Will I Be Committed to a Mental Hospital if I Tell a Therapist about my Suicidal Thoughts?

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Helsingør Psychiatric Hospital. Photo used with permission from JDS Architects.

You may be seriously considering suicide and yet not want to tell a therapist, because you fear landing in a mental hospital.

If you go to a therapist or psychiatrist and tell them you are seriously thinking of killing yourself, that does not necessarily mean you will be hospitalized. Hospitals are very strict these days about who they admit, and insurance companies are equally strict about covering a hospital stay. Some people joke that it is harder to get into a mental hospital than Harvard University.

Who Gets Hospitalized

Adults

Suicidal thoughts are not usually enough to warrant psychiatric hospitalization for adults. Instead, you would need to be in imminent danger (or in some states substantial danger) of trying to kill yourself. This generally means you are intent on acting very soon on your suicidal wishes. Perhaps you already have a plan on how you would kill yourself, you have whatever you need to carry out that plan, and you have some intent to follow through on that plan very soon.

If so, then yes, hospitalization would almost certainly be necessary. If you do not consent to be hospitalized (that is, you will not voluntarily admit yourself), then yes, a mental health professional would need to intervene to get you to a safe place. The reason for this is that serious suicidal intent is almost always temporary, as long as the person stays alive. Consider that even among people who attempt suicide and survive, more than 90% do not go on to die by suicide.

So, if you are thinking of killing yourself but do not intend to act on those thoughts any time soon, then a mental health professional most likely will not try to have you hospitalized. Instead, they will work to understand your reasons for wanting to die, to help you feel better, and to build up your coping skills.

If you a serious danger to yourself, however, then every effort will be made to keep you safe until the crisis passes and you are safe to be out on your own again.

Children and Adolescents

At many psychiatric hospitals, the standards for hospital admission tend to be more relaxed for children and adolescents. The younger a person is, the more alarming it can be that they would consider suicide. And children and adolescents are more impulsive than adults. So what I wrote above about strict criteria for hospitalization may not apply to young patients, because of the extra caution that they warrant. 

If You Do Need Hospitalization…

What are your fears of being hospitalized? Would you really rather die than go to a psychiatric hospital? If so, why?

Doctor In Discussion With Nurse At Nurses Station

Perhaps you fear being locked away for good, or at least for a long time. Most people do not stay in a mental hospital more than a few days, even if they come in with serious suicidal thoughts. Once upon a time, a great deal of patients did remain hospitalized for months and even years. Those days ended in the 1990s, when it became apparent that many hospitals were keeping patients longer than necessary for the sole purpose of collecting insurance money.

Perhaps you think mental hospitals are like that in One Flew Over the Cuckoo’s Nest or other Hollywood movies. But these days, hospitals do not use straitjackets on patients. In fact, they are not supposed to use restraints unless a patient is out of control and potentially violent. There are no bars on the windows unless it is a very old building. And nobody is forced to take “shock therapy,” more technically called electroconvulsive therapy (ECT). (Some people choose to receive ECT. It is a much safer, more humane procedure than it used to be, though it still can have dangerous side effects.)

If You are Admitted to a Psychiatric Hospital

Doctor psychiatric patient interviewThere are some important things to know about what happens in a psychiatric hospital. If you are admitted, a nurse or therapist will interview you about your problems, thoughts and feelings, and symptoms. You will be asked to turn over anything that could be used to try to hurt or kill yourself. This includes things like shoelaces, sharp items (called “sharps”), and belts. You will be evaluated to see if medication might help you. Depending on the hospital, you may participate in individual and group psychotherapy. You may have a room to yourself, or you may share.

There are definitely things that are scary about being in a psychiatric hospital. Staying with strangers, some of whom may have more serious problems than you, is frightening. Just as happens in any hospital, you do not have much privacy.

The unit is locked, and that can feel confining. You cannot come and go as you please. If you are very dangerous to yourself, you might have someone checking on you every 15 minutes or fewer, or even shadowing you.

All of these measures are to keep you safe from yourself. Suicides occur even in psychiatric hospitals, so every effort is made to protect you.

Someday, even if it is hard to imagine now, you may even be thankful that you were protected in this way.

 

© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for www.speakingofsuicide.com

 

Photos purchased from Fotolia.com

 

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  1. Anonymous says:

    What happens if you feel you will benefit from a psychiatric stay – even if briefly, but you do not have the money to do so? Will you be burdened with debt after your stay? Will you be denied access unless you are taken in as an involuntarily committed patient?

  2. I told my therapist and he threw me away. Ill never pay back the $3000+ the hospital charged me. Worst of all they could have cared less about me when I was there. All they did wa write in note books. BE WARNED MENTAL HOSPITALS ARE MENTAL PRISONS!!!!

  3. JJ says:

    Hi.

    I just had a question. If I tell my therapist that I’m suicidal and that I have a plan, is there any way to get treated without being hospitalized, or will they have me admitted because of the plan and intent?

    Thanks.

    JJ

    • Stacey Freedenthal, PhD, LCSW says:

      J.J., I don’t know the specifics of your situation so I will answer generally. And, generally, suicidal thoughts and a plan are not sufficient, by themselves, to warrant hospitalization. There also needs to be the intent to act soon, in fact quite soon, on those thoughts and plan.

      Of course, when anyone speaks in generalities, there are many situations that don’t apply. Someone with suicidal thoughts and a plan, but without the intent to act soon, might still warrant hospitalization if other factors are present, such as psychosis or inability to function.

      I have had quite a few clients who had suicidal thoughts and very detailed planning around how they would die by suicide, yet who did not need to be hospitalized. They did not have the intention to immediately carry out their plan (it was more like, “This is what I can do when and if the time comes….”) and they were able to collaborate with me on how to stay safe.

      Keep in mind that criteria for involuntary commitment tend to be quite stringent. The same applies, in many cities, to voluntary admission. Even people who are suicidal and want to be admitted to a hospital often are turned away. So I hope that fears of hospitalization will not stop you from seeking help.

      My best to you, and I am sorry you are dealing with suicidal thoughts! I hope other posts on this site can be of help to you, as well. Also please keep in mind the number of the National Suicide Prevention Hotline, which is open 24/7. The number is 800.273.TALK (8255).

  4. doc dave says:

    But there’s not good evidence that hospital admission saves lives. As a doctor I believe it’s more about showing care to avoid litigation. Despite suicide watch and removal of dangerous items / ligature points, a determined person will have little difficulty with suicide or more commonly act well to get discharged and then peform the deed. Starting medication, ect and or intense psychotherapy seem legitimate reasons for admission, but inpatient suicides still occur.

    • Stacey Freedenthal, PhD, LCSW says:

      Doc Dave, you are absolutely right about the limitations of hospitals. I address this briefly in my post about limitations in helping suicide people, which you can find here. Specifically, I write:

      “Even inside locked psychiatric hospital units, even when patients are under constant supervision, some patients die by suicide. That is staggering. It is also illuminating. If mental health professionals and psychiatric hospitals cannot prevent all suicides, then how can friends and family be expected to do so?”

      And I agree with you about hospitalization often serving solely to protect the mental health professional from liability. In fact, I think many professionals (and clients, family, friends, etc.) place excess hope in hospitalization, as if it will cure suicidality in 3 days or less.

      Finally, I don’t think there’s *any* evidence that hospitalization saves lives, but I am not entirely sure. There definitely is not, as you said, good evidence. The problem is, how does one really study this? We can’t randomize dangerously suicidal people into a no-treatment group, or even into an uncontrolled environment.

      These are all points I intend, at some point, to write about more in the future. Thank you for sharing your thoughts and adding to the discussion.

  5. Jes says:

    i’ve been feeling very Suicidal lately and my parents know that i have been cutting and stuff but i’m just really sick of crying so much over school problems and personal problems i really just want to tell my mum that i want to go to hospital and get help because i don’t feel safe at home anymore due to recent things that i have experianced. I hate being at home i really do all i can think about is family fights and something else i do not feel like saying i just really want to leave or run away but i know it would be better going to hospital insted of killing myself/running away but i just don’t know how to tell my mum or how she would react, she is amazing and helpful but when she found out about me cutting she started crying so me telling her that i want to kill myself and that i have recently tried it and that i need help i’m scared because i don’t know how she would react someone please help and give advice please! i really don’t want to seem attention seeking but i just don’t know what to do anymore.

    • Stacey Freedenthal, PhD, LCSW says:

      Jes, PLEASE tell your mother! Even if she gets upset, that’s a small price to pay for you to stay alive and get better.

      My advice is to show her this comment that you posted. That way, you don’t need to build up the courage to tell directly.

      It also might be helpful for your mom to read this post, 10 Reasons Teens Avoid Telling Parents about Suicidal Thoughts. That post also links to other posts with information about how parents can best respond to a suicidal child.

      Again, please tell your mom. She needs to be able to get you the help you need, but she can’t do that if she doesn’t know how much you need the help.

  6. JeanPaul says:

    Having worked with many mental health professionals over the years, my advice is:
    1. do seek help
    2. Be VERY careful who you seek it from.

    I have worked with wonderful therapists who I credit with saving my life. I have also worked with psychiatrists who were verbally abusive, dishonest and negligent. My experience has generally been that psychiatrists range from contemptuous to abusive, while most psychologists range from from good natured but stupid to wonderful. I would say that if you need help, find a psychiatrist to get medication and then talk to them as little as possible, find a therapist and let them heal you.

    And don’t wait until you are already suicidal to get help. I waited too long for support and landed in a hospital. That got me well (though I relapsed), but it was traumatic. It’s better than dying, but really not a good time.

    Get help NOW! Before it’s too late.

    Another warning for those seeking help… There is no quick fix. Depression isn’t like the flu. You don’t get better. It’s more like diabetes. You can manage it and live a full successful life, but it will never go away.

    • Alex Jude says:

      Hi Jean. Very true whom you speak to in regarded to mental health. Emergency department doctors are great for a broken bone or stitches but they should not write a prescription for SSRI medications. Or, your walk in mental health community center is over worked,under staffed,under paid and to be honest an entry level career position. I have found that a friend, teacher,or clergy is a better starting point. This web site is a better option then most community mental health facilities have to offer. Some people really need medication but talk therapy is often more helpful.Anyway, Im not an expert on the topic but I’ve had my up’s and downs. Right now im on a downward curve. Peace, Alex.

  7. Alx Jude says:

    Hi: I never had any mental health issues until I was put on psychotropic drugs for pain management, for a broken arm. Given the problems with opioids, it seemed like a good idea as I didn’t want to deal with any dependency problems. I didn’t do well on them,I complained to my Dr. only to be told that my body would get used to them. I didn’t. I started having major mood swings, It got to the point that I was hospitalized in behavioral health. I did sign my self in under the threat of being IVC. I was over medicated while inside and my actions were thought to be suicidal so I was put into seclusion. Your right when you say they don’t use straitjackets anymore. They use chemical restraints. A week or so later, I was discharged but still prescribed benzodiazepines. This caused more problems to the point of psychosis and suicidal ideation. Back to behavioral health. I was fortunate enough to find a good Psychiatrist . He took me off of the benzodiazepines and now, I am back to my old self. However, this history of hospitalization haunts me. I have a 3.5 GPA. in Human service and EMS. It is all but useless as any job I apply for with the state rejects me for my psychiatric. record. I don’t like to say it but I have come to the conclusion that it is better to not even talk about your own mental health issues. It seems no different than a criminal record. I would love to hear any feed back you may have on this situation. Alex.

    • Stacey Freedenthal, PhD, LCSW says:

      Hello Alex, I am so sorry to hear about your experience. It sounds traumatic on many different levels. How fortunate that you found a good psychiatrist who was able to recognize and relieve the side effects you were experiencing.

      I am confused about your mental health treatment history preventing you from getting job offers. Such information is confidential, protected health information. No employer has the right to know of any of your health treatment, psychiatric or otherwise. And no one is supposed to be able to discriminate on the basis of a health condition, regardless. There may be exceptions (such as airline pilots, who need to demonstrate they are mentally fit for the job) but these are very rare.

      Confidentiality in the U.S. is protected by HIPAA, among other statutes. What you describe above violates the law on multiple counts, both in terms of robbing you of privacy and of discriminating against you. I suggest you consult a lawyer!

    • Alex Jude says:

      Thanks for the response. The problem I am having is with the application questions about mental health history. If I don’t answer truthfully, I am omitting information. If i do answer truthfully i get passed over. I thought HIPAA laws would cover me but it doesn’t seem to. It is a background clearance issue. I do feel that seeking psychiatric help when needed is a good and healthy thing to do but, in the real world, some things are best left covert. Still confused, Alex.

    • Stacey Freedenthal, PhD, LCSW says:

      Hi Alex, I am really sorry to hear that you are being discriminated against in this way. I know some professions do have a justification for checking mental health history. (I suspect, for example, the Secret Service would be one.)

      It is already hard enough for people with mental health problems to get the help they need. The threat of job discrimination just makes it harder.

  8. jess says:

    I feel that I need “help” or therapy. I’ve attempted suicide multiple times throughout my life and I’m only 14. I’ve thought about death starting from a young age. My best friend is always telling me I should seek therapy but my parents don’t think it’s necessary and they say I’m not allowed to talk about death or think suicidal thoughts. I want help but my parents won’t allow me to get any

    • Stacey Freedenthal, PhD, LCSW says:

      Jess, it is painful to read that your parents won’t allow you to get professional help or to talk about death or to think of suicide. From your comment, it’s clear that you want help. And people can’t usually just “turn off” suicidal thoughts. (If only it were that easy!) We can’t control what thoughts visit us or intrude, only how we respond to them.

      So please, get help! Tell a teacher that you are thinking of suicide and want professional help. Tell a school counselor. Tell a friend’s parent. Tell a minister or other religious leader. Tell anyone you can who might be able to get you help.

      If you are in the U.S., I encourage you to call a hotline. The National Suicide Prevention Hopeline can be reached at 1.800.273.TALK (8255). There are other hotlines, too; please see various resources listed on this site at http://www.speakingofsuicide.com/resources/#immediatehelp

      Here’s the deal, Jess. If someone calls a hotline while actively suicidal, a hotline is likely to call the police. Often, the police will take the person to an emergency room for an evaluation. Depending on whether other adults are able to connect you with mental health services, this may be the only way that you can get connected with professional help.

      You are doing an excellent job reaching out for help by posting here. I hope that you will receive such help soon!

  9. Anonymous says:

    Im not suicidal but I feel if you are a certain age you should be able to take your own life if there are major reasons for it

    • Stacey Freedenthal, PhD, LCSW says:

      Permitting suicide, whether among older adults or people with terminal or painful physical illness, definitely is a much-discussed and controversial topic. Many support allowing people to end their lives, whether under the guise of “assisted suicide,” “hastened death,” “aid in dying,” or something else. This is something I intend to write more about…eventually!

  10. Justin says:

    I’m 18 and I’m having suicidal thoughts more and more often and am having a stronger urge to act on them. What will happen if I say that I’m feeling this way. My friend was about to attempt suicide a year ago when he was 17 but stopped and called the suicide hotline and then the police since he was in danger. Well he was put in a bahvioral complex for two weeks and then put in a safety plan and antidepressants. I was wondering what happens since I’m no longer an adolescent.

    • Stacey Freedenthal, PhD, LCSW says:

      Hi Justin, I’m sorry you’re having not only suicidal thoughts, but also urges to act on them. Whether you would be committed to a hospital depends on how severe your suicidal thinking is. Generally speaking, you’d need to say that you intend to attempt suicide within a short period of time. It depends where you live, but many states permit involuntary commitment only when a person be in imminent danger of suicide or harm to others.

      That said, you didn’t make clear whether you want to enter a psychiatric hospital. The admissions criteria for voluntary admission tend to be more lax than those for involuntary commitment, because with commitment, a person’s civil rights are suspended and the person is deprived of liberty against his or her will. Still, admissions criteria vary by hospital.

      I hope that information is helpful. I will add that admissions criteria for adolescents and adults aren’t really different from each other, but some hospitals appear to be more liberal in admitting adolescents, because the impulsivity of that age group makes them more vulnerable to acting on suicidal thoughts.

      Good luck to you!

  11. thomsen says:

    same with me I want to commit suicide I have a good life I’m just tired of life and find no reason to go on

  12. Atra says:

    Don’t seek therapy. If you’re forced to see a mental health professional, don’t tell them the truth. They can and do commit you, and while I can’t speak for every “looney bin,” my experience in them can be summed up as “torture chamber” – at least 100 times worse than anything I saw on TV. I will never seek help again. I will suffer in silence until I finally just fall off. It’s better than going back to one of those places. From that day forward, I will only tell lies to medical professionals who ask about my mental state, because I can’t trust them.

    • Stacey Freedenthal, PhD, LCSW says:

      Very sad response, Atra. I’m sorry you have had such negative experiences. This is precisely why I hate when a therapist overreacts – people who need help are less likely, if likely at all, to seek help again.

      For you and for others who read your comment, I will say this: There ARE mental health professionals who use hospitalization as an absolute last resort; some do not ever commit someone to a hospital involuntarily, for precisely the reasons you described.

      I will also go out on a limb and say, for those who do want hospitalization or end up hospitalized, there are hospitals that are not torture chambers. Each is different. I know people who have been greatly helped by hospitalization. Sadly, I also know people who have been greatly hurt.

      Sometimes when someone is making the ultimate life or death decision, they feel a profound need to talk about it. They might talk with friends, and they might be fortunate to have friends who can truly listen without judgment or pat advice. They might, on the other hand, have friends who react in ways that are hurtful: “How could you want to die? Don’t you know how selfish you are to hurt people like that?” “You just want attention.” “You need to get over this.”

      A mental health professional who is skilled at working with suicidal individuals – and who does NOT overreact, freak out, or otherwise resort to hospitalization unnecessarily – can be helpful to a person who is dealing with suicidal urges.

      The professional can listen and empathize without judgment or alarm, help the client go over pros and cons of suicide (yes, there clearly are benefits to explore), and explore with the client his or her ambivalence. Those are first steps. The clinician can also work toward helping the client to heal the wounds or illness that make suicide appealing, to rediscover meaning and value in life, to want to live again, and to come up with coping methods for safety and growth.

      None of this can happen if therapists have made people too afraid to seek their help.

      So please, if you are a therapist reading this, consider the great harm that can come from seeking commitment for a client without it being absolutely necessary – and keep in mind that it is absolutely necessary very, very rarely!

    • Atra says:

      Yes. I went seeking therapy after I spent years with rape-related PTSD symptoms that made maintaining a romantic relationship difficult, which then led to depression. Everyone I knew encouraged me to seek therapy, which I thought to be laughable – I always considered therapy to be a pseudoscience that does nothing for people with an IQ higher than their shoe size. But I wasn’t getting better on my own, so I thought, “What’s the worst that can happen?” When they asked if I’d thought of suicide, I answer truthfully, yes. When they asked how I would do it, I told them. When they asked if I wanted to do die, I again answered truthfully, yes, but I was too much of a wimp to actually do it. Their next response was to have four men force me into a vehicle against my will, take me someplace I didn’t want to be, and then have four more men strip search me before locking me away in a tiny stinking dirty cigarette-smoke-filled prison with no warmth, no food, none of my prescription medication for back pain, violent patients, violent night staff, no access to a phone despite signs posted all over saying I have that right, and sedatives waiting to go up my rectum if I got loud, like they did with everyone else. I don’t know which class taught these psychiatrists to have rape victims strip searched by four men and then forced into a hostile environment and kept in line under threat of anal violation, but I do know that I’m never being truthful to anyone with the authority to have me committed ever again. I might have been too much of a wuss to commit suicide before, but now knowing what it’s like is all the motivation I need to carry it out. If I ever find myself in that position again, I will bash my face into the ground until I’m dead or unable to know I exist anymore. I would rather die than go back to one. I don’t know if these psychiatrists/therapists know what the nuthouses are like they send patients to, but they’re outrageously negligent if they don’t, and outrageously stupid if they do. When it comes to mental health, honesty is the enemy. Best to just live with it until I can’t, and then I won’t.

    • Stacey Freedenthal, PhD, LCSW says:

      Hi Atra, thank you for sharing your experience. It is heartbreaking. You went to a therapist for help and received the opposite: loss of liberty, fear, further abuse. And it was so unnecessary. Forced hospitalization is necessary only rarely, very rarely! The fact that you said you were “too much of a wimp” to kill yourself indicated that you did not intend to try, and intent to act soon, usually imminently, is a requirement for forced hospitalization in most states, if not all.

      It was your misfortune that the therapist you saw appears to have panicked. A calm therapist knowledgeable about commitment laws would know that you did not meet criteria for commitment, based on your comment above. What such a therapist would do is explore further your reasons for not planning to die by suicide, your reasons for wanting to die, your ambivalence about suicide, your coping skills and protective factors, and what you need for the suicidal thoughts to diminish, or at least to not have such a hold on you.

      I want to add that your experience at the hospital sounds horrifying and abusive, and there are many hospitals that do not operate that way.

      If ever you do need help again for suicidal thoughts, I hope you will consider that there are therapists who can help a person through a suicidal crisis without resorting to unnecessary hospitalization, and, even when hospitalization is necessary to keep someone safe, it can, in many instances, be a helpful experience that enables someone to stay alive.

  13. YVONNE says:

    i tried to commit suicide last month. i still want to commit suicide i am so tired with my life, i hate myself, i hate going anywhere, i hate dealing with the public but i still have to work to pay for my medicle insurance, i use to work full time with the public but now i am down to 3 day’s a week…and it is so hard for me to do that. i just want to be alone, no one around me. and not have to go anywhere that has a crowd… it suck’s i dont know what to do, i can no longer handle working and dealing with the public, or anything or anyone, but i cant stop working, because i have to pay my medicle insurance to go to my doctor’s. without them to talk to and get medication to help me with my bipolar nos, with severe depression and anixity and pannic attack’s. so i dont try and commit suicide again, but i think about it all the time, but this time i want to make sure it work’s.

    • Stacey Freedenthal, PhD, LCSW says:

      Yvonne, I am so sorry you are hurting so badly. I hope that you continue to get help. Also, if you are in the U.S., you no longer need to get health insurance through your job. Because of the Affordable Care Act (Obamacare), you can get insurance on the exchange. This liberates a lot of people who had been shackled to their job purely to avoid losing their insurance.

      I have published a list of resources for people who are thinking about suicide here. It contains resources for getting help via hotlines, email, chat rooms online, and other websites. Please check them out. You never know what or who might help turn things around for you.

      p.s. I edited your comment to avoid giving graphic details about your attempt method and its aftermath. This material can trigger others who are seriously considering suicide or have already made an attempt.

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