How to ask for treatment for suicidal thoughts?

[Justmehere]

I’ve been thing to sort out new/different treatment and support options. I have been through some really bad intakes and experiences over the past six months, one assessment experience was bad enough I should probably report it to regulatory officials. I won’t share about details here except to say I’m really shutting down to trying to get help and I wonder if I’m sabatoging it by being too calmly frank.

I broke down and saw an old therapist and point blank told her “I’m having a lot of suicidal thoughts. I want to die.”
Therapist replied, “Do we need to go outside and call 911?”
Me: “No.”
Therapist: Ok.”
Silence for about two minutes, and then I said, “Can you say something more? I’m really struggling with this. Can you help me with it?”
Therapist: “I asked if we needed to call 911.”

I brought it up later too, asking what would be things we could do in therapy deal with it, reduce this, and again, she only asked, “do we need to go outside and call 911?”
I broke down sobbing and said,”Sure. Do it. If that’s my only treatment option, let’s do it. Then what will 911 do?”
She then said, “They will take you to the hospital and give you meds that won’t help and retraumatize you and send you home.”
“Ok. Call them.”

She didn’t. Wtf was this all about then? Making me feel humiliated for having this problem and not being sure right now what to do? I got so upset she told me if I didn’t calm down I would need to leave. I didn’t really calm down. She soon said time was up and I needed to pay and told me to mantraized opposite thoughts. I asked what that meant because it didn’t made immediate sense (does now) and she cut me off to tell me she didn’t have time to tell me. I dropped my wallet and everything came out and I was sobbing and just fell apart. I left and walked through an extremely public place. I am so messed up. I just walked crying. Only reason I didn’t die was my dog.

That was the entire discussion about the suicidal thoughts. I have tried with another therapist in the recent past and didn’t actually get any further.

Wtf. Is there some kind of thing I’m missing to be able to talk about this hellish symptom of my brain wanting to off myself?

I made an attempt months ago and stopped myself halfway through and went to and ER... where they stated in medical records that they discharged without a psych assessment because I showed no signs of distress and they didn’t believe I was suicidal. They did no medical history. Just did triage and a doc stopped by and asked what I wanted. I managed to say I’m suicidal, and a psych eval. My doctor was furious that they just discharged. I was still very affected by what I had done when I walked in but the records show I said I was suicidal and I said I needed a psych eval. My doctor ended up seeing me in her office and I told her everything and she put me on an antideressant and asked me to stay with a friend. I never connected to any friends and stayed up all night a mess.

I had to stop the antidepressant due to serious side effects a few days ago and things are bad. I am doing all I can on my own.

I don’t know why I have bothered to try to get help. I seem to be too calm or too upset.

I’m in a bad spot. I don’t think I have it in me to ask for help again. What would be the point? More feeling horrible that I asked? The therapist asking about 911 was last night and whatever I had to hang on is weaker today after that. It’s a moment by moment thing. I really want to know what I’m doing wrong. I think it’s mentioning the suicidal thoughts at all, but I don’t think I’d tell someone else that.

 

[scout86]

I guess I'm not surprised that the crisis line and the ER weren't helpful. I have no personal experience with either, but I haven't read any stirring recommendations either.

The T? Good grief! She obviously gets that calling 911 isn't a great option, but i have no idea what she expects you to do with what she said. My T sometimes makes cryptic comments, I guess because he thinks it's good to pick things apart my own, but he'll respond to continuing questions. (Sometimes it turns out he didn't realize I thought he was being cryptic.)

Do you have any ideas, yourself, about what would be helpful? Obviously, the ER probably isn't and neither is playing word games with that T. Something my T told me as that be thinks all these thoughts, at some level, are "adaptive". It's your brain's attempt at problem solving. Sometimes convoluted, often based on out dated information, but some kind of attempt at a solution. And that three idea behind it is to solve a problem, not very you killed. He says the first step is to identify the root "problem" and it isn't always what it superficially appears to be.

Would it help to talk about what those thoughts are like? Where they come from? How they show up? What gives them the power they have? Etc? It would be great if you could talk this through with a professional, but would it help to talk through with us here? You're definitely not the only one who deals with this.

I have no idea how you go about actually getting professional help. If I did, I'd have just answered your question. My answer, I guess is to rely on luck and get lucking when you contact a T. That's a terrible answer and your luck has been truly awful. The thing is "professionals" are supposed to be able to handle this. You're not supposed to have to put on the right performance to get help.

 

[Sandstone]

Usual caveats - I'm seeing your situation through my eyes, so ignore this if I'm wildly off-track and actually writing to myself.

It seems to me that you are struggling with a set of things that have restricted my ability to engage with therapy, and to move on.
I've had to conclude that feeling suicidal, or that I ought to be dead, are not problems I need to take to someone else. I report them to my T, because they are clear reflections of how well I am coping, but I don't expect her to do anything about them. So today I told her that I've had some very erratic thinking about taking too many pills, and about running away from home, but not in the expectation she would do anything about them. She asked if they were resistible, and they currently are. You and I have both been here for long enough to have learned a whole set of tools for self-management in the bad times. Mine are written down, ready to refer to and work through, and having them ready has saved me more than once.

It is only when those feelings become irresistible that I need to find someone else who can intervene. Once I am a danger to myself, or I know I can't be responsible for keeping myself or others safe, then I need outside intervention. For me that has been three times in eight years. But I think throughout the first four years I wasted a lot of my time by wanting someone to intervene before that stage. I've had to conclude that in the grip of the PTSD monster, there isn't much they can do, and that what can be done is more effective if it comes from me.

At that extreme stage, it isn't a therapist I need, but someone who can put me in a place of safety - in the UK that means sectioning onto a general ward. It would be pointless to ask a private therapist for help at that stage.

I also built up a lot of resentment towards various therapists because they didn't teach me distress management and grounding tools. Eventually I decided to learn them myself, because my need was more important than their deficiencies.

That resentment that a therapist wasn't meeting the approved standard has been a huge barrier for me. I've read the treatment guidelines, and I had a set of expectations of how therapy ought to be done. That caused a lot of conflict, one way and another. Now I've concluded that there are only good-enough therapists. The one I'm seeing now doesn't measure up to my expectations in several ways, and I think some of her ideas are absurd, airy-fairy and woo-woo. Yet she meets my main requirement, that she is direct and clear with me. As part of that she has spoken about holding me in "unconditional positive regard" and I've realised that is something I need. I don't remotely think she can offer everything I need to recover, but I've committed myself to working long term with her and doing all the work we are capable of together.

I'm absolutely not saying that the therapist you've written about here is in that category -I suspect she isn't. Looking back I can see that I've encountered T's who weren't up to the job at all, and others who couldn't match their communication style to mine. But I think I also rejected some who would have been perfectly adequate but simply weren't doing the job according to the standards I had created. I worry that you are putting that limitation on yourself. I know you've written elsewhere about another therapist (C?) you were seeing for emotional support, and she sounded much more useful to you right now.

I don't have any answers to the "too calm / too distressed" conundrum, beyond saying this has got in my way often. Our life experience has taught us not to express ourselves in the way the un-traumatised are able to. I recognise how painful it is to be penalised for something that is part of the condition we are seeking help for.

 

[Mayflower]

I’ve been thing to sort out new/different treatment and support options. I have been through some really bad intakes and experiences over the past six months, one assessment experience was bad enough I should probably report it to regulatory officials. I won’t share about details here except to say I’m really shutting down to trying to get help and I wonder if I’m sabatoging it by being too calmly frank.

I broke down and saw an old therapist and point blank told her “I’m having a lot of suicidal thoughts. I want to die.”
Therapist replied, “Do we need to go outside and call 911?”
Me: “No.”
Therapist: Ok.”
Silence for about two minutes, and then I said, “Can you say something more? I’m really struggling with this. Can you help me with it?”
Therapist: “I asked if we needed to call 911.”

I brought it up later too, asking what would be things we could do in therapy deal with it, reduce this, and again, she only asked, “do we need to go outside and call 911?”
I broke down sobbing and said,”Sure. Do it. If that’s my only treatment option, let’s do it. Then what will 911 do?”
She then said, “They will take you to the hospital and give you meds that won’t help and retraumatize you and send you home.”
“Ok. Call them.”

She didn’t. Wtf was this all about then? Making me feel humiliated for having this problem and not being sure right now what to do? I got so upset she told me if I didn’t calm down I would need to leave. I didn’t really calm down. She soon said time was up and I needed to pay and told me to mantraized opposite thoughts. I asked what that meant because it didn’t made immediate sense (does now) and she cut me off to tell me she didn’t have time to tell me. I dropped my wallet and everything came out and I was sobbing and just fell apart. I left and walked through an extremely public place. I am so messed up. I just walked crying. Only reason I didn’t die was my dog.

That was the entire discussion about the suicidal thoughts. I have tried with another therapist in the recent past and didn’t actually get any further.

Wtf. Is there some kind of thing I’m missing to be able to talk about this hellish symptom of my brain wanting to off myself?

I made an attempt months ago and stopped myself halfway through and went to and ER... where they stated in medical records that they discharged without a psych assessment because I showed no signs of distress and they didn’t believe I was suicidal. They did no medical history. Just did triage and a doc stopped by and asked what I wanted. I managed to say I’m suicidal, and a psych eval. My doctor was furious that they just discharged. I was still very affected by what I had done when I walked in but the records show I said I was suicidal and I said I needed a psych eval. My doctor ended up seeing me in her office and I told her everything and she put me on an antideressant and asked me to stay with a friend. I never connected to any friends and stayed up all night a mess.

I had to stop the antidepressant due to serious side effects a few days ago and things are bad. I am doing all I can on my own.

I don’t know why I have bothered to try to get help. I seem to be too calm or too upset.

I’m in a bad spot. I don’t think I have it in me to ask for help again. What would be the point? More feeling horrible that I asked? The therapist asking about 911 was last night and whatever I had to hang on is weaker today after that. It’s a moment by moment thing. I really want to know what I’m doing wrong. I think it’s mentioning the suicidal thoughts at all, but I don’t think I’d tell someone else that.

I can totally relate to the hell of what you are going through although not sure what I can offer in way of advice. Similar thing happened to me - I od'd but called the ambulance although can remember nothing about it. Discharged the next day after being ignored all day by medical staff.
My GP won't prescribe me more than 14 days worth of anti depressants due to me admitting to passive suicide ideation which I'm glad about. I never thought I would OD before as my thoughts have always been more passive.
I'm also having a really bad day today and have bought alcohol which I shouldn't. But I will ring the Samaritans if I feel suicidal later - I do think that the feelings can pass - even if they return again a few hours later and talking to someone does help.
I've worked out that it's pretty much up to me to sort out. Forums like this help so keep talking. x

 

[Justmehere]

There is I-need-to-be-hospitalized-or-good-chance-i’ll-be-dead. I don’t know how far away I am from that. I’d like to be further away. Or gone.

Or there is the I-have-all-these-thoughts-and-I-am-overwhelmed-by-them-and-the-pain-and-that’s-why-I’m-here.

I don’t understand why I can list out symptoms and therapists don’t engage in any like... safety planning or skills work or talking through what’s going on in my life.

We sat there in silence. When I said what should we work on they said it’s your therapy session. Other therapists do the same. Across the board. It’s not just the crappy therapists.

Maybe I’ve just exhausted therapeutic support for anything. I really don’t know why I go to therapy for depression or PTSD anymore.

I mean, if they would just even talk to me, that would help. Like not talk at me. Talk with me about my life or something.

I even told one new therapist when they asked what would be helpful - I said for someone to talk to me about my life - and they said, “ok, go and do that.” Uh... what? Like it was 20 minutes into a session. Like did they mean right then? Like I tried to ask them to talk to me about my life...

I can’t do this therapy thing.

 

[Tinyflame]

I had to stop the antidepressant due to serious side effects a few days ago and things are bad. I am doing all I can on my own.

Can you get help with this ^^ @Justmehere ? Maybe your prescribing doc?

I don't have any answers to the "too calm / too distressed" conundrum, beyond saying this has got in my way often. Our life experience has taught us not to express ourselves in the way the un-traumatised are able to. I recognise how painful it is to be penalised for something that is part of the condition we are seeking help for.

I think this ^^ is 100% true. As is having certain core beliefs about not asking for help, or how not to present, and what not to do.

I mean, if they would just even talk to me, that would help. Like not talk at me. Talk with me about my life or something.

I even told one new therapist when they asked what would be helpful - I said for someone to talk to me about my life - and they said, “ok, go and do that.” Uh... what? Like it was 20 minutes into a session. Like did they mean right then? Like I tried to ask them to talk to me about my life...

^^ then perhaps this is part of your solution? (I agree btw.) Where and how can that happen? Because I see that as an integral part- SI is about what is going on in your life, and what goes on in lives and life in general. Which is why, too, a culture of silence has the opposite affect.

I would say (for me) it can have many motivations, some or all present, depending: feeling like a burden; being overwhelmed; being terrified; being too tired to continue; being unable to keep trying. Etc. I suspect it has physiological influences unknown to the medical community yet too (not talking about depression, but things like the reward center in the brain, dopamine production, etc. I also think, for example, it's not coincidental heart medication hits some people very strangely). Also physical illness and pain.

So for each struggle, there may be different questions. But yes, talking about what is around those questions, I think that is the key. But it came to me, someone who teaches is a teacher- we don't expect students to know answers when they walk in the room on the 1st day of school. So (I) don't have to feel badly about that. Maybe they don't know either, but it helps to even get help to frame the questions, and work from there. Especially if it helps get new thoughts going, or to think of or see things in ways we didn't before. And sometimes (or often) that takes others' expertise or experience, and a safe platform to talk about these things. Even opinions are helpful.

 

[NightSky]

Man, I don’t know why there are so many harmful incompetent Ts out there. I’m so sorry you’re not getting the help you need.
My T is the first one out of a few who I brought my suicidal thoughts up to. It took me a couple of years to ask her what she would do if I texted or called if I felt I was in crisis, and she said she would not call mobile mental health. She would meet me somewhere and talk to me, and assess whether that was what I needed, or if I just needed to process in that moment why I felt I had to end it all. She says those thoughts are so heavy to carry alone, and she never wants me to feel alone in them because I’m not. That alone has kept me going so far and I haven’t had to reach out. But if I did, she would help in that way. And for me, that’s what i would need.
In those moments the pain is overwhelming And your system is actually trying to save you- it wants relief so suicide is an escape plan to save you. But it doesn’t save you. Obviously. It sounds like you need someone who can handle really being there with and for you. No they can’t be your savior or meet all of your needs. But in those moments you do need a person.

 

[Sandstone]

I don’t understand why I can list out symptoms and therapists don’t engage in any like... safety planning or skills work or talking through what’s going on in my life.

We sat there in silence. When I said what should we work on they said it’s your therapy session.

I'm not sure how to answer you now, because I can hear you are in pain, and want someone to support you through that pain. So it may not be the time to turn it back to you.

What safety planning or skills work have you done, with T's or by yourself? I've read all your recent posts, but I wasn't with you in your earlier history. I may be asking things you have already done. Do you have an actual plan for the times you are overwhelmed by distress? have you tried it and found gaps in it? If so, those are the things to bring to the next T - if you decide to try one. My experience is that sitting there and wondering why they don't do what I need doesn't help, and going away and fuming about why they don't do it makes things even worse.

I think asking a T what to work on, in that context can't work - it is just a recipe for the disaster you, and I, have experienced because it is too wide a question and they are guaranteed to go down the wrong path. If you have identified that you need to work on skills for specific situations, then what stops you from saying so?

 

[bellbird]

Do you have a safety plan @Justmehere ?

I have to admit that I've only skimmed through this thread as it's been a long night, so I hope I'm not doubling up on someone else's suggestion or completely missing something.

I would suggest approaching T specifically about designing a safety plan for you, together.

Even if you get nothing more from therapy, I think a safety plan is something really important to have.
And even though many points in a safety plan can involve seeking support from external sources, it will at least give you some autonomy in these moments by knowing what you need to do to get help.

Hang on in there.
I know it is so difficult, and frustrating (especially dealing with health professionals who should be making things easier and not the other way around). But it will get better again.

Keep reaching out here. We really care about you.

A sunflower, from my garden, for you.
And many virtual hugs :hug:

 

[MrMoonlight]

Right now @Justmehere please go to the hospital. There is no messing around with suicide, the day has only so many hours and the fact that you are that close and feeling so out of options makes me think you need additional help. IMO now is the time for action.

How are you feeling right now if you don't mind me asking?

 

[Justmehere]

What safety planning or skills work have you done, with T's or by yourself?

None with therapists. I sort of have one I've done myself. I guess part of the problem is that it's taking all I have to even sit in the room now, and I tell them, "I'm working on staying in the room and not leaving." I'm trying to be upfront and open, but I must seem like a confusing mess.

If you have identified that you need to work on skills for specific situations, then what stops you from saying so?

I say it... but not effectively?

I would suggest approaching T specifically about designing a safety plan for you, together.

That's a good idea. There are worksheets online I can download.

Right now @Justmehere please go to the hospital.

This recommendation makes sense to suggest but isn't right for me. The local ER laughs in my face. I'm too calm. They won't do a psych eval. If I can't stay alive, I can go sit in the waiting room there or something. But there are no open inpatient beds and at best they would keep me in the ER for days and then send me home. (A real thing that happens here.) I guess what's hard is that the therapist last night wasn't wrong about what would happen if I went to the ER. I kind of thought if she called at least they would do a psych eval. Sigh. But even if she had, the thoughts would be there when I left the ER.

I pulled out a book on coping skills and I read the first page, and started to flip through pages I had marked in the past. I stopped quickly. I had no motivation. Maybe I'm like a diabetic who is just really tired of taking insulin. I think I'm really depressed. I think I need to find some kind of motivation to keep trying.

 

[bellbird]

Maybe I'm like a diabetic who is just really tired of taking insulin. I think I'm really depressed.

I have to admit - I am feeling quite concerned about you and your condition @Justmehere .

Do you feel safe?