Life after suicide attempt

October 20, 2009 3:39 PM

My brother attempted suicide. Now he's in the hospital.

My brother was pulled off a bridge a couple nights ago. He is being held against his will at the hospital (St.Paul's in Vancouver). The dr's have said that he will be there for 3 days to 3 weeks, depending. My question is what is going on at the hospital? I'm assuming they are trying to figure out if he'll try it again (he's tried before but never been hospitalized) but I really have no idea how the days are playing out for him right now. I know that he's giving them a hard time and had to be sedated at least once. Of course, I'm half way across the country hearing all this from my mom, so there are layers of family drama to weed through and I don't feel like I really know anything. Any insight into the world of hospitalization following suicide attempts? Thanks.

posted by Abbril to health & fitness (22 comments total)

The documentary The Bridge is about the inner workings of depression and suicide. It focuses on the Golden Gate Bridge and there are a few stories about people who have survived their suicide attempts. It can be difficult to watch but it provides an exceptional amount of information on a topic that is hard to breach.

Hope everything works out for the best.
posted by pwally at 4:09 PM on October 20

Here's a guess at his day:

-Wake up at a set time. (7am?)
-Medication. He's undoubtedly been put on some sort of anti-depressant. The sedation might be only as needed, not a constant thing.
-Breakfast.
-Group therapy of some sort. Talking in a circle, discussing better coping mechanisms, etc.
-Lunch
-Another group therapy. This may be simple talk therapy or possibly music therapy, art therapy, or animal therapy (petting rescue kittens), if the hospital has the resources for those.
-Individual therapy. One-on-one with his assigned therapist.
-Afternoon medication
-Dinner
-Free time/ TV watching/ playing cards/ reading.
-Lights out (9 or 10pm?)

If your brother wasn't suicidal, he'd probably be allowed smoke breaks or outside walks, but these are probably curtailed for the first week or two, especially if he's being uncooperative.

An orderly probably checks your brother every 15-30 minutes at night to make sure he's safe.

In time, he will probably appreciate cards, notes, or a visit. Right now, he's in the best place for him and even if you were there you wouldn't be able to help him any better.

I hope he's able to find happiness.
posted by sharkfu at 4:23 PM on October 20

My step daughter has been hospitalized after suicide attempts several times, most recently about 18 months ago. We're in the US, so things might be different in Canada. I can tell you that she's been kept for varying amounts of time each time; her shortest stay was probably 4 days and her longest involved her being sent to inpatient rehab and lasted maybe 3 or 4 months (with most of it in a state-run rehab facility).

I can't really talk about the inner workings very much, but I can say that usually the mental health professionals spend the first few days trying to assess the patient: what lead to the suicide attempt; how likely are they to try again; and other stuff, probably. I think that usually if the patient can articulate a reason they were thinking of suicide that is something like an acute crisis (e.g., my girlfriend just broke up with me and I was drinking away my sorrows when I had this terrible idea but now that I'm sobered up, I see it was stupid and I'll never do that again), that's considered "better" than something more diffuse (e.g., I don't know...life is just misterable...what's the point?...we're all going to die eventually anyway). If the doctors and clinicians feel that the patient has made it past whatever lead to the attempt in the first place, usually they try to put together some sort of post-release plan (or at least they used to). In other words, I don't think that they just open the doors and send the patient on his way with no outside support plan in place.

Anyway, Abbril, I'm not sure how much that helps, but you have my sympathy. This is a really, really tough thing and I'm sorry this is happening. I hope your brother gets whatever the treatment is that he needs and that he puts this behind him once and for all.
posted by Maisie at 4:23 PM on October 20

Hey, I am terribly sorry, but whatever you do, do not watch The Bridge at this moment in your life.
posted by xmutex at 4:26 PM on October 20 [10 favorites]

This recent Globe and Mail article discusses some of the legal background and process involved in involuntary committment in Canada. As to his day to day "routine," he is still probably in an evaluation phase, where he is meeting once or more a day with psychiatric staff, who are attempting to understand and diagnose his condition. They're initially looking to see if he may have a chronic mental illness such as schizophrenia, or bi-polar disorder, which often push sufferers to attempt suicide, or whether he has a condition such as depression, or perhaps even some short term problem, like acute situational depression.

If necessary, he may be sedated on the orders of the treating psychiatrist, to prevent him doing harm to himself or staff. He'll be given a physical examination, to check if any physical disease is causing or aggravating his mental or emotional symptoms (infections and electrolyte and vitamin deficiencies can cause aberrant behavior without underlying mental illness). If necessary, he'll be treated for any physical conditions that are discovered (IV fluids, antibiotics, and other medicines as needed). Family visits may be curtailed during initial evaluation, so that the staff can see the patient without any additional complications that interaction with family or friends sometimes brings. If he reports a clear pattern of symptoms, or has neurological test results that indicate a diagnosable mental illness, he may be started on a regimen of therapeutic medications.

If he can be stabilized, and becomes coherent, he may progress to various kinds of therapy, including group therapy, talk therapy, or CBT, as his doctors deem most suitable. He may be allowed visitors, and can authorize staff to discuss his case, and their findings, with family (but this is not mandatory).

It would be good if you understand that evaluation and initial treatment phases can take as long as a week to 2 weeks, and that until any physical problems he has are corrected, and he acclimates to the care he is given, it may be difficult for hospital staff to make an accurate diagnosis. Even then, if your brother does not want his doctors to discuss his case with family, they may have legal restrictions governing what information they can pass on. So, it may be sometime, if ever, before you get any accurate picture of what is really happening with your brother.

For now, he seems to be in a place where he can't harm himself. Rest easy, and be patient, on that assurance, at least.
posted by paulsc at 4:30 PM on October 20

My information is based on knowledge of the mental health system and involuntary hospital holds in the states. I see your brother is in BC. YMMV.

He's under an involuntary hold right now because he's a danger to himself. In the states, this means that after 72 hours, a judge will determine whether or not he'll be held any longer. Usually, this means that the judge will review the hospital's records and consult with his treating psychiatrist and social worker before coming to a decision. The judges usually do whatever the doctors suggest. If he is deteremined to be a continued danger to himself, the involuntary hold will be continued. I'm not sure of the timeframe for review after the intial 72 hours.

In terms of how his days are playing out right now? Hmm. It's hard to say. He probably has little sense of time (psychiatric wards and sedating medications tend to scramble one's sense of time). People are probably coming in and out of his room at regular intervals and infuriating him with requests to take mediations and participate in group activities/therapy. He is probably on suicide watch which means someone is either sitting in the room with him or watching through a window/door. Other than that, hopefully he is sleeping and resting.

In terms of treatment, they can't do much while he's giving them a hard time except sedate him and try to medicate him until he is compliant with treatment. Sometimes people just need a "cooling off" period before they begin to engage with treatment. Treatment will consist of visits with the phychiatrist and probably individual/group therapy. In the states, he can be forced to take medication under the judge's order.

If he begins to comply and accept treatment before the initial 72 hours, they will probably release him to community treatment. He will need to "contract." Which means that he will promise to contact a mental health professional or return to the Emergency Department if he has further suicidal ideation.

If he is released, he will be given appointments for follow up with community treatment. It is unlikely that anyone will follow up regarding whether or not he makes those appointments. It will be up to him to follow through.

Note: Psychiatric hospital wards are very unpleasant places. He's probably very uncomfortable and angry.

Good luck to you and your brother.
posted by dchrssyr at 4:40 PM on October 20

check your mefi mail.
posted by gursky at 4:52 PM on October 20

Primarily they are holding him waiting to see what medications may work.

Please keep in mind, I can only extrapolate from my own experience:

He sleeps in an uncomfortable, narrow cot. He has a couple roommates, one of whom has that special crazy person stink. There's a small plastic window in his room that reminds him that he is being held against his will. In the middle of the night they come to stick a thermometer in his mouth and wrap a cuff around his arm to take his blood pressure. He'll be noticing many absurdities to the situation.

They wake him up at a given time, and have no sympathy for people who might prefer a different sleep schedule. He gets in a line to take his meds, or has to go up and take them when he's called. There's a couple loud patients on the ward, maybe a troublemaker or two, and he's just hoping they leave him alone. He wants all the other crazies to leave him alone, too. He's very alone.

He's bored out of his fucking mind. There's nothing interesting to do, nothing interesting to look at. The whole place is ugly and institutional. It's all stupid and pointless.

It's making him furious that he can't just walk out like a free person in charge of his own destiny. But he knows that if he acts furious he will just seem more crazy and get treated worse. Maybe his doctor will show up today and talk for a few minutes. Maybe they will do some stupid activity. But it's really just about killing time waiting for the meds to take effect. He's hating this episode in his life, hating it when family visits and they seem him like this, they write it into the family record as something that's happened. The stuff they're saying means nothing because they don't know what he's going through. They don't want it to exist, they don't want any of the icky bad stuff getting on them. Their self-interest in wanting to rewrite his brain is disgusting.

Sometimes it will seem so unreal because he thinks he should be dead. His life should have ended, and what's happening now is like some fake life that shouldn't have happened.

The pain inside seems unstoppable. It's ridiculous that this place can help him. It's only making things worse. He'll remember for the rest of his life that he was in a mental hospital.
posted by fleacircus at 5:22 PM on October 20 [14 favorites]

Yeah, I'm so sorry to hear about what happened with your brother. What they *should* be doing is evaluating him and trying to see if they can find a medication or other treatment that works. If any of the family knows anything about past history of effective-- or ineffective, especially harmful-- medications or treatment, they should be communicating that with the doctors. Presumably, the Canadian health system is more coordinated that ours, but the last thing you want is them trying stuff that you already know he's had bad experiences with if that is the case. If he has prior diagnoses or if there's other relevant information the family can provide, this can be really helpful.

If he wants visits, family support can also be extremely important-- but not if they will make him feel worse or he doesn't want them. Cards, phone calls, all kinds of expression of support are also good if they are simply supportive and remind him that he has people who truly love him.
posted by Maias at 5:34 PM on October 20

wow... the terrible situation described by fleacircus isn't the norm for a good psych hospital.. I've worked in psych wards, I've had family in psych wards....

Call and talk to him... ask him how things are..or call the nurses station and ask them to have him call you..

If you talk to him, ask him to give the staff permission to talk to you, they can update you...
posted by HuronBob at 6:07 PM on October 20

I recommend reading How Not to Commit Suicide, by Art Kleiner. Most people who attempt suicide are very happy to survive. Getting help is a good thing. Send him email and real mail, if possible. Good luck.
posted by theora55 at 6:19 PM on October 20 [1 favorite]

Fleacircus hits the nail right on the head, and I'm speaking from experience. Just being in a mental hospital is enough to make you never, never ever want to try and commit suicide again.
posted by Bageena at 6:31 PM on October 20 [1 favorite]

Rather oddly, I'm going to say he's experiencing *both* sharkfu's and fleacircus's descriptions at the same time. I've been in this situation and they both rang true - when you're hospitalized it can feel intolerable even when the actual day-to-day is relatively mundane and non threatening. Medication can exacerbate this if it's inappropriately chosen.

I was hospitalized at St Pauls for a few days but sadly can't remember much of it (subsequent ECT). Mostly what I recall is boredom and antsiness. There were a few rowdies but nothing unsafe.

Visitors are a lifeline. An acquaintance of of mine brought me chopped watermelon and I still feel a special place in my heart for her.
posted by media_itoku at 6:34 PM on October 20

Correction: *welcome* visits are a lifeline. Any family drama needs to be taken outside where it belongs.
posted by media_itoku at 6:38 PM on October 20

I was hospitalized for a suicide attempt. For several weeks, my days consisted of the following: After getting up in the morning, once I stepped out of the room, shared with a recovering heroin addict, they'd sit me down and check my vital signs, handing me a small plastic cup of medication they'd picked. Breakfast followed, accompanied by decaf coffee. Most of the days were a patchwork of free time spent wandering the common areas looking for something to do or someone to talk with and mundane group activities. I spent a lot of time playing checkers with a girl who'd drank a fair amount of bleach. I constructed a box out of popsicle sticks. They let us outside to walk around the grounds every other day or so. Well, depending on how much of a danger to us they thought we were. On the first night there, my shoelaces were confiscated, and I was on a "five-minute watch": every five minutes someone had to check up on me. A couple days later, I was downgraded to whatever was next, probably half-hours or hours or something. And my shoelaces were returned. And soon I was allowed outside for the walking sessions.

There was a small plexi-glass room with a vent. This was the designated smoking area. It had a heating element built into the wall. Only one person was allowed in at a time. If you didn't have cigarettes, you were allotted one per hour. They were GPCs.

Every evening we watched a movie. The second night I was there, everyone requested One Flew Over the Cuckoo's Nest, but one of the other floors of the hospital had it, leaving us with Sister Act 2.

The food was bland.

As a whole, it was boring, boring, boring, boring. And, sometimes, the medications would make it difficult to sleep. Or difficult to stay awake.
posted by The Great Big Mulp at 8:04 PM on October 20 [1 favorite]

St Paul's has two wards separated by a door. The ward he's in is small and, doesn't house many patients, 10 at most if memory serves. There's a small day room to hang out in, otherwise not much to do there. If they believe he's still a suicide risk then they'll more than likely put him on something called one on one; a nurse will be with him at all times. If he tries to flee he'll be put in four point restraints (velcro btw) on his back. I don't know if this is still true, its been a long time since I was a mental health advocate in Vancouver, but if he did try to run he'll be transferred to another hospital (used to be a locked ward called E6 at Riverview) via ambulance because St Paul's doesn't have a quiet room to lock him away in. He'll be assessed, medicated and, held until they believe he's no longer a risk with a referral to a community mental health centre. There'll be little, if any, group therapy since the hospital is only interested in getting him healthy enough to be released. Imagine three squares a day, medication and, lots of wall climbing out of sheer boredom. If he needs longer term in hospital care he'll be transferred to another hospital because St Paul's only covers emergency psychiatric care and, eating disorders.

drcryssyr, BC has community committal under the Mental Health Act, forced treatment and medication outside of the hospital its not just something that happens in the states any more. Holding someone under a mental health certificate doesn't require a judge's order to hold them, initially one signature does the trick, two are required for longer stays.

Sorry about your brother if you want more information feel free to send me a message.
posted by squeak at 8:06 PM on October 20 [2 favorites]

Oh (this is what I get for not previewing before posting) the ward has regular hospital beds, no cots and, the nurses would bring you your medication on that ward, no line up at the counter like at other hospitals. Otherwise, fleacircus is pretty spot on how your brother will be more than likely feeling.
posted by squeak at 8:19 PM on October 20

I'm sorry this happened to your brother. I don't know anything about hospitals, but I'll offer this advice: once you're able to make contact with him, resist the temptation to talk about his suicide attempt as something chose to do. Years from now, when he's fully recovered and living a happy life, that's when you [maybe] get to punch him in the arm and say, "Dude, what were you thinking? We all love you to bits and you had us really worried.'"

Right now, you need to treat the suicide attempt as a particularly unpleasant, but natural consequence of him having a serious, untreated illness. He had depression, or whatever, and it nearly killed him. Treat him with the same respect you'd give anyone who nearly died from a medical condition beyond their control. Don't ask him to engage with the idea that the suicide attempt was his decision, because he just isn't capable of processing that information right now.
posted by embrangled at 8:42 PM on October 20

I'm sorry for you and your brother.

Might it not be a bad idea to ask to have your question made anonymous? When your brother gets better, it might be helpful to let him decide on any links that exist, whatsoever, to what he's going through. Just a thought.
posted by iftheaccidentwill at 8:55 PM on October 20

Yeah now that I'm thinking more clearly, don't watch The Bridge right now... it does provide visceral perspective but it's a little much probably. argh was only trying to help!
posted by pwally at 9:05 PM on October 20

From friends' experiences (admittedly in the US), sharkfu's description sounds pretty close, as do those of the Great Big Mulp & paulsc. If things go well, your brother'll have a bit more freedom as the days go on - he'll be able to head outside for periods of time, or even go for a walk on the grounds with visitors. Right after admission, he's probably being much more closely monitored. His visitors can bring stuff, but some of it might not be allowed. (I've had to check things like cellphones and umbrellas before.) Books will be welcome, and will almost always make it through.

Since you're halfway across the country, you might want to contact the institution directly and find out if you can talk to him over the phone or even just send a card. Family drama's not good, but if you think an expression of love and support from you might be helpful, and wouldn't trigger the drama, go for it. Even good institutions full of voluntary patients can be boring, depressing, and alienating, and support from friends and relatives can make a difference.

Good luck, to both of you.
posted by ubersturm at 12:23 AM on October 21

fleacircus is right. One of my biggest barriers to true suicidal ideation (i.e. having a plan) is that I never, ever want to end up in the hospital again. It was hell. Not intentionally, and certainly by no fault of the doctors/nurses/etc who were as kind and helpful as could be under the circumstances, but it was pure, boring, unmitigated discomfort for hours on end, broken up by sleeping and the occasional insipid group activity.

While I was in the hospital I actually envied the people with eating disorders because they had a strict schedule to keep them busy so they couldn't work in exercise.
posted by saveyoursanity at 10:17 AM on October 21