What Happens If You Tell Your Therapist You’re Suicidal

If You Need Immediate Help

If you need immediate help, please call or text 988. The Suicide and Crisis Lifeline provides 24/7, confidential support to people in suicidal crisis or mental health-related distress. If you are uncomfortable speaking directly to a provider, you can also text the National Alliance on Mental Illness (NAMI) at 741-741 to be connected to a free, trained crisis counselor.

What Does a Therapist Have to Report?

If you tell your therapist you’re experiencing suicidal thoughts they are ethically and legally required to break confidentiality and report to a family member, government organization, or the police if you have a clear plan in place to harm yourself. Knowing a therapist is required to report suicidality may feel confusing because therapy is a place to share your most intimate self. However, there are laws created to prevent serious harm to yourself.

Your therapist will respond with warmth, understanding, and compassion if you tell them you have suicidal thoughts. They will ask you questions to assess how long, frequent, and severe your thoughts are. A good therapist will collaborate with you on what their required reporting will look like. The ultimate goal is to continue healthy communication and trust between you and your therapist while keeping you safe.

What Happens if You Tell Your Therapist You’re Suicidal?

In order to assess your risk of suicide, your therapist will ask you many questions about your risk factors and protective factors. Risk factors are characteristics that are associated with an increase in suicidal behavior, such as previous suicide attempts, high adverse childhood experiences (ACEs) scores, and childhood trauma.² Protective factors are characteristics that help protect people from acting on their suicidal thoughts. These include supportive relationships, cultural or religious beliefs, and a safe environment.

Other questions your therapist may ask you about feeling suicidal include:

• On a scale of 1 to 10, with 1 being easy to control and 10 being completely out of your control, how would you describe your ability to manage your suicidal thoughts?
• Are you sleeping? Eating regularly? Exercising?
• Sometimes, things feel so difficult we think about acting on our suicidal thoughts. Are you feeling that way?
• For some people, suicidal thoughts are just that—thoughts. For others, they become a concrete plan. Do you have a plan in place?
• Has anyone close to you ever died by suicide?
• What is your plan?
• Do you have the means to commit suicide?
• Do you have any weapons in the home? Can you remove them?
• How frequently are you having the thoughts, and what are the emotional reactions to the thoughts?

Do Therapists Have to Report Suicidal Thoughts?

If you have passive suicidal thoughts but you have not developed a plan, your therapist may create a safety plan with you, but there is no legal duty to report this. If you tell your therapist you’re suicidal, display warning signs of suicide, and your thoughts have increased in frequency, duration, and intensity, and you have an actionable plan in place, your therapist is required to report it in an effort to keep you safe.

Your therapist is not legally required to collaborate with you on the report, so there may be cases in which you are unaware of the report until after it is made. Due to the importance of the therapeutic relationship, it is important to share feelings of possible concern with your therapist and ask questions associated with their personal style of reporting.

Can Therapists Send You to a Mental Hospital if You Tell Your Therapist You’re Suicidal?

It depends on the therapist. After assessing the risk of suicide, your therapist will determine the best possible steps moving forward. This may include calling an inpatient hospital with you, calling 911, creating a safety plan and requesting you remove all possible weapons from your home, locking up medications, or creating a game plan that includes group therapy and daily check-ins. Involuntary hospitalization is required if your mental state is impairing your ability to function, and there is a risk you may harm yourself or others.

The paperwork that you sign prior to starting sessions with your therapist should outline their required duty to report suicidal behavior. The precise language included in this document should give you an understanding of how your therapist will assist you in navigating your suicidal ideation. If you are unsure, ask your therapist about their legal requirements. This varies by state and licensure level.

What Will NOT Happen If You Tell Your Therapist You’re Suicidal

If you decide to tell your therapist you are suicidal, they will not shame you. They will not tell you to suck it up. They will not smother you with platitudes and tell you to write a gratitude list. Lastly, if you have a competent therapist, they will not let you leave the room without developing a game plan for the next steps.

Healthy relationships are an essential part of our lives, and without them, we are left to sit in our loneliness alone. A competent and ethical therapist will sit with you and make you feel less alone when you have uncomfortable thoughts and feelings associated with wanting to die. Remember, therapists choose this profession because they want to be present for people who are suffering and help them build emotional regulation skills so that the next time darkness arises, they have the tools to get through it.

Why It Is Important to Tell Your Therapist You’re Suicidal

It is important to tell your therapist that you are suicidal because they are trained and qualified to help manage intense feelings of discomfort and keep you safe. It is also important because it removes any shame you may have around your suicidal ideation. Telling your therapist you are experiencing suicidal thoughts is the first step to take towards starting to feel better.

Here are seven reasons why it is important to tell your therapist you’re suicidal:

1. It Allows You to Get the Help You Need

Telling your therapist that you’re suicidal can be both terrifying and relieving at the same time. By telling your therapist that you are suicidal, you can receive the help you need. Sharing uncomfortable thoughts and feelings with your therapist is why they are there. They will seek to better understand what you are experiencing and how they can best help you.

It allows you to share the parts of you that you may hide from others, providing a warm space for introspection and curiosity without judgment.

2. It Lets Them Know How Much You Are Suffering

By sharing how much you are suffering with your therapist, you are allowing another person to sit with your pain. It gives your therapist a clear understanding of your suffering and how they can best help you. This may include shifting your treatment plan with your therapist or developing healthy coping skills for depression, such as progressive muscle relaxation, bilateral stimulation, or mindfulness activities.

3. You Can Collaborate on a Safety Plan

Safety planning is a collaborative process in which you and your therapist work together to develop a personalized list of coping strategies to use during times of increased suicide risk. This plan will include a support network of those you can call during times of distress, emotional regulation tools you will implement when suicidal thoughts arise, prevention behaviors such as taking a walk outside or placing a washcloth rag on your forehead, and what you will do if none of the above tools are working.

4. You Are Practicing Secure Attachments

Attachment theory is based on the belief that acceptance and love are just as much of a primal need as food and water. So, sharing your suicidal thoughts with a therapist that you trust can be a healing tool of transformation. Secure attachment with your therapist will increase your ability to communicate your feelings and needs in a trusting environment. It removes shame from fully expressing all parts of you.

5. Reduces Shame & Stigma

By sharing your suicidal thoughts and feelings with a trusted mental health professional, you are releasing shame and opening yourself up to healing. According to a 2020 Harris Poll,  55% of survey respondents stated that they are too embarrassed to seek help, which has reduced significantly from 2018, but still indicates a high level of shame.¹

In addition, the COVID-19 pandemic increased the need for mental health services and continues to have a longstanding impact on how we view ourselves and our world.

Shame needs three things to grow; silence, secrecy, and judgment. The antidote to shame is vulnerability. Vulnerability requires honesty and non-judgmental acceptance.

6. Provides You With Coping Strategies For the Future

Speaking with a trained therapist about suicidal thoughts can provide you with new resources to cope with future thoughts when they arise. Depending on your therapist, there are several tools that will be provided to you during the session. These tools vary based on individual needs and assessments. Your therapist will help you create a support system, practice open communication, create a safety plan, and build a life worth living again.

7. Increases Window of Tolerance

Sharing suicidal thoughts, feelings, or behaviors with a therapist can help increase your window of tolerance. Your window of tolerance is the sweet spot between feelings of depression and feelings of anxiety. You will develop the ability to manage life in a way that seems less like surviving on auto-pilot by sharing your story and implementing coping mechanisms that are effective for you, which will increase feelings of contentment and joy in your daily activities.

How to Talk to Your Therapist About Being Suicidal

The most common barriers to discussing suicide are not knowing the right words and not having enough knowledge.¹ It is important to remind yourself that your therapist is trained in handling these conversations, and therefore, you do not need to have the perfect words. It is also helpful to understand your therapist’s protocol for suicidal ideation. Talking to your therapist about suicidal thoughts can be terrifying at first but relieving afterward.

FOR IMMEDIATE HELP CALL: The Suicide Hotline: 988

Here are a few tips for how to talk to your therapist about being suicidal:

• Be honest: Share your authentic thoughts, including possible plans of action or previous attempts. This will help your therapist decide the best course of action for treatment.
• Express your fears/concerns: Share some of your fears associated with telling your therapist about your suicidal thoughts. This may include things like, “What will it look like if I share some of my suicidal thoughts with you?” or “I am scared to share my plan of action because I do not want to be involuntarily committed.”
• Practice nonjudgmental acceptance: When sharing scary thoughts or feelings with your therapist, it is important that you remove judgmental language or thinking patterns in order to improve your relationship with yourself. Non-judgmental acceptance of your thoughts and feelings will help you to validate your emotional experience as real and maintainable.
• Practice curiosity: Be open and curious about what you are feeling and experiencing. This will remove judgment and provide room for the exploration of feelings instead of condemnation.
• Practice self-compassion: Self-compassion is correlated to increased feelings of optimism, curiosity, and connectedness, as well as decreased feelings of anxiety, depressive symptoms, and fear of failure.³
• Be direct: Avoid sugar-coating your thoughts or feelings. It is important to share exactly what you are feeling.

What If You Need to Be Hospitalized for Thoughts of Suicide?

Your healthcare provider will determine if you are at risk of being hospitalized. There are times when collaboration between you and your therapist may not be possible, depending on the state of your mental health needs. Because decision-making is state-regulated, there are no national guidelines for inpatient hospitalization.

Can a Therapist Involuntarily Commit You?

Involuntary hospitalization is required when your therapist uses professional judgment to determine that you may be a threat to yourself or others or that your mental illness has increased to where you are incapable of functioning. The laws under which you can be involuntarily hospitalized vary by state, so it is important to research your state’s laws and requirements. If you have questions about your rights as a patient, you can contact your local Protection and Advocacy organization. Organizations such as these are put in place to protect the rights of persons with mental health needs.