Avoid Involuntary Hospitalization for the US

[MarbleArch]

I've been heavily considering going to a therapist for years (at the cost of my career), and have recently sunk to a level to where it's pretty much either go or ctb.

Where is the exact line when talking to a mental health professional, reference involuntary hospitalization? I am terrified of being institutionalized for several reasons, it simply isn't an option, but I do want to convey the depth of my mental problems (which include active and passive suicidal ideation) so that I can get appropriate treatment.

The pinned post about legally contesting involuntary hospitalization, while being a great resource, specifically references various EU countries and excludes the US. I'm looking more for advice on how to not be hospitalized in the first place. Does anyone knowledgeable on American laws have advice?

 

[Zzzzz]

I don't know but I'm thinking about this also. I think a psych ward might just push me over the edge.

 

[symphony]

Legally they can only involuntarily commit you if they reasonably believe you are an immediate danger to yourself or others. It doesn't matter if you *are* in actual danger, just whether they *believe* you are. And that goes both ways. So if you are in danger and convince them you're not, all good, but if you aren't in danger and they become convinced you are, at that point nothing you can say will avert a stay in a psych ward.

If you can, though, I'd recommend meeting with a therapist at least once or twice just to try it at. At the start, deny being suicidal. It's safe to say vaguely that sometimes you abstractly wish you could fall asleep and not wake up, but of course you'd never actually act on it, you don't have a plan or anything like that.

This is the difference between passive suicidal ideation and active suicidal ideation. Of course if you want to be 100% you could go to a therapist and deny suicidal thoughts completely, but if you want to talk about them and maybe get help, you have nothing to worry about as long as you stick completely to describing passive ideation, never active ideation. If you admit to passive suicidal ideation, chances are good they'll immediately launch into a risk assessment and ask if you have any plan or intent to CTB and whatnot. Tell them you don't and they'll discuss (passive) suicidal thoughts with you without referring you to the nearest hospital.

I'm editing this to add a disclaimer that if this is relevant to you, please do not take my word for it. Read up on the law in your state.

 

[MarbleArch]

Legally they can only involuntarily commit you if they reasonably believe you are an immediate danger to yourself or others. It doesn't matter if you *are* in actual danger, just whether they *believe* you are. And that goes both ways. So if you are in danger and convince them you're not, all good, but if you aren't in danger and they become convinced you are, at that point nothing you can say will avert a stay in a psych ward.

If you can, though, I'd recommend meeting with a therapist at least once or twice just to try it at. At the start, deny being suicidal. It's safe to say vaguely that sometimes you abstractly wish you could fall asleep and not wake up, but of course you'd never actually act on it, you don't have a plan or anything like that.

This is the difference between passive suicidal ideation and active suicidal ideation. Of course if you want to be 100% you could go to a therapist and deny suicidal thoughts completely, but if you want to talk about them and maybe get help, you have nothing to worry about as long as you stick completely to describing passive ideation, never active ideation. If you admit to passive suicidal ideation, chances are good they'll immediately launch into a risk assessment and ask if you have any plan or intent to CTB and whatnot. Tell them you don't and they'll discuss (passive) suicidal thoughts with you without referring you to the nearest hospital.

Thank you for your quick reply!

What would the practical difference in care be between someone on the radar as having passive ideation and someone who doesn't? Is it even worth going in to depth at all?

Also, would a diagnosis of a psychotic disorder such as one of the many forms of schizophrenia make them more likely to assume passive ideation is a threat?

 

[symphony]

Thank you for your quick reply!

What would the practical difference in care be between someone on the radar as having passive ideation and someone who doesn't? Is it even worth going in to depth at all?

Also, would a diagnosis of a psychotic disorder such as one of the many forms of schizophrenia make them more likely to assume passive ideation is a threat?

RE differences in care: I'm not sure I can give a good answer to that, but probably someone on the internet can. In my experience, when I talk about being actively suicidal, the focus is generally trying to keep me safe and alive in the short term... lots of safety planning. With passive ideation, it's more looking generally at why I want to die and trying to address that. Or sometimes at that point my suicidal thoughts aren't the most pressing concern, so we'll spend the therapy session focusing on something else. I'm sure people have lots of different experiences with that, though, so I can't really say in general.

And I have no experience with psychosis so I can't really say. I have no idea how psychosis interacts with suicidal ideation or how a therapist might perceive that. What I can say is in order to hospitalize you, they generally have to reasonably believe that not hospitalizing you will result in harm in the near future. It's not generally enough for someone to think "well, they might hurt themselves eventually, a year from now, idk, so we should have them committed". So make of that what you will.

 

[Dead Ghost]

This has always been my fear, not being able to talk openly about my problems with professionals because they have to follow a protocol of action, this happens even with the GP you have assigned to public health.

There is now a bill that may change forced entry, but we will have to see how the parliamentary procedures and political strategies that political leaders follow to discredit each other at the expense of our well-being need to be developed.

I don't have all of them that one day we can talk openly without consequences, that's why I'm on this website, it's the only place where I am respected as a person.

Spoiler: Original Text

Aquesta sempre ha estat la meva por, no poder parlar obertament dels meus problemes amb els professionals perquè han de seguir un protócol d'actuació, això passa fins i tot amb el metge de capçalera que tens assignat a la sanitat pública.

Ara hi ha un projecte de llei que potser canviarà l'ingrés forçós, però caldrà veure com es desenvolupen els tràmits parlamentaris i les estratègies polítiques que segueixen els líders polítics per desprestigiar-se els uns als altres a costa del nostre benestar.

No les tinc totes de que algún dia podem parlar obertament sense conseqüències, per això estic en aquesta web, és l'únic lloc on se'm respecta com a persona.

Last summer I came up with some tests that are used in the protocols and so I didn't ask for help, I thought they would follow a conservative approach and shut me down. Examples of tests in Catalan and Spanish filled by me:
//
L'Estiu passat em vaig fer amb alguns tests que s'usen en els protocols i per això no vaig demanar ajuda, vaig pensar que seguirien un criteri conservador i em tancarien. Exemples de tests en català i castellà omplerts per mi:







I'm not at all amused by these protocols, at least they already enter you, as in the second test.
//
No em fan gens de gràcia aquests protocols, per un mínim ja t'ingressen, com en el segon test.

Bye

 

[WhiteDespair]

easiest way: talk in past tense

"last weekend I..."

 

[Angi]

Ask them where they draw the line. They have to tell you. You may want to get to know them first, to make their answer more informative, but generally, just ask.

Thank you for your quick reply!

What would the practical difference in care be between someone on the radar as having passive ideation and someone who doesn't? Is it even worth going in to depth at all?

Also, would a diagnosis of a psychotic disorder such as one of the many forms of schizophrenia make them more likely to assume passive ideation is a threat?

No meaningful difference in care. If they believe you are a danger to yourself they will just spend more time on safety planning. Exception is if you are in care of a group practice or agency, they might transfer you to a provider with more experience with suicidal people. It may make a difference to you though, to be able to share a larger part of your experience.

Yes, very likely. This is one of the threatening factors in the books.

 

[UpandDownPrincess]

The hardest part is walking through the door and sitting down for the first time.

IME, it's not actually that easy to get involuntarily admitted. Most states do not have enough psych beds and there is a limit to how long an ER can hold you if a bed does not become available. When I went inpatient, I was an active danger to myself and my psychiatrist really had no choice. I mean, it was OBVIOUS. But I was still given the choice to voluntarily admit myself when I arrived at the ward. My care stayed in my hands, even with a referral.

For most of my life, I was the princess of passive death thoughts. I was always praying to be run over by a bus or something. I've never had a problem discussing these thoughts with anyone and they've never led anywhere close to an admittance. That's a good place to start. It's kind of like putting feelers out there. And follow your gut. If you think the provider is uncomfortable with what you're saying, it's time to clam up.

One more thing: don't no-show after an appointment with a discussion of suicide. Call and cancel, but don't no-show. This can make a provider very nervous and perhaps have them try to track you down. That's a hard pass.

If you're thinking you need more services than just a therapist can handle, I encourage you to look at day programs, partial hospitalizations and there are even some evening programs that let you go to work everyday. For me, these have been the most helpful interventions.

Edited because I am a lousy typist.

 

[noaccount]

The hardest part is walking through the door and sitting down for the first time.

IME, it's not actually that easy to get involuntarily admitted. Most states do not have enough psych beds and there is a limit to how long an ER can hold you if a bed does not become available. When I went inpatient, I was an active danger to myself and my psychiatrist really had no choice. I mean, it was OBVIOUS. But I was still given the choice to voluntarily admit myself when I arrived at the ward. My care stayed in my hands, even with a referral.

For most of my life, I was the princess of passive death thoughts. I was always praying to be run over by a bus or something. I've never had a problem discussing these thoughts with anyone and they've never led anywhere close to an admittance. That's a good place to start. It's kind of like putting feelers out there. And follow your gut. If you think the provider is uncomfortable with what you're saying, it's time to clam up.

One more thing: don't no-show after an appointment with a discussion of suicide. Call and cancel, but don't no-show. This can make a provider very nervous and perhaps have them try to track you down. That's a hard pass.

If you're thinking you need more services than just a therapist can handle, I encourage you to look at day programs, partial hospitalizations and there are even some evening programs that let you go to work everyday. For me, these have been the most helpful interventions.

Edited because I am a lousy typist.

For many, many people, "voluntary" admission has been no less violent than involuntary - once people sign themselves in they are still subject to all manner of abuses and cannot sign themselves out again at will.

Even if one is free to leave a "partial hospitalization" program at the end of the day, don't underestimate how traumatizing it is to be in an environment where staff are assaulting other people around us - even if they're not doing it *to us* directly, that is still not a safe environment.

Suicide risk goes up after being locked in a psych unit regardless of whether or not the person was suicidal before being detained.

 

[ornitier199]

Suicide risk goes up after being locked in a psych unit regardless of whether or not the person was suicidal before being detained.

Is true I attest.

 

[noaccount]

Is true I attest.

I'm sorry.