I Need a Counselor! (part 4) “My God, I want to die!”

This final post in the series is gonna’ be a longie. But, given its subject matter, and how little this topic is discussed, it needs to be. “My God, I’m in mental and/or emotional crisis and haven’t a clue what to do!”

If you have a counselor or a psychiatrist, call her for direction should you find yourself in the midst of a mental or emotional state you’re unable to manage. If you can’t reach her it’s time for Plan B.

If suicidal thoughts are part of your immediate circumstances you must take immediate and decisive action (and very frankly, that may be difficult to do if you’re hell bent on dying). Do not waste time contemplating what to do or where to go. Share what’s going on with the first person you see and one of you call 911. Obviously, if there’s no one around you’ll be making the call. Now, I’m fully aware the presentation of suicidal ideation, and its potential for lethal behavior, can vary greatly on a per case basis. However, I’m not going to risk offering any qualifiers or criteria with regard to just when to seek help in its presence. You sense it, you tell someone and call 911. Done.

But let’s say suicidal ideation isn’t part of the picture. You’ve left a voice mail for your counselor or psychiatrist and it’s taking a while to get a return call. Or maybe you’ve yet to establish such a relationship. If you have access to a phone book, there’s most often a section in the front listing a variety of community and human services. Take a look for “Crisis Intervention” or anything  “Suicide” and you’re likely to find several numbers. If you have access to the Internet, hop onto your favorite search engine and enter something like “Crisis line DuPage County Illinois.” Your choices should be plentiful.

Another alternative would be to call a local hospital, tell them you’re in crisis and need to speak to someone in behavioral health. If they don’t have behavioral health services they will provide a referral. The same access can be established by checking-out their website. If you’re involved with a church, don’t hesitate to make a phone call. Either the pastor or an on-call crisis worker will likely respond. Finally, just because you’re not suicidal doesn’t mean you can’t hit the closest emergency department should you simply not know what to do with yourself. I’ve seen countless cases exactly like this in the E.D. The same applies if a psychiatric hospital is in the vicinity.

Finally, I’d like to share a few thoughts on securing the appropriate level of care for managing your situation. Working individually, and in group, with a private counselor may well be just the fix for you. However, it’s possible that as you begin therapy the acuity of your disorder may call for more intense treatment. This can also occur during the course of treatment with your counselor or psychiatrist.

Should this become reality, relax, you’ll be just fine. Consider it akin to having a severe infection and being hospitalized to facilitate the administration of an I.V. antibiotic, though in this case you won’t be staying overnight anywhere but your own home. This type of programming is conducted at local mental health facilities, most of which are affiliated with a medical hospital.

Generally, the first step is to phone the intake department and schedule a free level of care assessment. After the assessment has been completed, the intake counselor will likely review your case with an on-call psychiatrist (if your psychiatrist has admitting privileges he’ll get the call), returning with a recommended level of care. The recommendation may be full-day programming (generally referred to as Partial Hospitalization – PHP), half-day programming (generally referred to as Intensive Outpatient – IOP), or they may provide referrals to private psychotherapists and/or psychiatrists, including yours, if you already have one.

And, yes, inpatient care will be the recommendation if you report suicidal thought or behavior within the past 72 hours. The same applies if you’re not comfortable with your safety should you leave the facility. And if you don’t voluntarily admit, a court petition could well be written to force you to stay. The same protocol would apply if you’re homicidal or if your ability to function has plummeted to the point where you simply can’t participate in life or care for yourself.

Now, scheduling an appointment is the preferred way to facilitate an assessment, but you can report as a walk-in should you feel unsafe or you’re struggling to the point where you just can’t put a day together and you can’t wait the day or two for a scheduled appointment. If you report as a walk-in, you may have to wait a couple of hours before seeing a counselor; however if you truly require immediate care, then that’s the way it is. Please make sure the receptionist knows if you’re feeling unsafe, as your case will have priority and your wait will be monitored.

Well, that’s all for the series, folks. The four posts will be available for you here on the blog anytime you need them. Or print them now if you’d like them to be easily within reach.

The only thing left to say is, will you have the courage and good common sense to solicit help when you need it most? And will you smash stigma right in the mouth as you act? Good.