Posted by noa on February 27, 2003, at 19:07:56
In reply to Re: Half-Baked Suicide Plans Hospitalization » LibbyH, posted by judy1 on February 27, 2003, at 17:41:40
I was once hospitalized but that was so long ago that I can't say if hospitalization today would be similar or not.
It is my impression that for most people nowadays, unfortunately, insurance plans limit hospitalization to extremely minimal numbers of days. The 35-45 day model seems to me to be quite rare these days. More likely is what Judy described-- the 2 to 3 days or until they were more confident that you were not going to be in imminent danger.
Unfortunately, it seems to me that the pendulum has swung from the days when hospitalizations could be rather endless (like about 25 to 30 years ago, when my friend was hospitalized for 18 months from the outset, lenght of hospitalization being based on her diagnosis) to the opposite end, where we typically are now,I think, with insurance companies trying to keep people out of hospitals as much as possible (I think if my friend presented with exactly the same problems and symptoms now, she would maybe be in hospital for 2 days, if they even admitted her at all).
A couple of years ago, when I was very depressed and sometimes feeling quite suicidal, I thought about whther to go into hospital. But I wasn't at the point of being unable to resist the urge to act on my plans. I did come very close during one episode, where my planned was more detailed and included not telling anyone including my therapist, with whom I have a very honest relationship. I withheld it from him but then blurted it out because I couldn't be dishonest with him for long. He then basically read me the riot act and told me if I couldn't discuss it openly and withheld my suicidal intentions from him again, I would need more intense level of treatment, like hospitalisation. I ended up being to contract for safety after that, and somehow got through it. But I had at points considered hospitalization. However, even though my therapist was supportive of the idea (if I was unable to agree to safety he would have insisted), my pdoc, who does a lot of hospital work, actually said that he didn't think my insurance would even approve it, and if they did they would only approve of a couple of days max.
However, my therapist at that point said that there were day treatment programs I could consider, if I couldn't feel confident about my ability to keep myself safe, the thinking being that while day programs are not exactly like being hospitalized, a day program could provide a lot more structure and "holding" than just outpatient therapy, to see me through the crisis. I ended up not needing it, but I think that is partly due to knowing it was there if I couldn't hold it together and be safe.Hopefully, you have better insurance coverage of hospitalization, and access to hospitalization for more than just 1 or 2 days, ie, enough to work through a med change if needed, and to "hold" you until your current suicide risk level subsides and you are safer.
Even though my own hospitalization was 20 years ago, it was rather brief (about 6 days) because my med insurance was one of the early HMOs. And it served its purpose for me--to hold me until I felt safer--but was at a rather mediocre hospital, where not much real therapy happened. The first unit I had been in was the locked unit, and most of the staff was fairly young and incompetent--I think they were sketchily trained "techs". Very little therapy happened while I was on that unit, except one session of art therapy with a fairly good therapist. No "aha" experiences or anything, but some sympathy and a chance to do some art work and connect with the two other patients who chose to participate (out of about 30 on the unit!). Mostly, people just sat around the day room complaining and being bored and depressed.
Then, they moved me to an open unit (open meaning there were incresing levels of grounds privileges you could gain depending on how you were doing). That allowed me to participate in some therapy groups, some of which were real jokes, led by very young and inexperienced and not very sophisticated, (even at my young and unsophisticated age myself this was so obvious to me) activities therapists, including one who basically flirted through entire sessions with a very ill (and rather perseverative and annoying) young man who only left his bed to attend this particular activities leader's groups.
But there was that one art therapist who was decent and I was able to go to two group sessions she led, one which was just kind of fun and distracting for me--music therapy--and one that was actually constructive, and where I think I learned a little bit about how to gauge mood and what kinds of activities could help improve mood. But it was VERY basic. Very basic. At the time, I was rather young and not possessed of much in the way of knowledge about depression, and not possessed of much in the way of coping skills, so even though it was so basic, I did learn something in that session. And there was one nurse on the unit who I liked talking to, who seemed to have some actual counseling skills. The other somewhat helpful resource was that the HMO sent a visitng case manager for a couple of meetings and she happened to be kind of helpful in thinking about how to increase supports in my life for after the hospitalization.
I rarely saw my assigned pdoc, especially since my hospitalization was mostly during an extended US holiday, and I did not find my meetings with him to be of much value, because he neither recommended any med changes, nor did he offer any support or counseling (I think I saw him a total of 3 times for literally 5 minutes each time).
So, lousy hospital program though it was, I did get some benefit out of it--it got me through the worst part of my crisis, and I did gain a little from those three women--Art therapist, nurse, clinical case manager, in the brief encounters with them.
So much has developed over the years in terms of short term treatment and I know nothing about what happens nowadays in hospital programs, except the part of the rationing of services by insurance companies.
Hopefully, programs are much more developed than the one I experienced 20 years ago. But I'm sure there are some that are very good and some not.
I did read here on Babble once that it is possible to call a hospital and request a meeting with someone (a social worker maybe?) to find out more about their particular program and what it would be like, and thus do some comparison shopping, as it were, before admitting yourself. This would only work if you are safe in the immediate term and don't need to go in this minute, and of course, if you even have more than one program to choose from (geography and health insurance limitations being what they might). Also, it might be important for you to go where your doctor and/or therapist has priveleges so you can continue the treatment you are already in (that was definitely lacking in my own hospital experience). Also, your pdoc/therapist might be able to tell you about the plusses and minuses of hospitals in your area.You do sound like you are at a higher risk at the moment than you have been at other times, and I'm glad you are considering hospitalization as an option. I have had some really scary suicidal episodes myself when I wasn't sure I would be able to get past the horrible pain and obsession with ending it, but I am sure glad I was open with my therapist about it because I am glad to be alive now (there was one time when it was really bad that I came close to not telling him. I knew that was a sign it was getting serious, because I knew the reason I was witholding it from him was to try to ensure being able to carry it out. I ended up telling him, but it was a struggle for me to get past the conflict of not wanting to tell him vs. otherwise being totally honest with him and unable to withold anything important).
Take care. I don't know if my rambling babbling is helpful. I hope so, anyway. I hope you get the exra support you need now.
poster:noa
thread:204244
URL: http://www.dr-bob.org/babble/psycho/20030203/msgs/204458.html