Suicidal Ideation and Urgent Care

Patient Expert

Taking mental health issues seriously makes a tremendous difference in obtaining treatment for mental illnesses as well as creating a sense of value and validation for those dealing with mental illness.

Last year, a good friend of mine confided in me that he felt deeply depressed, anxious and suicidal. I was grateful that he would trust me enough to take his concerns seriously. He was at a loss, out of work, and had no insurance and no hope for feeling better.

I shared with him the option to go through the county's mental health facility. They had an emergency intake process, and I would go with him if he wanted. We went. At this initial evaluation we were referred to the Emergency Department at a nearby hospital for him to receive a prescription for an anti-anxiety, as he would not be able to receive a formal intake until about four days later.

We went to the ER, and it was only due to the referral from the county mental health facility that he was able to see a doctor who prescribed medication. Also because of the referral from the county mental health facility, he was able to obtain a social worker to address the financial aspect of this visit she directed him to the appropriate financial counselor at the hospital (and although it did require an in-person visit and some paperwork, his ER visit was covered 100%).

Even though the medication was an immediate release formulation, my friend told me he did not feel any effects; what he did feel was taken seriously. That made a difference. He had been to several other psychiatrists and therapists and they each told him he was fine. He thought there was something wrong with him as a person, as he was not able to manage like other people in the world around him.

We then went to the first intake appointment at the county mental health facility. The intake personnel advised him that it would take several weeks before he would be able to see a psychiatrist for an evaluation and then be directed for therapy treatment. It was our understanding that he would be receiving an evaluation from a psychiatrist at this appointment, but this was not the case.

My friend's feelings of being taken seriously were not just slipping, but disappearing during this intake appointment. The intake personnel did not sense his situation as critical. When he was asked the question if he was suicidal, he lied. I spoke up and told the intake coordinator that my friend was lying. She asked him if he was lying about being suicidal, and he said yes. She then asked him if he would give her his word that he would not inflict self-harm. He said yes. I again spoke up and told the intake coordinator he was lying again. She asked him if this was true, and he again said, yes.

This woman insisted that if he gave his word, there was nothing she could do to expedite treatment, and that she was not authorized to make an earlier appointment. I asked this woman if she was of the same understanding as I that my friend was NOT giving his word. She said yes. I shared that his safety was a responsibility that I could not ensure on my own and that my friend was hurting, he just did not know how to express the depths of his emotional pain. I went over his symptoms again, the seriousness of the situation, and that my friend was shutting down even during this appointment due to the go-round that appeared to be occurring with the intake coordinator after his final admission of suicidal thoughts.

At this point, we both came to the understanding that asking my friend to continually to give his "word" was a discourse of futility. When I requested to speak to the person who had the authority move-up his appointment, she made a phone call, and he had an appointment to see a psychotherapist within two days. I thanked the intake coordinator for her choice to be part of my friend receiving urgent treatment.

My friend was appreciative for the rapid movement of treatment. He told me he was in a daze, and he would have just accepted the later appointment, not being sure if he was even going to make it that long. He wanted to care, but was struggling to do so. Knowing his mental health issues were being taken seriously was still a new concept for him.

When we went in to see the psychotherapist, after a few sessions (the second within a day of the first) my friend was diagnosed with major depression and generalized anxiety disorder. He then decided to go in the hospital because he knew he needed professional care. (The county health care facility would cover the costs for in-patient care due to his financial circumstances.) He was in the hospital for about one week, and when he came out, one of the things that made the most difference to him was that he was taken seriously. He said he felt relief for the first time in his life. What was going on with him had a name and it could be treated

I share this story and how the concept of being taken seriously by others be it family, friends or professionals makes a key difference when it comes to mental illnesses. My friend's mental health was taken seriously by the county mental health facility and he received the urgent care required for his mental illnesses. Because my friend was not able to be truthful about his suicidal thoughts initially, this almost hindered proper treatment.

Suicidal ideation is a symptom of mental illness, not a symptom of an attitude or personality trait. Mental illness is still caught under the stigma that it is a character flaw, not a medical condition that requires treatment. This is one of the many reasons why people with mental illness feel shame or embarrassment in sharing all symptoms relating to mental illness, suicide being on the top on this list.

According to the National Institute of Mental Health (NIMH), "Suicide is a major, preventable public health problem. In 2004, it was the eleventh leading cause of death in the U.S., accounting for 32,439 deaths. The overall rate was 10.9 suicide deaths per 100,000 people. An estimated eight to 25 attempted suicides occur per every suicide death.

Being truthful about suicidal thoughts with a professional is still very hard, even if we know it is essential for proper treatment. Struggling to take ourselves seriously in these moments is difficult as well; yes, we care, but at the same time, caring just doesn't seem within our own capacities or abilities to continue and this too is a function of mental illness: this so very important for us to remember so we do not beat ourselves up for feeling the way we do. Gaining the support from a friend or family member to say the tough words with us is okay. Support for treatment in whatever form it looks like is what matters.

As we with mental illnesses take our illnesses seriously, and work with others who feel similarly, we can be part of lifting the stigma of mental illness and removing within ourselves any feelings of shame or embarrassment because of the symptoms experienced; mental illness--like any other illness--requires taking serious action to access treatment to lead us into recovery.