While not popular to talk about, suicide is a sad reality in our society. The Centers for Disease Control estimated that more than 32,000 Americans died as a result of suicide in 2004. And contrary to some of our stereotypes about suicide, it occurs in all age groups, not just teenagers. Men, women, children, adults, older adults, and all ethnic and cultural groups can be at risk for developing suicidal thoughts or ideations, making it important for all health care practitioners and consumers, parents, teachers, children, and friends to know something about what to do when/if these thoughts come up.
I talk to folks in my practice on a regular basis about having a safety plan – i.e. what steps to take if they feel like they are in imminent danger of hurting or killing themselves. We discuss calling 911, or going directly to their nearest emergency room. The APA Help Center has more information about who to contact if you or someone you know is at a risk for suicide.
What I have realized over the years, is that often people are afraid to call 911 or go to the hospital (even when they really need to) because they don’t know what to expect. They are afraid they will be looked down on, chained to a bed, or made to feel “stupid” or “weak.” In fact, seeking immediate medical and psychological treatment is the most important thing you can do for yourself, and for most people is a positive, and helpful experience.
What generally happens is:
If you or a concerned loved one calls 911, a police car, ambulance, and fire truck will likely arrive several minutes later. This is part of the protocol for 911 calls, so do not be alarmed that many first responders arrive.
You are not a criminal, and should not be treated as one (i.e. no handcuffs used, Miranda Rights read, etc) – unless you are threatening to, or actually harming someone else. The first responders have been in situations like these before and will likely be understanding and kind as they escort you into one of their vehicles.
You will be transported to the nearest emergency room.
Once in the hospital you will likely be shown to an Emergency Department bed where you will wait for a nurse, aide, or other care provider to come in for an initial interview.
Just as if you hurt your arm or were suffering chest pains, a medical professional will come speak to you (this can be done in private, or with a friend or loved one present – it will be up to you) about what has brought you in. It is important to be honest and open – even if it is embarrassing.
After the initial interview, you will very likely have to wait for a period of time (hopefully not too long) to be evaluated by a mental health professional. You may speak with a psychiatrist, psychologist or a social worker. They will probably ask you similar questions to the first person who interviewed you, but in more depth. It is likely they will want to talk to you alone. Again, it is important to be open and honest with them about your mental state, your plans for suicide, as well as any medications you might have taken, or steps actually taken to harm yourself. They will also want to know about your mental health history as well as any mental health or psychiatric treatment you have had, or are participating in currently.
After the interview, the psychologist – or other mental health professional – should be open with you about their ideas for your care. Will you be best served (and safest) in an inpatient psychiatric hospital, in an intensive outpatient program, by your current mental health practitioner?
Whichever course of treatment is required, the psychologist will assist you (and your family if desired) in making necessary plans and arrangements. They will help you make appointments, find out about your insurance benefits, or arrange transportation to the nearest inpatient facility (many hospital do not have inpatient psychiatry/behavioral health departments, so if this level of care is needed then you will likely need to be transferred).
As a health care consumer, you are entitled to ask as many questions as you need to, ask for reasons behind any decisions made, ask for a second opinion, and be involved in all decisions. It is important to be aware, that most states have laws requiring that people who are in imminent danger of harming themselves be hospitalized for a period of time in order to provide psychiatric treatment – even if they do not want to be hospitalized. In most states this hold period is 72 hours.
The purpose of emergency mental health care is to ensure personal safety and establish psychiatric stability. These conditions should be met, a safety plan established, and solid, clear-cut plans for follow-up and/or continuing mental health care should be made before you are released from an emergency facility.