How can we advocate for a safe place to talk to mental health professionals about s***ide?

Good to see ypu again @Jlol . You may recall this is a topic very dear to me also. And i hear so many stories like yours too, and worry that one day it might happen to me also. 

For me, my local Safe Haven/Space is the place i can talk about it without fear of being detained. I wonder if your state has one?

I think for me the other thing thats helped keep me non-detained ever is *how* i talk about it with the doctors/psychs. I am always very clear that i have control between how I feel and how I act - this gives them a degree of "safety" in not detaining me. I explain to them that i've lived with this for 25 years and not ended up hospitalised, for example - evidence that I can be trusted to be safe despite the severity of my thoughts. I am always honest with them - so they dont need to worry i am lying (which makes them perceive risk if a patient does not engage or is considered to be lying). 

I have been fortunate that my non-emergency doctors & supports have taken to genuinely understanding me as a person and thus *trusting me*. They know there is potential for extreme risk, but they know it is not imminent and that if i don't want to hurt myself but am concerned i am at risk then i *will* reach out to *someone*. How they will handle the future when that might change I'm not sure yet, but for now they find my promises which are binding to me a great comfort to their Duty of Care requirements. Thus my doctors are allowed (by me) to know why i have suicidal thoughts and thus they can truely try to get to how to help me improve my quality of life in those areas and/or find supports for them.

I always start with convo with "I'm not going to act on it - but i feel this way." Being very clear to get in first about that.

However i will caution that sometimes because im chosing not to act on it, then i dont get the supports i need in the public system.

Hi @AlwaysMyself, nice to hear from you again too.

Yes, I've investigated the Safe Place near me. It is great, but not really what I'm talking about. They offer a good service to go if you are feeling like you might s***ide but not one to go for actual treatment (also, they still have Duty of Care).

"I think for me the other thing thats helped keep me non-detained ever is *how* i talk about it with the doctors/psychs. I am always very clear that i have control between how I feel and how I act"

Yes, this is what I've done in the past too and it is good advice. But the truth is that that is not entirely true for me. I feel I have very, very limited control between how I feel and how I act. I've found that when I say that I do have control the conversation goes in the direction of talking about what I do to control it and how I can enhance that, which is not useful for me since I can't control it at all.

To be honest too I'm tried of masking and not being me in these conversations. It's exhausting and it doesn't feel right to carefully measure and examine every word that comes out of my mouth. I just want to talk freely about my state of being - the good, bad, and the ugly.

Whilst I think its an important symptom to bring up, I don't want the s***diality and possibility of s***ide to always dominate and direct the conversation. I want to work on other things which will helpfully lessen these symptoms, but at the same time have the therapist admit that the symptoms are not managable in themselves and not focus on them.

For me I don't want to start a conversation with "I'm not going to act" but with "There's a possibility I might act" because that's true. Again, if I say "I'm not going to act" that implies I have control over the situation and the conversation goes in that direction. You've nailed it spot on here when you said "However i will caution that sometimes because im chosing not to act on it, then i dont get the supports i need in the public system."

Thanks for replying again!

Oh I hear you so much in all that you said @Jlol . 

For the sake of mods & others i will again remind that i am safe, i am not in any imminent risk of harm.

My appt with my psychiatrist this week, we spent the full 1.5 hours talking about how extra suicidal i've been feeling the past few weeks. No masking. No sugar coating. He's fully aware of my timeline. He doesn't diminish the emotional distress that I feel and the lack of available suitable supports when i'm either in that chronic severe state or the more acute state when it spirals. He listens. He enquires about whats underlying it. Whilst he asks if/how I can self-soothe inside for that part of me thats in pain, he also accepts when i explain that i already do and that the ways that it can also "backfire" and increase my risk when i do that. He's learned that sometimes listening without rushing to action or advice is the treatment we need *when actively in those states*.

We don't talk about "the end of the timeline" in terms of what that means for Duty of Care, because for now that's not important. He has a role in being able to try to change that course of possible future events, and that's his focus instead. 

I am very lucky to have found a (albeit temporary) psychiatrist that is like that. I know it is rare. But i encourage that they do exist. i often feel like i wish we could close this doc and distribute clones to all my suicidal friends and contacts 😅. (For context he does work in a crisis team also, so he is well trained in psych crisis management). If i knew i would get someone like him when finding supports (crisis or ongoing), i wouldn't be scared to.

My longterm psychotherapist is also very OK with me talking about my chronic suicidality too. I deliberately picked her because she had a background in dealing with trauma crisis, so i figured she would have been exposed to suicidal crisis patients from that. And i also was upfront in first approaching her about the main topics i wanted to discuss / impacted by, and acknowledged that not all therapists are comfortable with that and that it's OK with me to say its not the right fit if thats the case for her. (I previously had a psychiatrist who refused to talk to me abput my chronic suicidal thoughts/feelings, even though they were the thing in itself that was distressing me. She'd never talk about why i wanted to cease to exist. I never want that to happen again with a therapist.)

I wish i could offer something more. 😥. But hoping maybe that i can give some small.glimmer of hope that there are *some* treatment therapists out there that are comfortable sitting alongside chronic severe suicidality. Its just a matter of finding them.

I wish there was a specialist directory for these therapists!!

Thanks @AlwaysMyself,

Again you hit the nail on the head here: "I am very lucky to have found a (albeit temporary) psychiatrist that is like that. I know it is rare."

That's the point I'm trying to make and advocate for. Finding someone you can have this conversation with is extremely rare. I want to advocate for a place where you can talk to someone who doesn't follow Duty of Care.

However, I also want to say that I feel the rhetoric of "they're out there just try another one" isn't a good thing.

People are not made of money and simply rolling the dice each time in hopes to find a practitioner who fits your unique needs is very, very time consuming, expensive, stressful, and not realistic for most people. I often feel this rhetoric is used byt the mental health industry to "pass the buck" with difficult cases like mine. Eg they will never say that help isn't available and that the system needs to change, they will just say you "haven't clicked with anyone yet" or something like that.

It's a small thing, but by phrasing things that way they ensure the power stays with them: "Its not us that needs to change, but you who need to put the work in to find the right one of us".

I am very glad you've found this person though.

@Jlol Alt2su?

Thanks @EternalFlower,

Yes I have engaged with them before but I believe they're peer support not clinical

Correct @Jlol , alt2su is peer not clinical. And not 1:1 / focused therapy.

I also agree about the inability to "trial and error" a thousand times before finding the right person. Both financially and i feel emotionally.

I really wish there was a directory/listing of professional supports for therapy that have a special-interest and/or skill in dealing with suicidality in a safe, supported way with the understanding that sitting with what is traditionally seen as "high risk" and not over-reacting (giving trust, giving openness to engage and explore the topic without fear of unwated intervention - but support to access intervention if *wanted* by the individual), i believe it reduces risk of acting. Being able to share openly, be heard, and reason out the thoughts - that in itself i find can be soothing.

I actually explicitly thanked my pdoc yesterday for trusting me and not locking me up 😆. For allowing me to speak frankly without that fear.

Thanks @AlwaysMyself 

"I really wish there was a directory/listing of professional supports for therapy that have a special-interest and/or skill in dealing with suicidality in a safe, supported way "

Yes, that would be great!

Maybe I'm being unrealistic but I think if you're a MH professional who's engaging with s***idal people then you accept the risk that they may s***ide.