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chaplaincy, health, health care, mental-health, preventing suicide, psychiatric emergency, psychology, suicidal ideation, suicide
One of the most difficult subjects in regards to suicide and suicidal ideation is the issue of whether one can try to have a loved one temporarily hospitalized as a means of preventing suicide in someone who is at potential risk. The challenge lies in various legal and ethical issues. In the below piece, one doctor offers his advice to those dealing with the question of hospitalization.
Should I Make My Partner Go to the Hospital?
By Therese J. Borchard Associate Editor
The NAMI Maryland publication, “Connections,” published this question awhile back. It is one I am often asked, so I thought it would be helpful to share it with you:
I was recently faced with the dilemma of whether or not my wife was a danger to herself and others, and whether or not to take her to the emergency room as a psychiatric emergency.
Are there any guidelines or suggestions as to when its best to take a loved one to the hospital?
Dr. Mark Komrad, M.D. responded:
This is one of the challenging issues in all of psychiatry — both practically and ethically. So I can only attempt to address it in a most preliminary fashion.
The easy answer is: call your wife’s psychiatrist. I believe that all physicians should have a system to be available in the case of possible emergency. That is a fundamental ethical principle we are taught in medical school. Every patient and family should be familiar with how to contact the psychiatrist in the case of emergency.
One of the most common reasons psychiatrists are reached in an emergency is to consult on just this situation — whether or not a person should go to an emergency room (ER). As a part of residence training, all psychiatrists have extensive experience with this scenario.
What if the doctor can’t be reached or if there is no psychiatrist on the case … yet? The primary concern is safety — hers and yours. If there is any question that your wife is unable to control her behavior to maintain safety, it is reason enough to have an evaluation in the ER. Safety includes considerations of violence to self and others, as well as other kinds of safety such as fire safety, fall risk, or medical risk.
A diabetic who is refusing to eat, a person with unstable hypertension who is highly agitated, a person who has fallen into an unmoving catatonia and isn’t acting to take care of his basic needs, a person who environment has deteriorated to a fire or health hazard: these are all examples of various cases from my own clinical experience that have been appropriately brought to the ER.
So, if the doctor says go — go. If you feel there is a risk of harm afoot — go.
A final consideration in your decision: if someone has never been in for treatment, an ER evaluation can open the door to mental health treatment, and is sometimes the only first step a person is willing to take.
Therese J. Borchard is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Write to her at comment@thereseborchard.com or follow her on Twitter @thereseborchard.
The World of Pastoral and Spiritual Care 
Rabbi, that may be practical advise for this man, whose wife is, presumably, suffering from depression and who has him (at least) as a support system. A lot of people aren’t so fortunate.
I find blanket statements about suicide, such as those made habitually by the American Psychiatric and Psychological Associations, to be offensive. There is a terrible arrogance in reserving to oneself the right to determine whether or not another individual’s life is worth living. Years of past experience with that profession has convinced me that position has far more to do with ego than with helping people in pain (frankly, I think it describes the profession in general).
If a person has a horrible life and is unable to change it – especially if that inability is due to lack of resources – I feel very strongly that s/he should be allowed to end it. Profound unhappiness, in such a case, isn’t the result of a “biochemical imbalance”, but is a reasonable reaction to a miserable situation – and the willingness of therapists to get involved is invariably extremely limited.
I grant that what you are saying is entirely accurate. I sense that you are someone who has been through this with a loved one. If my assumption is incorrect, I apologize in advance. One of the most difficult aspects of suicide is that grief that surrounds it. We can offer words such as “a person has lived a horrible life,” but the emotional and spiritual effects of suicide on the “survivors,” should always warrant conversation about prevention. This is not to suggest that blame can be laid if prevention wasn’t successful. Rather, it means we should consider all possible avenues of support because it is never too late to change one’s life.
I sense that you are someone who has been through this with a loved one.
No, I’ve been through it myself!
but the emotional and spiritual effects of suicide on the “survivors,” should always warrant conversation about prevention
In my opinion, this is something that gets trotted out as a rationalization far too often. It has been both my observation and my experience that people often wish to end their lives not in spite of the fact that they have support systems and loved ones who care about them, but because they don’t have them. (And frankly, I think this is a huge problem for Jewish theology – in fact, theology in general.)
because it is never too late to change one’s life
I disagree. There comes a point at which, in my opinion, the most reasonable course of action is to give up.
Life really sucks for a lot of people, Rabbi, and it often becomes unbearable – and as the years go by and life becomes more complex, and people increasingly become burned out, self-absorbed and apathetic, the phenomenon of the lonely person with no support, no connection and no inherent meaning to his or her life becomes increasingly common. Also, with the economy the way it is, more and more people have little to no money to spend on “treatment”, which simultaneously has become even more expensive – and you know psychiatrists and psychologists ain’t giving it away (and don’t even talk to me about the clinical social workers at community mental health centers).
It may be different in Western Europe – their societies have gone out of their way to create climates of mutual support – but that isn’t the way it is here. Americans, because of their allegiance to conservative theologies and their fear of their own mortality, won’t help you to die – but neither can they be bothered to try to help you to live.