Q: What happens if my character is brought to the hospital after attempting suicide?

What Won’t Happen

There are a lot of rumors, misunderstandings, and misconceptions surrounding the treatment of suicide attempts. I’ll start out by addressing some of the most flagrant here.

• Your character won’t wake up in restraints. In fact, they won’t even be put in restraints unless they are extremely agitated and cannot be calmed down (and even then, they’d probably be given “chemical restraints” — aka a shot of a sedative.)
• The psychiatrist won’t ask for your character’s life story or try to perform any sort of psychoanalysis. Their focus will be on the recent suicide attempt and determining if your character remains a danger to themselves.   
• Your character won’t have their stomach pumped (gastric lavage) unless they ingested the substance very recently (within an hour)
• Your character won’t go straight to the psych ward – if 911 was called, they’ll go to the ED first, even if they aren’t critically injured.
  • If you’re writing historical fiction (or if your contemporary character is filthy rich) they may be admitted directly to a private psychiatric hospital.
• Your character won’t be sent to the psych ward while they have an acute medical condition.
• Your character won’t be involuntarily committed to the psych ward while they are unconscious.     

What Will Happen

Now that I’ve got that out of my system, let’s move on to what will happen.

If your character is brought to the hospital after attempting suicide, the very first thing doctors are going to do is treat any life-threatening conditions. If your character tried to shoot themselves in the head, they’ll be taken for neurosurgery. If they took a ton of pills, they’ll be given a reversal agent (if there is one), then have their breathing and blood pressures closely monitored. If they took a ton of pills less than an hour ago, they’ll give them activated charcoal or perform a gastric lavage . If they are very ill and need to be admitted to the hospital or the ICU, they will be.

If your character was brought to the ED alone, they’ll be assigned a “sitter” – someone employed by the hospital to sit with them and make sure they don’t try to hurt themselves again. If your character is brought in with a friend or family member, that person can sit with your character instead.

Once your character is awake and no longer in critical condition, a psychiatrist will be sent down to the ED (or the ICU/hospital floor if they’ve already been admitted) for a preliminary evaluation. The psychiatrist will ask your character a lot of questions, trying to determine your character’s diagnosis and whether or not they are a danger to themselves. They will ask about your character’s known mental illnesses, and how they’ve been feeling recently. They will also ask about the suicide attempt: what precipitated it, how they planned it, and what they did. They will also ask if your character is currently wanting to kill themselves, and if they have a plan to do so. This will help determine the level of hospitalization your character will require.

Medical vs. Psychiatric Admission

Psychiatric wards are not equipped to care for patients needing high-level medical care. If your character requires surgery, intubation/ventilation, airway monitoring, IV fluids, high-level nursing care, or even just consistent monitoring of their vital signs (blood pressure, heart rate, breathing rate, etc.), they will be admitted to the medical hospital, rather than the psych unit.

Criteria for Inpatient Psychiatric Hospitalization

Inpatient psychiatric hospitalization – the “psych ward” – is reserved for patients who are an immediate danger to themselves or others. Your character will be recommended inpatient hospitalization if:

• They are actively suicidal and have a plan to kill themselves
• They are suicidal and show signs of impulsivity
• They are suicidal and do not have good social support (no friends/family, homeless, etc.)
• They are acutely mentally ill and appear to be concealing an intent to hurt themselves
• They are acutely mentally ill and a danger to themselves or others
• They are acutely mentally ill to the point where they cannot care for themselves (particularly if they have concomitant health problems, such as diabetes, that require a higher level of care)  

Voluntary vs. Involuntary Admission

If the psychiatrist recommends inpatient hospitalization, they will try their best to get your character to sign themselves in voluntarily. Voluntary admission means less paperwork for the doctor. Names and rules for involuntary holds vary widely by state, but they always require an absurd amount of paperwork, so the doctor will try their best to get your character to sign in voluntarily. Only if your character refuses will they go down the involuntary hospitalization route. In Oregon, where I trained, an involuntary hold requires filing a detailed form called a 5150, which allows the patient to be held for up to 72 hours, at which point the psychiatrist must file at 5250 to extend the hold for up to 14 days, during which time the patient gets an automatic hearing presided over by a judge.¹⁶ It’s a headache for everyone involved.

Only once your character is medically stable and has signed the paperwork – or the psychiatrist filled out the involuntary commitment forms – can your they be transferred to the inpatient psychiatric ward. But they may not get to go right away. Psychiatric wards are notoriously overbooked; it wouldn’t be unusual if your character had to camp out in the ED for hours, even days, before they are able to secure a bed in the psych ward.   

Not All Emergent Psychiatric Care is Inpatient

If your character doesn’t fulfill the criteria for inpatient psychiatric hospitalization, they will probably qualify for a partial hospitalization or intensive outpatient program. These day programs usually run from 9 am-5 pm every day, including weekends.

The purpose of these outpatient programs is to provide a level of care similar to inpatient hospitalization, just without 24-hour monitoring. These programs provide daily group and one-on-one therapy as well as close monitoring by an attending psychiatrist. However, your character will get to sleep in their own bed, wear their own clothes, and eat food that didn’t come from a hospital cafeteria. In order to qualify for this level of care, your character will need adequate social support – someone who can stay with them during the hours the program isn’t running. That person will need to drive your character to-and-from the program, administer your character’s medications and ensure that the home is free of lethal means. These programs are also quite expensive.

Summary

If your character attempts suicide, the first priority will be to save their life. This may require admission to the hospital floors or ICU. Only once they are medically stable will they be offered psychiatric hospitalization. Most psychiatric hospitalizations are voluntary. If your character is not an immediate danger to themselves or others AND they have adequate support at home, they may be offered intensive outpatient treatment instead.