What happens when you tell a doctor you think about suicide?

April 15, 2008 8:49 AM

What happens when you tell a doctor you think about suicide?

I'm pretty sure I'm depressed. I have a doctor's appointment tomorrow, with a GP at a university clinic in Australia. What will they do when I say 'I think I'm depressed, I never want to get out of bed and I have trouble doing any work, I cut my arms, and I've been thinking about killing myself for years, but I'm not going to do it, I just thought I should include it in my list of symptoms'?
Is there any kind of mandatory response? Will they freak out?

DON'T PANIC. I am not going to kill myself. I am not a danger to myself. I swear to God I'm going to tell the doctor this tomorrow, I just want to know what to expect.

posted by anonymous to health & fitness (18 comments total)

I don't think they'll freak out because those seem to be some common symptoms when a person is severely depressed. They will probably try to get you help in the form of referral to psychiatrist, group or one-on-one therapy, and medication.

You're doing a great thing and you will feel *so* much better. It'll get better and better as time goes on. I went through a similar thing and life now is so different and wonderful in ways I didn't even know existed before. Hang in there.
posted by nessahead at 8:59 AM on April 15, 2008

I worked Suicide Prevention for 6 months (yes, I burned out - I volunteered for 1 year). This was in the U.S.

When we decided whether to have the person arrested to prevent danger to themselves, we looked for 3 things:
- means to kill themselves according to a sane and possibly effective plan
- motive to try to kill themselves
- specific plan that was practical and possible

Without these three things, we could generally write that person off as a crank or a whack job or someone calling just to have someone to talk with. It didn't mean we could stop being nice and supportive, but it usually meant that we could call off the red alerts.

There were other challenges for an anonymous hotline. We had to know the person's address. We could potentially get a trace if we needed the police to get there. Logistics won't matter as much in your case as you'd be in the doctor's office at the time.

Personally, if I were going to tell a health professional anything, I'd probably want to tell the right health professional that thing. Once I made the mistake of ruining a good GP by telling him I had taken LSD. The man couldn't handle it, hadn't been trained to handle it and did not handle it gracefully. I'd probably tell, instead, a psychologist or mental health clinician. There is some possibility that such a person has already had training on how to deal with such a contingency and less chance you'd catch that person flat-footed with unexpected news.
posted by kalessin at 9:01 AM on April 15, 2008 [1 favorite]

The protocol for an involuntary commitment to a psychiatric facility in Philadelphia is a determination that a person is a danger to themselves or others. Suicidal ideation does not make you a danger to yourself, necessarily, but more information would be needed to make a better determination about that. Specifically, practitioners are supposed to follow up on an expression of suicidal ideation with questions about whether the person has a plan for carrying out the act and whether they have the materials necessary to do it. Saying, "I think about killing myself sometimes" is one thing. Saying, "I'm thinking about killing myself today with the gun I have in the glove compartment of my car" is another thing entirely. The former probably would not prompt interventive action on the part of a clinician, the latter would definitely prompt a 302, or involuntary commitment to a psychiatric facility, in the city of Philadelphia, Pennsylvania, USA. I have no idea what the standards are in Australia.
posted by The Straightener at 9:08 AM on April 15, 2008

The doctor will try and help you. I don't think he will call the police and have you detained or anything drastic...although I'm not familiar with Australia.
The fact that you are seeking help is definitely the first step. I was looking after someone who had a bad turn in life and was deeply depressed. She started picking at her face and was contemplating suicide. She told me that she wasn't going to commit suicide...well, until she did try to commit suicide. Please find help before it is too late. Suicide is not the easy way out, it is the hard way out of things. Creating the best life you possibly can is the easy way out of your depression.

Good luck!
posted by nickerbocker at 9:09 AM on April 15, 2008

I'm in the US. I would expect the doctor would evaluate to determine if you were a danger to yourself or others. Since your doctor is a GP she will very likely refer you for psychiatric evaluation. She may even want to hospitalize you. A mental health professional might determine you are a danger to yourself, and have you involuntarily committed for evaluation. I'm not sure about the laws in Australia. I am sure they will refer you for psychiatric evaluation but involuntarily committing you may be very unlikely since you say you are not a danger to yourself (other than cutting) and thoughts of suicide has been going on for "years." IANAD.

Good luck anonymous. It's good that you are going to talk about this with a doctor. Do try to see a mental health professional very soon.
posted by LoriFLA at 9:10 AM on April 15, 2008

Nessahead is right...it is a great step you're taking! The doctor should follow up with specific questions about how long you've felt this way, if there are specific triggers of your suicidal/self-harm thoughts, and about any drugs or alcohol. Be honest with your doctor. He or she can't help you if you don't give them the complete story. Be aware that any treatment will likely take some time to help you to feel dramatically different. Be patient with yourself as you get better.

I'm on my way back from a severe period of depression and getting help saved my life. I didn't necessarily want to kill myself (well, I did, but wouldn't have) and therapy and medication have saved my life by making it a better place to be. Even my worst days now are so much better than my best days then.

You are doing a good thing. Best of luck to you.
posted by heathergirl at 9:14 AM on April 15, 2008 [1 favorite]

In Australia, as long as you explain it in the same way as you've said above, you don't need to worry: the doctor will not freak out. You won't be detained or involuntarily committed or anything like that.

Good on you for managing to find the strength and energy to be able to go for help. Remember: these things can take time, but there IS a way out of depression.

(Very unlikely, but) Just in case this doctor can't/won't help you: don't give up! Go back and see someone else instead, or go to your local GP.

I wish I had something more profound to say than "good luck", but I wish you good luck all the same.
posted by different at 9:19 AM on April 15, 2008

Here is a link to a guide to evaluating a suicidal patent. Here's another. As you can see, a major part is determining if that person has a plan, although there are a number of factors which would increase or decrease the need to urgently intervene on that person.

One of the most feared aspects of treating someone who's depressed is that as the motivation-crushing depression lifts, the patient starts to feel like he can accomplish something again. That something might be killing themselves. To try and prevent that, you'll be probed in great detail about thought of suicide, and given information about what to do if you feel like hurting yourself.
posted by a robot made out of meat at 9:21 AM on April 15, 2008 [1 favorite]

I recommend reading How Not to Commit Suicide by Art Kleiner. I recommend not killing yourself. Seriously. You are thinking about suicide, and you are cutting yourself. You should be closely monitored while you start meds, as you might feel enough better to have the energy to do yourself harm, before you feel enough better to not want to harm yourself.

Do you have friends and family who can help? It would be good for you to be living with someone sane, who can help you while you get better. I've been in some severe depressions, and it will get better. Be persistent about getting the help you need and deserve. Good luck.
posted by theora55 at 9:55 AM on April 15, 2008 [1 favorite]

They won't be shocked at all, these sound like pretty common symptoms.

From my experience, they would note everything down, maybe prescribe something for the short term, but definitely refer you to a specialist so you can undertake the best course of treatment. The GP's notes will be passed to the specialist.

They won't freak out or force you to do anything.

You're doing the right thing, go for it.
posted by Blip at 10:15 AM on April 15, 2008

Good on you for going to get help, and ABSOLUTELY tell the doctor about suicidal thoughts (even if you have no plan of acting them out). This doctor should then ask some more probing questions to determine if there is a likelihood that you will kill yourself. he should then refer you to a shrink, talk to you about medication, etc.

if the doctor does not do these things, or waves you off, or you just don't get a vibe from him, SEE SOMEONE ELSE. don't give up on getting help just because one doctor sucked.

good luck.
posted by misanthropicsarah at 10:29 AM on April 15, 2008

You should definitely tell them you have suicidal thoughts. The only way they can hold you involuntarily is if you are a danger to yourself or others (at least in the US). Mostly, if you tell them you have a definite plan to carry out, that will get you committed. But just having suicidal thoughts is not enough for that. Hopefully s/he will refer to you a psychologist or psychiatrist to help you. Good luck.
posted by hulahulagirl at 10:52 AM on April 15, 2008

Congratulations for being willing to ask for help. That's huge and positive.
I think you should tell your doctor in the context of asking for a psych recommendation. That way, your dr will know you are serious about getting help and are less likely to go through with your thoughts. It would probably also make your dr less likely to put you in some sort of strict observation program.
posted by rmless at 11:10 AM on April 15, 2008

Echoing all the above, the GP will be well used to such presentations and will help you. Worst case scenario here is your GP does nothing and tells you to get some sleep and/or excercise.

S/he will NOT freak out, will NOT refer you to the Police, they will try to get more detail of the shape these suicidal thoughts take to see are you a current threat to yourself or others, but this information is gleaned to assist in a treatment plan.

(Unless you tell them you are currently actively planning to top yourself or others)

Otherwise nthing all the above, well done you on getting help.
posted by Wilder at 11:57 AM on April 15, 2008

I have told doctors in Australia about my thoughts about suicide and none of them have reacted weirdly. They treated it like any other symptom and asked questions like earlier posters have noted - how would you do it, are they strong thoughts, that sort of thing. I think GPs at university clinics are going to be even more reasonable about this, because university is often a stressful time when young people experience new and difficult life events (for some, sex, drugs, inability to cope with workload, social isolation, etc). Universities sometimes have other options too, like free counsellors, but in my experience, they're of a social worker type rather than a psychologist.

I think there is no reason to be worried about telling your doctor about this. I have told doctors about my ideas of suicide on and off for 20 years and I have never been institutionalized.
posted by b33j at 2:07 PM on April 15, 2008

Doctors tend to be a lot more cool about this kind of thing than some therapists (although you'd think it would be their job description). A doctor will just refer you to a mental health professional, and if you're having these feelings, you should definitely mention it to him or her.

I've had a couple of therapists who couldn't deal with my confessions of suicidal feelings. One simply felt he was unskilled in the area, so he continued to "treat" me (with talk therapy), but we never discussed that issue. I should have dropped him altogether, I now think, but hindsight is 20-20.

Another therapist said she was refusing me as a client because of my suicidal feelings. She claimed she had had a previous patient commit suicide, and she wasn't willing to go through it again. (It may just have been an excuse--we didn't have great chemistry, and maybe she felt an elaborate excuse was kinder than, "I don't like you.")

I've also had therapists who wouldn't treat me until I'd signed a form promising not to commit suicide during my course of therapy with them. (After it was done, I assume, I would have been free to go swing from the nearest oak tree for all they cared.)

But your question wasn't even about therapists. Anyway, good luck and I hope you find a good person to talk to.
posted by frosty_hut at 3:30 PM on April 15, 2008

Unless you have a plan of how and why, suicidal thoughts should only get you the help you need, and not weird out the doctors or get you institutionalized.

Also, you get a big internet hug from me. Good for you for getting help. I've been there, I think a lot of people have been there, and I know it doesn't make your suffering any less, hearing that, but sometimes it's good to share, so feel free to Mefimail me if you just want to vent to someone and you are depressed. Really!
posted by misha at 4:22 PM on April 15, 2008

Hi, anon asked me to post this follow-up to yesterday's question:

I went to the doctor, mentioned everything, cried a little. She said I
seem to be severely depressed, took blood for a full test, gave me a
prescription for an antidepressant (Loven) and a referral to a
psychologist and a followup appointment at the clinic on Monday. I
really appreciated everyones answers, it helped when I was chickening
out and thinking about piking on the appointment!
posted by misha at 11:13 AM on April 16, 2008 [1 favorite]