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
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?
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
There 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.