What are the consequences of telling a mental health professional about past suicidal thoughts?
June 22, 2011 12:48 PM Subscribe
What are the consequences of telling a mental health professional about past suicidal thoughts?
I will be seeking help for what I suspect is depression through my university's mental health services. This question is not about whether to go talk to somebody, but about exactly how forthright to be.
I am currently feeling apathetic about pretty much everything - I am not horribly sad or upset, but neither can I find any interest or excitement. I still care (or maybe just want to care) about doing well in school, but it's a more abstract feeling, without follow-through or proper concern for the consequences of flaming out.
I am currently a graduate student with a prestigious fellowship at my dream school, probably the best for my field, but haven't been productive for a few months. I had been struggling even before coming to this complete stop, but I've gotten to a point where I can't summon the motivation or momentum to get anything done. I switched advisors halfway through my program, which wound up being quite painful. I'm having trouble sorting out the start of my problems from just choosing an advisor who turned out to be a really bad match. I really like my new advisor, but am on the edge of ruining that too.
Even just doing the dishes and laundry has been a struggle. I still pursue my hobby, though without the passion that I'm used to. At this point, I do it more out of habit than anything else. I am not seeking a diagnosis/label, but rather strategies for managing this better, since figuring it out on my own obviously isn't working. I haven't told anybody this stuff, other than admitting to my friends that I don't know if I'm going to be staying with the PhD program.
I plan to discuss all of the above. However, while I am definitely not currently suicidal - just numb - I have been in the past. Once, two years ago, with just a general desire to not exist anymore. More recently, I was scared to go home because it would have been so easy to just jump out the window. Obviously, in an ideal world, I would tell my therapist about all of this. However, I am concerned about the possible consequences. So, we get to my questions:
1) Under what conditions can I be involuntarily committed?
2) What other consequences can I expect from having this information on my health record? (especially regarding insurance/education/employment)
If it would be better to go through other channels than my university, I have decent insurance, and could probably pay out-of-pocket, at least for a little while.
I live in PA. Anonymous for obvious reasons.
I will be seeking help for what I suspect is depression through my university's mental health services. This question is not about whether to go talk to somebody, but about exactly how forthright to be.
I am currently feeling apathetic about pretty much everything - I am not horribly sad or upset, but neither can I find any interest or excitement. I still care (or maybe just want to care) about doing well in school, but it's a more abstract feeling, without follow-through or proper concern for the consequences of flaming out.
I am currently a graduate student with a prestigious fellowship at my dream school, probably the best for my field, but haven't been productive for a few months. I had been struggling even before coming to this complete stop, but I've gotten to a point where I can't summon the motivation or momentum to get anything done. I switched advisors halfway through my program, which wound up being quite painful. I'm having trouble sorting out the start of my problems from just choosing an advisor who turned out to be a really bad match. I really like my new advisor, but am on the edge of ruining that too.
Even just doing the dishes and laundry has been a struggle. I still pursue my hobby, though without the passion that I'm used to. At this point, I do it more out of habit than anything else. I am not seeking a diagnosis/label, but rather strategies for managing this better, since figuring it out on my own obviously isn't working. I haven't told anybody this stuff, other than admitting to my friends that I don't know if I'm going to be staying with the PhD program.
I plan to discuss all of the above. However, while I am definitely not currently suicidal - just numb - I have been in the past. Once, two years ago, with just a general desire to not exist anymore. More recently, I was scared to go home because it would have been so easy to just jump out the window. Obviously, in an ideal world, I would tell my therapist about all of this. However, I am concerned about the possible consequences. So, we get to my questions:
1) Under what conditions can I be involuntarily committed?
2) What other consequences can I expect from having this information on my health record? (especially regarding insurance/education/employment)
If it would be better to go through other channels than my university, I have decent insurance, and could probably pay out-of-pocket, at least for a little while.
I live in PA. Anonymous for obvious reasons.
The primary issue you'll face--assuming you are not actively suicidal, have no plans or intents in that direction--is the annoyance of answering questions about how you have no plans or intents. It's probably better to go ahead and get it out in the open, including, with absolute clarity, that you are, as you say, definitely not currently suicidal.
I remember having to sign a lot of contracts in therapy, promising not to do myself in. Which always struck me as silly, but if it makes the therapist feel better, I suppose it's okay.
Involuntary commitment laws will vary, but if you're not a present danger to yourself, don't worry about it. Nobody's going to lock you up for having a wish not to exist anymore. And in my experience, there are no other consequences of having it on your record. It has never once come up, certainly not in school or from my employers.
posted by mittens at 1:01 PM on June 22, 2011
I remember having to sign a lot of contracts in therapy, promising not to do myself in. Which always struck me as silly, but if it makes the therapist feel better, I suppose it's okay.
Involuntary commitment laws will vary, but if you're not a present danger to yourself, don't worry about it. Nobody's going to lock you up for having a wish not to exist anymore. And in my experience, there are no other consequences of having it on your record. It has never once come up, certainly not in school or from my employers.
posted by mittens at 1:01 PM on June 22, 2011
I'm glad to read that you are deciding to seek help for the issues you've been struggling with.
While I am not in PA, I am a licensed social worker and know about informed consent. This is a basic premise of all clinical contact with clients and patients. A therapist should talk with you about the limits to confidentiality at the beginning of your first session and you should be given a statement of understanding for your records. Generally speaking, the threshold for involuntary commitment is imminent harm to oneself or others. It sounds like you have some serious depressive symptoms currently but no plan to hurt yourself. That's generally not considered imminent risk and would not rise to the level of involuntary commitment. That being said, giving your full history to your provider will allow them to have a better sense of what your work together will look like and will help in creating a more effective clinical plan.
Most importantly, a provider will want to insure that you are safe and that you're not planning to walk out of their office and put a suicide plan into motion. Clinicians often talk about contracting for safety - making a plan with your provider to call them or go to an emergency department if you're thinking about hurting yourself (as examples) - with patients who are expressing suicidal ideation.
I feel for you, sounds like what you're going through is really painful. Having a therapist to help you increase your own safety and manage these (at times) overwhelming emotions.
posted by boofidies at 1:02 PM on June 22, 2011 [4 favorites]
While I am not in PA, I am a licensed social worker and know about informed consent. This is a basic premise of all clinical contact with clients and patients. A therapist should talk with you about the limits to confidentiality at the beginning of your first session and you should be given a statement of understanding for your records. Generally speaking, the threshold for involuntary commitment is imminent harm to oneself or others. It sounds like you have some serious depressive symptoms currently but no plan to hurt yourself. That's generally not considered imminent risk and would not rise to the level of involuntary commitment. That being said, giving your full history to your provider will allow them to have a better sense of what your work together will look like and will help in creating a more effective clinical plan.
Most importantly, a provider will want to insure that you are safe and that you're not planning to walk out of their office and put a suicide plan into motion. Clinicians often talk about contracting for safety - making a plan with your provider to call them or go to an emergency department if you're thinking about hurting yourself (as examples) - with patients who are expressing suicidal ideation.
I feel for you, sounds like what you're going through is really painful. Having a therapist to help you increase your own safety and manage these (at times) overwhelming emotions.
posted by boofidies at 1:02 PM on June 22, 2011 [4 favorites]
Anonymous, I'm so sorry that you are struggling now. I'm proud of you for seeking help and I have faith that things will get better.
Suicidal ideation like you described is one of the most common symptoms of depression. I promise that your therapist will have heard very similar stories many, many times and would actually probably be more surprised if you did not say something like this. It's so common that they will likely ask you directly about this.
You are not at risk for being involuntarily committed. That only happens in very extreme cases when the therapist feels that there is absolutely no alternative that will keep you or someone else safe. Even then, there are legal guidelines that have to be met in order to be hospitalized. What you are describing does not even come close to a situation like that.
The suicidal ideation won't even necessarily end up in your "health record" in a way that others would be able to access it. They may document it in a note, but this is not the kind of information that is passed along to others without your express consent.
It is really important that you do share this information, though, because it gives your therapist additional information that they will use to make decisions about how to treat you. I would really encourage you to be honest.
Take good care.
posted by goggie at 1:03 PM on June 22, 2011 [1 favorite]
Suicidal ideation like you described is one of the most common symptoms of depression. I promise that your therapist will have heard very similar stories many, many times and would actually probably be more surprised if you did not say something like this. It's so common that they will likely ask you directly about this.
You are not at risk for being involuntarily committed. That only happens in very extreme cases when the therapist feels that there is absolutely no alternative that will keep you or someone else safe. Even then, there are legal guidelines that have to be met in order to be hospitalized. What you are describing does not even come close to a situation like that.
The suicidal ideation won't even necessarily end up in your "health record" in a way that others would be able to access it. They may document it in a note, but this is not the kind of information that is passed along to others without your express consent.
It is really important that you do share this information, though, because it gives your therapist additional information that they will use to make decisions about how to treat you. I would really encourage you to be honest.
Take good care.
posted by goggie at 1:03 PM on June 22, 2011 [1 favorite]
I've disclosed similar information many times. Never been committed. They will pointedly ask you if you are currently suicidal (and/or homicidal), have a plan, etc., but I doubt anything will come of disclosing past feelings. No one would ever go to therapy if we were punished for things we felt in the past.
posted by desjardins at 1:03 PM on June 22, 2011 [2 favorites]
posted by desjardins at 1:03 PM on June 22, 2011 [2 favorites]
They may document it in a note, but this is not the kind of information that is passed along to others without your express consent.
Unless you are a minor.
posted by desjardins at 1:04 PM on June 22, 2011 [1 favorite]
Unless you are a minor.
posted by desjardins at 1:04 PM on June 22, 2011 [1 favorite]
@desjardins: True, there are slightly different rules for minors, but even then the only disclosure would be to a legal guardian, not a school, employer, etc.
posted by goggie at 1:08 PM on June 22, 2011
posted by goggie at 1:08 PM on June 22, 2011
First, I am not your therapist, yada yada. In general you can be involuntarily committed only if you pose an immediate risk to yourself or others. Further, in the real world, commitment and institutionalization are an expensive, bureaucratic undertaking that no one wants. I have a hard time imagining a situation in which the things you've discussed about your past in this post lead to your present hospitalization. Your therapist/psychiatrist/mental health professional will ask you whether you still ever have those feelings. They will likely ask you about how detailed your suicidal thoughts were in the past because there's a difference between thinking, "It would be easy to just jump out that window" and taking the time to write a note, or deciding on a specific day and time so that you cause the least or most amount of disturbance to passers by.
The reason they want to know about these things is that it's important for them to know how difficult your situation is in order to know what warning signs to look for. For example, if you start taking an antidepressant there is sometimes an increase in energy and mental focus before there's an improvement in mood. That's why people are at slightly greater risk of suicide in the weeks immediately after beginning an antidepressant. So if your mental health professional recommends an antidepressant, it's important that they know that you've had suicidal thoughts before so that they can be sure to monitor your mood and provide more emotional support during that time.
Regarding the second part of your question, you have almost no risk of negative consequences to your education or employment prospects simply because no one involved with your education or employment would ever have a legal right to know about it. There are probably a few fields where this wouldn't apply - maybe if you were planning to work for the CIA or the like they would require you to disclose it as a requirement for employment, but no one can legally know unless you choose to tell them.
As far as your insurance provider knowing, insurance companies pay for therapy and medicine for depression all the time - antidepressants are one of the most prescribed types of medication in America.
If it really bothers you (and I really don't think it needs to), you can tell the therapist that, while you'd like to give them that information so that they can provide you with the best treatment possible, you'd also like to approve what they write about it in their records because you don't want your past thoughts to be misconstrued. You may also be comforted by the fact that "medical records" aren't a cohesive entity. In other words, a doctor or therapist keeps records, but those records aren't combined with the records of other doctors or therapists at other hospitals, clinics, or practices you may have seen before. Rather than having one complete set of "medical records" you've got several, maybe dozens, moldering away in filing cabinets in places that don't communicate with one another or even necessarily know of one another's existence.
Good luck, and don't worry, just get the help you need so you can get back to your studies and your life.
posted by Quizicalcoatl at 1:17 PM on June 22, 2011
The reason they want to know about these things is that it's important for them to know how difficult your situation is in order to know what warning signs to look for. For example, if you start taking an antidepressant there is sometimes an increase in energy and mental focus before there's an improvement in mood. That's why people are at slightly greater risk of suicide in the weeks immediately after beginning an antidepressant. So if your mental health professional recommends an antidepressant, it's important that they know that you've had suicidal thoughts before so that they can be sure to monitor your mood and provide more emotional support during that time.
Regarding the second part of your question, you have almost no risk of negative consequences to your education or employment prospects simply because no one involved with your education or employment would ever have a legal right to know about it. There are probably a few fields where this wouldn't apply - maybe if you were planning to work for the CIA or the like they would require you to disclose it as a requirement for employment, but no one can legally know unless you choose to tell them.
As far as your insurance provider knowing, insurance companies pay for therapy and medicine for depression all the time - antidepressants are one of the most prescribed types of medication in America.
If it really bothers you (and I really don't think it needs to), you can tell the therapist that, while you'd like to give them that information so that they can provide you with the best treatment possible, you'd also like to approve what they write about it in their records because you don't want your past thoughts to be misconstrued. You may also be comforted by the fact that "medical records" aren't a cohesive entity. In other words, a doctor or therapist keeps records, but those records aren't combined with the records of other doctors or therapists at other hospitals, clinics, or practices you may have seen before. Rather than having one complete set of "medical records" you've got several, maybe dozens, moldering away in filing cabinets in places that don't communicate with one another or even necessarily know of one another's existence.
Good luck, and don't worry, just get the help you need so you can get back to your studies and your life.
posted by Quizicalcoatl at 1:17 PM on June 22, 2011
So sorry you're struggling.
Know thyself, and as long as you know you aren't in danger to yourself, disclose any past incidents without hesitation. That way you can start exploring it sooner rather than later and the therapist will be better equipped to provide you with the counseling and resources that will help you.
Know you're doing the right thing and that seeing a therapist is something many people are never brave enough to do.
As my brother said, you see a doctor for your body and for your teeth for regular checkups, why not one for your mind and feelings?
posted by glaucon at 1:20 PM on June 22, 2011
Know thyself, and as long as you know you aren't in danger to yourself, disclose any past incidents without hesitation. That way you can start exploring it sooner rather than later and the therapist will be better equipped to provide you with the counseling and resources that will help you.
Know you're doing the right thing and that seeing a therapist is something many people are never brave enough to do.
As my brother said, you see a doctor for your body and for your teeth for regular checkups, why not one for your mind and feelings?
posted by glaucon at 1:20 PM on June 22, 2011
Nthing what everyone else said: they will ask you if you are currently suicidal and if you have a plan and the means. If the answer to any of these is no, you won't be committed.
Also, it can be a huge, huge, huge relief to tell someone you've been having suicidal thoughts, to say it out loud and have someone listen and understand, without judging or treating you differently. It can be the very thing that starts to make you feel better.
You are doing a wonderful thing for yourself, and it will get better from here. Best of luck to you.
posted by Metroid Baby at 1:35 PM on June 22, 2011 [1 favorite]
Also, it can be a huge, huge, huge relief to tell someone you've been having suicidal thoughts, to say it out loud and have someone listen and understand, without judging or treating you differently. It can be the very thing that starts to make you feel better.
You are doing a wonderful thing for yourself, and it will get better from here. Best of luck to you.
posted by Metroid Baby at 1:35 PM on June 22, 2011 [1 favorite]
Know thyself, and as long as you know you aren't in danger to yourself...
Keep in mind that depression distorts your judgment the way you see yourself. It's possible but unlikely that you're actually doing worse than you are admitting to yourself (now there's a cheerful thought). From what you're saying that's unlikely. You don't seem to be in any immanent danger. Sounds like you're doing about as well/badly as I am, sad to say. However, trust the outside-your-head opinion of your professional. If she thinks you're in danger of impulsive self-harm and wants to commit you, go. A few days in the clink is inconvenient, not the end of the world. You'll meet interesting people.
Academics seem to be helpful and accomodating in my experience, and pretty good at maintaining confidentiality. It's likely to be good for their opinion of you if they know that there's a valid reason why you missed meeting X or deadline Y. Better that than letting them think that you're a flake. If you're diagnosed you won't want the world to know, but it's wise to tell your advisor in confidence.
In Canada your medical record would be confidential and will not affect your medical coverage or employment prospects. Where do you live? Where might you live?
posted by justsomebodythatyouusedtoknow at 1:38 PM on June 22, 2011
Keep in mind that depression distorts your judgment the way you see yourself. It's possible but unlikely that you're actually doing worse than you are admitting to yourself (now there's a cheerful thought). From what you're saying that's unlikely. You don't seem to be in any immanent danger. Sounds like you're doing about as well/badly as I am, sad to say. However, trust the outside-your-head opinion of your professional. If she thinks you're in danger of impulsive self-harm and wants to commit you, go. A few days in the clink is inconvenient, not the end of the world. You'll meet interesting people.
Academics seem to be helpful and accomodating in my experience, and pretty good at maintaining confidentiality. It's likely to be good for their opinion of you if they know that there's a valid reason why you missed meeting X or deadline Y. Better that than letting them think that you're a flake. If you're diagnosed you won't want the world to know, but it's wise to tell your advisor in confidence.
In Canada your medical record would be confidential and will not affect your medical coverage or employment prospects. Where do you live? Where might you live?
posted by justsomebodythatyouusedtoknow at 1:38 PM on June 22, 2011
Ditto everyone else. They will also ask you fairly regularly from then on if you're having suicidal thoughts or ideations. A quick yes/no (hopefully no) will be sufficient for most, unless you're exhibiting signs that that might not be true. And, they'll probably remind you to get good sleep, eat right to ward it off.
And what Metroid Baby said: suicide attempts or serious thoughts are such personal, "shameful" things to admit that it's a huge weight off your shoulders to finally tell someone and talk about it. And I say shameful only because that's how society sees it, not that the act itself is shameful.
posted by amoeba syndrome at 1:45 PM on June 22, 2011
And what Metroid Baby said: suicide attempts or serious thoughts are such personal, "shameful" things to admit that it's a huge weight off your shoulders to finally tell someone and talk about it. And I say shameful only because that's how society sees it, not that the act itself is shameful.
posted by amoeba syndrome at 1:45 PM on June 22, 2011
If they are a counsellor, it's confidential and they will lose licensure if they say anything from your sessions. unless you are a minor. Or unless you have those feelings currently. I imagine a psychologist or psychiatrist is bound by the same principles.
And you can also ask what the facility's policies are up front, if you have concerns.
posted by Elagabalus at 11:18 PM on June 22, 2011
And you can also ask what the facility's policies are up front, if you have concerns.
posted by Elagabalus at 11:18 PM on June 22, 2011
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Rules and regs have changed a bunch in recent years, so I can't comment on the "will this go on my permanent record?" aspect of things.
Good for you for getting help. It's hard, but it's a good thing to do.
posted by rtha at 1:01 PM on June 22, 2011