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

You may be 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’re seriously thinking of killing yourself, that doesn’t necessarily mean you’ll be hospitalized – even if you want to be admitted. Hospitals are pretty strict these days about who they admit, and insurance companies are equally strict about covering a hospital stay. Some therapists joke that it’s harder to get into a mental hospital than Harvard University.

Who Gets Admitted to a Psychiatric Hospital for Suicide Risk

Adults

Suicidal thoughts alone aren’t usually enough to warrant psychiatric hospitalization for adults. Instead, you’d need to be in significant and immediate danger of killing yourself. This generally means you’re intent on acting on your suicidal wishes very soon or you’re unable to control your suicidal urges. Perhaps you already have a plan for how you’d 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. And, on top of all that, you don’t want to try to stay safe.

If so, then yes, hospitalization would almost certainly be necessary. If you don’t consent to be hospitalized (that is, you won’t voluntarily admit yourself), then you might be committed to a hospital. This should an absolute last resort, but it can happen if someone’s suicide seems imminent.

People get admitted to a psychiatric hospital when suicidal danger is extreme because serious suicidal intent is almost always temporary. Consider that even among people who attempt suicide and survive, more than 90% do not go on to die by suicide.

So, if you’re thinking of killing yourself but don’t intend to act on those thoughts any time soon, then a mental health professional shouldn’t try to have you hospitalized. Instead, they should work to understand your reasons for wanting to die, to help you feel better, to increase your hope and reasons for living, and to build up your coping skills. (I say “should,” because unfortunately some therapists and doctors overreact. Here are ways to try to avoid a therapist who panics.)

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 consider suicide. And adolescents tend to be more impulsive than adults. So what I wrote above about strict criteria for hospitalization may not apply as much to young patients, because of the extra caution that they warrant.

If You Do Need Psychiatric Hospitalization for Suicide Risk…

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 a long time. It might help you to know that, on average, people admitted to a mental hospital with suicidal thoughts or behavior don’t stay more than a few days. 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 the ones in One Flew Over the Cuckoo’s Nest or other Hollywood movies. But these days, hospitals don’t use straitjackets. In fact, they’re not supposed to use restraints at all 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.)

What Happens If You are Admitted to a Psychiatric Hospital for Suicide Risk

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’ll be asked to turn over anything that you could use to try to hurt or kill yourself. This includes things like shoelaces, sharp items like razor blades (called “sharps”), and belts. You might be examined without your clothes on, to ensure you aren’t hiding any weapons or pills.

During your stay, you’ll likely 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. You probably won’t be able to keep your phone with you at all times.

There are definitely things that are scary about being in a psychiatric hospital. I’m not going to sugarcoat it: Bad things can happen in psych hospitals. For some people, hospitalization appears to make them feel worse than they did before they were admitted.

Even if nothing outright awful happens to you in a psych hospital, everyday aspects can be hard to deal with. Staying with strangers, some of whom may have more serious problems than you, is frightening. Just as happens in any hospital, you don’t have much privacy. Being searched can be unsettling, even traumatic for somebody who’s been sexually abused in the past.

The unit is locked, and that can feel confining. You can’t come and go as you please. If you’re very dangerous to yourself, you might have someone who shadows you, watching you even when you’re using the bathroom.

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

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

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Copyright 2013 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for Speaking of Suicide. Photos purchased from Fotolia.com, except where noted.