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.
Been there before & it’s hard. I keep cancelling my psychiatrist appointment for fear of getting bakered in.
I stayed in a facility for 7 months. That part isn’t accurate.
Serious question here. Do you guys have anyone else, other than your therapist, whom you could tell? I am slightly embarrassed to admit that I was a part of the group of people, out in the world, who think their therapists will put them in a mental institution if their therapists know about their suicidal thoughts. And I will tell you, from personal experience, that my therapist did choose to send me to the hospital the very night she became aware of my thoughts of suicide. But. It was a medical hospital she sent me to. So I would tell you to be aware of the fact that your therapist sending you to your local emergency room may happen. Good luck everyone,I hope this helps.
I’ve tried reaching out for help, been admitted to hospitals and subjected to “group therapy”, all which do nothing to help my situation. My last suicide attempt was actually 2 weeks ago because I can’t deal with the hurt and pain anymore. I’m made to feel bad about how and what I’m feeling, basically told that I’m selfish, ungrateful and attention seeking. I’ve been told to think positively, pray, be happy because there are people who have it worse than I do, etc. I can’t talk to anyone honestly because I’ll be tossed into the hospital again. And let’s not forget about the stigma. I’ve had a doctor tell me there was nothing else he could do for me; a social worker tell me I wasn’t “trying hard enough”; a doctor change medication as often as one changes underwear; and therapists that would call me by another patient’s name constantly. I’m sorry but the entire mental health and medical community’s view on this subject is horrible and extremely unhelpful.
I’m very sorry to hear about your situation. I’ve been there before, but I promise that it gets better. I know everyone says that, but you will find reasons to live and the hurt will slowly lessen each day. It won’t be easy and I know you know nothing in life is easy anymore, but the hard work is so worth it. Engage in therapy and make sure that you want it to work because it can’t work if you don’t want it to or do your part. I know that sounds like too much work to feel normal and everything, but your life is worth everything. Anything that it takes to experience feelings of love, joy, hopefulness again is worth it even if you can’t even imagine those feelings right now. I know how impossible it feels, but there is hope and there are people out there that will do everything to help you. Mental health is complicated, so sometimes it just takes a while to find those people. I hope that you take care of yourself and try to make progress little by little. I love you so much!
I’m so sorry that you haven’t gotten the relief that you need. I’ll tell you up front, I’m a huge believer in psych meds. It took many years to find the right combination of meds for my disorder (bipolar type 2, mixed). But I rarely experience suicidal ideation anymore and when I do it’s usually on a day when I’ve forgotten to take my meds. The pain you are feeling is real and the mental health “industry” is messed up but you can feel better. It’s okay to switch psychiatrists…look for someone with 5 stars…or ask for personal recommendations. Praying for you.
Thanks, until reading this I was genuinely thinking about telling someone, but I realize that would have been a mistake. I’m glad to finally find someone that is honest about the way that suicide cases are handled.
Payton,
I hope you’ll still consider telling someone. Yes, some people have had negative experiences when they disclosed their suicidality, and I wish those didn’t happen. But I also know many others have been helped. One person’s experience isn’t everyone’s — for better and for worse. If you’re worried that you’ll encounter a therapist who overreacts, this article might be helpful to you: How to Find a Therapist Who Doesn’t Panic about Suicide.
Thanks for sharing here, and I hope things get better for you!
Payton, please tell someone how you are feeling. Anonymous starts her comment telling us her last attempt was 2 weeks ago…so we know her method of preventing suicide is not working.
i am extremely disappointed with the comments here. anonymous is telling about their negative experience, something that by the way, is not as rare as you people think and what do they get? a bunch of meaningless comment repeating the same platitudes like “it gets better” or “it has worked for some people” i can’t even believe that this is what mental health discussions have come to.
Hello Stacey. I would like to read your book. Could you send a copy for free? I don’t approve of monetizing on the loss of life.
Lost Love,
Thanks for your interest in my book! You probably can check out the book for free at your local library. If you want to own a copy, you can purchase it from the publisher at a discount by using the code ADC22. Right now, for some reason only the library hardcover edition and the e-book are listed, but normally there’s also a softcover version. Amazon has the softcover version.
As for monetizing the loss of life, I’m not sure what you mean. Are you saying that funeral homes, cemeteries, estate planners, etc. should offer their services for free? As for books, I personally am grateful authorship isn’t limited only to those wealthy few who can cover the expenses of writing, printing, and distributing a book.
Thanks again for your interest.