What would be a likely medical response to past suicidal ideation.

In My Humble Opinion (IMHO)
#1

(posted here since there isn’t really an objective answer, and it potentially touches against medical or legal topics which may be jurisdiction dependent) This is not a solicitation for regulated professional advice.

First of all, let me make it very clear that I have NO intention of committing suicide. Period. Full Stop. End of line.

Now, years ago, I can recall a specific incident in college that invoved a police response during which I had a fantasy and temptation involving suicide, but I KNEW that I wouldn’t actually do it, and the temptation ended a few minutes later as the situation calmed down and it worked out for me, with no injuries and no charges.

Now, I was thinking about what would happen if I were at a doctor’s office or hospital sometime in the future and they decided to do a psychiatric screening for some reason (policy for all new patients, for example). If I was given a questionnaire that said “Have you ever thought of harming yourself?” and I, being a guy who has been told he is excessively honest, answer “yes”, assuming that it’s no big deal because it was years ago and I never intended to kill myself anyway, what is the likelyhood that I would be whisked away by white-coated men and put in a ward on observation? I’ve heard tell of “suicide watch” at a mental ward from someone who was in such a facility, but I’ve never experienced it and don’t want to. If I were faced with such a question, what would be a good way to avoid getting entangled with emergency psychiatric services and the whopping bill I’d get from them for my 48 hour emergency hold that it took them to confirm that I’m really not suicidal?

#2

A past history of suicidal ideation would not give them any reason to hospitalize you for psychiatric reasons now. What would they be treating if you weren’t having a problem now?
The only reason you’d be hospitalized would be if you were showing signs of intending to harm yourself (or someone else) currently.

#3

The concern is that if I reveal past suicidal ideation, the doctors would overreact with a “better to be safe than sorry” hospitalization that I could have avoided by refusing to answer the question or by requesting to explain in depth to the doctor in person before giving an answer, as opposed to just ticking off the form or giving a quick unqualified “yes”.

#4

No, most likely they would ask the circumstances of the prior event, and ask more questions about the current situation and ask you if you feel suicidal at the present time.

And sometimes you aren’t hospitalized when you are suicidal and the person who knows it doesn’t do anything about it.

#5

I believe they have to be convinced that you are in current danger of posing harm to yourself or others to whisk you anywhere. That’s not to say that they wouldn’t ask you annoying follow-up questions under some circumstances. If they ask at all in the kind of situation you describe, they’re definitely going to get clarification from you.

I have to say I think your described situation is unlikely in the first place; I’ve certainly never seen anything like it in many, many new-patient interviews/forms over the years. That is, new medical patient.

#6

I think they would almost certainly ask for more details. Unless you were in the ER with suspicious gashes on your wrists, or rope burns on your neck, or some other sign this is a present problem.

There are even some circumstances were severe depression or even suicidal ideation are somewhat normal - after a severe accident that leaves you paralysed, for example, or an extremely large burn.

I have trouble imagining that if you answered “yes” they’d immediately cart you away in a straitjacket. Maybe not impossible, but pretty damn unlikely.

I think the most that would happen, given that this was an event years in the past, is that they’d be careful to monitor your mental state and treat any negative mental state more aggressively than average. That doesn’t necessarily mean putting you on a locked ward, more like a psych eval and possibly offering you something like Prozac a little sooner than otherwise.

Basically, a one-time flirt with suicide - particularly one never acted on - doesn’t condemn you to the lunatic category for life.

#7

While it’s true that past suicidal ideation is not considered a problem–heck, even the current version isn’t if there are no real plans–I don’t think it wise to tell a psychiatrist anything other than what you are coming to them about. Too many want to give you a drug for every little bad feeling you have, and this is unhealthy.

I might be a little more open with a psychologist, but I’d still wait for the question to be asked, and not give additional information for no reason. About the only reason I’d tell them is if the idea that I’d thought that before was causing me current distress. And, even then, you’re going to be told what we are already telling you. Occasionally wishing yourself to die is not abnormal.

And if you are asked directly in a form, I’d still say no. What they are really asking on those forms is if it is currently a problem. You really aren’t being dishonest, as marking yes can be misleading. And, anyways, if you are at an even halfway competent location, you should have someone administering the test who can help you out.

#8

My roommate cut her wrists up pretty bad once. ER people and later a psychiatrist said it wasn’t a suicide attempt but suicidal ideation.

I found out about the incident that same afternoon, she called me to pick her up from the ER. The response to CURRENT suicidal ideation was to let a friend take her home with the advice to seek counseling.

I just can’t imagine the “big they” hauling you off because of past suicidal ideation. That being said, I think BigT made good points. I wouldn’t bring it up unless you’re being treated for psychological stuff.

Lots of meds have nasty side effects though so I think you need to be ready to discuss it with your doctor or pharmacist even if you don’t want to mark up a form.

#9

I’m doing a Psych rotation in nursing school now, so while I’m by no means an expert, I have been looking through a lot of forms and Policies and Procedures manuals. Most
(I won’t say all, because I haven’t read all of them ever used everywhere, but I can say all of the ones I have read) of these questionnaires don’t ask “ever” questions, like, “Have you ever thought about ending your life?” but rather frame them with some time period: “In the last seven days, have you thought about ending your life?”

What we’re taught as students is that if, right now, today, someone is a danger to themselves or others, then they can be held as an Emergency admit, Involuntary if need be (although, honestly, most people who are thinking of harming themselves or others recognize the need for medical care and admit Voluntarily.)

In the charting of people who were admitted with suicidal thoughts, things will be charted like this: “Suicidal Thoughts - pt. (patient) denies suicidal thoughts at this time” That’s not snarky nurse talk, it’s a genuine way to say “Yes, the pt. came in with suicidal thoughts and we’re keeping an eye on them and asking them about that and during my shift the pt. says he didn’t have any suicidal thoughts.”

The first thing they’ll ask you if you do go into the hospital with suicidal thoughts is if you have a plan. If you do, then we’re really worried - a lot of people think vague thoughts about “ending it all”, but most of them don’t get so far as to make a plan for how to actually do it. If you do have a plan, you’re almost surely going to be admitted, unless there’s someone who can convince us you’d be better off going home with them. If you don’t have a plan, but show other signs and symptoms that you may indeed harm yourself, you’ll probably be asked to make a verbal (or sometimes written) contract with the healthcare provider not to kill yourself for the next few days. It sounds weird, but this emotional, not legal, contract made with a stranger really does seem to hold people off from drastic measures much of the time.

But, again, this is all if it’s happening right now. If you bring up a years old suicidal attempt, ideation or thought, I’m probably going to wonder why you brought it up, and I’ll ask some questions to make sure it’s not a current problem as well, but I’m not going to do more than chart it as part of your Health History, not a current issue needing treatment (as long as it really is all in the past).

#10

Hospitalizing someone is extremely expensive. In most communities psych care is very underfunded, often provided to people with little/no insurance, and even with those patients who do have insurance the insurance companies will fight hard to avoid paying for unnecessary hospitalizations. There isn’t enough money or space in psych units for all the people who actually need to be there (let alone the ones who want to be there but don’t really have to be like the many homeless people who will fake being psychotic because they prefer being in the hospital to being in a homeless shelter - yes, it happens all the time).

For another thing, psychiatric commitment is a pain in the ass that involves paperwork and court testimony (if the person doesn’t want to accept treatment you have to go to court to give testimony to a judge about why they are so dangerous they need to be forced to accept psych care - and docs are usually busy people who would prefer not to interrupt their schedule waiting around in a courthouse, just like normal people don’t look forward to jury duty).
Bottom line, there is no incentive for a doc to cart people off to the psych hospital unless the doc actually thinks the person is dangerous.
Suicidal thoughts and attempts are common enough that no doctor would commit someone for having had previous thoughts of it with no current sign of dangerous suicidal intentions.
Every day, psych units discharge people back onto the street just a few days after they were admitting to being suicidal or even had attempted suicide. The old days of keeping people in psych wards for months are now mostly gone with very rare exceptions for very sick chronic schizophrenics.

As for the issue of hiding things from a mental health worker, that happens all the time and I think it’s a big part of why some people don’t get anything out of therapy. They’re trying to help you and to help you they need to know what’s really going on. It reminds me of my friend who went to a therapist during a time in life when he was having a hard time coming to terms with being gay. Of course, he never did tell the therapist he was gay, so big surprise, the therapist couldn’t do a whole lot for him.

#11

Another vote here for “highly unlikely you’d be carted away.” Earlier this year I went to the ER with severe post-partum depression. I was very frank about my suicidal ideation, but they talked to me about it and knew that I didn’t have thought-out plans, just a general “wouldn’t it be nice if…” feeling. Plus I was with my husband who was obviously taking good care of me. The idea of having me hospitalized was quickly dropped.

Doctors aren’t robots…they don’t see something marked on a form and automatically go, “zoinks! must be taken away in a straight-jacket!” It might give them reason to talk to you further, but they’re going to assess the situation logically. (Hopefully.)

#12

Just to mirror what the others have said from a personal perspective:

I’ve expressed suicidal tendencies to many social workers, counselors, psychologists and psychiatrists over the years and most of them get the full history – depression, suicide attempts, suicidal gestures, etc. For the most part they don’t even blink an eye. They’ve heard it all a thousand times before and your one “temptation” that lasted but a few minutes probably won’t register as anything significant.

They ask you things like “How are you feeling now?” and “Do you still feel like hurting yourself?” and “Do you think you’re a danger to yourself or anyone else?”. If they believe your answer, they just move on to the next question. Depending on how available they are, sometimes they’ll give you their own cell phone number or a that of some third-party suicide hotlines and make you promise to call if you start feeling suicidal, but that’s about it.

If you’re receiving psychiatric care and aren’t honest with your care providers, you’ll only end up hurting your own quality of care. Not only will they have incomplete/incorrect information to work with, you’ll also be damaging the trust in the relationship and making it harder to connect and work together meaningfully.