My sexual accessibility has never been up to me, and this was a crucial and painful epiphany to have. Content Warning: this essay mentions depression and instances of sexual coercion. It’s not that I haven’t been celibate before. As someone who lives in the gray area of the asexual and aromantic spectrums, I’ve gone long […]
Crazy Talk: I’m Suicidal. Should I Go to the Emergency Room?
I went to the hospital because I was suicidal and the only alternative for me was dying, and I figured if that was the only alternative, I would give this “living” thing one last shot.
Welcome to Crazy Talk: a mental health advice column written by yours truly, a mentally ill and queer writer reclaiming his “crazy” to educate and empower. In a world that tries to push us to the margins, I’m all about getting loud and kicking the stigma where it hurts. In this column, we explore what it’s like to live with mental illness without shame or apologies. Expect frank advice, a little self-deprecation and a good dose of humor.
I’ve got to start this column off by saying — because I care about you — that if you’re in crisis and need immediate resources, here are some you can utilize right now:
The National Suicide Prevention Helpline: 1-800-273-8255
The Trevor Lifeline for LGBTQIA+ youth: 1-866-488-7386
Trans Lifeline: 1-877-565-8860
If you’re not into chatting on the phone (I’m not either, I get it), learn more about the Crisis Text Line by clicking here. Remember, this is an advice column written by a mentally ill person — not a clinician — so the advice that I’m giving you shouldn’t replace the support you’d get from a mental health professional.
Phew. Okay. Are we ready?
This last year, I was hospitalized not once, but twice. I was deeply depressed and suicidal — and not only could I not take care of myself, but I also wasn’t safe to be left alone. And as scared as I was to take myself to the emergency room, I realized it was the only way to keep myself alive.
But is it right for you? It’s certainly not right for everyone. It can be hard to know when it’s time to seek out this kind of intervention. So I want to pose some questions as you consider psychiatric hospitalization:
Have you explored all of your options?
In some communities, there are psychiatric crisis clinics that can get you in touch with a clinician immediately. There are also partial hospitalization programs (PHP), where you get the benefit of close supervision and care, but sleep in your own bed at the end of the day. There are intensive outpatient programs (IOP), which you attend during the day as well, and have a variety of schedules that you’d keep depending on the program.
The accessibility of these options will depend on your location and insurance (and if you don’t have good insurance or any insurance, don’t give up! There are often specific resources that serve underinsured folks, depending on where you are).
The best way to sort through these options is to chat with an advocate, therapist, or psychiatrist in your area. When we’re in crisis, we’re not always in the best place to assess our state of mind and our options. When making an appointment, be ready to assert yourself; emphasize that while you aren’t in imminent danger, you need to see a clinician immediately. Don’t back down, and bring in a loved one to help you with this process if need be.
You can also use a crisis line (like the ones I mentioned above) and ask for help making this decision. It’s my understanding that if you don’t have access to clinicians, the emergency room can also refer you to these services as long as you aren’t in immediate danger. This will vary by location and hospital.
How immediate is the risk?
Typically, psychiatric hospitalization happens if you’re a danger to yourself, a danger to others, or gravely disabled. Sometimes when psychosis is involved, a person might also be admitted depending on the severity and risk involved.
I knew that I needed to go to the emergency room because I couldn’t be left alone for very long without imminent risk, and I wasn’t able to tend to my basic needs (feeding myself, taking my medication, showering, etc).
The danger was evident: I had a plan. I was going to act if the opportunity presented itself. Frankly, I wasn’t safe, and the other options available to me couldn’t ensure my safety.
Immediate risks like these warrant immediate care. If this sounds like you, please don’t wait — reach out for help or go to the nearest emergency room.
If you’re not sure of the immediacy, you can always talk to a crisis helpline to get perspective, or touch base with a clinician if one is available to you. You can also just go to the emergency room — it’s their job to assess you. Going to the ER doesn’t guarantee that you’ll be admitted to a facility, but it can help connect you with resources that you might not know about otherwise.
How long can you (realistically) wait?
The last time I went to the hospital, I was on seven different medications, none of which were really working for me because I was incorrectly diagnosed as bipolar.
My psychiatrist later commented that his hands were tied — because I was in crisis, it wasn’t necessarily safe to start taking me off of my meds, nor did he have the option to keep adding medications. We were stuck.
I needed a safe space where I could quickly be taken off of large quantities of medication, be given new medications to stabilize me, and be supervised while it happened. So it made sense to hospitalize me — we could make big changes in a very short amount of time, knowing that clinicians would be there 24/7 to support me through the process.
It turned out to be exactly what I needed. We completely reworked my medication regimen within a week, choosing more effective treatment options. When I left, I was on totally different meds and significantly less medication overall — and I felt a lot more stable.
That’s one thing that’s pretty great about psychiatric hospitals: Ideally, you can be stabilized in a shorter timeframe because your level of care and supervision allows for them to move quickly. If you’re in crisis and you can’t imagine waiting weeks or even months to get better, it makes sense to consider hospitalization.
Have you thought about packing a bag?
The last time I was hospitalized, I packed a small suitcase.
I brought a soft throw blanket for comfort; plenty of books to read (I always find that graphic novels are the best for this sort of thing); lots of underwear, pajamas and fuzzy socks (drawstrings removed); and a journal for writing in. There’s a great online guide here to help you figure out what to pack when you go to the hospital.
It was incredibly helpful to have comforting items with me and ways to pass the time. Compared to the time that I brought nothing with me, the experience was like night and day. Knowing this is an option often helps folks feel a little bit safer about the possibility of being hospitalized.
If you aren’t sure if you’ll be going to the hospital, pack a bag anyway and keep it somewhere a loved one could retrieve it. If things hit a crisis point, you’ll already be prepared to go, or you can ask someone to get it for you and bring it to you later.
Hospitals are not fun places to be. But there are ways you can take control of the situation and make it a better experience for yourself — and trust me, it makes a difference.
When you’re out of options, can the trauma of being hospitalized still be worth it?
It’s absolutely true — especially for marginalized folks — that a hospitalization likely will be traumatic in some way. There are so many contributing factors, including what facility you’re sent to, whether or not the services you receive are culturally competent and the length and quality of your stay. Many of those factors are totally unpredictable.
I’ve known people who’ve had very good hospitalization experiences. Just the same, I’ve known many people who walked away feeling broken. You can find someone with every experience in-between. Some people vow never to step foot in a psychiatric facility again, which I empathize with; I won’t sugarcoat that reality or dismiss the validity of it.
So why did I personally risk it more than once? I was desperate, plain and simple. I went to the hospital because the only alternative for me was dying, and I figured if that was the only alternative, I would give this “living” thing one last shot, one last push.
Friends often told me that there very well may be a “future me” — a healthier, more whole person — that would be endlessly grateful that I did. And they weren’t wrong.
I’m that “future me,” right here and right now. I’m happy and I’m whole, thanks to the courageous decisions that I made at my darkest hour. I’m better than I ever thought I could be. While that’s not everyone’s truth, that’s my truth.
Did the benefits outweigh the risks? The pain, the trauma, the fear that shattered me for a time? The short term was so much to endure, pain that I can’t describe with words. But I would do it all over again if it meant getting me to the place that I’m in now.
The messy reality is that something that deeply traumatized me more than once also kept me alive. I have to hold these truths at the same time.
I don’t believe hospitalization is right for each and every person. I think we should all consider our options very carefully. But I think it’s also true that folks struggling with their mental health aren’t given a lot of good options in the first place — which often means that we have to make difficult choices in order to survive, choices that may wound us deeply but simultaneously give us a fighting chance.
The truth is, there’s no perfect choice. There’s no “right” choice, no “good” choice. There’s just choices — risks that we take because there’s always the hope that the risks are worth taking. That’s the reality of mental illness, and if you think about it, that’s the reality of life. We hold our breath, put one foot in front of the other and hope for the best.
Should you go to the emergency room? I can’t answer that for you. But I can speak for myself, and the complicated truth I’ve found is this: For me, whatever it’s taken to survive — emergency room or otherwise — are risks that have always been worth taking.