Well, Bats, getting hospitalized is a bit harder than you imagine. Also, your therapist does not have the authority to "hospitalize" you. Inpatient psych beds are in short supply everywhere, while "suicidal ideation" is rampant among the despondent. There simply is nowhere near enough space in psych units to take in all the folks who reveal to therapists that they've been musing about doing themselves in. If you are an adult who appears rational, then the expectation is that you can take some responsibility for yourself. You would be asked whether or not you have a plan for how you would commit suicide. Even having a concrete plan and the means to carry it out won't necessarily get you hospitalized. Next you would be flat out asked what your intention is. If you dither on that, you would be asked to make a commitment to not harm yourself for a short period of time. You would be asked to agree to notify someone if your intention becomes more serious. Your answers are documented.

Your therapist can recommend that you go to an emergency room for a psych evaluation, usually performed by a social worker or a nurse (ir a psychiatrist in an actual psych facility.) If you seem utterly distraught, your therapist could call police to intervene. They would ask you some questions. Depending on your answers, the police can decide to forcibly bring you to a hospital E.R. or the crisis unit of a psych facility. Only a doctor can "hospitalize" you. If the interviewer doing the psych evaluation thinks you are an imminent danger to yourself, that person would notify a doctor. The doctor has the authority to mandate that you be involuntarily hospitalized for a short stay.

During this whole process, you are given ample opportunity to make a "contract" for safety, whereby you are released based on you agreeing to stay safe, or call for help, if you feel you are about to commit suicide. Unless you're practically psychotic, the assumption is made that a rational adult can make a commitment to be responsible for his or her own safety.

In unusual circumstances, an individual may be deemed unable to make that commitment. For instance, if you get arrested and incarcerated for causing an auto accident, in which someone is killed, the jail may choose to regard you as having a high potential for suicide, regardless of what you say. You might be automatically placed on a "suicide watch." That might mean you are kept under close surveillance and your condition documented every 15 minutes.

So you can go right ahead and be very forthright is discussing exactly what your thoughts have been on the subject of suicide. For that to lead to you getting involuntarily hospitalized involves quite a process that has built in opportunities for you to agree to be responsible for your own safety, which is what everyone engaged in the process hopes you will do.

To be involuntarily kept for more than a short period of time is something that not even a doctor can mandate. Extended hospitalization requires an order from a judge. For that purpose any hospital with a psych unit also has a conference room that serves as a courtroom where hearings are held, presided over by a judge. The doctor tells the judge that the patient is unwilling to stay hospitalized voluntarily and seems too much a danger to self to be released. The doctor must say why that danger is feared. The judge asks the patient for input. Then the judge orders a "hold" or a release. Judges don't always agree with doctors. In a society, such as ours, where liberty is a fundamental right, the system wants to be slow to deprive anyone of their freedom.

Some people think that the system will be quick to lock you up, just to be on the safe side, and out of fear of being sued, if they let you go and you do actually kill yourself. That's a myth. Our society considers that, if you are a rational adult, then the main responsibility for your safety is with you. Suicides occur from time to time in any large city jail. Courts have determined that it is not possible for any facility to prevent all suicides. If a facility gets sued, they are judged based on whether or not the suicide victim was offered reasonable access to mental health support and whether or not people doing mental health evaluations made a reasonable attempt to promote the victims safety, without subjecting the person to undue restriction of freedom.