if I'd have had any money to pay them, it would have cost me a fortune for total bullshit. For the patients committed as a suicide risk, it's all about following the rules and telling them what they want to hear. I really did hope I would get something useful and tried to having a meaningful conversation with my psychiatrist, but he never responded other than saying I was "very articulate," which did not help. You will be on the list of "mental defectives" for the rest of your life, and if they put you in jail awaiting a bed they will put your mugshot on the internet, like they did to me. I even complained and got a SB2229 sent to MS legislature no more mugshots but it "died in committee." Folks, we are the best scapegoats in sight for all the school shootings. HR 4717, the Helping Families in Mental Health Crisis Act, "the Murphy Bill" is trying to make it easier to commit us, take away our privacy rights and our access to advocacy while in mental hospitals (where there are some people who will abuse you if they get the chance, along with some nice people). I wish I had lied my a*s off at my psychiatric interviews. They won't help you. Call a friend or pastor or a nonprofessional and talk about your problems but don't say anything about suicide. People are naiive like my friend was, and will get you in the system. You don't want to be on their radar, especially not now.

  • Anonymous

    My friend had an appointment with a psychiatrist. During the several month wait, she had called them twice to inform them that she was suicidal and that she needed to be seen as soon as possible. They informed her that it was not an option. Is the psychiatric office supposed to help the patient before anything happens or not?

  • Betsy

    Your friend was not a patient of that Doctor at the time. Therefore, he is not responsible for her care. His office could have been more compassionate, but if your friend had gone to the office and expressed suicidal intent, that office would have referred her to the hospital enyway...

    If you are ever feeling suicidal, call a crisis hotline or go to an emergency room.

    People only get "committed" if they refuse to contract for safety.

  • no

    psych wards don't help at all. talking about suicide may be helpful, but psych wards are basically prison, punishing you for trying to talk. they only goal of it is to generate money for the doctors, easy money, cuz they don't do a damn thing to help you. they make your life worse: you can't take care of pets, lose your job, can't pay rent, all because you've been imprisoned for being honest about how you feel. its a crime against humanity. people need help, but the medical professionals aren't offering any, they are just getting rich by abusing people.

  • sickninja

    So the past few days, i've had a LOT of thoughts about suicide, of course, this really is a daily issue for me the past 30 years.

    I post this, because i sit needing help, because i really do NOT want to kill myself, it's just one day i may...

    I've gone to psych's, and MHMR, etc.. taken medications, lots of medications, and really, even medicated to the gills, i feel the exact same way, I tried turning to god, no help, no friends of family either, etc.. boohoo pitty me, etc etc..

    that's not what im posting this for, just a little background,

    two months ago, I went to a gal i know sells heroin, told her, "I need a gram, in a rig, now, so i can kill myself"

    she looked at me funny, then said "here is 1.25grams, it should do the trick.. "

    and proceeded to demand lots of money.. anyone realize what they just read?

    this person was completely aware of my intention, demanded the money, then proceeded to want to hang out...it meant nothing to her, i was going to kill myself...

    i obliged, went my way, and was trying to get the nuts to do it...

    i hate this, i feel it all the time, but just like anything else in life.. i don't finish what i start..

    so i go to the ER for psych at the local general hospital..

    tell the doc what was up, welll, it wasn't a doc, it was some sort of psych assistant,

    she says, are you thinking about killing yourself now?

    i was like,, "Duh, that's why i'm here" "that's what i told triage"

    she was like "Do you have thoughts of cutting yourself?

    i was like... look b1tch, don't patronize me, you're reading to me from a script, like a customer service agent at GEICO"

    so i whipped out the syringe, shook it, warmed it by rolling it in my hands, and then she FINALLY actually looked at me, as i plunged the needle into my arm, get this, i dont use heroin, so.. a tenth of a gram would have been fatal for me,

    her eyes widened, i plunged the plunger, my eyes rolled back "white out for re, nothingness"

    well, apparently, doctors are hip on narcan everywhere,

    9 hours later, im awake, handcuffed to a bed, and now im awaiting sentencing for a 3rd degree felony suicide charge, 2-10 years..

    how is this helping me?

    bond was 25,000 dollars...

    someone anonymous bailed me out..

    im going to get more heroin