Helping the Suicidal

Suicide. Not a pleasant subject but working in the Crisis field ten years ago and treating thousands that were suicidal makes me some kind of an expert, I guess. The facts are that if we don’t get a handle on depression, it can take you out.

As a supervisor of interns, it is my job to help new therapists read the signs. Does the person have a desire to kill themselves, do they have a plan, is there a history of past attempts and if so how did they try to do it? Treating people that want to harm themselves or others is as real as it gets. It is so important to remain calm and centered whenever you are in the presence of somebody that is unstable because they have lost their center, their ability to properly reason, and are seeking it from others.

Legally, mental healthcare workers are mandated by law to take action. I treated a lot of suicidal people when I worked at the Mental Health Urgent Care in Long Beach California. Each week I would place a “5150 hold” on at least two people who were dangerous to themselves, others, or were gravely disabled. A 5150 is basically a 72-hour Psychiatric Hospital stay, and working with the county of Los Angeles I had to locate county Psychiatric Hospitals that had the room for the person in question. They prayed they weren’t going to Harbor UCLA because you took your life into your hands there, and I am talking about the staff. This was one hospital in which there was a policeman on the unit at all times – no kidding. I could only imagine what the clients were going through. It may have felt like they were being punished for having these thoughts or taking the action in the first place.

What happens at the hospital? Normally, it is time to adjust medication, talk about your feelings with a nurse or counselor, and probably detox from substances. Psychiatric hospitals have a lot of free time to think about your life and what are your next steps in life. For many, it is nice to have a time out of doing for others, substance use, or simply getting out of a bad situation. Now, that is the normal route for people with no insurance. For those who had good insurance, simply check into a good as you can hospital and get much more hands-on care.  

The psychiatric hospitals in the Seattle area are a piece of cake as compared to what goes on in South Central Los Angeles, near where my office was. This is based on only Swedish Edmonds and Fairfax where I made a few visits. I make house calls when a client needs some assistance. I’d like to joke that I was there for myself, but hospitalizations are not a joking matter. When in a hospital it is serious. All of your life experiences have led you to this place. You either make the best of the situation, use it as motivation to go forward in life, or simply remain behind.  

Let me step you through the full process. The first step if you go to a counseling center and they find you unstable is for the clinician to write out a 5150 Hold. In L.A. County I had to go through special training to be certified to do so. It is weird having the ability to place anybody at any time on hold. But if they are dangerous to themselves, others, or gravely disabled and in need of stabilization, I was licensed to do so.

At the Urgent Care Center, I would often include the client in on the process. A hold is basically a cover letter presenting the client to the hospital and letting them know all the facts, from that point the hospital can make a decision to honor the hold or not. Depending on the client, if they were cooperative, the process was simple. However, for those who were paranoid and psychotic, I would wait until the ambulance drivers came into the unit with the gurney. The client needed to be locked into that apparatus to be transported to an ambulance for transport and many didn’t like this one bit. A show of the entire staff was often required for those who were angry with the process – which you could understand. You can imagine the terror of a normal person being held down, well add mental illness into the mix. Once the LBPD was called in and a big Samoan man, almost 6’6” calmly sat down and was carted away. For the clinician, remaining calm is the best practice.

Once the ambulance arrived at the hospital, it was now under the jurisdiction of the hospital to decide if the person was suited for treatment or would be sent home. I hope you have good insurance because the county method was problematic oftentimes.

Psychiatric facilities are so important and can lead to amazing healing. What helps a person that is struggling? Well here, they have it down to a formula. Medicate, communicate, and refer for further help. Just because a person went into a psychiatric hospital doesn’t mean the battle is over. Afterward, the real work begins. Therapy is key and finding a good therapist that is easy to get along with is ultimately important.

It would be great having a Mental Health Urgent Care Center up here in Washington. We helped over 24,000 people in the ten years I worked there. I recall one day when nobody came in and I exclaimed – “We healed everyone!” Only to have 26 people show up the next day.

The Mental Health Urgent Care was the first of its kind in the nation. The Urgent Care was set up to keep people out of not only psychiatric hospitals but also jail. Many people with anger issues were put in jail instead of getting back on their medication. So that’s what we did and a whole lot more. When we first opened we could treat someone for a whole day. We gave them medication, counseled them, clothed, and fed them, but when our budget was cut, they could only come in for half the day and maybe get a boxed lunch.

I laugh now thinking back on that facility. People at first would come in all hours of the night. Soon we had to close our doors at 6:00 pm, leaving the homeless to once again fend for themselves. Even though our times were advertised people still showed up after hours or at 5:45 pm demanding to be seen. At that time, we could only treat people who were suicidal. So often these people would throw out the “I’m going to kill myself” line to get inside. So, I’d walk them back to the unit, get out my 5150 forms and ask them what Psychiatric hospital they preferred to be transported to. They played their game and I was playing mine, all the while knowing that they didn’t want to sit for the two-hour interview process and just show up, like we were Walgreens, for their fix. “Oh no! I don’t want to go into any damn hospital! I just want medication!” But every once in a while, the late person really was in a crisis so I stayed the few extra hours and helped them get into a hospital.  

I’ve learned a few things about working with people who are suicidal. Here are a few tips:

If somebody tells you “I just want to kill myself” call them on their bluff. Take them to a walk-in clinic immediately. Even if they are joking, it isn’t a joking manner and you being stern in your response will show them it is serious and since they have the thought get them to talk with somebody about the thought. Better safe than sorry.  

Unfortunately, this is not L.A. County and there isn’t a mobile Psychiatric team that will come to your home and makes an evaluation. If someone is really suicidal the real battle then becomes getting them to the mental health facility in your area. This is not a time to bargain. Once this is blurted out, take it seriously. What if you didn’t and they made an attempt? Offer to drive them down – even if you’ve had a long day. This is someone’s life we are talking about and professionals are trained on how to treat them.

Next, remove any guns, knives, and medication from the home. Or simply lock them up. Minimize the damage. In fact, rid yourself of all alcohol as well. This is not a time for them to drink away their sorrows, but get the help they need.  

Get them talking. Help them talk about their feelings. People think that it is taboo to ask someone if they have suicidal thoughts. It’s absolutely the opposite. This conversation, to them, is liberating. Finally, someone cares enough to listen and that is all you need to do. Simply listen and don’t give them any advice. Even if they are psychotic and delusional, let them vent. Now if they are accusing you of something and you feel in danger, thank them for the information, ask them for a moment to go to the bathroom, and dial 911. The first priority is your safety and, as my best friend’s mother said when we were 10 years old, “You can’t argue with a crazy person”.

When somebody is in a crisis, it is difficult for them to take in any information. So this is a time to avoid giving advice or arguing with them. After they calm down would be a better time to talk things out, but in the acute phase, simply listen.

A good practice is to ask them what they need from you. If you can do it, great. If you can’t help them, find out where they can get this handled. I often ask myself if I am helping them with their weakness or their strength. Am I giving them a fish or teaching them how to fish?

Ultimately, a little kindness goes a long way when you are working with someone who feels there is no more goodness left in this world. Suddenly you become front line and being centered in your loving heart can show them they matter, people do care, and they are going to be better.   

Compassionate Care is Always Available

There are many more tools and strategies you can use in your pursuit of happiness. Here is where we come in. Contact us at Basic Steps Mental Health and let us support and educate you on this journey back to your loving heart center. Imagine living a heart-centered life, regardless of what is happening externally. We’d love to be of help.

For 25 years, Dr. Scott Alpert, the clinical director of Basic Steps Mental Health, has treated over 7,000 people with mental health and addiction problems, using a Psychological approach that mixes and matches ten of the top approaches used in the industry.  We are here virtually and in-person to help you get through this COVID-19 pandemic and many other difficulties you may be experiencing.

May you have good mental health.