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.
The Psychiatric hospital literally almost killed me and then almost let me die from insomnia.
I was there because I stopped falling asleep, and not one of these “doctors” or “nurses” had ever even heard of Anti-NMDA receptor encephalitis, or agrypina excitita: at night you could literally hear every other patients room, when they flushed the toilet, if they washed their hands, if they snored. I literally went 240 hours without any sleep. These places are clueless evil idiots, the first time they made me obese, the second time they put me on contraindicated polypharmacy and the third time they don’t treat me for me disease total insomnia in any way. If it’s a voluntary hospital then why is it locked? Who the hell thought this was even a good idea? Stay away from these places. Don’t go voluntarily; in my experience they will only make you sicker. What a shitty place to treat insomnia.
Your words read to me like someone who tilts their head and leans in. “Did you know 90% of people who were admitted to psychiatric hospitals did *not* go on to kill themselves?”. I sit here, reading your words. How do I feel? I check in with myself. I don’t feel hope. I feel invalidated.
You say that mental hospitals have evolved way beyond chaining mentally ill people to radiators. And yeah, I guess there is at least that. At least we’re beyond the age of showing mentally challenged and ill people off like zoo animals. But I am of scarce belief from my own experience being nearly involuntarily committed that it really is that different from what you described. (You saying that it’s harder to get into a mental hospital then Harvard? Absolutely false statement and only an anecdote of “someone said” to lull people into thinking they won’t get committed. When it is extremely easy to be thrown into what is essentially prison for the crime of being abandoned enough by life to no longer love it.) People, yourself, me, and whoever is reading this. We have limited amounts of patience for each other. When someone doesn’t fit into a mold, there is a very good chance they will not be listened to, their concerns pushed past to insist that a certain mold is for them. When all they really need is someone to *pay attention* to what they’re saying. But this whole website feels like it’s a pamphlet they’d give out to people who had a close one kill themselves. One size does not, and never does fit all. You never made that claim. But the way you talk about staying in a mental hospital is full of hope. “Maybe you’ll be happy that you were protected by having your privacy violated! It’s not like you get enough of that from your probably abusive parents!”. It’s paternalistic. And honestly, harmful.
This has only solidified my determination to not call the 988 hotline. You all seem to give me just as much pain as my life does when it comes to invalidation. This article wears a veneer of a calm, sympathetic voice while using language that firmly redirects people into its narrative even if people have conflicting experiences. Perpetuating a pattern that hurts the mentally ill and showing just how useless your work is outside of gaslighting and chemically lobotomizing people just because it works for a handful. I detect no sympathy for the truly mentally ill. Just someone trying to open they arms to lull people into a trap that may kill them.
This is all rubbish . I am from Canada and there are a bunch of hypocrites. Psychiatrists are the worst they try to talk with a nice tone of voice to gain their trust and when they write their reports they say lot of rubbish of me. They do not have the nerve to tell you why they want you to live. I do not have any purpose in life. by the way I am a failed losser 60 year old female that I have no friends, no connections, I lost the ability to connect and reconnect nobody can see any good in me so what is the point to share. In 3 years I have not had any hugs human touch and the way I express that need is by been extremely physically violent to myself . I will not tell the details as I do not want problems. I was assaulted by my husband and he is the one who is getting justice. I am a laughing stock and since everybody has neglected me I am neglecting myself too. If I do not get what I want I am planning to start a hunger strike , If I am involuntary in a mental institution , my only words will say dead and do not waste time with their interviews and to do their job by keeping me heavily secured in heavy chains and treat me as an animal, as all mental institutions dehumanize people, at least they should dehumanize by keeping me heavily chained 24/7 . and the worst corporal punishment that has existed in this world as you know there is nothing for me in this earth no love and support no friends, I am very jealous of people and when I come home I am extremely enraged that I become extremely violent towards myself. Everybody walked away from me when I needed most what I need is compassion, care, comfort and without that there is no life. I am in pain and agony the only goal I have in this life is to die and hope is soon. There is a lot of evidence that I have done a lot helped a lot of people but when I am in need everybody walked away from me. I do 9/10 right and they only concentrate on the wrong, I am sick and tired of being seen by my defects versus the good in me. I am a walking dead. Also for many years I signed the organ donor card ,but now I withdraw my consent so when I die nobody can have my organs. For a quick death. No funeral as I want to be thrown to the garbage as that is what I am.
Zuzu,
It sounds like you feel abandoned by people you’ve helped and cared for in the past, and you are understandably furious. It’s interesting to me that, from what you wrote here, it appears you take that anger out on yourself, instead of giving yourself grace and compassion. As human beings our minds are complex and can work against our best interests. This might be one of those times.
Living in the dark, in fear, with so much anger – as you describe above and in a separate comment – is so painful. You made clear you don’t trust psychiatrists. I wonder if a “warmline” might be helpful to you. Warmlines (as opposed to hotlines) typically are staffed by peers who have had similar experiences, and many explicitly have a policy of not calling the police. If you call, you could ask their policy before confiding in the peer supporter. I don’t know where you are in Canada, so I just did a Google search for warmlines in Canada and found these results. Maybe one will be helpful to you. I hope so! And thank you for sharing here.
Thanks for answering my comment. Sorry it took me too long to reply to you. I tried the Warm Line at progress place for sometime and thanks for your effort to prepare this for me. Unfortunately my pain and agony will not end Yesterday I went with a friend it was ok at the beginning but at the end she hurts me horrible, she told me nobody will hire me because I am old and mentally unstable and that I scare people reason that I do not have friends, I am extremely hurt with her comments that I do not wish to live anymore. I call the Warm Line but it was busy then call 988 I let them know how scared I was and the pain and I asked them not to call police and 1 hour later they knocked at my door versus calling first. This has been scare me more that I wish I am dead very soon. Nobody has compassion of me, without connections I feel like a walking dead. I wish I am dead soon. I am exhausted. Although 988 did that to me before, what I do now is not accept a follow up call, even when I call I mask my number and how they reported to the police. If they really care, they should do human follow up really connecting me with people . THis is the only way I can function and if they consider me that I need to be put in the hospital at least they should have the courtesy to lock me in heavy chains 24/7. I am done
The world is shit, it’s full of shit, both the literal pollution we leave and all the horrible things we do, but I’m starting to see a pattern. It tends to be the good people who get covered in the shit. They are the ones that try so hard, so often that care gets taken advantage off. But I think the idea that anyone who has enough of a heart to care about anything deeply enough to get it broken being trash is absurd. You are worth something even if it’s only the impact you had on the people you helped, even if you think that wasn’t worth much at all. It seems to me that you really want someone to care about you because you feel like the people in your life aren’t. I find that, at least in my own experiences, that there are more people who care about you than the immediately obvious. Those who are only casually acquainted with you may actually want to know about your pain and deepening those connections can help with your view of yourself and the world.
Also, in relation to number tracing and welfare check ins, I’m not entirely sure how the tracing of calls works, but if the city you live in is walkable, you can go on mental health walks while talking, which could help with your trust in them and allow you to open up more, and you may even meet new people out and about
Also, and I don’t know if this is weird or preachy to other people, sorry if it is because it’s not meant that way, but I grew up Catholic so the church is quite comfortable to me. I’m not sure about the situation in Canada, but I’m sure that all Catholic churches if not all religious buildings, will accept people coming in to meet with the attendees, talk to the preist/ other minister of faith and form real friendships even without a belief in the faith, so depending on the people in your area this might be a good option to form real human connections without that element of mistrust.
what if its out of protest for being gaslit
Here is the catch if you call the 988 number. If the person with whom you’re talking thinks that you are at an imminent risk of committing suicide, they can use their service’s system to trace your call and location and then call the police. I know someone this happened to, and he said that he would NEVER again call 988 because they violated the trust he placed in them. So think a long, long time before picking up the phone unless, of course, you don’t mind getting a knock at the door.
I know many “people with lived experience” in the mental health recovery movement, including myself, who would never call for that reason. I have had really deep emotional pain that I truly wanted to reach out for support with, and knowing that I have no one I would trust in my city who would not make things worse, has been so difficult knowing I have to deal with that all alone.
I agree with you. I will not trust them anymore. I am already in distress when I call 988 and bring the police creates more trauma. Why trust them? It happens twice in 10 months and since the first time the police came I no longer open my blinds, I am very scared and distressed that I will no longer see light. There is no way I will open the blinds again. If they care they will do proper follow ups . WHat I really need is love , support, compassion, comfort and connections if they cannot give you that onlyl traumatize you more they are rubbish