Debating telling my psychiatrist an therapist I have suicidal thoughts.

I made the mistake of admitting to a psychiatrist in 2012 that I have had suicidal thoughts at times, even though I also explicitly told her that I would NEVER act of them, had no intention of doing so, and had had these thoughts from time to time for decades. And, for my trouble, I was sent to a psych day program. Which broke me and nearly made me kill myself for real.

So, I've struggled ever since. At first, I thought, give it time, you will come out of this and feel ok about life again. But, I don't. I feel so hopeless that I will ever think of myself as anything but a "mental patient" again. I hate myself, a white-hot burning hatred. I am miserable.

I know they can't help me if they don't know the full situation. And, I really, really like both of them, the psychiatrist in particular is the exact opposite of the first one, who was, in hindsight, a real quack.

Still, it would be such a leap of faith for me to tell them what I really think -- because I am so afraid of being sent back to a psych ward. I have vowed, and meant it, that that will never happen. I would literally die first, and it would have to be by force if they got me there alive.

So, if I do this, I need to make sure they understand that thoughts and actions are NOT the same, I have no intention of acting on it.

Any advice on how I should approach this, come clean, and not end up in cuffs in the back of a police car on my way to the psych ward?

You need to find a pdoc with a good rep and not panic and send you to a mental ward every time you talk about suicide. I talk about suicidal thoughts weekly with mine and has only once mentioned the possibility of committing me if I were any worse. I have told even about ways I would consider doing it, and why I don't.

They look for things besides for admitting thoughts. Having plans, feeling hopeless, not showering.

My suicidal thoughts are impulsive. I think about tough stuff, and a lot of times a sui thought pops in my head. I am in no risk of harming myself like that. My therapist knows that, and is cool about it. She knows they are impulsive and has not threatened to lock me up.

I think as long as she knows that your life is not in danger then, she will help you and not lock you up.

My sui thoughts are kinda recurrent. It just keeps going on and on.. but the real danger is when I know I'm really close to doing so. My T and pdoc knows this.. that when I do feel ok my sui thoughts are still present.

You can try to be honest again... if pdoc does that then why not try it with T?

I don't think it is absolutely necessary to tell your pdoc and therapist every single thing. If you were in imminent danger, then I would retract that. If not, you can choose what to share, and that is okay.

After years of getting treated, I have the following approach. I ask myself, what do I expect to get out of sharing this or that? Then I select what I talk about based on that.

I found a day psych program very helpful for me. I'm sorry if your experience was not so good. Two years ago, I did go in-patient, and that was a bad experience that I would not volunteer for again.

You should be able to discuss having suicidal ideation without getting immediately locked up, if you are clear that you do not mean to harm yourself in the near future. Some providers of psych care do over-react. Sometimes you need to change providers a few times to find someone you connect with in a productive way. I hope you can talk candidly to your care providers and come up with a plan that is reasonable to keep you safe, but respect your autonomy.

I recently had a really rotten experience with a volunteer in-patient program. I, like you, vowed I would never do that again. Still, you need to be able to talk the mental health professional you are trusting with your care. May be try putting it in more abstract terms. You know...not about something that is happening right now, but as a hypothetical you want to propose to better clarify your treatment relationship. If it was me, I might say:

"Listen...I had a REALLY awful experience in the past with confiding in my psychiatrist with regard to suicidal ideation. I need to know that I can talk to you about IDEATION and have you understand that it is distinct and separate from INTENT. If I begin to have INTENT, I will tell you, but I also need to know that I can discuss the ideations without you flying into a panic and hospitalizing me. If I can't discuss these ideations freely, without fear of unnecessary, involuntary hospitalization, then I'm going to have to find somebody else who I CAN discuss these things with."

Does that help?

I never tell a therapist about suicidal feelings. Every medication I've ever been prescribed has given me suicidal thoughts. In my experience asking for help has been disastrous.

Wishing you the best.

I have them every day. Have no plan. Many of my days seem happy. But almost a day doesn't go by that I don't think of it. I mentioned to my T once that I had them...but not to the extent I do.

IDK, at this point, I'm not sure what she'd do. I like her. she's great. I'm not afraid to tell her. Maybe the thoughts comfort me in some way and I don't want to address it?

I read somewhere that everybody has thoughts that they don't want. Sometimes those thoughts are suicidal, but because they are thoughts, they are not action. I will admit to my doctors that I have the thoughts, that they disturb me, but that I have no plan or means to enact a plan.

I do get the idea though because I'm afraid to get into details about the pain these thoughts have on me. When they hit hard, it's so painful that I just want the pain to stop. I'm afraid if I get into that level with my providers they will push me to a hospital.

I guess there are differences in national/regional responses to such disclosure. In the UK and from personal experiences, admitting and struggling with suicidal ideation is dealt with only if you plummet feet first down that path... which I personally think is pretty irresponsible and dangerous... but budgets are budgets.

I would advise that if you’ve experienced overkill responses to admissions, then balance up the pro’s and con’s of if you do vs you don’t.

If you think you are at risk, then it is going to be reassuring that you’ll be taken seriously and given care rather than shrugged off.

Hey, I DID IT. I was very direct with her, and I reassured her I had absolutely no intention of follow through on these thoughts.

She was AWESOME about it -- her first words were "don't be afraid to tell me things like that, suicidal thoughts are normal, I'm not going to stick you in the hospital just because of that".

So, we're changing medications (again, alas, but that happens), and I told her I was going to make a real effort to try to concentrate on the positives in my life. She wants to check in via email or text message weekly, and I'll see her again in my regular 3 weeks.

I'm so relieved.

That's great to hear MJ