Seeking professional support when you’re contemplating hurting yourself or others is a brave and effective step. Going to the ER can help.
Support is available, and you’re not alone if you’re thinking about suicide or self-harm or if someone you love is.
This support can come from many sources, and one of them is your local hospital or emergency room.
If you’re considering self-harm or suicide, you’re not alone
You can access free support right away with these resources:
- The National Suicide Prevention Lifeline. Call the Lifeline at 800-273-8255 for English or 888-628-9454 for Spanish, 24 hours a day, 7 days a week.
- The Crisis Text Line. Text HOME to the Crisis Text Line at 741741.
- The Trevor Project. LGBTQIA+ and under 25 years old? Call 866-488-7386, text “START” to 678678, or chat online 24/7.
- Veterans Crisis Line. Call 800-273-8255, text 838255, or chat online 24/7.
- Deaf Crisis Line. Call 321-800-3323, text “HAND” to 839863, or visit their website.
- Befrienders Worldwide. This international crisis helpline network can help you find a local helpline.
Everyone’s different, and your reasons are unique to your circumstances. In general, thoughts of suicide can come up after a significant loss or when you live with conditions like depression, bipolar disorder, or post-traumatic stress disorder (PTSD).
If you’re contemplating ending your life, know that this is pain talking to you, and it’s possible to heal and relieve pain.
If you’ve attempted to end your life or are considering doing so now, reaching out to your support system as soon as you can is essential.
You could talk about what you’re going through, distract yourself with them, and work together to devise the next steps for help.
Your support system might include:
- trusted friends
- family members
- counselors and therapists
When you feel you’ve exhausted all other options, though, and you still think about suicide, consider going to the ER for immediate support, says Dr. Amy Barnhorst, vice-chair of community mental health at the University of California Davis Department of Psychiatry.
ER and hospital protocols for suicide vary from state to state.
When you arrive at the hospital and tell health workers the reason is suicidal thoughts, they’ll call a mental health professional to determine the needed level of care.
Mental health evaluations generally take the form of a suicide assessment. Barnhorst says the assessments — and their outcomes — are highly complex but help determine the next steps.
One of the assessment tools mental health professionals may use at the ER is the Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS).
The Columbia Protocol is designed to identify how likely someone is to attempt suicide and gauge the level of support they need.
Some of the topics this scale addresses include:
- whether and when you have thoughts about suicide
- what actions you have taken — and when — when you think of suicide
- whether and when you have attempted suicide or began a suicide attempt that was either interrupted by another person or stopped by will
While comprehensive, evidence-based, and created by leading professionals, the assessment’s questions can sometimes feel overwhelming when you go to the ER for mental health help. But it’s the protocol for many hospitals.
“They do the [suicide assessment] in the emergency department because it’s partially a response to administrative and regulatory pressures,” Barnhorst explains.
Beyond routine assessments, a mental health professional may also spend time talking with you. They could ask you to brainstorm reasons you want to keep living, for example. This is considered motivational interviewing, and it has been
Hospitalization and care options for mental health and suicidal thoughts can be both voluntary and involuntary.
You can decide if you need additional support managing your emotions and thoughts of suicide. In some instances, though, a health professional may decide for you if they determine your emotional state might not allow you to follow through with a plan on your own.
While outcomes to a suicidal assessment vary widely, you may sometimes get clearance to go home if professionals determine your chances of going through a suicide attempt have lowered.
In these cases, you are likely sent home with a care plan. This plan could include returning to the hospital for outpatient visits or working with a psychologist or psychiatrist.
Inpatient or residential care
If a mental health professional at the ER determines that you need additional support that cannot wait, you may be transferred to a higher level of care. Examples of this include a residential treatment program or a psychiatric hospital.
Although this may sound overwhelming or scary, the goal is to get you to a place specializing in what you’re going through.
Recommending one of these places is getting you the best care available for your specific needs.
In the same way a person who has received a cancer diagnosis may be referred to a cancer treatment center, someone facing suicidal thoughts can be referred to a psychiatric hospital.
Admission for inpatient psychiatric care likely will involve:
- treatment with medications and forms of therapy, depending on what you need
- higher levels of support so your care is constantly supervised by professionals
- creation of safer environments by removing any potential objects of harm
The length of time someone spends in an inpatient facility depends on the initial assessment, treatment progress and response, and existing treatment for contributing conditions like bipolar disorder or depression.
Partial hospitalization program (PHP)
A partial hospitalization program allows you to sleep at home while visiting a facility during the day.
This can be done at a hospital, behavioral health clinic, or mental health care center.
You can spend up to 6 days a week attending:
- group therapy sessions
- mental health education
- recreational activities
- one-on-one therapy sessions
Your health team will probably talk with you and ask you to take an assessment every week to determine your progress.
Intensive outpatient program (IOP)
An intensive outpatient program lets you continue your typical work or school routine and stay at home while providing the maximum level of care during your time off.
The idea is that you see your mental health team as often as possible to work on your symptoms and suicidal thoughts without interrupting your daily responsibilities.
Support and guidance are available if you or someone you love are thinking about suicide or self-harm.
A mental health professional can help you navigate difficult times. Thoughts of suicide are often related to underlying mental health conditions like depression or PTSD. Managing the symptoms of these conditions can often reduce the chances of thinking about ending your life.
If you’re going through an intense experience and are considering suicide, going to an ER for help can make a difference.
Professionals at the emergency room can refer you to a mental health worker who can support and guide you through your emotional pain. They can then work on a long-term plan to get you the care you need.
Laws and regulations may vary from state to state. To check those in your hometown, consider visiting the Treatment Advocacy Center.