What Happens When You Tell Your Therapist You're Suicidal

The Importance of Being Open With Your Therapist About Suicidal Thoughts

Experiencing suicidal thoughts can be scary and overwhelming. You may feel hesitant to be honest with your therapist about these feelings due to shame, fear of hospitalization, or other concerns. However, it is critical that you are open about any suicidal thoughts or tendencies so you can get the proper support and care.

Why You Should Tell Your Therapist

There are several important reasons why you should tell your therapist if you are having suicidal thoughts:

• So they can conduct a thorough suicide risk assessment
• To discuss safety planning and limiting access to lethal means
• To explore the root causes and coping strategies
• So your therapist can monitor your symptoms closely
• To adjust medications if needed to help alleviate suicidal thoughts
• To get you proper support services if hospitalization is warranted

Your therapist's top priority is keeping you safe. Being transparent allows them to take appropriate steps to ensure your wellbeing.

What Will Happen When You Tell Your Therapist

When you confide suicidal thoughts to your therapist, here's generally what you can expect:

• Compassionate listening without judgment
• Questions to assess your risk level and means access
• Discussion of coping strategies and sources of support
• Closer monitoring of your symptoms and functioning
• Potential changes to your treatment plan or medications
• Possible recommendation of partial or full hospitalization if risk is high

Your therapist will work collaboratively with you to keep you safe while respecting your autonomy to the extent possible.

You Will Not Necessarily Be Hospitalized

Some people fear disclosing suicidal thoughts because they worry they will automatically be hospitalized against their will. However, hospitalization is not always necessary if other safety measures can be put in place. Some factors your therapist may consider include:

• Presence of a detailed, workable safety plan
• Your level of commitment to staying safe
• Removing access to lethal means from your environment
• Your willingness and ability to follow safety precautions
• Support from family and friends
• Your history of suicidal behavior

For those not at immediate, high risk, outpatient treatment may be recommended instead of hospitalization. Your preferences will be considered.

The Assessment Process for Suicidal Thoughts

When you open up about suicidal thoughts, your therapist will conduct an assessment to gauge the severity of risk and determine next steps.

Risk and Protective Factors

Your therapist will review various risk and protective factors that can impact suicide risk, such as:

• Prior suicide attempts
• Family history of suicide
• Access to lethal means
• Substance misuse
• Mental health diagnoses like depression or PTSD
• Life stressors and access to support

Suicide Risk Screening Tools

Standardized screening tools like the Columbia-Suicide Severity Rating Scale may be used to systematically assess your risk level.

Questions About Thoughts, Plans and Intent

You'll be asked specific questions about any suicidal thoughts, plans or means, frequency and duration, precipitating events, reasons for living, and other areas.

Level of Dangerousness

Your therapist will evaluate the immediacy of risk, availability of methods, feasibility of plans, and preparation efforts made in determining dangerousness.

Mental Status Examination

Assessing your appearance, mood, thought process, cognition, insight and judgment provides clinical information about your mental state related to suicide risk.

Answering openly helps your therapist make an accurate appraisal.

Safety Planning Interventions and Support

Based on the assessment, your therapist will work with you to develop a safety plan and explore evidence-based interventions to manage suicidal thoughts.

No-Harm Contract

You may be asked to make a verbal or written contract agreeing not to engage in suicidal behavior and to reach out for help when needed.

Means Restriction

Limiting access to potentially lethal means of suicide, like firearms or stockpiled pills, is a critical safety step.

Cognitive Behavioral Therapy

CBT helps identify and modify negative thought patterns contributing to suicidal ideation.

Dialectical Behavior Therapy

DBT provides skills training, emotional regulation, and distress tolerance techniques to cope with suicidality.

Safety Planning Interventions

Collaboratively developing a written safety plan outlining warning signs, coping strategies, support contacts can help manage suicidal crises.

Support Network Involvement

Your therapist may work with you to strengthen your social support system and involve family/friends to assist with monitoring and support.

Hospitalization Criteria If Warranted

If outpatient management is insufficient to assure safety, more intensive interventions like hospitalization may be needed in specific situations.

Immediate Suicide Risk

Those assessed to be in imminent danger of suicide with high intent and lethal means access may require immediate inpatient admission.

Failed Outpatient Treatment

Worsening suicidal thoughts despite outpatient therapy efforts may indicate a higher level of care is needed.

Lack of Other Supports

For those without family or community supports, hospitalization may provide more adequate safety monitoring in a time of crisis.

Unsafe Environment

If your home environment makes safety precautions infeasible, hospitalization removes you from that setting until risks stabilize.

Serious Mental Illness

The structure of inpatient units can benefit those with serious psychiatric disorders contributing to acute suicide risk.

Medical Stabilization

Hospitalization allows medical treatment and monitoring after suicide attempts or in preparation for psychiatric medications.

What to Expect If Hospitalized for Suicidality

Here's what you can generally expect if hospitalized due to suicidal risk:

Evaluation and Admission

The ER will assess your risk and if hospitalization criteria are met, admit you to an inpatient psychiatric unit.

Safety Precautions

Measures will be implemented to maintain a safe environment, including restricting access to objects that could be used for self-harm.

Stabilization

The focus is on monitoring and managing acute symptoms 24/7 until your condition improves and stabilizes.

Observation

You will be under continuous observation by staff to ensure your safety and wellbeing.

Treatment Planning

Your treatment team will assess your needs and develop an individualized treatment plan including medication, therapy, etc.

Discharge Planning

The team will develop a comprehensive discharge plan for continuing care, referrals and safety precautions after leaving the hospital.

Working Collaboratively with Your Treatment Providers

Be open and honest with your therapist and treatment team. While hospitalization can seem intimidating, the goal is to keep you safe while involving you in decisions about your care. Maintain hope in your recovery.

The Bottom Line

If you are experiencing suicidal thoughts, it is essential to be upfront with your therapist so they can help you create a safety plan, provide support, and determine if hospitalization is needed. With professional help, suicidal crises can be overcome. There are people who want to help you stay alive.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.