Logan Reid
If you or someone you know is experiencing suicidal ideation, it's important to seek immediate help. Suicidal ideation can manifest in various ways, such as falling asleep with the hope of not waking up or thinking about jumping in front of a fast-moving vehicle. While having these thoughts does not always lead to suicide attempts, they can significantly impact one's mental health and lead to self-harm. To get help, one can call or text crisis support lines, such as 988 in the US, or go to the emergency room (ER) of a local hospital. At the ER, a mental health professional will conduct an evaluation or suicide risk assessment to determine the appropriate treatment and level of care needed, which could include inpatient or outpatient hospitalization. Inpatient hospitalization provides 24/7 acute care and support, typically lasting 5-7 days, while outpatient treatment allows the patient to sleep at home and receive care during the day. Seeking help is a crucial step towards stabilizing one's mental health and ensuring safety.
| Characteristics | Values |
|---|---|
| When to hospitalize | If you believe that you or someone you know is in immediate danger of harming themselves or others |
| Who to contact | National Suicide Prevention Lifeline, 911, or local emergency services number |
| What to do if calling on behalf of someone else | Stay with them until help arrives, remove weapons or harmful substances if possible |
| What to expect at the hospital | A mental health professional will determine the level of care needed through a suicide risk assessment |
| Types of treatment | Inpatient hospitalization, partial hospitalization program, residential treatment program, outpatient treatment |
| Goals of treatment | Stabilization, safety, support |
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What You'll Learn
- Seeking help: Call a helpline, 911, or go to the emergency room
- Evaluation: A mental health professional assesses suicide risk and determines the level of care needed
- Inpatient hospitalization: Acute 24/7 care for those at risk of harming themselves or others
- Partial hospitalization: Outpatient treatment with therapy and psychiatric support
- Aftercare: Discharge with a care plan, which may include outpatient visits or residential treatment
Seeking help: Call a helpline, 911, or go to the emergency room
If you or someone you know is experiencing suicidal ideation, it is important to seek help immediately. Here are some steps you can take:
Call a helpline
If you are in the United States, you can call or text the Suicide & Crisis Lifeline at 988. This service is available 24/7, and you don't need to be in a crisis to call. You can also text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counsellor for free and confidential support. If you are not in the United States, you can find a helpline in your country through Befrienders Worldwide. These helplines provide a safe and confidential space to talk about your thoughts and feelings and can offer support and resources to help you through this difficult time.
Call 911 or your local emergency services number
If you or someone you know is in immediate danger of harming themselves or others, call 911 or your local emergency services number. If you are calling on behalf of someone else, stay with them until help arrives. You can also remove any weapons or substances that could cause harm if you can do so safely.
Go to the emergency room
If you or someone you know is experiencing suicidal ideation, you can go to the local emergency room (ER) of your nearest hospital. The ER staff will evaluate your mental state and determine the level of care you need. Be honest with the staff about your thoughts and feelings so they can provide the best possible care. They may ask questions about your plan, previous attempts or thoughts, medications you are taking, and any issues going on in your life. This evaluation helps them understand your suicide risk and ensure you get the help you need.
Remember, seeking help is a sign of strength, and you don't have to go through this alone. There are people and resources available to support you through this difficult time.
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Evaluation: A mental health professional assesses suicide risk and determines the level of care needed
When an individual arrives at the hospital and discloses their suicidal thoughts, the health workers will call a mental health professional to assess their suicide risk and determine the level of care needed. This evaluation is a critical step in ensuring that the person receives the most suitable treatment for their specific situation.
Mental health evaluations typically involve a suicide risk assessment, which can be complex and comprehensive. One commonly used tool is the Columbia-Suicide Severity Rating Scale (C-SSRS), also known as the Columbia Protocol. This tool helps professionals understand the individual's level of risk and determine the appropriate care in the least restrictive environment. It assesses active and passive suicidal ideation, method, plan, intent, and suicidal behaviour. The C-SSRS is validated for use with individuals of all ages, including children, adolescents, and adults.
Another screening tool is the Ask Suicide-Screening Questions (ASQ) Toolkit, developed by the National Institute of Mental Health (NIMH). The ASQ consists of four yes/no questions that can be administered in 20 seconds. It is suitable for individuals aged 8 and older. For younger children, a full mental health evaluation is recommended instead of screening. If an individual screens positive on the ASQ, a trained clinician should conduct a brief suicide safety assessment (BSSA) to determine the need for further evaluation.
During the evaluation, the mental health professional will ask a range of questions to understand the individual's mental state and determine the appropriate level of care. These questions may include inquiries about any suicide plan, previous attempts or thoughts, medications, and issues in their life. The professional will also consider the individual's personal history, current mental state, home environment, and specific suicidal thoughts or behaviours. Based on this comprehensive assessment, they will decide if inpatient hospitalization or outpatient treatment is most suitable.
Inpatient hospitalization involves 24/7 acute care and support, with the individual staying at the facility day and night. This level of care is typically reserved for individuals at high risk of harming themselves or others. On the other hand, outpatient treatment allows individuals to return home while receiving treatment during the day. This may include partial hospitalization programs with therapy, psychiatry, and group therapy components. The goal of the evaluation is to ensure that individuals receive the necessary level of care to stabilize their condition and connect them to ongoing treatment.
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Inpatient hospitalization: Acute 24/7 care for those at risk of harming themselves or others
Inpatient hospitalization is a 24/7 acute care option for those at risk of harming themselves or others. It is a short-term treatment in a hospital that will help stabilize an individual's mental health and keep them safe. It is used when an individual is at risk of harming themselves or someone else. This treatment is available at behavioral health hospitals or clinics, or it may be a floor of a regular hospital or a freestanding psychiatric hospital.
Inpatient hospitalization is often a life-saving option for those in an acute mental health crisis. It is not meant to cure the patient but to stabilize them so that they can receive further treatment. The average length of stay is 5-7 days, but this can vary depending on the patient's needs.
When an individual arrives at the hospital, they will undergo a mental health evaluation by a mental health professional who will determine the level of care required. The evaluation will involve questions about the patient's mental state, including whether they have a plan, previous attempts, thoughts, hospitalizations, medications, and any issues in their life. The patient should be honest with the evaluator to ensure they receive the appropriate level of care.
Inpatient hospitalization can be voluntary or involuntary. Involuntary hospitalization is typically required when an individual is in imminent danger of harming themselves or others and is unable to care for themselves. The laws regarding involuntary hospitalization vary by state, and a hearing with a judge is usually required to extend the hospitalization beyond 48 to 120 hours.
It is important to note that inpatient hospitalization is not the only option for those experiencing suicidal ideation. Outpatient treatment is also available and involves weekly therapy, psychiatry, and group meetings. Partial hospitalization programs (PHP) are another option, where individuals attend treatment during the day but return home to sleep.
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Partial hospitalization: Outpatient treatment with therapy and psychiatric support
Partial hospitalization is a form of outpatient treatment for people experiencing suicidal ideation. This means that patients can receive treatment while continuing to live at home and maintain their daily routines. This can include work, school, or family responsibilities.
Partial hospitalization programs (PHP) are typically day treatment programs where patients attend for 6+ hours either every day or every weekday. Treatment consists of 1:1 therapy, psychiatry, group therapy, psycho-educational groups, and recreational/expression therapy.
Partial hospitalization is a good option for those who are safe enough to be unsupervised but are struggling enough that they need more intensive care than weekly therapy. It can also be a good transition step for those who are stepping down from inpatient care and no longer require such intensive treatment.
Outpatient treatment allows individuals to maintain their privacy and autonomy, respecting their boundaries regarding therapy and personal feelings. It also allows for the ongoing support of family and friends, which can be a crucial component of recovery. This support system can also be involved in the therapeutic process.
Outpatient treatment is also more cost-effective than inpatient programs, making it a more accessible option for many people. It can provide the right balance of support and independence, allowing individuals to stay integrated into their community and daily life while receiving the care they need.
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Aftercare: Discharge with a care plan, which may include outpatient visits or residential treatment
After inpatient hospitalization, care doesn't end, and individuals are not deemed cured. Instead, they are considered safe enough to transfer to a lower level of care. This often involves being discharged with a care plan, which may include outpatient visits or residential treatment.
Outpatient treatment means that individuals can sleep at home while receiving care during the day. This can take place at a hospital, a behavioural health clinic, or a mental health care centre. Partial hospitalization treatment usually consists of one-on-one therapy, psychiatry, group therapy, psycho-educational groups, and recreational/expression therapy.
Residential treatment programs are another option for individuals who need additional support. These programs specialize in treating individuals facing suicidal thoughts and can provide a higher level of care.
Brief interventions can be therapeutic and help prevent future self-harm. They are especially important for patients being discharged. These interventions focus on helping patients develop skills to recognize and cope with suicidal thoughts and create action plans for making their environment safer. Local practices should be tailored to both need and feasibility.
It is important to note that treatment providers should hone in on the person's unique triggers and concerns to help them directly. Helping individuals connect more closely to their reasons for living and actively learning to resist urges to engage in suicidal behaviour are essential components of managing suicidal ideation.
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Frequently asked questions
If you or someone you know is in crisis and considering suicide or self-harm, seek support immediately. Call or text a crisis helpline, such as 988 in the US, or the National Suicide Prevention Lifeline. If you feel safe to do so, call 911 or your local emergency services number. If you are calling on behalf of someone else, stay with them until help arrives, and remove any weapons or harmful substances from their vicinity if you can do so safely.
When someone arrives at the emergency room for suicidal thoughts, they will be evaluated by a mental health professional to determine their level of care. This evaluation will involve a suicide risk assessment, which aims to determine the appropriate treatment. The patient will be asked a series of questions to assess their mental state, personal history, home environment, and specific suicidal thoughts or behaviours. Based on the evaluation, the patient may be discharged with a care plan or transferred to a higher level of care, such as a psychiatric hospital.
Inpatient hospitalization provides 24/7 acute care and support for individuals at risk of harming themselves or others. It can take place in a regular hospital, a freestanding psychiatric hospital, or a behavioural health hospital or clinic. The average length of stay is 5-7 days but can vary depending on the individual's needs. Inpatient hospitalization is not meant to "cure" the patient but rather to stabilize them and connect them to the necessary long-term treatment.
