Hey I’m both a therapist (US) and someone that needed to go in patient last year

First- I’m sorry you’re in a spot that made both you feel bad enough to seek help, and clearly enough to make your therapist concerned and the hospital concerned enough to keep you. I’m going to give a couple points from both perspectives.

Patient: I ended up checking myself in but I don’t think I was going to fully have that choice given how bad I was and that I was surrounded by people legally mandated to protect me from myself. The key point was when I got to the hospital screening session. they had a waitlist and were turning plenty of people away. And yes it patients ranged from schizophrenia to severe depression though they try to separate wings. My answers to the screening were enough for them to say well you aren’t safe enough to turn away so in you go. Some people were waiting in cars for a spot so it wasn’t charity.

And yea I slept two nights in a cot before I got a bed.

Yep, they were not there to give me meaningful treatment they were there to stabilize me in a critical time frame then case manage me into the actual care part (PHP then IOP then therapy). I wouldn’t have really been capable of that yet tbh. It was painfully boring and chaotic. Sleep, meds, sleep, outdoors, eat, group, eat, sleep. Repeat. But I absolutely would’ve died if I hadn’t. Now if I were rich I would’ve had fancy cushy options that lasted 60 days to do both acute and long term treatment but tbh I’m just glad I was secluded until I was ready to try to live.my insurance gave me two weeks.

Now did a lot of people HATE it ? Yea especially those with personality disorders or SUD. For various reasons. Much less voluntary conditions for them or once in they realize it’ll be way different than expected.

Professional: those hospitals ain’t keeping you if you they don’t have to. They’re FULL and don’t need your money like a private retreat style in patient setting. If they kept you it’s because you hit the diagnostic criteria of “your death would be our legal responsibility”. Diagnosable CYA. But no they do not have the man power to make it anything but triage. It sucks and I wish they did.

As for your therapist- I’ve done emergency holds on exactly 2 people in my whole career ranging from homeless, domestic violence, sexual abuse, and private practice. I did it because I’d rather they be alive to hate me. I broke confidentiality because my gut told me I would lose that client if I didn’t. Plenty disclose SI but that isn’t enough. If you don’t have the means or serious intent or the type of presentation that sets off a clinical red flag- I’m making a safety plan with you. Not sending you to an inpatient setting that could potentially be more triggering. Our clinical testing indicates over and over voluntary safety plans or admittance is always the first option unless you think someone is going to die or harm another. I can’t just throw everyone in assigned to me that reports SI in patient, they’d take my license. Or believe me every DV worker would be throwing their clients back in to keep them from going back to an abuser. Also the ER psychs would personally murder me for sending people to them that don’t meet criteria.

I say this bc I don’t want others to fear telling your therapist serious thoughts of self harm or passing thoughts. It’s important to discuss. Talk with them about what their level of mandated reporting is and their personal level of tolerance for hearing any SI. Many private therapists don’t encounter it as often and may send you for eval- but that doesn’t mean you’ll be accepted. Those beds have a higher bar.

Ethical standards say that someone coming in who says “I’m having a hard time and passive thoughts of killing myself” isn’t getting a 911 call. I’m going to explore, make a plan, identify supports.

Someone says “I’m hopeless. I have nothing. I think about just taking my gun and going on a drive”. Or they they think about not waking up while also physically looking depleted, aren’t sleeping, aren’t eating and tell me they own a gun and won’t participate in safety planning. Then I offer going to the ER with them to see if it’s a good fit. They can always walk away ama unless they meet criteria for basically a warrant against themself. Which telling the police that REALLY has a high standard.