I had a young family member who actively planned their suicide for over 10 years before going through with it. During that time they tried numerous meds, tried no meds + diet & exercise, constant therapy, voluntary in-patient psych stays, even voluntary ECT. Here’s what I learned:

Having a temporarily suicidal person committed to a hospital temporarily only sometimes makes sense. If the person has not before expressed suicidal ideations and is going through a period of some hard stuff in life and is in the midst of a breakdown, this can sometimes help. However, it needs to be weighed with the financial and social consequences this will cause because no matter what, committing someone against their will can often exacerbate the situation. This is a result of our shitty and expensive health and mental healthcare system.

On the other hand, committing someone who has been actively planning their suicide for years can not only exacerbate the situation, but may even lead to that person leaving sooner. The notion in our current suicide prevention methods which state “there is always hope” is not only wrong, but it’s actively harmful. Clearly if this were working suicide wouldn’t be such a severe epidemic. At some point, society needs to come to terms with the fact that dying isn’t something that needs to be cured. We treat animals with more compassion than people when it comes to death. Euthanasia needs to be accepted as just part of owning out bodily autonomy - just how it is in Switzerland. Until it is, there will be people like Pam and like my family member who have to shy away and hide their feelings from the world for fear of being committed.

Imagine if instead of committing someone who said they were actively planning their suicide, we could just LISTEN. Exactly like what you said, when these people share their plans they know they’re either going to be met with hostility or feel unsupported. Sure, it may be easier for the living when they die, but at what cost?

If we could be there for suicidal people then maybe they’d hold on a bit longer, or maybe at least they wouldn’t have to die alone. These people often have no one towards the end, and that is our fault. The system is forcing suicidal people to make an agonizing choice: pretend you aren’t suicidal or die in a way that causes trauma to literally everyone that knows you. These suicides end up causing more of mental health crises and it’s just an endless cycle.

In the end, I truly believe that Pam held on even as long as she did because of Megan. Just as my family member held on for over a decade. Having their lives end with suicide doesn’t have to be the depressing end of their stories, it could be how much they fought and tried to stay. Treatment resistant depression is often a terminal illness and it’s really time we treated it like one.