You’re listening to a client describe very specific plans to attempt suicide by overdosing. She has 94 pills of a potentially lethal medication at home. She knows the number because she has counted, again and again, in a sort of ritual to prepare herself for the act.
A familiar unease settles in you. You ask her if what she is describing are merely thoughts, or plans. That is, does she really intend to actually attempt suicide very soon?
“Yes, yes,” she says quietly, sobbing. “I just don’t want to live anymore.”
You invite her to tell you more about her situation, her pain, her plans. She tells you she will take the pills tonight and that nothing will deter her. You probe for ambivalence, hope, desire to live. There is none. She says she is beyond hope or help. She is insistent on killing herself that evening in a motel room out of town, so that she won’t be interrupted.
Eventually you say you believe she needs to be in a hospital to ensure her safety.
“I would die before going to a hospital,” she says.
She then tells you that if you do anything to make her go to a hospital, then if she does survive, she will quit therapy and hate you forever, because you will have shattered her trust.
What next?
Psychotherapists, Suicidal Clients, and Psychiatric Hospitalization
A very difficult tension exists for therapists when working with a client at high risk for suicide. On the one hand, we want to provide a safe space for people to reveal their deepest thoughts without judgment. Our goal is for clients to be understood, safe, and, above all, helped.
On the other hand, if a person’s statements indicate that the person is at imminent risk of suicide, then we may need to move beyond supportive, nonjudgmental listening. We may need to take action – whether the client wants us to or not.
Let me first emphasize this: The person needs to be at very high risk of dying to justify involuntary treatment, and involuntary treatment should be an absolute last resort. More on that later.
Some clients at imminent risk of suicide will recognize that they need to be in a safe environment. These clients will go willingly, perhaps even gratefully, for an evaluation to see if they need inpatient hospitalization to protect them. They may even appreciate having a refuge from their problems for a bit.
But when severely suicidal clients resist our efforts to keep them safe, we risk moving from ally to adversary. We now are in the position of potentially using the information that they shared with us to thwart their plans and, in the process, possibly limit their freedoms.
Danger of Overreacting to Clients with Suicidal Thoughts
It is difficult to have someone involuntarily hospitalized, and appropriately so. Commitment to a psychiatric hospital is a drastic move and should be avoided unless you truly believe the person otherwise will die in the coming days. Involuntary treatment takes away a person’s freedom, potentially harming the person’s livelihood, social relationships, and emotional state.
Commitment to a psychiatric hospital also can strain or even rupture the therapeutic relationship with a client. The client may become angry about needing to go to a hospital for an evaluation or admission. And the client may find it unsafe to ever confide again in you or, perhaps, any other mental health professional.
Finally, on top of all that, hospitalization can be traumatic. Assaults happen in hospitals. Patients sometimes are placed in physical restraints. The terms “hospital-related PTSD” and “sanctuary harm” address these harms.
For these reasons, psychotherapists must not overreact. Clients need to have a safe space in which they can talk about their suicidal thoughts without the therapist “freaking out” or moving to hospitalize when it is not actually justified.
Too often, therapists move toward hospitalization as a means to assuage their own anxiety about the client’s safety, not to meet the client’s needs. Desire to die is not enough to constitute imminent risk of suicide, the criterion in most states for involuntary hospitalization. Persistent suicidal thoughts are not enough to constitute imminent risk. Even having a plan to die by suicide is not enough.
To justify involuntary commitment for suicide risk, the therapist must judge that a client will die by suicide within minutes, hours, or at most a few days if they’re not protected.
I’ve had clients describe to me in very specific detail how they would attempt suicide. And they expressed strong desires to die. But they did not strongly intend to act on their suicidal thoughts any time soon. For them, it was necessary over many sessions to be able to talk through their suicidal wishes, to not feel so alone, to develop skills to stay safe and to find reasons to stay alive. Premature or outright unnecessary hospitalization would have been devastating.
Even so, there are times when a therapist finds it necessary to seek involuntary hospitalization for a client. And there are times when it might seem necessary, but isn’t.
In the example I began with, the suicidal client had a clear plan to die by suicide that night, intent to carry out the plan, and the lethal means to do so. For the therapist to not take action to protect the client’s life would be irresponsible, even malpractice. In this case, the therapist had options besides involuntary hospitalization. As a couple examples, the therapist could help the client create a safety plan and enlist a significant other to help the client stay safe.
However, if the client remained adamant that she’d kill herself that night, the therapist might need to pursue involuntary hospitalization to protect the client and, not incidentally, protect their career, too.
(I should note that some states allow for terminally ill people to die by suicide without interference if they use medication prescribed for that purpose. In those cases, it would be inappropriate to try to thwart the person from dying by suicide.)
Are Therapists Adversaries to Suicidal Clients?
Earlier I wrote that we may move from ally to adversary in our efforts to keep a client safe against their wishes. The reality is that, in trying to keep an imminently dangerous client safe, we are the ally of the client’s healthy self, the part that wants to live.
When we believe that the client truly intends to act on suicidal thoughts very soon, the adversarial relationship exists only with the client’s unhealthy self, the part that wants to die.
When suicide is imminent, the client’s healthy self has become muted, cut off even from the client. The client may feel especially betrayed by our efforts to step in and keep them safe.
But they came to us for help. The client’s healthy self, that is, sought help. Our task is to help them stay safe in the most empowering, unrestricted way possible, but sometimes it’s simply not possible to avoid hospitalization if the client is to survive.
If all goes well, sometime later, they may even agree.
UPDATED: May 29, 2014; June 4, 2017; Sept. 2, 2022; April 30, 2023
© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All rights Reserved. Written For: Speaking of Suicide. Photos purchased from Fotolia.com
This was enlightening, but perhaps not in the way the author hoped. While I won’t speak for others, I will say that depriving me of my right to self-determination is an absolute non-starter. If I caught even a whiff of my therapist’s thoughts going in that direction, that would be the last session with that person.
Seeking therapy in good faith is all the patient owes a therapist, and doing so absolutely does not represent an abdication of my rights to personal liberty. Frankly, this post makes me less likely to seek therapy, even though I would never let it get to the point where my liberty was deprived to me.
My situation was at least 20 years in the making. It started when I was an ent and then went to paramedics, working in a morgue and continuously being around dead people and people dying in front of me. 3 suicidal attempts-I gave up trying. Out of the 3 mental issues I have and a handful of physical problems, I have what’s called “ passive suicidal ideation “ which means that I don’t have a reason to stay alive but I can’t kill myself either.
Dave,
Those situations are so painful – the trauma you were exposed to, your suicide attempts, and your ongoing feelings of not having a reason to stay alive. An article on this site about passive suicidal ideation might be of interest, if you haven’t already seen it: Do You Wish You Could Go to Sleep and Never Wake Up?
Thanks for sharing here. I’m certain some people have read what you wrote and now feel less alone for feeling the same way.
I actually just got out of the hospital a few days ago…I admitted myself, but at the time I was still not terribly happy with those who advised it.
That only lasted while I wasn’t myself, though. Once I leveled out I could see clearly that they had been right and most likely saved my life in a very literal sense.
Selena,
Thanks for sharing here. There are people who recognize the value of their hospitalization well after the fact, but it seems like they seldom post here! I appreciate your letting people know that it is possible to level out and recognize that your treatment was life-saving. I hope you’re doing much better now.
I haven’t checked, if I’ve previously mentioned some of the following points, which are only those which immediately sprung to mind, on reading this up-date and some of the responses.
I assume that the task of social workers in the USA is the same as that in the UK., e.g. to use and create a range of innovative services, to prevent the need for hospital admissions. The theory sounds fine but it is unusual for such services to exist. When they do, social workers may not know if the staff act with sensitivity. It may not be known, if they have the courage to challenge abuses of power, by those in more senior positions.
An example is when I had to assess, whether to compulsorily detain, a young woman in the Intensive Care Unit of the hospital where I was working. She had come very close to ending her own life. One of three consultant psychiatrists had rung me and when I walked into the ICU., he persuaded nursing and junior medical staff, to form a human barricade, so I could not get to the woman’s bed. He insisted that all I had to do was rubber stamp his decision. I reiterated in front of the other staff, what I had said to him on previous occasions, i.e. that legally I was required to make my own assessment. I refused to leave and later did make my own assessment. I agreed with the woman the best way forward, leaving her and close relatives in control. She never met with a psychiatrist again.
Some years later, that consultant appeared before the courts. It was revealed, that many women had made accusations about him but he successfully argued, that he was unfit to stand trial. However, he was placed on a register of sex offenders and another of the three consultants was imprisoned.
In December 1992, a TV documentary and national newspapers reported, that the person then in charge of the National Health Service in the UK., (a former psychiatric social worker), had not acted on formal reports over at least four years, to stop another consultant psychiatrist from forcing people to have ECT without a general anaesthetic and muscle relaxant. What was happening would meet any definition of torture.
There have been endless reports of abuse of vulnerable people by callous staff in public and commercial services. What gets overlooked, is that such individuals do not work in isolation, so many staff who would otherwise work to high standards, do not speak out.
I have put forward simple solutions to the UK parliament but those haven’t been grasped. However, it will soon consider the draft of a new law, to protect staff who do speak out, i.e. whistleblowers.
One of the most important reasons to avoid compulsory hospital detentions, is that they remove any sense of having full personal control. Emotional and social crises are invariably about having lost control over what is most crucial. So, the task of social workers and others, must be to try and find ways for those who are acutely vulnerable, to have control whenever possible. That means, being able to turn to services with known staff who will do exactly the same.
There are excellent services and we need ways to bring those to public attention. It must be made easy to know, which are good or bad or just mediocre.
Apart from vary rare circumstances, staff should see compulsory detentions as an inability or failure to provide what is really necessary.
A film which I have yet to see is The Switch from 1993. That I am reliably informed, powerfully illustrates the importance of being in control of our own lives. It is based on the true story of Larry McAfee, who became paralysed from the neck down after an accident. He wanted to end his own life but when his legal right to do was agreed by the Supreme Court of Georgia, his perspective radically changed, because he then knew and felt he had control. Note that this example was about someone who medically, was not close to dying.
Regarding dilemmas and how best to respond, a key point is as you say, “But they came … for help”.
What help did they come for? What would enable them to feel in control? Do they need to feel protected and if so, how might that be achieved, where, when, how and so on? Are appropriate services available when they are needed, day or night?
John,
Oh my gosh, the abuses (and abusers) you describe are horrific. It’s tragic that in every helping profession, some abuse occurs. Unfortunately, some people are drawn to positions of power over people who are vulnerable, and as you note some systems aren’t set up to rout out abusers. We need to do better, absolutely.
I appreciate your balanced view of mental health services — yes, abuse occurs, but so does constructive help. In fact, I’d venture to say that an extremely small percentage of service providers are abusive. I wish that small percentage didn’t do so much damage.
You’re right — good help is out there, and I hope people will try to find it. And as you note, ood help involves empowering the person, working collaboratively, and avoiding involuntary care except when there truly is no other alternative way to prevent someone from doing harm to others or ending their own life. (And even then, in the latter case, I’m ambivalent about how far we should go.)
Thanks for sharing here! I’ve valued the comments you’ve left over the years.
I’ve posted on this thread many times.. if u live in California is anyone else terrified of the bill Gavin Newsome is getting ready to probably sign at the end of September. It’s called CARE COURT if u don’t know about it find out about it.. it’s terrifying. It doesn’t just affect homeless people.. if ur homeless, have mental health issues or have addiction issues be scared.. anyone familiar with Brittany Spears and the conservatorship she went threw? Please read about CARE COURT IT WILL NOT SOLVE THE HOMELESS ISSUE IN ANY WAY.. THIS BILL WOULD BE A HUMAN RIGHTS VIOLATION.
A. Rose,
I agree, I’m very concerned about this program. It’s overly coercive and, in the long run, could do more harm than good, I fear. Until we have a system set up with adequate housing, mental health services, and other resources, I question why we would force people into services that are inadequate. Of course, if their life is at stake immediately, that’s a different question – but the Care Court specifically will be for people who do *not* meet the usual criteria for involuntary hospitalization.
Thanks for sharing here!
I don’t live in California, but read about what they are doing with Care Court, and am appalled.
I’m also afraid that could spread to other states the way Kendra’s law did from NY, via the push by E. Fuller Torrey and the Treatment Advocacy Center. It has done more harm than good, so yes, I am worried.
Ihave never shared this with anyone so thank you for the space Stacey When I was 17 a few weeks shy of 18th birthday I took over does and my sister who never came to my room, came to my room, found me unconscious and I was taken to local hospital where I stayed in ICU for few days. from there I was hospitalized, Since under 18 it was not voluntary. This was supposed to be a well-respected hospital. The first 3 days they wont let you wear anything but a hospital robe and bathrobe, so you wouldn’t run away. First day I was in the shower and a nurse opened the door, no knock, nothing and told me she needed a urine sample It was not an emergency but opening the door so I was nude and vulnerable was the only cause I could find for it.
The psychiatrist was this awful person. Every meeting I sat saying nothing because I could not talk to her, and every meeting halfway through she would say “what are you thinking?” I would say “Nothing.” and she would reply “Nature abhors a vacuum” then total silence for the rest of the session. Unbeknownst to me a nurse was assigned to me for me to talk with but the nurse never told me this so whenever she sat by me we had a regular out in the world “How are you?” Fine and you? “weather’s nice huh? etc.
When iut was my birthday other patients told me the psychiatrist I was assigned to thght very bad sign if you didn’t ask for leave to celebrate with family. My family never did celebrate it and I was hurt every single year by it but I went anyway. My mother an excellent baker, had gotten a box of bakery pastries, danish mostly and there was one pizza for the 5 people there. No gifts, no cards. nothing to indicate I was wanted there. (In fact not one of them ever said “we’re glad you did;t succeed.” I went back to the hospital and she never asked me about it so I kept my mouth shut but worse than when I went in. I told her I would sign myself out the day I turned 18. She told me if I did she would tell my parents I wasn’t ready to go to college so I had tostay. Then 3 days later she releasedme, nothing on her part but a power play. Turns out she told them I could not go to the college I was intending to go to and had to attend the local University because it was closer to them (as though they wanted me closer) The diagnosis from the chart. “adjustment reaction to adolescence.”, an asinine and there’s nothing wrong with her dx which psychiatrically was true but she couldn’t;t say well hey nothing wrong with her that we found absent the suicide attempt. No the reasons were many and had to do with abuse and feeling, despite knowing I was going away to college, it would never end. so instead of help the hospital experience and the psychiatrist not only made this worse then but reinforced that I should keep my mouth shut whenever I was upset/about when I was being abused. .I apologize for the length and typos and hope this makes sense as I decided I don’t want to revisit it even in the writing of it.
Lee,
Thank you for telling your story here. That’s A LOT to carry alone. I’m so sorry you had such painful experiences. I hurt for you while reading your words; when you most needed care and compassion, people failed you. I’m glad you’re still here despite all that, and I hope things are at least a little better for you…?
More than you’ll ever know, your sharing can help other people who now won’t feel so alone. I hope you’ll continue to reach out to others about your experience.
Thanks, Stacey. Well, no things are better because abuser dead but absent that, given my chronic pain and that I am essentially alone, only a nephew in Texas as a relative who takes time to “talk’to me on twitter messaging, and visits 2 x /year. I have posted that here before believe, my family has lied to others, including their own children about me, said my disability is fake, I am a malingerer despite 14 brain surgeries against my pain by doctors of high regard (so not some bums who will operate just cause) They also lied said I tried to steal mother’s money, when they actually blackmailed me into giving it to them. Sounds bizarre thinking but their lawyer wrote me only way they would agree to keep my mother safe from the aides who had been provably stealing from her, was if I gave up the money my mother specifically left for me as she knew they, who could work and have money, would never help me. So along with the chronic pain, aloneness and loneliness, I am financially struggling, not as bad as many but at my age I need money when something happens and that I don’t have. So no things not good. Unfortunately have read too many articles on failure of suicide attempts and at this point more afraid of making things worse, no one finding me but the attempt failed and I am in trouble. Many years ago a psychiatrist, a social worker and a judge felt “rational suicide” would be “acceptable” in my case. I didn’t then because one doctor did such awful things that made my sitution worse I didn’t know if suicide would be from that or from the pain. i wish I had done it then because the fear of failure wasn’t there then. If my experience can help than it is worth the sharing (btw not sure if in post and for makes it hard for me to read I was clear that I was only in hospital for 13 days after the 4 she kept me there extra for her power play. In my case it was truly pointless. For others I think hospitalization is a good choice if it can help get them through a bad period. Involuntarily? Better to not have to go that route but sometimes someone needs an other to help them get the help they need
Lee,
You describe very well the physical and emotional pain you’re in – I’m so sorry, and I wish it were different for you. I often read and hear about the income disparity in the U.S. (and elsewhere), but what vexes me even more is the pain disparity. Some people’s lives have far more pain than others, and it’s not fair. I’m not saying others should feel more pain! I’m saying that you and others who have an extraordinary amount of suffering in your lives ought to have less of it, in a fair world. (I know, I know; life’s not fair, and all that. And that’s painful.)
I’m struck that hospitalization hurt you but you still acknowledge that it helps some, even when it’s involuntary. Of course involuntary hospitalization should be an absolute last resort, but I do think there are times when it’s necessary. Many people argue that psychiatric hospitalization (voluntary and involuntary) is unilaterally bad, without acknowledging that some people need it and even report it helped them. I hope to write more about that topic soon.
Thanks for sharing here!
I’ve been in constant pain and numbness for 18+ years from Transverse Myelitis. I wish more folks would try and wrap their heads around rational suicide.
I’m sorry you;re dealing with that. Yes, it’s frustrating that doctors can say sorry nothing more I can do about your disabling debilitating pain and they can’t help more than that by prescribing a lethal dose of meds or other form of assistance. The idea in the states that allow it, that it is only when you are 6 months away from death to have help in dying ignores that it is not always when you’re facing death that you want the help but when the pain is unbearable and you have no life to speak of. Best I can say unfortunately is I hope some day that will change (I thought of going to Belgium, other places abroad where it is allowed but the expense is way too prohibitive. Wish I had better words fo support for you
John,
The pain and numbness you describe sound awful. Chronic pain is correlated with suicidal thoughts and behavior, so I can understand your interest in rational suicide.
If you ever want to write a guest post about rational suicide, please let me know! While I don’t publish things that encourage or advocate suicide unilaterally, I’m interested in a critical look at the arguments for and against rational suicide.
Thanks for sharing here!
I am reading this article as a medical student curious to learn more about the process of involuntary hospitalization and how it affects the therapeutic relationship. How really do you tell a patient that you must involuntarily admit them to a hospital? This sounds like a very painful conversation for both parties, and one in which the suicidal patient will meet with anger, frustration, and feelings of betrayal. I appreciate the journal articles that are linked.
As more and more people are aware, many of us in the healthcare field are also afflicted by thoughts of suicide, I am also curious how the psychiatrist/psychologist/social worker approaches suicidal thoughts with these patients, who are intimately aware of what the process is like but are more apprehensive about sharing details of imminent suicidal ideation for fear of hospitalization, which is a threat to their livelihoods – many licensing organizations have questions regarding psychiatric histories and/or psychiatric hospitalizations on renewal of medical licenses. No physician would be willing to jeopardize the practice of their profession that they worked so hard for and incurred so much debt from, and entered with a genuine desire to help others. There’s just too much at risk.
That’s terrible. If anything, people should be more willing to trust a doctor who had been through the same thing as them. I think it would do wonders for helping overcome that feeling of extreme “aloneness” a person who struggles with mental health problems usually feels.
Involuntary hospitalization AKA How to legally kidnap someone and give them PTSD 101
I realize that this article was printed some time ago. I was involuntarily hospitalized for what I believe to be unprofessional actions on the part of my student health services provider (the person who authorized my hospitalization did so after a three minute discussion in which I reiterated the same ideations I have been struggling with for years; the psychiatrist who certified me justified it by saying, and I quote, ‘you have not benefited from the full range of what psychiatry has to offer.’ I am now taking medical leave as a consequence of the lost study time and the trauma from the psych ward.
What are my options for legal restitution? I lost a 15K semester over this, I have MWs all over my transcript, and I will have to deferr my enterance into a 55K median starting salary profession on account of this. I have never once made an attempt on my life, and there is not a mark from self-harm on my body.
Here are some options at the bottom of this article. https://power2u.org/what-is-psychiatric-malpractice/
My advice? Don’t sue, too stressful, I’ve been through a lawsuit.
Going forward, only talk about SI with people that don’t involve the authorities. Even then, there’s always a risk that someone will break policy and call the police. There’s always a risk anytime you disclose to another person! As a result, some people’s only confidant is a diary. https://www.madinamerica.com/2018/08/deadly-serious-talking-openly-suicide/
I find this article disturbing as it promotes the ever-so-prevalent idea that the severely mentally ill shouldn’t have the right to be euthanized if they so choose. Most people in the mental health community overlook the fact that suicidal crises have much more to do than just a lack of clarity of thought from the suicidal individual. Suicidal crises often times arise from complex and strenuous circumstances which pills, talk therapy sessions, and government programs cannot always address adequately on their own or altogether [especially the latter, which is often slow to serve their consumers due to high demand]. It is sad that the US government is so oblivious to this and makes life an obligation, rather than “a right,” by not giving the mentally ill the choice to give life a chance or be euthanized. It makes the US feel more like a dictatorship, rather than, “a free country” as many people like to call it.
NAMI is heavily funded by the drug industry. I would’ve added it to my earlier comment but I can’t figure out how to edit it.
Agree!
Dr. Stacey , ( I hope that’s okay, it’s easier than typing your last name),
NAMI is as pro psychiatry and pro forced drugging as one can get. Please don’t put them on the list.
To Stacey and Becky,
Thank you both so much for the helpful responses. It’s crazy how hard I’ve had to work to find out how to report such obvious egregious -and illegal – treatment. So, I truly appreciate the specific suggestions. In fact, many I’ve been familiar with for years, some like NAMI are part of the problem, although I did try their poorly run support group here, and want nothing to do with them. MHA has really come a long way (since NMHA), in terms of potent advocacy for autonomy and patient rights. I contacted the headquarters, had to leave a message, but I stressed the severity of the problem, and the need for a local affiliate -which I would be willing to help start, but I never got a call or response.
And it’s this site that introduced me to MadinAmerica, which is AWESOME, and I was surprised I had never run into it before.
I have followed a lot of leads from your website, Stacey, and will go through each suggestion I haven’t tried yet.
I have to say how angry I am that they’ve made this so difficult because I’m all I’ve got, and my mental conditions were so severe when I sought help, and they only made them so much worse. And now I have to figure this out by myself too. So, it’s taking me a long time, but I absolutely cannot let this go, unless or when it kills me.
And, btw, I’m not against the medical model. On the contrary, my depression did well for 16 years on Paxil and trazodone, but then things got really bad, and when I moved here, I was begging them for help! But I was totally misdiagnosed, ignored, couldn’t get a med appt for 4 months, not with a psychiatrist, and then the NP sends the police to my house to hospitalize me for not taking antipsychotics!
Becky, my first thought was how standard their procedures were with me at the hospital, as if that’s the way they treat everyone. I want the public to know exactly what these unqualified people do behind closed doors, and how cruel, corrupt and despicable the culture is here.
I came to get better, so I could get back to living. They sought to take every bit of power away from me.
Stacey, you stated: “It is extremely difficult to have someone involuntarily hospitalized”.
Well, news for you in Southern New Mexico: It is EXTREMELY EASY to have someone involuntarily hospitalized, AND INVOLUNTARILY MEDICATED WITHOUT FOLLOWING LEGAL REQUIREMENTS for a judge’s signature, or even notification.
And, btw, I was told “you have no rights in this situation. Asking about rights, laws, a lawyer, were all answered “you can do that when you get out of the hospital.”
To this day, I can’t find anyone who cares about what they did to me.
Pattie,
It’s sad you had such a negative experience. I hope that you’re able to get help. Are you familiar with groups and literature for “psychiatric survivors”?
There are many websites and blogs that might be of interest to you. Here are just a couple:
Mad in America
The Antipsychiatry Coalition
An article that might be of interest:
An Open Letter to Psychiatrists and Mental Health Professionals from a Psychiatric Survivor
In addition, here are some grassroots groups that might also have resources or be resources themselves:
National Alliance on Mental Illness
https://www.nami.org/
Mental Health America
http://www.mentalhealthamerica.net/
I hope this information is helpful to you in your efforts to find healing, hope, and connection. Thanks for sharing here.
Pattie, I am so sorry. You will find many similar stories on http://www.madinamerica.com. I’d file a complaint as it’s illegal to not inform you of your legal rights while in a psych hospital. If they did it to you, they’ve likely done it to other patients too.
How to file a complaint
I got this advice from a friend
1) Write the state medical board, INCLUDING a formal complaint.
2) Write up reviews, including as much detail as you feel comfortable giving, on sites like Yelp, Healthgrades, etc.
3) Write a formal letter to the hospital: copy the patient advocate, the Patient Safety/Quality Care officer, the president and/or CEO and/or Chief of Staff of the hospital, any other customer service higher-ups that work for the hospital. You might also consider copying the hospital’s legal counsel on your complaint.
4) File a formal complaint with the Board of Health.
5) If you’re also having issues with the hospital itself, write a letter to the BBB.
And, if all else fails, contact the media. This accomplishes several things: gets word out about the disease, gets word out about the crappy care this doctor and his staff are providing, and puts all parties involved on alert status that you don’t take crap lying down.
Dr. Freedenthal, why do you assume the choices or hospitalization or no hospitalization? What about alternatives to hospitalization like peer respites (the one in New York City that opened a year or two ago is only for clients with psychosis, that particular respite does not accept non-psychotic clients ) , psychosocial residential treatment like Soteria, Windhorse, etc.? What about cognitive therapy for psychosis (there are therapists that specialize in this), or open dialogue therapy? Open dialogue therapy has an 80% success rate for first episode psychosis. https://www.madinamerica.com/2013/07/harrow-wunkerlink-open-dialogue-an-evidence-based-mandate-for-a-new-standard-of-care/
Those are all good alternatives to hospitalization for people with psychosis. However, as far as I know, those services are not equipped, by themselves, to prevent suicide in someone (psychotic or not) at imminent risk of ending their life. If you have information to the contrary, please let me know.
I will also note that, along the same lines as what you list, there are many less intensive treatments for people who are suicidal but not at imminent risk of acting on their suicidal thoughts.
Suicide is legal!
[This comment was edited to abide by the site’s Comments Policy. – SF]
Indeed it is – there is no law against suicide.
However, professional ethics and civil statutes allow for – and some people would say require – mental health professionals to intervene when someone is at imminent risk of dying by suicide. I don’t always support this expectation, but it’s the reality we deal with.
Forcibly preventing someone from killing themselves is surely the antithesis of professional ethics, regardless of their motivations.
How is it in any way ethical to forcibly remove somebody choice? To subjugate somebody’s will?
Are you suggesting that death is inherently bad, and life inherently good. And any individual who’s beliefs or desires contradict that is invalid and must be of an unsound mind?
It seems like more a problem of ingraining certain religions into medicine than of anything else.
I was involuntarily hospitalized a couple months ago. I’m still LIVID. It was the most dehumanizing, hopeless situation I’ve ever been in and I left feeling more alone than ever, because it was now quite apparent that I couldn’t be honest without the threat of being hospitalized again. My trust was betrayed, and it put a huge strain on my relationship with my parents. I don’t trust them, I barely even like them. I refused to talk to the psychiatrist who hospitalized me (he’d been seeing me for 5 years beforehand) and quit. I don’t trust anyone, I cannot ask for help, I’m trapped- because if I talk to anyone, I’ll end up back there.
Involuntary hospitalization is disgusting and borderline criminal.
Maria, I agree with you 100%!!
And this is from someone who is proactive about my condition, and has sought voluntary hospitalization!
Involuntary hospitalization is rarely necessary if we have QUALIFIED mental health professionals, which are becoming rare. A good doctor or therapist would not need to terrorize someone who is doing the right thing by talking about their feelings, and if need be, would respect their client by talking to them as an equal in terms of their thoughts. Ultimately, it’s the clients life, and the clients responsibility for their decisions.
I’m with Maria— I will never trust them again. I’ve been abused, humiliated, threatened, treated like a criminal, an animal, a lunatic, and held hostage by them one too many times!
The fact that she told you in no uncertain or ambivalent terms would indicate she actually wanted you to have her committed. If she didn’t want an intervention she could have either kept her mouth shut or denied immidiate planning making involuntary admission legally impossible (absence of serious risk of harm). The fact that she didn’t and at the same time told you she would hate you etcetera to me is clear evidence of irrationality.(unthinking, childish behaviour). Committing suicide under those circumstances would be a bad decision in my book (lack of clear headedness and rational decision making) and given your legal obligation I fully understand the decision you made.
As long as therapists can be held liable for their client’s personal decisions they have little control over like suicide (which I think is ridiculous) the ethical thing to do for a person seeking therapy is to avoid puttng their therapist or doctor in that position. Which of course makes therapy aimed at uncovering the motives that lead someone to consider self-destruction difficult unless your moral view is that suicide is always wrong under any circumstances.
That seems to be the guiding principle (I’d call it dogma since it cannot be substantiated objectively) for the mental health industry and in a way that’s fine (you’d want your therapist to go to great lengths to help you explore other options since no matter how you look at it suicide is a very grave matter with potentially devastating consequences) but not if the state grants him or her not only the power but also the responsibility to keep you alive against your will. In that sense I really don’t agree with your metaphor of a ‘healthy’ and ‘unhealthy’ self since such terms serve to disguise a moral position (anti suicide): to regard wanting to die as a sign of mental illness (whatever that may mean: I’ve read about this a lot and nowhere did I find a proper definition clearly stating what it is and isn’t) is a non sequitur (feeling depressed and committing suicide may be correlated but does not mean there’s a causal relationship) and a subjective opinion based on socio-cultural bias. To me it signifies nothing more than that the person in question has serious problems and is looking for a way to solve them.
In my mind suicide is a private matter and a decision, like most everything in life, that can be regarded as a good or a bad idea depending on the circumstances. If your life is utter excrement and you really are not able to enjoy it no matter what you try then to me it makes sense to end it. If on the other hand you are distraught, wracked with guilt, pain or despair and because of that (or complete detachment from reality as in psychosis) unable to think clearly and evaluate your options carefully (which would imply sufficient knowledge and consultation of specialists and others) then I don’t agree with it. Whether that is sufficient justification for the state to take away someone’s freedom is another matter.
Unfortunately the law does not differentiate between rational and irrational suicide: the first should be legal owing to the unalienable right a person has to his or her body and life, in the latter a case could be made the state would be acting in the person’s best interest when they intervene to preserve life. Such a provision in the law would safeguard the people’s right to self-determination, allow for the rescue of those in the middle of a mental crisis (when you feel you compelled to suicide a wise person would advise to get help and consider the matter again in a better frame of mind) and relieve professionals of the need to act as their clients’ keeper or surrogate-parent when it’s clear they’ve made a reasoned, personal decision about the issue (regardless of whether one agrees with it or not: how can anyone know what’s truly in another’s best interest?).
If there is a procedure that guarantees one the right to suicide (after having spoken with a mental health professional, been told the options, waited a few months to see whether they’d change their mind etcetera) and people still try to commit suicide on their own (that usually doesn’t bode very well for the outcome) or threatens others with it for any reason they should be committed to a mental hospital because either they’re just weak-willed folks who can’t fend for themselves or they have a serious condition that justifies forced intervention.
I was “voluntarily” hospitalized about a year and a half ago. I was gradually recovering from multiple years of chronic depression, self injury, and suicidal thoughts but I still had trouble sometimes. I hadn’t hurt myself in months but I still kept vague plans for suicide and razorblades as an option and I was talking about this with my therapist. She told me she wanted to take me to the hospital immediately, but I didn’t want to go and I didn’t think it was necessary. Then she explained the whole “voluntary” thing. Basically, they wanted me to come quietly but I didn’t really have a choice anymore.
The local mental hospital didn’t have any beds open, so I spent the first night on a couch in an empty room with a two-way mirror. I most definitely did not sleep. The next morning, I was packed up in a car with a police officer and some other guy and driven four hours away over snowy mountain passes to the nearest hospital with available rooms. I was put on a seventy-two hour hold but was actually made to stay there for closer to a week. There was a lot of weird double speak; you can leave after three days but actually you can’t leave until I say you can, this is voluntary but we’ll keep you here if you don’t choose to stay. I spent a lot of the time confused about my situation.
I hadn’t hurt myself in a long time, like I said, but I relapsed almost immediately when I got there. I threw all my food away instead of eating it. This went unnoticed because it was all packed in to-go boxes with lids. I lied and said I’d been taking my antidepressants when I hadn’t been so that the dose they gave me made me sick. I scratched my arms and hands with my fingernails until I drew blood and then hid it under the blankets and the sleeves of my hoodie when they’d check on me. Just because I felt I had to prove that I could, to take back some of the control that I’d lost.
I was tachycardic the entire time I was there. Due to heightened stress and lack of sleep, I experienced a resurgence of my mayoclonic seizures — uncontrollable movement while remaining conscious for the most part — something which the doctors there apparently chose not to record? I had to explain to each new nurse that came upon me when I had one. They would approach me with suspicion if they found me jerking uncontrollably in my bed at night. One particularly bad night, I was drugged against my will with something that I knew hadn’t helped with the seizures in the past. I told the nurse “No, it doesn’t work, it doesn’t work” and they held me down and stuck me with it anyway. I knew it wouldn’t do anything to help and that it would hurt worse the way I was thrashing. I panicked in that moment and I begged them not to when I realized that they weren’t listening while I was trying to explain. It’s a memory that’ll stay with me for a long time.
I also managed to pick up a bit of a stalker while I was there. After the first day, I was forced to socialize and participate in meals. This allowed a male patient to follow me around because he was allowed everywhere except my room during the day — just like me. I was sexually harassed by someone who I could tell was just a lot less stable than everyone else there, and I was trapped. After a few days, someone noticed and he wasn’t allowed to be near me anymore, but he would find me anyway and it just made him very… upset. I just wanted to leave.
I fed the staff what they wanted to hear, gradually ‘improving’, and left that place with more problems than I entered it with.
I know this is long, but I was never exactly able to talk with anyone about my experience there afterwards.
Amanda, if you read this, I understand the need to tell your story, no matter how long. To be victimized and then silenced or blamed is extremely painful.
From my experience, it IS certainly illegal to express the wish to commit suicide in Los Angeles. An ex-boyfriend called the police, believing I was going to try. I was calm by the time the police arrived, but as I had stated I was suicidal, I was arrested, handcuffed, and taken to jail, where I sat for several hours.
After being admitted to a lock-down ward of a hospital, I was ignored for 5 days. Originally, it had been three days, but I complained to the psychiatrist (who occasionally wandered in), he was angry, and gave me 2 more days.
There were ward staff, but other than to call us for meals and medications, or tell us to get away from the door, they did not speak to us. There was nothing to do except watch TV, or read one of the few books on the ward.
I was asked to cover a cigar box with material.
It was a hideous experience. Had I had minor children, they would have been taken to DPSS…had a I had job, I would have been fired. The phones did not work consistently enough to call out.
I was more suicidal when I got out.
Treat me without permission, incarcerate me, and when I got out I swear I would take you with me, and anyone else who helped put me there.
Mari, I have known people who similarly felt very angry about having been involuntarily hospitalized, but who felt very differently when they were in a better state emotionally.
Many years ago, I worked at a crisis hotline where one of these people was legendary. The person had called the hotline and described plans to kill someone and then die by suicide. The hotline counselor passed a note to another counselor, who called the police. The police went to the person’s house, where they found loaded firearms in a gym bag beside the front door.
The hotline caller was involuntarily committed to a psychiatric hospital. Months later, after being discharged, the person called the hotline director to say thank you. The caller was grateful for having been stopped from killing another person and then himself.
That is only one story, of course. But it is a good one. Generally speaking, for someone to be involuntary hospitalized, they have to be at grave risk of doing violence to themselves or to others. I am certain there are others out there who recognize that the trauma of being committed involuntarily to a hospital prevented an even greater trauma from occurring.
It is never okay to remove control away from someone. It is a lack of control over their lives that produces depression. You act as God. And have no right to do so. Because of YOUR beliefs I will die. Under no circumstances will I try to get help again. The risk to my self and my children is far too great. You are monsters. Every one of you…I hope that those, like yourself rot…but it will not happen. You do not care about the patient. You said it yourself…you would be subject to malpractice. Merry Christmas to the most untrustworthy, powerful segment in society. Hope you rot.
“Anonymous,” from your anger I can only conclude that you have been hurt deeply by mental health professionals. Perhaps you have even experienced involuntary hospitalization.
I am sorry you have had negative experiences. I hope you will keep in mind that there are hundreds of thousands of mental health professionals and thousands of psychiatric hospitals in the United States. While some professionals might not help you, there are others who can help.
Yes, to seek help again would mean taking a risk.
Yes, depending on what you disclose about your mental state and your level of danger, you might risk being hospitalized against your will.
It is terribly difficult for me to believe that your children would be hurt more by your being hospitalized than by your dying by suicide.
I wish for you hope and healing amid your great pain.
Unfortunately Stacey as long as there is a risk of patients being neglected, abused. or otherwise exploited by mental health professionals due to a lack of safeguards, then this is not an issue to be taken lightly. We cannot justify involuntary civil commitment — that is taking away people’s personal freedoms — on the basis that it “usually” works out okay. Until the system protects mentally ill people first and foremost, and there is adequate oversight and accountability then I don’t think that a person’s fundamental human rights should be denied just because sometimes the mental health system function correctly.
Yes indeed controlling others lives is never ok….
Mental illness industry is a disgrace, and the dsm iv has proven to be fake, voted upon like a candy factory
Controlling others is intruding on others private space, it is a universal sin. People doing it, or helping doing it, will get their karma back one day.
They will become very sad people, who neversmile for real, only fake smile
Ever seen a psychiatrist smile? nope, they are in love with Control
I expressed thoughts that I was having to a therapist and they wanted me to commit myself. I didn’t have any intent but I had tried to commit suicide a month ago. I felt very betrayed by this therapist because I wanted someone to talk me through the thoughts and help calm me down. I’m afraid that they still want to have me committed.
Cat, that must have been very frightening. I’m sorry that you are not able to trust your therapist. Is this something you could to him or her about? As a therapist myself, I would certainly want to know if my client did not trust me. And I would want to know what I needed to do, within limits, to rebuild that trust.
Best wishes for you in your healing. I hope that you are able to talk through your thoughts and be helped.