[BatsBelfry]

I worry about being fully honest with my therapist because I think she will hospitalize me. Like I have my session tonight and I should probably tell her I daydreamed about suicide last night. I should have been watching TV but I couldn't concentrate. If you tell her/him about your thoughts can they force you in a hospital? Is talking suicide in and of itself enough to go that far. I'm concerned that I am not getting all I can out of the sessions if I don't talk to her about this. I rapid cycle and today I feel ok. The last two days were a different story though. My gut reaction is to hide this from her.

[Terabithia]

You wont be hospitalized by just telling her about your dream. She will probably want to explore it to see if in your waking life you are having thoughts of killing yourself. A therapist or psychiatrist will hospitalize you if they think you are a danger to yourself or to others. The hospital is a safe place to be, and for me, it has saved me many many times from the anxiety of just trying to decide whether or not to kill myself. If it is something you are wrestling with intensely in your waking hours, it would be a good idea to talk to your therapist about checking yourself in.

[BatsBelfry]

Originally Posted by Terabithia

She will probably want to explore it to see if in your waking life you are having thoughts of killing yourself.

Yea, I was wake. I was supposed to be watching tv with my wife. I kinda mentally floated off and was thinking about doing it and had a specific way. I'm more afraid of a hospital than death so I want to avoid it. When I have had this in the past and mentioned it, I quickly try and change the focus of the conversation. All purely on a fear of a hospital. It happens enough now that I think I should really talk to her about this. Then again, I don't want to go away.

[Daonnachd]

I had that very conversation with my T in my last session with her. My words were that I had fantasized about suicide, but that I felt I could hang on. We then focused on coping strategies, both short term and long term so I could get those fantasies out of my head.

My recommendation is that you be open and honest with her.

[CaminoDeOro]

I'm in DBT and they know I have suicidal thoughts almost every day, but also I've only gotten close twice in my life and both more than 20 years ago. It's just part of my reality which subsides greatly when my life doesn't suck. When I've mentioned it to therapist and pdoc they ask the obligatory questions and are satisfied with my explanation. Thinking about it (without making plans) is a lot more common than a lot of people realize I think.

[emgreen]

What others have said...Unless you outline a plan they don't petition you. I'd lie through my freakin' teeth to stay out of the hospital. I'm never going back again. I've mastered the art of selective lying....Plus, I'm still here, so...

[Northchild]

Why the fear of hospitalization? I'm sure that very few people enjoy spending a lot of time in a hospital because it's not as comfy as home and some of the usual distractions aren't there, but hospitalization can be an excellent way to really focus on getting well as quickly as possible.

[Rose76]

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.

[Terabithia]

Originally Posted by Rose76

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.

A person who is suicidal is not thinking rationally. A responsible physician knows this. You are right about how bad off you must be to be involuntarily admitted to the hospital, but in all my 20+ times I have been hospitalized, voluntarily, since 1989, I have never had the experiences you are describing - not to say that isn’t the case in some places. I would not discourage one from going to the hospital if he is suicidal, and again a suicidal person is not rational. If I tell my psychiatrist I’m suicidal and I need to go in the hospital, then I will be admitted to the hospital, usually for 2-3 weeks.

I think the issue is feeling comfortable going in the hospital. Whenever I’ve been suicidal, the hospital has always been that place where I feel safe. I stop the insane contemplations, because I know I simply can’t do it in the hospital. It’s a relief. Yes, there are a shortage of beds and I’ve had to wait in the emergency room overnight, waiting for a bed in the psych unit to become available. But I always encourage someone who is obsessed with, or having very serious, not dismissible, thoughts of suicide, to go to the hospital.

[Terabithia]

Can you look into different inpatient facilities, or find out more about your local hospitals psych unit? I’m just wondering if learning more about the place - the daily routine, etc. might make you feel more comfortable....or have you heard bad things about these places in your area? The most stressful part of it all to me is the admissions process. All the questions and how long it takes to be admitted makes me wonder if I shouldn’t just go back home, but I’ve never regretted staying. Hopefully, the thoughts you are having are in passing, like mine almost always are.

[Rose76]

The O.P. asked whether one could be forcibly hospitalized for discussing suicidal ideas with a therapist. The short answer to that question is "no."

It would be unfortunate for Bats to feel afraid to honestly discuss thoughts and feelings with a therapist based on an unrealistic fear. Bats has an unrealistic fear. I would encourage Bats to be open with the therapist.

I don't know how suicidal or how rational Bats is. A therapist who knows Bats is in a much better position than me to evaluate that. The therapist might very well encourage Bats to go to a hospital. It might be the best thing to do. Or not. Therapists don't automatically tell everyone who discloses suicidal ideation to go to a hospital immediately.

The question was about involuntary hospitalization. I was explaining how involuntary hospitalization comes about.

[BatsBelfry]

Originally Posted by Terabithia

I’m just wondering if learning more about the place - the daily routine, etc. might make you feel more comfortable....or have you heard bad things about these places in your area?

Nothing about my area. I just don't want it to happen to me. I would rather never say anything, except here I guess.

I started out asking if sharing this with her is risky in the was of hospitalization. It seems like it isn't from the responses. Now I need to courage to talk about it more I guess.

[Rose76]

Being an inpatient in a psychiatric facility can be a positive experience, or it can be a negative experience. Some people find it comforting. For some, it allows a reduction in anxiety and a clarification of their thinking. For some, it can result in a referral for some outpatient services that they might not have gotten otherwise. For some, it defuses a crisis that might have had a tragic outcome otherwise.

For some, it can feel like being warehoused. The food might be awful. Some of the staff might not be very nice. There might not be much programming and a person might be left with very little to do except stare at a TV set. Sometimes, people walk out of an inpatient stay not much better than how they walked in. People have been known to walk out and go commit suicide.

Everyone has the right to ask for admission. Intake is decided on a case-by-case basis. One time I was kept for a 23 hour crisis intervention. That led to a very good doctor taking a real interest in me and referring me to a partial hospitalization program. It was a good outcome for me.

Another time I went in with severe anxiety that had me feeling suicidal. It was a miserable experience. After one night there, all I wanted was to get out and go home.

These places are not set up to be like staying at a spa. You're not likely to get in-depth psychotherapy while you are there. Staff tend to be busy and have only limited time to listen to you talk about your issues. That can vary from place to place and, even, from time to time in the same place.

Going inpatient can be life saving, or it can be just a boring, dismal experience. When in doubt, you can always go for an evaluation. Either way, it's not a good longterm solution to anything. It's intended mainly as a way to be kept safe during a crisis.

To the O.P., I would ask: What is your main fear? I doubt that anything horrible would happen to you. And, as I've explained above, it's not common that you would be there for very long. I worked in a psych facility. A guy got admitted who had shot himself in the shoulder. He was released in four days. So that might give you some perspective. No one should try to compare their own experience to anyone else's. The doctors take into consideration a great deal of individual circumstances, and they vary considerably from person to person.

Another consideration is the other people who are your fellow patients. Some are understanding and supportive. Some are incapable of thinking past themselves. Some may be homeless and barely able to function. Some may have a business of their own they need to get back to. There really is no one "type" of person who gets hospitalized. It can be anyone.

Bats, I hope you do have a good heart to heart talk with your therapist.

[Leia78]

Your therapist DOES have the right and the ability to hospitalize you. I know this because my therapist hospitalized me from her office. She called an ambulance straight to her office and an ambulance and two police officers came and I was taken directly from her office by ambulance to the ER and from there I was sent inpatient to a pysch. hospital. Why did she have me admitted? Because I was suicidal and had a plan. Also, the night before I had chewed up and swallowed half a bottle of Lunesta.

So, YES, your therapist CAN put you in the hospital.

[~Christina]

Thoughts ? No

Plan possible but unlikely if T feels you need it

Plan with intent Yes

Going IP isnt some massive horrible thing, Its not where most people want to go but its there if you need it.

I have suicidal thoughts most days but its just a passing thought. When I start to think of intent then I need IP , right then.

IP isn't terrible.

[Rose76]

Originally Posted by Leia78

Your therapist DOES have the right and the ability to hospitalize you. I know this because my therapist hospitalized me from her office. She called an ambulance straight to her office and an ambulance and two police officers came and I was taken directly from her office by ambulance to the ER and from there I was sent inpatient to a pysch. hospital. Why did she have me admitted? Because I was suicidal and had a plan. Also, the night before I had chewed up and swallowed half a bottle of Lunesta.

So, YES, your therapist CAN put you in the hospital.

In this case, your therapist convinced police to see to it that you were transported to an emergency room for an evaluation. Any citizen can potentially do that. If you call a crisis "hotline," the counselor or volunteer at the other end of the line can call police and get the same result. That happened to me once. The paramedics are there to actually transport you safely, but the cops are there to see to it that you cooperate with the paramedics. Sometimes, police will simply transport you themselves, though they prefer to let healthcare personnel do that.

Once in the emergency room, it is the emergency room physician who makes the actual decision about whether or not to order that you be hospitalized. That doctor will be very interested in knowing what caused the therapist to call the police. That doctor will get that information from the accompanying police officers. No therapist out in the community has "admitting privileges" at any local hospitals. Emergency rooms often have clinical social workers on staff or on call, who can perform psych evals and give their impression to the E.R. physician. Specially trained "psych nurses" also sometimes perform this function.

I'm not trying to split hairs with anyone. The O.P. seems interested in knowing who has exactly what legal authority to do what. It just so happens I was in position to learn that. In my own case, when the cops and paramedics took me to the psych hospital, the doctors there didn't think I needed to be admitted, despite the counselor conveying very serious concerns. I had to talk them into keeping me. They did - for just 23 hours.

Where I live a therapist would not hospitalize you for thinking about it. You have to have a serious plan. I wouldn't worry about it...

Thank you for this thread. I have always lied when asked about SI. I assumed they would send the paddy wagon to take me away.

[annielovesbacon]

I think in general, if you simply discuss thoughts/daydreams of suicide with a therapist, they will not send you to the hospital. It's if you sound like you're in danger -- like you have made a plan to kill yourself, for example -- that they may hospitalize you.

[winter loneliness]

I once told my therapist that i have had frequent suicidal ideations. I have seen her for about 4 yrs, and she knows I would never do anything.

I think if you and your therapist have good trust between the two of you,then they won't hospitalize you.

[SparkySmart]

Tarabithia: Very nice summary! Thanks! This information is entirely consistent with my experiences.

In my state, there are 3 criteria for involuntary admission: Potential for harm to self, harm to others, or perceived inability to care for self. I asked for an admission in March and was admitted under the 3rd criterion as involuntary, with this being a condition of the receiving facility. I really needed help so didn't care either way; the legalities were daunting but very protective of my autonomy. I was grateful for the help and used this time wisely.

Having said that, after insurance paid its part, my out-of-pocket for this adventure exceeded 10,000, not including a 1700.00 ambulance transfer. I'll be paying on this for years, so it's a good thing I took advantage of all they had to offer instead of sulking over the involuntary status issue. In fact, I felt it was a great experience overall and provided me with lots of useful information and tools. It's kind of embarrassing having that on my record, but it's not the first time and probably will not the last (sigh). It is what it is. I will, of course, do my part to avoid a crisis in future.

Haha no. Therapists don´t take you seriously unless you are ACTUALLY literally planning and preparing to kill yourself. Told a therapist i wanted to die and thought about suicide several times a day, she said it was normal to have "existential questioning"

[SparkySmart]

Oh...I have something to add to my above post.

Some 10 years ago, I was seeing a pdoc (MD) in her private practice for med checks. She was also an attending at the nearby psych hospital and split her time between both. During one such visit, she didn't want to deal with my emotionality (which would have taken longer than the allotted 6 minutes), so she called an ambulance (unbeknownst to me) and had me carted off to the ER for IP admission. Frankly, I felt she had overreacted and said as much to the ER physician, who agreed and discharged me.

The point is that she was well qualified, as an attending MD, to have me admitted directly but deferred to the ER doc for the final decision. Anyway, I felt betrayed by the pdoc and never saw her again.

Really, I have a problem trusting ANYone in this field. I didn't fully appreciate it until just now. Hmmm. The problem, I think, is that I overestimate my intelligence...or maybe I've just been in the system too long and am jaded. I want to make my OWN decision whether hospitalization is warranted, thank you very much.

[Rose76]

Just because someone is an attending M.D. does not mean that she can "have you admitted" to the local hospital. She can "have you taken" for an evaluation. That's where her say-so ends. The emergency room doctor is under no obligation to admit you to the hospital no matter how eminently qualified a psychiatrist may have sent you there.

Here's a link. As it explains, what the attending pdoc can do is "initiate the process." https://www.psychologytoday.com/blog...nst-their-will

Of course, E.R. doctors will take very seriously the recommendation of a psychiatrist in the community who feels a patient is dangerously suicidal. But no doctor from a private office can dictate to any hospital that they must admit anyone.

"Initiating the process" of involuntarily forcing a patient to go to the hospital means that, first, the pdoc must convince police to compel the person to go. The police don't automatically take orders from anyone. The cops don't have to take you to the hospital just because some doctor calls 911. Normally, however, they probably would trust the doctor's judgement. But they don't absolutely have to. They would speak with both the patient and the doctor. They would look for evidence in the patient's speech and demeanor that indicates cause for concern. They might call paramedics. The paramedics might first consult by phone with the E.D. doc about what's going on. The E.D. doc might have the paramedics ask specific questions.

The mere fact that someone is a psychiatrist doesn't mean that person has the automatic authority to have anyone locked up. It might seem automatic because first responders would certainly take very seriously the recommendation of a psychiatrist reporting a patient as being in imminent danger of self-harm.

In the example above, the private attending pdoc didn't "defer to the ER doc for the final decision." The ER doc is the one has the right to make the final decision. The ER doc might chose to defer to the community psychiatrist, if the patient seems fine in the ER, but the ER doc feels the referring psychiatrist was seeing something worrisome that the patient may be covering up.

[SparkySmart]

It may appear to you that I'm disagreeing with you when, in fact, I'm not. Perhaps I'm not expressing myself well. The only point I wished to make was that the emergency department doc had the final say in the matter, not the pdoc. Whoever deferred to whom is not my problem; I was just glad to leave the drama and go home. Really, I'm immobilized with depression at the moment and can't even think clearly. My apologies. I shouldn't be posting at all in this frame of mind.