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Considering suicide and possible psychiatric commitment
September 7, 2010 12:26 PM   Subscribe

Considering a somewhat voluntary psychiatric commitment for myself. Meeting with a psychiatrist this afternoon. What should I tell him?

I'm really, really upset about my life, have a huge decision to make regarding graduate school, I just lashed out at this boy that I'm starting to date, and am descending into a fog of suicidal ideation, panic attacks, and emotional numbness.

I have had suicidal thoughts most of my life (awful, abusive, mentally ill, addicted parents, etc., very long story). I was imagining methods for suicide from the time I was nine years old. My whole life, I've been putting it off and telling myself that I can always commit suicide later, that I should try other avenues to improve my situation and see what happens.

But I think that maybe this is something, as odd as it sounds, that I need to "get out of my system". Not an attempt, exactly, but just for someone to finally take my concerns about myself and my life with some seriousness. My cousin attempted to kill himself and got put in an institution, on good meds, and emerged a month later a lot happier, saner, and on track in his life. Maybe it could happen with me.

I've been to therapy before, tried meds, a million things. Nothing seems to work for me. And I have to make this graduate school decision within the next two weeks. And I'm going crazy with it. If I were committed, I could definitely get a medical leave of absence, and then sort this out.

I'm seeing a psychiatrist this afternoon. I've seen him before and I feel like we have good rapport. He works independently, so not officially affiliated with a hospital. If I feel like I need to be committed, I think he would sign the papers or do whatever I need. He knows I have depression and severe anxiety.

What should I tell him? What should I ask for?

How expensive would a commitment be? Will it ruin my life (if I have one after this)?

Where should I go? A local hospital? A specialist of some kind?
posted by 3491again to Human Relations (21 answers total) 1 user marked this as a favorite
 
I don't know about where or how expensive it is, but I know someone who was committed and she went on to have a good life - she has been hired by normal companies, is now married to a nice guy, and her life was not ruined in any way (at least that I know of). She said that her time spent there was 100% a lifesaver, and she was treated very well. She was committed for a nervous breakdown with suicidal tendencies after a very bad relationship ended.
posted by meepmeow at 12:33 PM on September 7, 2010


The commitment is not as expensive as the possible consequences of not getting the help you need. You will have a life after this. You won't ruin anything as any health professional must follow HIPAA law which says everything is confidential (beyond alerting authorities if you're a danger to yourself and others). You're taking steps to ensure a better future and I think that's great.

Tell the psychiatrist everything. Answer his questions completely and truthfully. Hide nothing. Tell him how you're feeling. Tell him what you're thinking. Tell him that you are thinking of harming yourself if that's the case.

I wish you all the best and I hope you get the care you need.
posted by inturnaround at 12:37 PM on September 7, 2010


I do not know whether or to what extent this is true, I bring it up only as something to look into and consider (perhaps another poster will have more information): It may affect your ability to get/price of health insurance in the future.
posted by brainmouse at 12:37 PM on September 7, 2010


What should I tell him?

You should tell him that you are thinking about hurting yourself.

How expensive would a commitment be?

Do you have medical insurance? If not, you might be covered by county mental health funding for a short inpatient stay, this is something that would get figured out at the crisis center.

Where should I go? A local hospital?

If you don't have insurance, at least in the City of Philadelphia, you don't really have any choice in the matter. You present at one of the city's many Crisis Response Centers (psychiatric emergency rooms) and while you are triaged and assessed by the staff psychiatrist a system wide search is done to find out which inpatient facilities have bed availability. You are assigned to one of these facilities. Regardless, psychiatric emergency rooms are the gateways to the inpatient system and this is where one would present if one wanted to voluntarily commit oneself. This is likely where your psychiatrist will recommend you go after you've met with him.

My cousin attempted to kill himself and got put in an institution, on good meds, and emerged a month later a lot happier, saner, and on track in his life. Maybe it could happen with me.

It could, but considering that you have a lot on your plate right now and in the immediate future the greater likelihood is that you will benefit from some amount of ongoing contact with a professional on an outpatient basis. Going to an inpatient psych facility and emerging radically transformed for the better is the exception, not the rule. Especially if you don't have a Cadillac private insurance plan your stay is not going to be anywhere near a month long, and depending on where you wind up, you really might not want to be there for a month anyway. Engaging in quality therapy and treatment on an outpatient basis in the community is much more likely to result in ongoing positive outcomes.
posted by The Straightener at 12:37 PM on September 7, 2010 [8 favorites]


One of my friends made a half-hearted attempt (in a long string of half-hearted attempts), told her therapist, and her therapist had her committed for three nights, against her wishes. She was furious and hysterical, and she said it was a really creepy and dehumanizing experience, but tolerable. Somehow she then ended up doing random, fun stuff like being an airline stewardess, which she loved, and then she went off to law school. I hear from her every so often, and I think she's pretty happy now. Hope that's useful in some small way.
posted by zeek321 at 12:44 PM on September 7, 2010 [1 favorite]


I commend you for looking out for yourself. Being in an environment where you can really focus intensely on what you need to get better and have a support system of staff who are there to look out for you and help you can be enormously beneficial.

If you don't have insurance, at least in the City of Philadelphia, you don't really have any choice in the matter. You present at one of the city's many Crisis Response Centers (psychiatric emergency rooms) and while you are triaged and assessed by the staff psychiatrist a system wide search is done to find out which inpatient facilities have bed availability. You are assigned to one of these facilities. Regardless, psychiatric emergency rooms are the gateways to the inpatient system and this is where one would present if one wanted to voluntarily commit oneself. This is likely where your psychiatrist will recommend you go after you've met with him.


The Straightener usually has the goods on this kind of stuff, but you actually have a little more leeway than just showing up at the nearest ER. You have some time to do a little planning. Do some research about the programming and resources available at local hospitals, and also get a sense of what and where your insurance will pay for. If you can find a university-affiliated or private hospital that accepts your insurance you will most likely get a higher quality of care and are less likely to be lumped in with people who are facing a multitude of other challenges (homelessness, drug abuse) that might make the programming less relevant to you and might make your experience of being in the hospital more difficult.

Can you let us know what area you are in? People might have some ideas/recommendations.

During your stay, as The Straightener mentioned, work with the staff to make a plan for long-term care and support, whether it includes individual therapy, medication management, and/or support groups.

Good luck!
posted by foxy_hedgehog at 12:44 PM on September 7, 2010


Engaging in quality therapy and treatment on an outpatient basis in the community is much more likely to result in ongoing positive outcomes.

Not if the thought of suicide becomes an attempt.

I mean, if your doctor says you'd do well under outpatient care instead of in a facility, then fine, but don't listen to anyone here about that. What the hell do we know?

But your doctor can only make an informed decision if he actually is fully informed. Tell him everything you're thinking about. That will benefit you the most.
posted by inturnaround at 12:46 PM on September 7, 2010


from what i understand, most hospitals will only commit you inpatient if you are an immediate threat to yourself or others. Therefore you need to impress to your doctor that you feel you are a threat to yourself if you want to go inpatient. Your doctor will probably recommend the best place for you. If you think you're in immediate distress, you can go to the ER.

I have been inpatient myself, about 23 years ago. I had insurance and it was so long ago that I cannot tell you what it cost.

I've gone on to live a fairly normal life. Being inpatient didn't ruin my life at all.

My twin has been in and out of the hospital a few times, and she's never med-compliant, so her visits do little more than pull her out of her current crisis. Being in and out of the hospital doesn't ruin her life but it doesn't help either.

Your inpatient stay will help you as much as you want it to help you. That's what they're there for, but you have to work with them. It won't ruin your life, and it can give you the help you need right now.
posted by patheral at 12:48 PM on September 7, 2010


I'm visiting my grandparents (and where I used to live) in the San Francisco Bay Area.

Also, this psychiatrist is very patient-oriented. I think he'd ask me what I want to do and not commit me unless I was bleeding in front of him or raving or something. He's very big on patient rights, etc. So I think it's a matter of how serious *I* think it is. And I don't know what to expect if I tell him, yes, I want you to say I need to be committed.
posted by 3491again at 12:50 PM on September 7, 2010


The Straightener usually has the goods on this kind of stuff, but you actually have a little more leeway than just showing up at the nearest ER.

Depends in the insurance sitch. No insurance, very few options. Insurance, more options, possibly many more, depending on the coverage.
posted by The Straightener at 12:52 PM on September 7, 2010


Health insurance situation is weird. I have insurance through the graduate school, but I have to attend at least one day of classes in order to be a student before taking a leave of absence for the health insurance to stick.
posted by 3491again at 12:52 PM on September 7, 2010


Call your insurance provider right now and find out what your options are for inpatient mental health treatment. If they aren't covering you for anything because you haven't attended classes you're going to need to come up with an alternative plan. Paying out of pocket for inpatient treatment is going to be prohibitively expensive even at the lowest end publicly funded joint in town.
posted by The Straightener at 12:55 PM on September 7, 2010


Good news. I have insurance and they cover inpatient treatment. But I'm still not sure what to tell the doctor. Practicalities aside, I'm still out of my mind with anxiety and can't stop thinking suicidal thoughts. And I have NO family to help me. NONE. My grandmother is too old and unworldly and my grandfather has Alzheimers.
posted by 3491again at 1:29 PM on September 7, 2010


What others have said re: figuring out your health insurance situation ahead of time.

Also, remember that due to the nature of managed care, most regular hospital psychiatric wards are set up nowadays mostly as holding tanks for those who are a direct danger to themselves or others. You will not see your doctors or a therapist or anyone other than your fellow patients and some aides very much. You will be in a very small place that you cannot leave with terrible food and many, many rules (many of which people will find ways to circumvent--just ask my friend who smoked up in the shower while she was in the hospital). A private hospital may be somewhat more comfy and focused on being therapeutic as well as just preventative, but it may well not be a locked ward, and insurance rarely covers non-locked ward stays.

I was on a psych ward for five days when I was 22. I was a "voluntary" committal in that I signed the paperwork myself and went in willingly, but I only got there because my mother took me in. It was fairly horrible, but in some ways ultimately helpful in that it did get me to want to get out of there, and that was the first thing I'd actually wanted to do in months. So in that sense it was therapeutic, and it certainly did not ruin my life or affect my future career or what have you. It did not, however, make me all better: that took a lot of years, a lot of drugs, several therapists, and a lot of time, and the proverbial bell jar is still always out there.

That said, if you do feel you're considering suicide or feel frightened for your life or simply feel that it might help, I would not totally discourage you from looking into it. See what your doctor thinks. And hang in there.
posted by newrambler at 1:34 PM on September 7, 2010


But I'm still not sure what to tell the doctor.

You still start off by telling him that you're thinking about hurting yourself, then you show him the insurance information you brought along to your appointment and you let him assist you in making a referral to the best local facility that accepts your insurance.
posted by The Straightener at 1:38 PM on September 7, 2010


If your insurance allows it, I'd recommend California Pacific Medical Center or UCSF. But your doctor will know local resources much better than I do.
posted by foxy_hedgehog at 1:53 PM on September 7, 2010


I'm about to leave the office so I'd like to recap before I do because I won't able to contribute any more to this today:

1) Definitely keep your doctor's appointment. Bring your insurance information with you, you might have to make another call while you're with your doctor so you want to have all the phone numbers and account information.

2) Let the doctor recommend the best facility from the list of facilities they cover. Follow his instructions on how to proceed once you've mutually agreed on the best facility.

3) If you feel like hurting yourself before you can get to see the doctor, go to the emergency room. If you for whatever reason miss your doctor's appointment and you think you're going to hurt yourself, go to the emergency room.

4) If for whatever reason you miss your doctor's appointment but you don't need to go to the emergency room, keep the National Suicide Prevention Hotline number 1-800-273-TALK (8255) handy until you are able to get another doctor's appointment.

5) If you need have questions pertaining to non-emergency mental health treatment after you've seen the doctor, you can Memail me. However, if it's an emergency, don't rely on the Internet, go to the emergency room or call the hotline.

Best of luck, hope you feel better.
posted by The Straightener at 2:04 PM on September 7, 2010


Print out what you wrote in your question to AskMe and give a copy to your doctor. Then talk about it.
posted by Carol Anne at 2:11 PM on September 7, 2010 [2 favorites]


From the perspective of a friend who's visited people who have been committed (albeit for psychotic episodes, rather than depression) and has gone on to lead a relatively normal life afterwards. My friend was committed twice voluntarily and once involuntarily. Also, this was in Illinois, but I looked into it in CA once:

1) Find out what you can and can't bring with you. My friend, for example, was only allowed to have bedroom slippers; nothing with laces. Some places won't allow anything sharper than pencils. She typically lost much of what she came in with, but I don't know how much of that was because she was doing stuff with it and how much of that was stuff she gave to other patients or other patients took...in any case, don't go into the institution with anything you really care about to the point where you would be devastated if you lost it.

2) There is a chance they will overmedicate you in the institution. You need to talk to your psychiatrist and anyone who might be making medical decisions for you to make sure that your wishes in regards to medication are made clear.

3) No one will be allowed to visit you (or even know where you are) unless you sign something to that effect BEFORE being admitted.

4) I do not know what you're going to grad school for, but you should be aware if you're going into a licensed profession (doctor, lawyer, architect, engineer, real estate agent, teacher, etc.) that they may ask if you've ever been committed and will want information on exactly what happened and why and to talk to your doctor to make sure that you're fine now. It will not necessarily, in and of itself, stop you from becoming licensed...but it may and can delay the process. Commitment is seen as a big deal in some states--in others, not so much.

5) As The Straightener says and others said above, the most important things to get from this are effectively a reboot...but it will make no difference if you aren't consistent about medication and therapy afterwards. You will also want to find out how to figure out what causes extreme episodes and how to avoid those situations in the future.

6) Lastly: Be aware that your state's independent living centers and rehabilitative services can help you, pre- or post-commitment, to learn coping skills and figure out what to do with your life afterwards. They can be superawesome.

Having said all of that: it appears to have helped her. She has a support community she would not otherwise have had. However, she can still only work part time and second guesses herself on her ability to function in the outside world sometimes. This apparently (from my research after her 3rd commitment) is not atypical.

Hope that helps. Feel free to Memail if you're interested in additional resources. I created a website of post-commitment resources for her at one point that I'd be happy to pass on.
posted by eleanna at 9:27 PM on September 7, 2010


I think the word "committed" is possibly being used in an incorrect way. If you go voluntarily to a hospital, you are "admitting" yourself, and unless the doctors feel you need to stay you can leave voluntarily. The word "commitment" is usually "involuntary commitment" for someone who is so ill that they don't have insight that they need help, and must be legally committed by a doctor or other professional.

Having been through hospitalizations (voluntary) myself, I don't believe that a voluntary admission would affect any licensing. If any mental health history is pertinent, I believe it is only concerning involuntary commitment.

Once you are in the hospital and if you are not actively psychotic to the point where you have to be forcibly medicated, there is little danger of you being overmedicated. Any patient has the right to refuse any medication at any time. That being said, sometimes when you are started on a new medication, side effects such as extreme sleepiness, etc. can be bothersome until you get used to the medication. Once you get used to the med, the side effects will affect you less.

Tell your doctor everything you've told us about how you're feeling. I wish that I had gotten the help I needed before an attempt. There is help out there -- best wishes to you.
posted by la petite marie at 9:32 PM on September 8, 2010


Committed w/ insurance? They'll bleed you until it runs out.

Committed w/out insurance? Good luck.

I would not suggest it unless you 100% know what you're getting yourself into. Mental health support isn't always grand in that environment; lots of insurance abuse.

I'm sorry you're going through this. But I would not advise voluntary committment.
posted by stormpooper at 12:54 PM on September 10, 2010


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