Avoiding (Involuntary) Inpatient

[homesoon.]

I feel as though I have tried everything at this point: support groups, cbt therapy, emdr, medication, online groups, talk therapy, self-work, pushing myself to do better, forcing myself to not cave into self-harm, etc. I'm about to try intensive outpatient, which involves intensive group and trauma 1-on-1 therapy several times a week for the next 3 months.

I made the mistake of being a little too honest about my suicidal ideations and ended myself up here. I refuse to be honest about getting SN (aka how far I really have gone in "active ideation"). I want to avoid mentioning I have my method readily available as much as possible. I've accepted being honest enough to get myself referred to this type of program, but I refuse to be sent to involuntary inpatient because I'm "a danger to myself."

Has anyone gone through this? What is your advice?

EDIT: I'm worried that this will just be another thing to push me closer to cbt if it doesn't help.

 

[Saturn_]

From being in therapy and programs like this, I've tried talking about my active suicidal thoughts but framing them as if I don't currently have them, framing them as if they were just thoughts I had last night, feigning a "sound mind", and stressing that I'd never act on them. If I use this framing device and throw out as many "I wouldn't actually kill myself" qualifiers as possible, I've found that my therapists have been okay with that. But I feel like you should still take caution. I know how awful and traumatizing inpatient visits are, and I wish we could just talk to professionals about our problems without this fear of being thrown in hospitals against our will. I think involuntary inpatient just contributes to a higher amount of suicides -- out of sight, out of mind.

 

[willitpass]

Being honest enough to still be able to benefit from therapy while also not being honest enough to go inpatient and risk severe trauma is a difficult line to toe. Ever admitting you have SN will likely you get locked up, or at the very least have it confiscated. I will say, if you do ever decide you fully want to get better, eventually that would require letting go of the SN, as holding onto it "just in case" is probably a sign you aren't fully there yet. What I did before I eventually quit therapy after over a decade was I would be honest about having suicidal thoughts and occasionally mention pondering a plan, but if ever asked if my I had a true plan, the answer was always no. Remember, the more honest you are, the more helpful therapy is. The more you hide, the less benefit you will receive. I would discourage hiding anything other than having SN, as it will hinder your progress.

 

[thenamingofcats]

If you even admit to having a method that could be enough to lock you up, even if you don't disclose what the method is. If I were you I wouldn't mention suicide again. It's a symptom anyway but is often treated like the disease itself.

 

[willitpass]

If you even admit to having a method that could be enough to lock you up, even if you don't disclose what the method is. If I were you I wouldn't mention suicide again. It's a symptom anyway but is often treated like the disease itself.

If you don't mention suicide to a therapist, they can't help you work through why you're suicidal. I spent many years working my way through every nook and cranny of the mental health system. Saying you're suicidal is not going to throw you into the hospital. Saying you're suicidal with a plan can even be managed at home in some cases, though that one is very risky. Being suicidal in and of itself is not going to freak any good therapist out. They see suicidal people every single day, the have guidelines to follow about what is considered a crisis and what isn't. But going to a therapist for suicidal thoughts and not telling them is like going to a doctor for a headache and telling them you don't have one. If they don't know it's there, they can't help you.

 

[thenamingofcats]

If you don't mention suicide to a therapist, they can't help you work through why you're suicidal. I spent many years working my way through every nook and cranny of the mental health system. Saying you're suicidal is not going to throw you into the hospital. Saying you're suicidal with a plan can even be managed at home in some cases, though that one is very risky. Being suicidal in and of itself is not going to freak any good therapist out. They see suicidal people every single day, the have guidelines to follow about what is considered a crisis and what isn't. But going to a therapist for suicidal thoughts and not telling them is like going to a doctor for a headache and telling them you don't have one. If they don't know it's there, they can't help you.

I really disagree. There are many bad therapists out there and especially in an intensive outpatient setting you don't know who you're dealing with. Suicide is a symptom, not the bottom line. Most people know why they're suicidal already and don't need help working that out. Most people need help with the reasons they're suicidal. I've received better help and had a more relaxed therapist when I didn't mention suicide. They may or may not lock you up for mentioning being suicidal, it's at their discretion whether you're a threat to yourself or not.

 

[willitpass]

I really disagree. There are many bad therapists out there and especially in an intensive outpatient setting you don't know who you're dealing with. Suicide is a symptom, not the bottom line. Most people know why they're suicidal already and don't need help working that out. Most people need help with the reasons they're suicidal. I've received better help and had a more relaxed therapist when I didn't mention suicide. They may or may not lock you up for mentioning being suicidal, it's at their discretion whether you're a threat to yourself or not.

And I had a therapist who was actually willing to say I was in my remission from depression despite my continuing "passive" suicidal thoughts because she was aware that for me that was baseline. It's usually pretty easy to tell when a therapist is trying to interrogate you for more information because they think you're high risk, and that's when you carefully back track. Getting admitted is a process that involves review from multiple people anyhow, just because one therapist thinks you need admitted doesn't mean the doctor at the hospital will. It seems pretty clear OP wants to be as open as possible, and talking about suicidal thoughts can be important. If OP didn't want to bring up suicide to their therapist they would not have made a post asking about how to bring up suicide to their therapist.

 

[homesoon.]

If you don't mention suicide to a therapist, they can't help you work through why you're suicidal. I spent many years working my way through every nook and cranny of the mental health system. Saying you're suicidal is not going to throw you into the hospital. Saying you're suicidal with a plan can even be managed at home in some cases, though that one is very risky. Being suicidal in and of itself is not going to freak any good therapist out. They see suicidal people every single day, the have guidelines to follow about what is considered a crisis and what isn't. But going to a therapist for suicidal thoughts and not telling them is like going to a doctor for a headache and telling them you don't have one. If they don't know it's there, they can't help you.

I agree with this to the degree that I made the choice to be honest enough about my ideations to try and find another resource to help with them. However, I recognize that purposely getting access to a method that could be used to accomplish cbt will be handled completely differently. So, I've been honest enough to try another method to "getting help," but not to put myself in a position where I may become involuntarily forced to do something I don't want to do and/or lose my resource.

Most people know why they're suicidal already and don't need help working that out. Most people need help with the reasons they're suicidal. I've received better help and had a more relaxed therapist when I didn't mention suicide. They may or may not lock you up for mentioning being suicidal, it's at their discretion whether you're a threat to yourself or not.

At the time same time, I understand what you're saying. I have dealt with some therapists who are more sympathetic/empathetic than others. I think it falls upon who you're dealing with and how open you're willing to be. With or without this program, I may plan to end things anyways. If I do reach that point, I will not let anyone take that option away from me, especially some psychiatrist who I have never met or talked with outside of outpatient.

Getting admitted is a process that involves review from multiple people anyhow, just because one therapist thinks you need admitted doesn't mean the doctor at the hospital will. It seems pretty clear OP wants to be as open as possible, and talking about suicidal thoughts can be important. If OP didn't want to bring up suicide to their therapist they would not have made a post asking about how to bring up suicide to their therapist.

I'm trying to be open for the sake of other people and the fact I harbor guilt over knowing what suicide loss does to someone. However, I am reaching a point where I feel as though I am running out of options in terms of finding something that will actually help me; particularly helping me feel as though I can function as a human being.

 

[thenamingofcats]

And I had a therapist who was actually willing to say I was in my remission from depression despite my continuing "passive" suicidal thoughts because she was aware that for me that was baseline. It's usually pretty easy to tell when a therapist is trying to interrogate you for more information because they think you're high risk, and that's when you carefully back track. Getting admitted is a process that involves review from multiple people anyhow, just because one therapist thinks you need admitted doesn't mean the doctor at the hospital will. It seems pretty clear OP wants to be as open as possible, and talking about suicidal thoughts can be important. If OP didn't want to bring up suicide to their therapist they would not have made a post asking about how to bring up suicide to their therapist.

They asked for advice from people that have been there. I gave my advice, you don't like it. Oh well. My interpretation of their post is that they're trying to get help while avoiding being involuntarily committed.

 

[willitpass]

They asked for advice from people that have been there. I gave my advice, you don't like it. Oh well. My interpretation of their post is that they're trying to get help while avoiding being involuntarily committed.

And you can get help while being 90% honest without being involuntarily committed in many cases.

I'm trying to be open for the sake of other people and the fact I harbor guilt over knowing what suicide loss does to someone. However, I am reaching a point where I feel as though I am running out of options in terms of finding something that will actually help me; particularly helping me feel as though I can function as a human being.

I understand that. I stayed in therapy for about 3 years after I gave up trying for the sake of trying to stay for my family. After a certain point there was nothing more for me to say and nothing more for me to be told. She last minute canceled an appointment and I took that as my out. I haven't been back since. I hope that this is able to be a lifeline for you, and if not I hope you find peace.

 

[thenamingofcats]

And you can get help while being 90% honest without being involuntarily committed in many cases.

What is 90% honest?

 

[homesoon.]

And you can get help while being 90% honest without being involuntarily committed in many cases.

I understand that. I stayed in therapy for about 3 years after I gave up trying for the sake of trying to stay for my family. After a certain point there was nothing more for me to say and nothing more for me to be told. She last minute canceled an appointment and I took that as my out. I haven't been back since. I hope that this is able to be a lifeline for you, and if not I hope you find peace.

I truly appreciate you; especially because I have seen your prior posts relating to SN experience.

I have done therapy/emdr/etc. for over a year and a half, though it is not my first rodeo in doing so. I believe that part of the reason that I was referred to intensive outpatient was because my current mental health team does not know what else to do to help me get "unstuck." I am putting myself through this program as another attempt to get better and not subject others to what I have been through (i.e., cycle back to the guilt, SI, and suicide loss). However, I feel as though I am certainly losing more and more hope. After 15 years, you only have so much energy left to give to try and "wait it out." So, I am willing to be honest enough to seek help, but I certainly will not be honest enough to screw myself.

 

[willitpass]

What is 90% honest?

Sharing everything except the fact that you have an active plan. I suppose that could be 99% honest depending on your definitions. You can say you're suicidal. Once you've felt your therapist out and feel comfortable, you may even say you've thought about making a plan but don't intend to and you feel confident you'd reach out for help if you did start to make one. You can talk about death and suicide freely, you just never say you have an active plan or a method or time or location. "I don't have a plan and I feel confident in my coping skills" is your get out of jail free card.

I truly appreciate you; especially because I have seen your prior posts relating to SN experience.

I have done therapy/emdr/etc. for over a year and a half, though it is not my first rodeo in doing so. I believe that part of the reason that I was referred to intensive outpatient was because my current mental health team does not know what else to do to help me get "unstuck." I am putting myself through this program as another attempt to get better and not subject others to what I have been through (i.e., cycle back to the guilt, SI, and suicide loss). However, I feel as though I am certainly losing more and more hope. After 15 years, you only have so much energy left to give to try and "wait it out." So, I am willing to be honest enough to seek help, but I certainly will not be honest enough to screw myself.

The exhaustion is truly indescribable. People give so much grace to people with physical illness who've been fighting for so many years, but they always seem to lack understanding when those of us with mental illness run out of fight. I really do hope this is your moment to get unstuck. Best of luck.

 

[thenamingofcats]

Sharing everything except the fact that you have an active plan. I suppose that could be 99% honest depending on your definitions. You can say you're suicidal. Once you've felt your therapist out and feel comfortable, you may even say you've thought about making a plan but don't intend to and you feel confident you'd reach out for help if you did start to make one. You can talk about death and suicide freely, you just never say you have an active plan or a method or time or location. "I don't have a plan and I feel confident in my coping skills" is your get out of jail free card.

The exhaustion is truly indescribable. People give so much grace to people with physical illness who've been fighting for so many years, but they always seem to lack understanding when those of us with mental illness run out of fight. I really do hope this is your moment to get unstuck. Best of luck.

Due to my experiences I err on the side of caution with mental health professionals always. I don't trust in their sense of reason. It also depends how devastating being locked up would be and what level of risk you're willing to take to get help.

 

[willitpass]

Due to my experiences I err on the side of caution with mental health professionals always. I don't trust in their sense of reason. It also depends how devastating being locked up would be and what level of risk you're willing to take to get help.

If you chose to not disclose your suicidal thoughts that is fine, it is your choice to make. My point was that a therapist cannot treat what they do not know is there. While it may just be a symptom and not the disorder, they still have things that they can work on with you specifically relating to suicidality to help you process those. Obviously it doesn't always work, I'm a prime example of when mental health treatment doesn't work. However to get the most out of therapy, you have to give them the most information. So disclosing literally as much as you can without being hospitalized gives you the most chance at success. No one can force you to talk about things in therapy, but you won't benefit from it if you don't tell them.

 

[thenamingofcats]

If you chose to not disclose your suicidal thoughts that is fine, it is your choice to make. My point was that a therapist cannot treat what they do not know is there. While it may just be a symptom and not the disorder, they still have things that they can work on with you specifically relating to suicidality to help you process those. Obviously it doesn't always work, I'm a prime example of when mental health treatment doesn't work. However to get the most out of therapy, you have to give them the most information. So disclosing literally as much as you can without being hospitalized gives you the most chance at success. No one can force you to talk about things in therapy, but you won't benefit from it if you don't tell them.

I see what you're saying and it's how it's supposed to work, but it doesn't always work that way. I've paid dearly in therapy for my honesty and wanted to present that side of it as well, especially since I don't know anything about the program OP is going to.

 

[willitpass]

I see what you're saying and it's how it's supposed to work, but it doesn't always work that way. I've paid dearly in therapy for my honesty and wanted to present that side of it as well, especially since I don't know anything about the program OP is going to.

I have also paid for my honesty. Especially once already inpatient. I would say "fuck it I'm already here might as well" and next thing I know I'm on 1:1 having someone watch me piss. I also have experienced the lack of benefit I got from hiding. My therapist who said my depression was in remission told me that while I was at my absolute lowest. It felt so discrediting but I couldn't fault her because I was the one lying. Going to therapy week after week just to lie and say I was doing fine felt like such a waste of everyone's time and money. There's a line you have to toe, and it falls somewhere between 100% honesty and 100% lies. Neither extreme will do you any good. In my experience, the most honest you can be before you cross the line into hospitalization is the most beneficial.

 

[thenamingofcats]

I have also paid for my honesty. Especially once already inpatient. I would say "fuck it I'm already here might as well" and next thing I know I'm on 1:1 having someone watch me piss. I also have experienced the lack of benefit I got from hiding. My therapist who said my depression was in remission told me that while I was at my absolute lowest. It felt so discrediting but I couldn't fault her because I was the one lying. Going to therapy week after week just to lie and say I was doing fine felt like such a waste of everyone's time and money. There's a line you have to toe, and it falls somewhere between 100% honesty and 100% lies. Neither extreme will do you any good. In my experience, the most honest you can be before you cross the line into hospitalization is the most beneficial.

I wouldn't be willing to take those risks.

 

[willitpass]

I wouldn't be willing to take those risks.

And that's a choice you are allowed to make. Hell I made the decision to fully stop treatment after about a decade, although there wasn't anything left for me anyway. We're all allowed to make our own decisions. OP can read all of our advice but it's still up to them at the end of the day.

 

[thenamingofcats]

And that's a choice you are allowed to make. Hell I made the decision to fully stop treatment after about a decade, although there wasn't anything left for me anyway. We're all allowed to make our own decisions. OP can read all of our advice but it's still up to them at the end of the day.

I feel like I'm being lectured.