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What happens when a suicidal person asks for help?

Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

The first thing a mental health professional will do when encountering a suicidal person is to conduct an interview to establish the acuteness and lethality of his or her present suicide risk. When this interview occurs in a hospital environment, the entrance interview is typically known as triage. At the conclusion of triage, a suicidal person will likely be asked to enter the hospital as a psychiatric patient on an inpatient unit if his or her suicide risk is judged to be severe. If suicide risk is judged to be lower than severe, he or she will likely be sent home with a list of local mental health professional referrals.

Triage-like screening interviews will also occur upon first contact with mental health professionals encountered in both inpatient and outpatient settings. Essentially, any doctor or therapist who becomes responsible for a suicidal person's treatment will need to conduct their own interview. This process is repetitive, but necessary to bring everyone up to speed. Each professional must establish their patient's level of suicide risk and think through the type of care necessary to reasonably ensure the patient's safety. Psychiatric hospitalization during the period of acute suicidal crisis is generally going to be the level of care recommended whenever suicide is judged to be imminent. For example, a therapist in an outpatient setting who meets with a client who confides that she will end her life that day is extremely likely to attempt to coordinate an inpatient hospitalization that day.

A therapist or admitting clinician who judges a person's suicide risk to be substantial will often first invite that patient to voluntarily enter the hospital for a few days. Voluntary hospitalization, where a person accepts the need for professional help, is the preferred scenario when hospitalization is necessary. However, involuntary hospitalization also occurs on a regular basis. If, for example, someone is judged to be a high risk for suicide and refuses the therapist's recommendation for voluntary hospitalization, or if they are intoxicated, they may be lawfully hospitalized against their will for several days. In many states, involuntary substance abuse and psychiatric systems are separate, so whether or not someone is intoxicated will determine which type of involuntary hospitalization scenario is used.

Many people fear involuntary commitment and are resistant to the idea of seeking help for their suicidal impulses purely on this basis. Do what you can to reassure the suicidal person you're helping that hospitalization is necessary to keep him or her safe. Try to allay fears of being restrained and/or hospitalized indefinitely which, though frightening, are not all that realistic. Most people who are hospitalized are not restrained, except for the fact that the door to the unit may be locked in some facilities. Only very agitated or violent patients are restrained. So long as your friend or family member does not threaten anyone else on the unit, he or she will not be restrained.

In addition, many factors work to keep hospital stays short. In a typical scenario, the initial commitment period lasts three days, after which it must be reviewed by two court-appointed specialists who might re-certify it for perhaps an additional three days. All the while, insurance companies (and the courts) are reviewing patient progress closely with an eye to order discharge as soon as possible so that costs are kept to a minimum and a person's freedoms are not overly impeded. It is the rare and very ill patient who is kept hospitalized on an indefinite basis these days. In fact, in many cases today, patients are discharged before they feel they are ready to go home, and while they are still feeling somewhat overwhelmed and suicidal.

People who enter the hospital on a voluntary basis are typically free to leave the hospital once their level of suicidality has decreased. However, if a person's doctors think that he or she continues to be an acute risk for suicide and that individual decides to leave the hospital against medical advice, those doctors may be allowed by law to ask for involuntary commitment at that point. Involuntary hospitalization may also be extended while someone's risk remains high, but such extensions require additional assessment procedures to take place as well as certification by a court or a mental health court, depending on local governing law.

Unfortunately, there may not be any available hospital beds in your area at the particular time your friend or family member needs one. In such a case, the mental health professional who is in charge of triage will work to find another crisis facility that has room. If a suitable placement cannot be found, do what you can to help keep the suicidal person safe. If possible, stay with the suicidal person until they are feeling safer.

While people are in the hospital receiving treatment, they will likely be interviewed at least once by a psychiatrist, who may prescribe various medications (described below). They will also likely be asked to participate in individual or group therapy sessions.

You can visit the suicidal patient while he or she is in the hospital (in most cases). Be respectful of a person's privacy and therapy schedule while they are in the hospital, however, and ask whether he or she would like to be visited before showing up. Some people don't want visitors in the hospital, while others do. If your friend or family member does not want frequent visits (or visits during certain times), please respect and follow those wishes.

Being suicidal (which usually means being depressed), and then participating in hospital unit therapeutic activities on top of that can cause fatigue. Do not be surprised or feel terribly hurt if your friend or family member seems tired or emotionally worn out during your visit. Do not force them to rehash what is happening in treatment or to justify their thoughts or feelings to you. It's better if you simply offer companionship and human support. Offer to play a card game, bring in a favorite snack, or simply sit and watch T.V.