Help Seeing my psychiatrist tomorrow, should I tell him about my intentions?

[Canto XIII]

As the title says, I'm seeing my psychiatrist tomorrow. It's a routine visit to check on the farms dosage and the general progress of the therapy. I was thinking of discussing my intentions with him because I feel like I should have a conversation with someone irl about them before making the big step, just to be sure I've considered everything. And of course I can't talk about this with my family or friends. He's also a smart and learned person, and as skeptical as I've grown of psychiatry his expertise can't hurt in this case. Of course I know this is potentially a bad idea. In my country (Italy) a psychiatrist can break professional confidentiality if their patient's life is in danger, so he could potentially warn my parents, and an "obligatory sanitary treatment" (TSO) is also on the table, even if it apparently requires a bit of bureocracy. He did none of this stuff when I first confessed such impulses a year and a half ago, but that was arguably because I was collaborative, which I'm no longer willing to be. I'd prefer not to anguish my parents. I'm not scared of being sent to the psych ward, but it would be an annoyance. I wonder if threatening legal retaliations would help.

Of course, I'll eventually make this decision by myself, but I was curious of hearing your advice. Will bro rat me out?

 

[bagel12]

you should check out the laws for this in italy. and you should directly ask your psychiatrist what he has to report vs what can be kept confidential.

in my area, they are legally obligated to send you to the psych ward if (1) you have a specific actionable plan to ctb, (2) you have the means to carry out that plan, and (3) if you intend to carry it out in the near future. but if you don't fulfill all of those criteria, and if the professional you're working with is chill, you probably won't be involuntarily committed. for example if you just mention ideation, but not a plan, they might change up meds, or ask you to try a therapist, an intensive outpatient program, or partial hospitalization

but again this mainly depends on the laws in your country, and the disposition of your psychiatrist. i think it's worth mentioning the thoughts of ctb and maybe the motivation for why you feel that way, as long as you're careful and deny having the means, the plan, or the intent to carry it out soon

 

[Set Real Goul]

I can't imagine what I'd have to confess to a psychiatrist. But in any case, you probably shouldn't tell them that you're planning to do CTB anytime soon. I don't know what you intend to talk to them about, but it's better if, from their perspective, it's something that's at least a year away. I think that reduces the risk of hospitalization.

 

[Canto XIII]

you should check out the laws for this in italy. and you should directly ask your psychiatrist what he has to report vs what can be kept confidential.

in my area, they are legally obligated to send you to the psych ward if (1) you have a specific actionable plan to ctb, (2) you have the means to carry out that plan, and (3) if you intend to carry it out in the near future. but if you don't fulfill all of those criteria, and if the professional you're working with is chill, you probably won't be involuntarily committed. for example if you just mention ideation, but not a plan, they might change up meds, or ask you to try a therapist, an intensive outpatient program, or partial hospitalization

but again this mainly depends on the laws in your country, and the disposition of your psychiatrist. i think it's worth mentioning the thoughts of ctb as long as you're careful

Thank you for your asnwer. As far as I know, one condition which is required for a TSO is the presence of "psychic alterations", whatever that means. I think I am in possess of my wits, as far as common perception goes, but I guess suicidal ideation itself could be seen as the sign of an alteration.

I can't imagine what I'd have to confess to a psychiatrist. But in any case, you probably shouldn't tell them that you're planning to do CTB anytime soon. I don't know what you intend to talk to them about, but it's better if, from their perspective, it's something that's at least a year away. I think that reduces the risk of hospitalization.

This could actually be a smart way to do it. He knows a lot about me already.

 

[bagel12]

Thank you for your asnwer. As far as I know, one condition which is required for a TSO is the presence of "psychic alterations", whatever that means. I think I am in possess of my wits, as far as common perception goes, but I guess suicidal ideation itself could be seen as the sign of an alteration.

This could actually be a smart way to do it. He knows a lot about me already.

i'm reading about tso requirements on this website and, if it's accurate, it looks like you have to "require immediate treatment for acute crisis" and that you "cannot be adequately treated by other means". so i agree with the other commenter that if you make it seem like something you've thought about, but you don't have any plan to do it in the near future, it seems like you wouldn't qualify for a tso. especially if you agree to other treatment like a change in medication, or seeing a therapist

 

[DontTouchMeImFamous]

you will end up in a ward and they will tell ur family. if ur okay with that, go for it

 

[Pulse9477]

Hello. I agree with what Bagel12 and Set Real Goul have said. Additionally, if you plan on telling him about your SI, you should prepare for it likely resulting in TSO, or some other form of obligatory treatment. I can't guarantee that it would be that, but he definitely would have to do something about it, especially if this isn't your first time talking with him about suicide.
-Pulse9477

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Hello. I agree with what Bagel12 and Set Real Goul have said. Additionally, if you plan on telling him about your SI, you should prepare for it likely resulting in TSO, or some other form of obligatory treatment. I can't guarantee that it would be that, but he definitely would have to do something about it, especially if this isn't your first time talking with him about suicide.
- -Pulse9477
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[fadedghost]

Do you know if reporting you is an obligation or optional for him if you disclose extremely serious suicidal plans? There may be rules and requirements of the profession that don't create a lot of choice for him. It sounds like the last time you disclosed being suicidal, it was a casual ideation without a serious plan. That may be different?

If you feel like you should possibly have a conversation with someone before taking "the big step," you aren't ready. Survival instinct is extraordinarily difficult to overcome. If you have any hesitation, you may fail in the attempt or be unable to do it, and you could get injured in a failed attempt.

You could find out more about inpatient care in your area, see if they treat people well or poorly, find out the financial impact on your family (which may be nothing depending on how health care is paid for in your country), and consider doing inpatient. Really, 1 year of psychiatry isn't a lot... sometimes people improve and get better and it takes a long time. If you're getting on 3+ years of trying to get better with psychiatry, and always feel awful, it seems more sensible to consider it.

It is normal for it to take a number of medication attempts for someone to start feeling better. Some people are medication treatment resistant, but at 1 year, you can't possibly know.

I think you should bring it up, but also be prepared for hospitalization. If you get involuntarily hospitalized, do not consent to ECT, and make sure you have the ability to refuse in your area and check that online before considering getting hospitalized. ECT fucks up your memory long term, you never get it back, even if you are feel alright.
I also suggest you read about hospitalization experiences in your area and average length of stay. You should also know that some people leave in-patient saying how great it is, but they do that because people who complain may not be let out as quickly, so sometimes people trapped there do it as a form of survival mechanism, to say the place is great, and once they are out it's like they still have a kind of PTSD/Stockholm Syndrome and can't say how bad it is. I would just try to find some accounts from people in your area of what inpatient care is like.

 

[Canto XIII]

Do you know if reporting you is an obligation or optional for him if you disclose extremely serious suicidal plans? There may be rules and requirements of the profession that don't create a lot of choice for him.

This might be the case, under certain circumstances at least.

It sounds like the last time you disclosed being suicidal, it was a casual ideation without a serious plan. That may be different?

It was a serious ideation, but since I willingly accepted an internment, I guess there was no reason for him to stress his powers. However, both facilities I was confined to required my explicit approval.

You could find out more about inpatient care in your area, see if they treat people well or poorly, find out the financial impact on your family (which may be nothing depending on how health care is paid for in your country), and consider doing inpatient. Really, 1 year of psychiatry isn't a lot... sometimes people improve and get better and it takes a long time. If you're getting on 3+ years of trying to get better with psychiatry, and always feel awful, it seems more sensible to consider it.

This is honestly not a big concern for me. When I was hospitalized last year everyone treated me well. The brief stay in the public hospital was free of charge, since I was taken in at the ER, the (hefty) bill for the affiliated facility was fully paid off by the NHS. Also, I was left go after 2-3 months. Honestly, I don't think another hospitalization would help at all, for me.

It is normal for it to take a number of medication attempts for someone to start feeling better. Some people are medication treatment resistant, but at 1 year, you can't possibly know.

I've been under medication for several years now, and I was in therapy for much longer. But I agree people in general should not give up at the first try.

If you get involuntarily hospitalized, do not consent to ECT, and make sure you have the ability to refuse in your area and check that online before considering getting hospitalized. ECT fucks up your memory long term, you never get it back, even if you are feel alright.

I actually didn't know about ECT-related memory loss, good to know. In any case, it's apparently always voluntary in Italy.
Thank you for your answer.

 

[fadedghost]

This might be the case, under certain circumstances at least.

It was a serious ideation, but since I willingly accepted an internment, I guess there was no reason for him to stress his powers. However, both facilities I was confined to required my explicit approval.

This is honestly not a big concern for me. When I was hospitalized last year everyone treated me well. The brief stay in the public hospital was free of charge, since I was taken in at the ER, the (hefty) bill for the affiliated facility was fully paid off by the NHS. Also, I was left go after 2-3 months. Honestly, I don't think another hospitalization would help at all, for me.

I've been under medication for several years now, and I was in therapy for much longer. But I agree people in general should not give up at the first try.

I actually didn't know about ECT-related memory loss, good to know. In any case, it's apparently always voluntary in Italy.
Thank you for your answer.

If it's a free 2-3 month stay, why not go? Do you have a job? If you have a job, it would be a reason not to go perhaps, to try to stay with the job and keep doing well, but if you're just depressed and not currently working and the facility treats people well and let you go 2-3 months later, it seems like no harm in giving it a try to see if you feel better in 2-3 months?

 

[Canto XIII]

If it's a free 2-3 month stay, why not go? Do you have a job? If you have a job, it would be a reason not to go perhaps, to try to stay with the job and keep doing well, but if you're just depressed and not currently working and the facility treats people well and let you go 2-3 months later, it seems like no harm in giving it a try to see if you feel better in 2-3 months?

I'm a NEET. While I appreciate your interest, the first stay didn't help and I don't think a second one would; I've since realised there's nothing that really could, I'm beyond help (just to be clear, I'm talking about myself specifically, I'm not saying it would be the same for everyone). I'd also feel guilty about wasting my government's money which could be profitably used for a better goal, starting from treating other people who are afflicted by concrete and treatable diseases, or doing medical research.

Edit: ESL mistake

 

[AgathaChristieLover]

You should definitely tell him. As bad as some psychiatrists are, most of them are good. If you tell him, there's a chance he'll be able to help you deal with your issues, maybe you won't even have to CTB if he does a good enough job. As long as you don't tell him you're gonna shoot yourself on July 27, 7:00 PM he probably won't hospitalize you

 

[Canto XIII]

As bad as some psychiatrists are, most of them are good.

I agree. He's a good person and a competent physician, and he's grown on me over time.

As long as you don't tell him you're gonna shoot yourself on July 27, 7:00 PM

lol
I'll probably tell him.

 

[Captive_Mind515]

So your psychiatrist is in Italy and you are in the uk? (you mentioned NHS)

I would be very careful telling professionals about such plans. It rarely ends well. But then you must also trust your instincts, if you think they can help you and if it might alter their treatment path. It's really a judgement only you can ultimately make.

I guess you could tell them that you are considering giving yourself one more year to see improvements, and then considering ctb. This means you are not in immediate danger to yourself (their terms) and this might make the psychiatrist pick a more aggressive treatment strategy. But it's usually a very risky move. They could still deem you to be actively suicidal. If it's the NHS, they can be very strict with applying their rules governing these situations.

 

[Canto XIII]

So your psychiatrist is in Italy and you are in the uk? (you mentioned NHS)

I wrote NHS as a generic term or translation, I probably should've said SSN (Servizio sanitario nazionale, that is National Sanitary Service). I live in Italy and I'm an Italian citizen.

I would be very careful telling professionals about such plans. It rarely ends well. But then you must also trust your instincts, if you think they can help you and if it might alter their treatment path. It's really a judgement only you can ultimately make.

I guess you could tell them that you are considering giving yourself one more year to see improvements, and then considering ctb. This means you are not in immediate danger to yourself (their terms) and this might make the psychiatrist pick a more aggressive treatment strategy. But it's usually a very risky move. They could still deem you to be actively suicidal. If it's the NHS, they can be very strict with applying their rules governing these situations.

I ended up mentioning it but not really dwelling into it, and nothing happened. I don't think I alerted him much, but maybe I would've if I were more explicit. From my experience, Italian MH professionals tend to be pretty hands-off in their approach.