Carolyn Hax: Leaving suicidal thoughts off the medical intake forms – Lifotravel

Adapted from an online discussion.

Dear Carolyn: I know I need to see a therapist.

I suspect I am picking at details to stall, but I get hung up on the question “Have you had suicidal thoughts?” on the intake forms.

I did a depression screening sheet at my primary care and I put “never,” because, frankly, I was afraid that if I put yes, I might get involuntarily admitted to a psych ward. As it was, answering truthfully other than that, what I thought would rate as mild depression my physician assessed as more than that.

I know I am not in imminent danger of suicide, because I have accepted not putting that burden on my 90-year-old mother. But yes, I do see it as a reasonable solution down the road. I do look forward to the day when I can feel the freedom to make that choice if I feel it is warranted. I do have carefully thought-out plans to ensure it is complete if I do so choose.

Part of me feels all of this is more an argument for how I am not suicidal, but part of me wonders whether this counts as suicidal thoughts in the diagnostic sense of the question. Or is answering yes just being melodramatic, because the question is meant to help those in a current crisis state?

Anonymous: Yes, you have had suicidal thoughts, so please check that box. The question is meant to help your providers determine how to treat you, and they can’t do that if you withhold key information.

Just as an example, they may prescribe something for you that they wouldn’t prescribe for someone who has had suicidal ideation, or they may provide less frequent supervision. Meanwhile, a yes to “Have you had suicidal thoughts?” can mean you had them 10 years ago or a month ago or yesterday, so there are a lot of steps between an intake form and an involuntary commitment.

I certainly won’t argue that any health system or set of protocols is perfect, but in my experience, you’re inviting more error and suffering by lying on your form than you are by telling the truth.

Please also humor me and memorize this number: 988 gets you to the Suicide and Crisis Lifeline.

And make that appointment. No more stalling, please.

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Re: Intake: You can leave questions blank on a therapy intake form, or any medical form, for that matter. It will allow the therapist to ask you about it, and you can then provide a fuller, more nuanced answer than the checklist allows for — which then allows you to feel safer and better understood.

Reader: Thank you. I would write instead, “Please ask me about this.” Letting it all hinge on an unchecked box requires more faith in the universe than I possess.

Another reader’s thought:

· Therapist here. Assessing for suicidal ideation is a critical part of my job. Never, not once, have I even thought about sending someone to a hospital because they have told me they’ve had such thoughts. It’s data; it’s part of the puzzle but far from the only piece. The therapist’s job is to explore and understand the thoughts and the role they’ve played for you.

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