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.
*
Copyright 2013 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for Speaking of Suicide. Photos purchased from Fotolia.com, except where noted.
Just want to say thank you for the article. I’m 65 I was afraid to talk to my VA therapist about my occasional passive ideations. I’ve been hospitalized three times and I really don’t want to have a reunion with the nurses on the floor.
I often wonder if there is not some self-selection going on inside that famous statistic that “most people who attempt suicide do not go on to die of suicide later”. Please understand what I’m NOT saying:
That people who survive aren’t genuinely suffering;
That the attempt is a “cry for attention”;
Or that the attempt wasn’t serious.
But the survivors of attempts survive precisely because the method that they used/had available to them were survivable, at least to a limited degree. Plus, what the survivors were put through by the US Mental Health Industrial Complex was so horrifying that the risk of going through it again is too terrible to consider. They are not happy, not “cured”, perhaps just so tortured by our “health” system that the fear of this overcomes the despair/pain/anomie/nihilism that led to the attempt in the first place.
There are practically failsafe methods that would allow final escape from the pain of living and of well-meaning busybodies that somehow feel entitled to judge the thoughts and pain of others.
From a mid-60s YO male autistic person who has had despair and passive thoughts for half-a-century
Hello I’m about to go to high school and I already hate my life. I feel as if I’m dumb in everything, math, science, etc. besides art or band. I’ve stood in a road one time just wanting someone to hit me after a concert I did and in my head I was questioning my existence and if I’ll ever be good enough. My mum also has a big effect on me, she tells me if I ever killed myself she’d beat me. I was around 7. I was also suicidal then. I’m debating on telling my school psycologist. I’ve even given up on most things, I’d been writing a story for 3 years on paper until I stopped and continued everything on my phone due to my mum not liking the things I write about. She also told me that if I ever went to the hospital and was caught in the act of killing myself I wouldn’t be able to get a job because I would be considered crazy and no one likes crazy people. My Band teacher (not gonna say his name) notices me crying in the back of his class, outside the bandroom, or just at my seat (I play oboe so I’m in the front) I wanna tell me but… I’m scared also I’m extremley shy. I’m in 8th grade by the way.
It’s okay to feel like this, I’m only a year or two older than you and I know how this feels. I used to live in an abusive household that made me hate myself and others. At the time I never really considered it as abuse as a saw news stories of kids who were in abusive situations that seemed way more drastic than mine did, but something I learnt from processing this trauma is… Remember: you are justified in feeling upset or angry or hopeless at the things people say to you, you’re allowed to feel those emotions. Getting help is also okay. Personally I haven’t spoken to a therapist or been to a mental hospital due to suicide because I was afraid of the stories I heard about them; however not every person is out to get you. The fact that you’re on this thread at all means you want to seek help and the fact that you’re thinking about what happens after a suicide attempt means your thinking about a future anyway. Being suicidal isn’t a forever thing. Sometimes life sucks and you want to end it and nothing ever goes right, but inevitably something will always change. Whether that something is a new thing you enjoy at school, or good friends or moving out and away from a toxic environment, something will eventually change. At first you may not notice it, or feel its effects at all; but it will be there and bring with it other changes that make you happy. I know it seems impossible to consider, but think about what you want to do in the future. Start very generally, vague ideas about what you enjoy now and work your way down. It doesn’t have to be set in stone, it can be changed whenever you want, about anything you want, but start general. After a time you can start to think about what you need to do in order to achieve this future. Keep working your way down until you can think about what you want or need to do in the next year, month or week. The general ideas give you something to focus on and work toward in the future while working your way down gives you more and more achievable tasks to work on until you no longer even consider suicide as anything except another aspect of your life to be proud that you worked through. You will always be more cared about than you realise, there are people you may not know who will miss you when your gone. Stay strong through the struggle and things will get better.
Sincerely, A person who has felt what you feel and is hoping you get to experience moving past it too. 🙂
Im in year 7 and ive been feeling like i just want to kill myself for a few years now. I just dont want to tell my parents, because my mum will say im just looking for attention, my dad wont give a shit at all because he wishes i was never born. He even told me to go kill myself once. Schools really hard for me because everyone is in their own friend groups already, so they leave me out. The only friends that i had either called me selfish, mean and stupid or just simply didnt want to be seen with me because I was so unpopular. My bff moved away a few years ago and she hasnt texted me in about a year. I just find it so hard to not go jump off the bridge a few meteres away from my house, which would probaly just seriously injure myself because its so shallow just not that high. Since im in a mixed school we dont have school physcarists and or school therapy and its still over a year until i go to college. Ive also been bullied a lot at school, they either call me fat or are mean to me just because there was like someone from israel in my bloodline from hundreds of years ago. Im extremly shy and i get sucidal thoughts every single day. My house also doesnt feel like a safe place because my dad and my mum abuse me sometimes mostly my dad. I honestly dont know what to do.
I’m 54 and have been suffering for literally decades. I’m tired of it. My biggest thing is that I don’t want to hurt people that I know that I will leave behind. I’m actively trying to figure that out. It’s actually what lead me to this article. How do I let people know that it wasn’t their fault? or they should have noticed? etc.
I’m so sorry you’re hurting like this.
I’ve been in your situation before. And you can try your best. But I don’t think that blame ever really goes away. Your loved ones will likely always blame themselves for your death.
I wish I could tell you how much hope there is in the world for you. How much light and love and joy. So many people need you. It may not seem significant now, but I care. A random stranger cares. Remember that.
Tell them now how much you’re suffering. Remember suicide does not end the pain, it transfers the pain to others.
Nobody cares about how much someone is suffering. People only care about their own suffering. Live and die for yourself — not for others.
So be it.
I’ve been having thoughts for a long time. I’m 14 and I haven’t told my parents since these feelings started 3 years ago. I have really bad social anxiety so its almost impossible for me to do anything face to face especially with my parents. I go to this therapist type thing where she gives me medication for my ADD and social anxiety. But it’s terrible and agonizing for me to sit there talking to her. I feel a lot more comfortable texting because I don’t have to see them or hear their voice. I’ve texted my mom about some situations where my anxiety were through the roof and all she told me to do was man up. I almost started crying in the middle of school. I want the thoughts to go away but I don’t know what to do. It’s bad enough I have to speak about my feelings and adding the part where I’m face to face talking it’s terrible. I just want to feel loved. I had a girlfriend for about 5 months and she was perfect. I’m not attractive at all and no one likes me so I was pretty amazed. Until she broke up with me in July last year because having a boyfriend was too much for her. I don’t blame her for leaving but it’s almost been a year since and the pain isn’t gone. I have an absolutely amazing memory long term so I still remember everything about her and it’s killing me. I miss her. I’m lost. I wanna die. I have no options. None of my friends take me seriously except this one female friend I have. The problem is she will never like me how I like her. She leaves me on delivered but the problem is she is the only one that listens. Please help me I don’t know what to do. I already feel pathetic since I’ve said so much and I don’t think anyone wants to waste their time reading this.
If u ever wanna talk, I’m here. I’m a female who’s also been having suicidal thoughts so I get it. Don’t feel pressured to be strong all the time, you’re allowed to have feelings. It’s literally what makes you human. I hate when ppl stereotype men. You deserve to feel loved 🫶
I read your comment! In fact I was driving my daughter (12) to the hospital when an email alert came across. She saw the subject was “speaking of Suicide” and was really surprised. So I opened the email and we read it together. Thank you so much for sharing. She said it’s helpful to know that people in completely different circumstances who we don’t even know, are experiencing the same thing I am.
I’m home from the hospital now but running some comfy clothes up to her shortly. They’re going to keep her for a few days. Average is 5-7 days. She’s in a great ward. She’ll be very busy with goal setting and learning relaxation techniques, attending group sessions, art therapy and one-on-ones. She’ll leave the ward with an assigned therapist and shrink. She’s feeling positive about it and made her intake goal, “to learn to cope and heal.”
im sorry your mom told you to “man up”. I’ve said similar things because I thought my daughter was just trying to get out of going to school. I hope you’ll find the courage to be really frank with your mom. “Mom, I’m suffering and I need some professional support.” And then realize that it’s very difficult to find a child therapist so you’re going to have to be persistent.
Did you know this crisis line is text only? Text HOME to 741741.