Again, Bats, your therapist doesn't have the authority to "hospitalize" you. The most she could do would be to send you to the ER for a crisis evaluation. She does not control the outcome of that evaluation.

I say this because it's important to know who can "order" what. It's important to know this system isn't foolproof. In my community a family is suing a hospital that failed to "hospitalize" their daughter who went to the hospital with suicidal thinking. They discharged her and she went and successfully committed suicide that night. This was less than 2 years ago.

There simply are no set, ironclad guidelines that determine who does and who doesn't get admitted. To a fairly good extent, it depends on the gut reaction of the ER physician. That is true everywhere in the U.S. It is not an exact science. Guidelines do exist, as discussed above. They look for "plan, lethality of plan and intent." They look for "prior history of attempts." But many people have been sent away who proved to be way more serious than was believed.

Sometimes a person shows up who makes very specific threats, but just is not considered entirely credible, based on just gut feeling of ER staff. That person may be detained in the E.R. for hours and hours, possibly left sitting in a chair and not given a great deal of attention, other than being observed and detained behind a locked door. A security guard may be the main observer. This can be a test. The ER staff may be seeing whether this may cause the individual to become so bored, tired and uncomfortable that he or she will simply ask to leave, saying "I'll be alright."