My husband is depressed and wants to kill himself. He refuses counseling. How can I stop him?
May 31, 2010 4:54 PM   Subscribe

My husband has convinced himself that his life is worthless and the world is better off without him. How can I help a man who refuses help?

My husband wants to kill himself.

He's been depressed for a while -- he showers maybe once a week, often stays up until 3 or 4 in the morning, then sleeps until noon.

He burst out sobbing on Thursday night (very unusual for him), and said that earlier that day he had a target pistol up to his eye and was trying to figure out the correct angle to shoot so it would get the best part of the brain. (I've found the pistol and will dispose of it).

However, he's a very clever man, and will figure out some other way. He refuses any sort of counseling as he would "pwn the counselor intellectually", which limits my options in getting him any help.

I told him repeatedly that he was not being rational, and that this crisis would pass, but he's adamant that he's felt this way for a very long time, that he's "not a nice man" and that there's been something missing in his life for years, and it would be easier for everyone if he "just went away."

Another kink -- I've been selected as a grand juror in my county and must report on Tuesday. I don't want to leave him alone in this frame of mind.

He says the only thing that keeps him from doing the deed would be the affect the act would have on his brother, who also suffers from depression.

I'm trying to get him to focus on the future -- he misses the land of his birth, so I'm encouraging him to fly there in the next few weeks (or sooner, if possible) so he can reconnect with his folks and his friends (he works remotely now, so he doesn't connect with many people here in the States). He's balking at the plane fare, which is weird since we can afford it. His brother in Germany and his best friend in Australia have spoken to him, but he left them with the impression that he was "a bit low."

What are my options here? He thinks he's a lunatic, but he's a very high-functioning one.

throwaway email:
posted by anonymous to Health & Fitness (31 answers total) 7 users marked this as a favorite
Call 911 or whatever the local emergency number is for your area. You're in an emergency situation.
posted by Meg_Murry at 4:57 PM on May 31, 2010 [25 favorites]

I will let others with more knowledge of mental health issues answer your question. But I strongly suggest that you call the court and tell them that you are the primary care giver for someone who is seriously ill and that you need a postponement of your jury service.
posted by nestor_makhno at 4:58 PM on May 31, 2010 [8 favorites]

This is what committal is for.
posted by i_am_joe's_spleen at 5:01 PM on May 31, 2010 [1 favorite]

OP, lest my answer above might seem short or sarcastic: the situation you describe is not one you can talk someone out of on your own. You and your husband both need help, urgently. If you call the emergency number or take him to an emergency room, you will have access to experts who can safely address your husband's situation. Please don't try to handle this alone.
posted by Meg_Murry at 5:03 PM on May 31, 2010

He's balking at the plane fare, which is weird since we can afford it.

My guess is, he thinks he's not worth spending the money on.

I agree with the above: this is a psychiatric emergency. He has expressed a desire to commit suicide and he found the means to do it. Call the emergency number where you are and ask which hospital has a Psych ER.
posted by shiny blue object at 5:07 PM on May 31, 2010 [4 favorites]

Please call 911 NOW and have him evaluated. This is a true emergency.

Step away from the computer NOW and call!
posted by St. Alia of the Bunnies at 5:09 PM on May 31, 2010 [9 favorites]

Yes, please call 911. This is the definition of psychiatric emergency. You cannot talk or humor someone out of suicidal depression any more than you could talk or humor someone out of diabetes or cancer or a broken leg. He's ill and and needs immediate medical help from trained professionals.

As for the the grand jury: there is surely a number you can call in the morning to tell them you are in the midst of a serious medical emergency with your spouse and thus you must postpone your service.
posted by scody at 5:09 PM on May 31, 2010 [21 favorites]

He needs immediate inpatient care. Visiting the homeland can happen when he is recovered, not while he is in crisis mode. Jury duty can be deferred. Please don't wait--just get him admitted to a psych unit (I have no personal experience with this but it seems that 911 might be preferable than trying to talk him into it).
posted by tetralix at 5:11 PM on May 31, 2010 [1 favorite]

You both need professional help. I'm seconding all of the people who say call 911 NOW. I'd also like you to know how sorry I am that you are in this situation, and that you don't have to do this alone. You shouldn't do this alone: it's time to call in the people with the training to help someone having a major mental health crisis. A hug to you.
posted by pickypicky at 5:16 PM on May 31, 2010

You are not a trained professional, and you should not try to handle this alone any more than you would try to handle it alone if your husband had a brain tumor. Depression is a life-threatening illness, and your husband is in a very dangerous episode of a life-threatening illness.

You cannot talk him out of this. He is sick. He needs a doctor.

You cannot handle this yourself.

You are understandably reluctant to call 911, because he doesn't want you to. You should do it anyway, because your husband desperately, desperately needs a doctor.
posted by jennyjenny at 5:19 PM on May 31, 2010 [2 favorites]

You can also call the National Suicide Hotline (1-800-273-8255), and have them talk you through your choices. Calling 911 can seem daunting and scary, and they can give you extra support. The hotline is routed to a local crisis center (in Minnesota, at least), and they field calls like yours all the time. (I volunteer for our local crisis center, and I've talked to many, many people like you who are worried about family members/friends.) Good luck.
posted by Zosia Blue at 5:20 PM on May 31, 2010 [8 favorites]

Piling on here but this man needs to be committed to a acute care psychiatric unit right now. If he'll do it voluntarily, that's great but if not, he needs to be committed involuntarily. Call a local suicide hot-line and ask for help, they'll know what you'll need to do. If he's got a gun to his head, the time to act is now.
posted by octothorpe at 5:23 PM on May 31, 2010

I'll also nth everyone that this is too big for you to handle alone, but your husband isn't in a state of mind where he can make rational decisions for himself. He may try to talk you out of it, but that's his irrational, suicidal mind speaking for him, and it can't be trusted. He can't be talked out of it. This isn't the husband you know and love - this is a version of himself that's self-destructive and terrified. He needs professional help that you can't provide, even if he tells you he doesn't. Thinking good thoughts for you.
posted by Zosia Blue at 5:23 PM on May 31, 2010 [1 favorite]

Posting again to say: I had to take my husband to the psych ER for threatening suicide. I posted about it on this thread. I'm going to repeat one of the things I said there:

although the day I called 911 on my husband was probably the worst day of my life, it was perfectly routine for the officer who dealt with him. The professionals know how to handle this kind of thing; they've seen it, and worse, a thousand times before. It helped a lot, knowing that they had experience in a situation like this, when I was so lost and confused and frightened.

This is not a normal situation, and you can use the help to get through it. You do not have to solve this all by yourself.
posted by shiny blue object at 5:33 PM on May 31, 2010 [4 favorites]

The advice I give people who ask about involuntary commitment best practices is to not wait until a 911 call needs to be placed, knowing that your loved one is resistant to treatment and not getting better, you should speak to your county behavioral health department in advance about the commitment process. Explain to the mental health delegate that you are the spouse of someone who is in a recurring state of psychiatric crisis and that you may need pre-approval for a civil commitment order. Also contact your local police precinct and ask them if they have CIT (Crisis Intervention Training) certified officers, and if so could you have their names so you could request them as responders. If you take steps ahead of time to familiarize yourself with the process you may be able to prevent the situation more being traumatic than it already will be for both you and your husband.

That said, committing a family member is always traumatic and you should anticipate that taking this action will do considerable damage to your marriage. You can work all this out later, though; in my experience people do come around but every single client I ever participated in a commitment with held titanic grudges against the treatment team that took us months to overcome.

I never recommend a family member take action to involuntarily commit a loved on on this forum because taking someone's freedom away is the most serious matter and should never be done in the absence of total certainty of necessity, but if your husband is being truthful in his description of literally having a gun to his head with the intention of pulling the trigger, that is very clear grounds for an involuntary commitment. This is also why it is especially crucial that you have responding officers who are trained in mental health crisis. Police officers tend to change in demeanor when they discover a gun is involved in an emergency response, you want to make sure that your husband's life is saved without him getting seriously hurt in the process.

I can speak with you in greater detail about this privately, contact me if you like.
posted by The Straightener at 5:39 PM on May 31, 2010 [16 favorites]

I'll address the jury duty part first, since I recently did jury duty. I'll explain how the process went for me; I ended up on a federal grand jury in California.

When you show up for jury duty there will be a process you'll go through where you can explain the situation and postpone your appointment; I think you can also get your jury duty tossed out entirely at this point too, it's just not as common, but if you explain your husband has been trying to kill himself I would be surprised if they didn't at least postpone it. They let me postpone my appointment by one week for a driver's exam, which seems less important and which I could have rescheduled.

If that doesn't work and you get sent off to a court room for the selection process, the judge will ask again if anyone feels they can't serve for some reason. By default people had to announce their reason in front of everyone, but if they wanted privacy they could approach the judge and tell him (or her) away from everyone else. One person was permitted to get out of jury duty because there was a funeral she had to attend out of the city that conflicted with it. Another guy got out of it just because he had only started his current job the week prior and they really needed him around. Someone else got out of it because she was the primary caregiver for someone that was ill. Again, if you explain your situation here, you might get out of it.

Failing that, and you get put in the jury box for evaluation, you can give answers you know they won't like. Normally I wouldn't encourage anyone to do that sort of thing -- plus I'm a weirdo who likes jury duty -- but if they won't let you out of it during the first couple rounds then that's pretty much your last option. Just know that we had to give some background explanation for everything we said, especially if it might disqualify us from serving. For example, my case was about taxes, and some people got eliminated during the jury selection process because they answered "yes" to whether they were associated with any movements that wanted to abolish the U.S. tax code. Another woman got eliminated because she admitted that she didn't like cops and was unlikely to trust one if they testified. If anyone had admitted to racism -- the defendant was a minority -- then they would have been disqualified too. I doubt you'll even find yourself in the jury box, though.

Hopefully you'll have your husband committed or something before then. Terribly sorry you're going through this -- my father went through depressive phases where he would talk about wanting to kill himself. I know how horrible it can be, and how hard it was on my mom. If he won't get help, you have to force it on him. My dad responded very well to Prozac, though before that he was on something -- I'm not sure what -- that made him manic and awful. I'm not sure how many antidepressants he went through, but I know it took a while to find something that worked; everyone is different. Just keep that in mind if you don't hit the medication bullseye the first time around and keep at it, because it takes time and observation.

Also, so my talking about my father in the past tense doesn't alarm you, he died of a heart medication that was mistakenly manufactured at twice the appropriate dosage and for which we're part of a class action lawsuit -- not suicide.

Good luck, and I'm sorry you're both going through this.
posted by Nattie at 5:56 PM on May 31, 2010

A family friend recently went through this. She took her husband to the ER when he was suicidal and talking much like your husband. Once she got him there, the ER doctors were able to convince him to voluntarily commit himself. He spent about a week in the inpatient psychiatric unit and, while he is still getting things back on track, he is doing MUCH better. And he is very grateful to his wife for taking the steps necessary to get him the help he needed. We visited him while he was inpatient at the psych unit and the unit itself was very pleasant, not at all scary, and he was getting the help he needed to get better. I had no familiarity with inpatient psychiatric care and imagined it was all rather frightening, but it really was a calm and peaceful hospital ward -- it reminded me more of the maternity ward than anything else, with families visiting and mostly-healthy people there for a specific thing (getting mentally well) and a very caring staff.

Remember, his depression will protect itself. That's why it doesn't want you calling doctors. Your HUSBAND, underneath the mental illness, very likely DOES want your help.
posted by Eyebrows McGee at 6:08 PM on May 31, 2010 [7 favorites]

Take him immediately to the nearest ER or crisis center. This is very serious: he will be admitted if he is truthful and repeats what he has said to you.

This is the advice I was given when my schizophrenic son started to feel suicidal. I took him to the ER, and he stayed in the ward for over ten days, until stable. After that we watched him constantly for two months, before we felt comfortable in leaving him by himself.
posted by francesca too at 6:12 PM on May 31, 2010

Someone in my family threatened suicide some months ago - I got a phone call at 4am saying that he had left his house with the intention of killing himself. I got around there, checked out the situation, and phoned the police to say that he was driving around somewhere and planning suicide. The police put out a notice to watch for his car, then, when he was found, spoke to him and suggested he go to hospital for assessment. Best thing we could have done was getting him to hospital - and I think the best thing you can do too.

He was mad at me at the time, because it was an embarrassing situation for him. But obviously he didn't hurt himself, and after being treated at hospital and in follow-up visits, he was okay with what I had done. Your husband will be angry and hurt at first, but it's the best thing for both of you, to save a lot of anguish down the line. Be prepared for it, because it hurts like hell and maybe you'll feel disloyal (although you aren't at all), but you would do it if he was dying of cancer, and this is no different.
posted by tracicle at 6:16 PM on May 31, 2010

Taking someone to a crisis center presumes that 1) they are currently in a crisis state and 2) that they are willing to go to the crisis center. We don't know if either are the case right now. This is an anon AskMe, we can't know how long ago it went in the queue and the details of the situation could be very different right now then they were 24 or 48 hours ago. Having someone voluntarily present at a crisis center is always preferable to having them involuntarily committed, but if he's not willing to go and he has a gun in his possession and is stating his intention to use it on himself then it goes beyond asking if he's willing to go to the crisis center. On the other hand, taking someone to a crisis center after the crisis has passed and having them tell the intake nurse, "I was feeling like hurting myself two nights ago but I think I'm fine now and do not want to be treated" is going to result in a big waste of time. What is going on with him right now, as in this second? We can't really know that with an anon AskMe so it makes an already extremely touchy situation even more difficult to provide any useful guidance on.
posted by The Straightener at 6:25 PM on May 31, 2010 [1 favorite]

The day before the last time I had jury duty, my sister called to tell me that her cancer had recurred and that she needed me to come visit immediately. I called the number on my jury duty notification to inquire if I could delay my service for a month or so. They said I absolutely could. It was all done in about five minutes, all over the phone.
posted by Sara Anne at 6:40 PM on May 31, 2010

You are correct: he is not rational and you cannot reason him out of this. Someone who threatens suicide, and has a plan for how to carry it out (as your husband does) is very likely to execute his plan. So your husband needs help that you cannot give him.

Please heed the advice here, for your own health, and treat this as the medical emergency it is.

Long term you will BOTH need therapy and doubtless, other interventions too. This is stuff you can talk to a professional counselor about and to the suicide hotline counselor about. But right now you have a medical emergency on your hands that requires immediate hospitalization.

Good luck. Please treat yourself with the kindness and compassion you will surely need in the coming weeks.
posted by serazin at 7:20 PM on May 31, 2010

My best friend, who I used to see everyday, just committed suicide last week. She was 25, like me.

I survived my own attempt at the age of 16, by sheer luck that my parents found me at the crucial moment.

I will try to bring my first-hand experiences, as both a survivor of suicidal depression and as someone that tried to help someone that suffered from the same, and failed.

If you take anything from this, please understand this:

Your husband can't be left alone for any extended period of time. Do what you need to do to excuse yourself from jury duty immediately. You simply don't have that time. Take time from work as well if you need.

You can't help your husband by yourself. You must get him to a mental health professional, preferably an ER. You have to do everything in your power to do this short of leaving his side. Serious clinical depression is as real an illness, as cancer. Depression so severely alters a person's mood that it taints their entire understanding of what's happening to themselves, and the events around them.

Focus on getting him help by sharing your feelings. Don't appeal to his own self-esteem. He is lacking a sense of self-worth and thus arguments that build on that are less likely to work than the fact that you care for him, this is important to you. And that his leaving this world will devastate those that care for him.

In the interim, you can establish a psychological 'roadblock' by having him promise you, in the most serious fashion to talk to you before he again makes attempt to hurt himself. Make him commit to this promise and remind him of it.

This is not a hypothetical, it is difficult to face the possibility that this can happen but it's crucial that you do everything you can to get him the help he needs. He may get mad, this may cost you time with other responsibilities in your life, but you must get him that help.

Here are my additional thoughts on what you've posted:

-Don't try to "cheer" him up, fix his problems, or otherwise apply rational problem solving to improve his life. HIs problem isn't based on the rationale of his life, it's his mental outlook of his life, and his emotional suffering. Put your energy into getting him professional help.

-This is appropriately severe a situation that you shouldn't need a referral or to make any appointments. Get him in front of a mental health professional:
--Get him to with you to the ER. He won't want to go, ask him to do it for you.
--If you believe he will go but can't muster the energy to, call the hospital and ask for an ambulance
--If you can't get him to do those things but believe he will see your regular doctor, do this. Ask for a housecall if necessary explaining the situation

-That he is talking about suicide is actually good in such a situation. These are active cries for help. It's important that you continue having a dialog with him, without judgement but also not to pander to his destructive moods. Respond to his lack of self-worth by sharing with him how important it is to you that he survives. Focus on you, and the impact of those around him. It's like talking to a brick wall but you must continue doing it.

-Engage him in the world as much as possible. Don't let him sleep in or not get dressed. If you wake him at the right time, he'll naturally fall asleep properly. Try to ground him into the world, have people over, eat out at restaurants if you cant, etc.

-Actively retire things that may help him commit suicide. Yes, dispose of the gun. I don't know how it is in your area but if you need a gun permit to purchase guns, take that from him.

-I feel that it is actually more difficult to admit to depression, requiring mental help when you've witness this in another family member - you can see all too well the impact that it has. This make it difficult to accept that you might be the one to cause similar pain.

-Finally, whatever happens it is inevitable. You are doing everything you can to save him, and I only hope that he gets the help he needs and in time, will recover.

I've setup an email: For you, and others that might be in this situation, please feel free to contact me about anything I will try to help. However my advice is no substitute for that of a mental health professional.
posted by artificialard at 7:23 PM on May 31, 2010 [23 favorites]

former counselor for suicides here:your husband needs to be hospitalized. immediately.
posted by lester's sock puppet at 8:34 PM on May 31, 2010

Thank you for your excellent comment artifiialard, and I am so sorry to hear about your friend.

I want to reiterate the point you made which I don't recall being made elsewhere in this thread: In the interim, you can establish a psychological 'roadblock' by having him promise you, in the most serious fashion to talk to you before he again makes attempt to hurt himself. Make him commit to this promise and remind him of it.

I believe one term for this is "contracting for safety". Ask him to make a verbal contract with you, that he will tell you before he harms himself.
posted by serazin at 9:00 PM on May 31, 2010

I actually went to the ER in a psychiatric emergency, although the remedy turned out to be much simpler than what your husband will require. (I was psychotic from having gone without more than three consecutive hours of sleep for a year and a half.) I was aware that I needed help and I was willing to get it, but I didn't know how.

The professionals at the Emergency Room treated me so, so well. I cannot stress this enough; they did their job thoroughly and competently, evaluated me successfully, and moved quickly to get me into the care of professionals who could actually help. When I apologized for absorbing ER resources with something that may not have really been an emergency, the social worker (who stayed in my room the entire time with me, btw) said, very seriously, "No, this is exactly what we are here for. If someone is too critically ill to be able to seek their own treatment, well, that's why there's an ER. One of our functions is to be a crisis access point to mental health services."

Ask your husband if he is 1) willing to go to the Emergency Room with you and 2) willing to promise not to lie to anybody. If the answer to both those questions is yes, drive to the ER right now. If the answer to either of them is no, call 911 and tell them your husband is imminently threatening suicide and you don't trust your ability to keep him safe. This is an emergency.
posted by KathrynT at 9:17 PM on May 31, 2010 [4 favorites]

First, listen to the other people here; they are right about the need for your husband to be admitted. If you can get your husband to go with you to the ER and talk to someone himself, then you won't have to do the scary-sounding "call 911" thing. Even if he doesn't care about himself right now, tell him that it would make you feel better if he talked to someone at the ER. Tell him how people go to the ER all the time, it's just a convenient place for help that's open 24 hours. I had an experience where I needed to get my partner checked into a safe place, and although it was a strange trip, it was so great to have him someplace where competent professionals could take care of him.

The thing I would add, in regards to him feeling too smart for a counselor, is that it doesn't matter how smart you are; it's the difference between a professional and a non-professional. He's probably smart about all sorts of things, but a psychiatrist has been trained to help people work through their headspace, and your husband hasn't gotten that training. All the smarts in the world doesn't make up for actually being trained to deal with something.
posted by brisquette at 9:46 PM on May 31, 2010

Let me also add, Anon, that if you want, you can memail me and I will walk you through everything that happened in my ER experience, from the patient's point of view. Again, it's not the same, though I was threatening self-harm, but it may be information that will help you feel comfortable with your decision.
posted by KathrynT at 9:57 PM on May 31, 2010

As others have said, there are dedicated professionals available at all hours to handle crises of this nature, and they should be your first port of call.

The different cultural attitudes towards mental health may be an additional hindrance here, especially if OP's husband, as part of his depression, is antagonistic towards interactions that he perceives as foreign. It may be helpful in the medium term for him to receive treatment or at least some advice in his native country, if that's feasible. This should not, however, get in the way of seeking immediate help, whether voluntary or involuntary, in an environment that treats his depression like the pernicious illness it is.
posted by holgate at 10:18 PM on May 31, 2010

You should know ahead of time that admittance into an inpatient psychiatric facility will be, if he does not want treatment, likely limited to an observation period of 72 hours, after which he'll be released, quite possibly without even having met with anyone to discuss outpatient treatment in the community let alone with a comprehensive after care plan. Commitments are extremely bad ways of engaging new consumers in mental health services; the experience is de facto traumatizing and often made worse by extremely bad conditions depending on what psych unit he winds up on. Some here say they've had positive experiences with psychiatric emergencies; I've been on every psych unit in the city of Philadelphia and would feel comfortable spending 72 hours on maybe two of them. Additionally, with an involuntary commitment you have no say in where you are held for observation, it's simply based on bed availability system wide, so you won't know ahead of time if you'll like where you wind up. This experience can really put people off the idea of mental health treatment, or, in your husband's case more likely simply reinforce his already negative preconception of what treatment has to offer him.

Effective treatment happens in the community, not while someone is being held for 72 hours on a locked psych unit against their will. Even getting your husband into a crisis center if he reaches a state of crisis again does nothing more than prevent him from committing suicide during this one discreet incident of suicidality. He will still be left upon his release with the same disorder which evinces the same symptoms if left untreated once he's back in the community. If he remains unwilling to engage in treatment -- which is perfectly within his rights -- he may begin the familiar cycle mental health professionals regularly encounter of clients cycling in and out of inpatient facilities, obtaining brief moments of stability only to later decompensate again in the community. Any action taken should be with the ultimate goal of having your husband find effective treatment and learn to manage his symptoms. If he remains unwilling to do this you may reach a point where you decide to reevaluate your relationship with him, as you likely won't be able to rationally expect positive outcomes over time without some change in the way your husband manages his disorder.
posted by The Straightener at 11:14 PM on May 31, 2010 [3 favorites]

However, he's a very clever man, and will figure out some other way. He refuses any sort of counseling as he would "pwn the counselor intellectually", which limits my options in getting him any help.

Counselling isn't an intellectual exercise and it very much is not an adversarial exercise either. It doesn't particularly matter whether the patient has a higher (or lower) IQ than the counsellor. It's not an argument, he doesn't have to justify being depressed to the counsellor. That he presents as depressed is enough. Why is something that he has to figure out, with the counsellor's aid and counsel. The first thing a competent counsellor will do, if your husband brings up the issue of intellectual capacity, is explore why that matters to him so much. I would say that issues of this nature will be highly relevant to his depression.

Another thing intellect won't do a damn thing about either way is love. If he loves you, and I think we may presume that he does, or did when he last felt capable of love, then he should be emotionally reluctant to hurt you in any way. It doesn't matter if this gets intellectualized in his head, it's there. Unambiguously make clear to him that you love him, and that if he was to kill himself, this would hurt you a great deal. He needs to protect you from his desires to self-harm. Of course this is obvious, but if he were capable of rationally assessing the obvious and acting accordingly he wouldn't be depressed. He needs to have it specifically made clear, in the context of emotional cues like hugging him and looking into his eyes.
posted by aeschenkarnos at 12:25 AM on June 1, 2010 [3 favorites]

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