If you tell your therapist that you hate your boss and are angry enough to kill him or her, could that get you committed to a hospital against your will? Suppose you confide in your therapist that you feel hopeless and wish you could fall asleep and never wake up — might that lead to paramedics securing you on a stretcher and loading you into an ambulance for a ride to the nearest hospital?
Based on fictional Hollywood depictions of people being committed to a psychiatric ward against their will, or similar scenes in novels, you might think sharing such thoughts, even in a clinical setting, might land a patient in the psychiatric unit of a hospital. In fact, involuntary commitment is rare, according to several practicing therapists interviewed by U.S. News. Merely talking about wanting to kill someone or expressing the idea that you want your life to end isn’t typically enough to prompt a mental health professional to take steps to have a patient committed for safety reasons, says Eileen Kennedy-Moore, a clinical psychologist based in Princeton, New Jersey.
“Therapists aren’t trying to ‘catch’ people saying things that will automatically get them committed,” Kennedy-Moore says. “Involuntary commitment is difficult and rare. Some people choose to have inpatient care because their symptoms are too severe to manage with less restrictive treatment. Some people in severe crisis may be picked up by the police and held in an inpatient mental health facility for a relatively short period of time, such as 72 hours, while mental health professionals try to stabilize them.”
Kennedy-Moore points out that experienced therapists are accustomed to listening to patients talk about being angry or frustrated with other people, whether it’s their spouse, a work colleague or President Donald Trump. Therefore, therapists evaluate provocative statements in context. “Saying ‘I want to strangle my boss!’ will not get you committed if it’s merely an expression of frustration,” she says. For therapy to be effective, the patient needs to trust the therapist and feel free to say what’s on his or her mind, Kennedy-Moore says. That trust could be broken if patients worry that expressing a violent thought could lead to a hospital commitment against their will, which would make it more difficult to treat people suffering from depression, bipolar disorder and just the daily pressures of life, she says.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
If a therapist is concerned about the well-being of the patient or of others, he or she would likely ask a series of questions to try to gain an understanding of whether there’s an imminent danger. “The goal is safety, not commitment,” Kennedy-Moore says.
For example, if a patient said he wanted to kill someone, whether his boss or himself, such a statement by itself wouldn’t necessarily cause a therapist to suggest hospitalization, says Erin Thase, a clinical psychologist with UC Health. She’s also an assistant professor at the University of Cincinnati Department of Psychiatry and Behaviorial Neuroscience. To trip that level of alarm, “the patient would have to describe a very specific plan, such as, ‘I have a gun in my car, and I’m leaving here and I’m going to kill myself,'” Thase says. Such a declaration would lead to a longer conversation between the therapist and the patient, she says. A therapist would also take into account whether the patient has behaved in a dangerous manner in the past, and consider if he or she has easy access to weapons. Another factor to consider is whether the patient has the means to harm himself or herself, such as access to potentially fatal drugs, Thase says.
In extreme cases, in which a therapist believes there is an imminent danger the patient will carry out a threat to kill or harm someone, the health care provider has a duty to try to detain the patient, notify law enforcement and, in some states, also contact the target of the threat, says Jeffrey Gardere, a board-certified clinical psychologist in New York City. He’s also an assistant professor at the Touro College of Osteopathic Medicine.
Committing people to a hospital against their will is not only rare, it’s part of a process that involves the legal system. Laws vary by state, but most patients who are committed to a hospital for safety reasons have a right to a prompt court hearing, usually within 72 hours, says Lawrence O. Gostin, a professor at Georgetown University Law Center in the District of Columbia. He’s also the faculty director of the school’s O’Neill Institute for National and Global Health Law. Based on U.S. Supreme Court decisions, the standard to have someone committed to a hospital or mental health facility against his or her will is the presence of “clear and convincing evidence” the patient is a threat to harm himself or herself or others, he says. That’s not as stringent as the “beyond a reasonable doubt” standard that jurors are instructed to use as their standard in determining guilt in criminal trials. “It is still a very high standard of proof needed for civil commitment,” Gostin says.
Most patients who exhibit signs of being a threat to themselves or others don’t end up in court, even if they’re hospitalized. When a therapist is concerned a patient poses an imminent threat, the health care professional will typically try to convince the patient to enter a hospital voluntarily, Thase says. That scenario is far more common than one in which a therapist has a patient committed involuntarily, she says. “It’s not like a snap decision is made to have a patient taken away in a straitjacket by guys in white coats,” Thase says.
[See: 9 Reasons Getting Away for the Weekend is Good for Your Mental Health.]
If your therapist suggests you may need hospitalization because you’re a threat to yourself or others, here are the things you should consider, experts say:
Don’t get defensive. Keep in mind that your therapist is trying to help you get better with the appropriate treatment, not take away your freedom. “Most of the time, the health professional will find the least restrictive treatment approach, but there may be times when a patient needs short-term hospitalization,” says Dr. Madhukar Trivedi, the director of the Center for Depression Research and Clinical Care at UT Southwestern Medical Center in Dallas.
Ask your therapist lots of questions. If a health care provider suggests you need inpatient care or another form of more intensive treatment, you should ask plenty of questions, says Stephen Odom, chief executive officer of New Vista Behavioral Health in Costa Mesa, California. Odom suggests asking, what type of treatment is it and in what setting will it be: inpatient hospitalization, residential, or partial hospitalization with intensive outpatient services? “Some of us do not want an institutional feel, while others believe a hospital setting is the safest place to be,” Odom says. “Some of us know we need to be in a residential or safe living situation, while others would feel better being at home and attending outpatient services. Make sure you know that where you will be going to treatment will match both what your doctor or therapist recommends and what feels best to you whenever possible.”
Inquire about how long the treatment program is likely to last, and the milestones to track your progress. Better programs have general guidelines for length of stay, but ultimately the length of mental health treatment should be based on progress and not strictly time, Odom says. For example, many programs transition patients from higher levels of care, like inpatient hospitalization, to lower levels, such as partial hospitalization, day treatment and intensive outpatient care as progress is made.
[See: How to Find the Best Mental Health Professional for You.]
Be sure there’s ongoing support. Staying connected to the care, the staff and peers where you received help is a valuable tool to aid in maintaining the gains you made during treatment, Odom says. Make sure the program you go to has an “aftercare” program, continuing post-inpatient and intensive outpatient therapeutic services.
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Will I Get Committed if I Say This to My Therapist? originally appeared on usnews.com
