We developed this guide to provide resources on how to take care of yourself and your family following a suicide attempt. Suicidal thoughts and actions often generate conflicting feelings in family members who love the person who wishes to take his or her own life, making it challenging to act after a crisis. We hope this guide on what to do after taking your adolescent to the emergency department can reduce confusion and burnout and keep you and your family safe.
What Happens in the Emergency Department
The goal of an emergency department visit is stabilization. This includes physical and emotional stabilization and referrals for follow-up care or treatment. These all can take several steps and take time.
When someone is admitted to an emergency department for a suicide attempt, a doctor will evaluate the person’s physical and mental health. Emergency department staff should look for underlying physical problems that may have contributed to the suicidal behavior, such as side effects from medications, untreated medical conditions, or the presence of street drugs that can cause emotional distress. While emergency department staff prefer to assess sober people, they should not dismiss things people say or do when intoxicated, especially comments about how they might harm themselves or others.
After emergency department staff evaluate your family member’s physical health, a mental health assessment should be performed, and the physician doing the exam should put your relative’s suicidal behavior into context.
The assessment will generally include the following questions:
- What psychiatric or medical conditions are present? Are they being, or have they been treated?
- Are the suicidal thoughts and behavior a result of a recent change, or are they a longstanding condition?
- What did the person do to harm himself or herself?
- Have there been previous attempts?
- Why did the person act, and why now?
- What stressors, including financial or relationship losses, may have contributed to this decision?
- Is the person angry with someone?
- Are they trying to reunite with someone else who has died?
- Does the person regret surviving the suicide attempt?
- What is the person’s perspective on death?
- What support systems are there?
- What treatment programs are a good match for the person?
- What does the individual and the family feel comfortable with?
- Was there a suicide note?
- What was the seriousness of the attempt?
- Is there a history of previous attempts?
Involuntary Care: M1 Hold
If your teen is in the emergency room involuntarily due to the danger they pose to themselves, they may be placed on an M1 hold. An “M1 hold” typically refers to a specific type of psychiatric hold or involuntary commitment for individuals who pose an immediate danger to themselves or others due to mental illness.
Generally, an M1 hold allows qualified mental health professionals or law enforcement officers to detain an individual for a limited period, typically up to 72 hours, for psychiatric evaluation and stabilization. During this time, the individual may receive assessment, treatment, and intervention to address their immediate mental health needs and mitigate the risk of harm. Depending on the evaluation outcome, further treatment or intervention may be recommended, including voluntary or involuntary psychiatric hospitalization, outpatient services, or community-based support. The goal of an M1 hold is to ensure the safety and well-being of the individual and others while providing appropriate mental health care and support.
After the initial 72-hour period, if it is determined that the individual continues to meet the criteria for involuntary commitment, further legal proceedings may be initiated to extend the hold or pursue other treatment options, such as involuntary hospitalization or outpatient treatment. It’s important to note that specific procedures and criteria for M1 holds may vary slightly between jurisdictions within Colorado, so it’s advisable to consult the relevant statutes and regulations or seek guidance from legal or mental health professionals for accurate information.
How you can help the emergency department:
Family members are a source of history and are often key to the discharge plan. Provide as much information as possible to the emergency department staff. Even if confidentiality laws prevent the medical staff from giving you information about your relative, you can always give them information. Find out who is doing the evaluation and talk with that person. You can offer information that may influence the decisions made for your relative. Remember to bring all medications, suspected causes of overdose, and any names and phone numbers of providers who may have information.
You may want permission from the staff and your relative to sit in on your relative’s evaluation in the emergency department to listen and add information as needed. The best emergency department decisions are made with all the relevant information.
If your relative has a hearing impairment or does not speak English, he or she may have to wait for someone who knows American Sign Language or an interpreter. It is generally not a good idea to use a family member to interpret in a medical situation.
Be sure to Inform them if your relative has…
- Access to a gun
- Lethal doses of medications or other means of suicide.
- Stopped taking prescribed medicines.
- Stopped seeing a mental health provider or physician.
- Written a suicide note or will.
- Given possessions away.
- Been in or is currently in an abusive relationship.
- An upcoming anniversary of a loss.
- Started abusing alcohol or drugs.
- Recovered well from a previous suicidal crisis following a certain type of intervention.
Next Steps After the Emergency Department
After your relative’s physical and mental health are thoroughly examined, the emergency department personnel will decide if your relative needs to be hospitalized—either voluntarily or by a commitment. If hospitalization is necessary, you can work with the receiving hospital to offer information and support and develop a plan for the next steps in your relative’s care. If involuntary hospitalization is necessary, the hospital staff should explain this legal procedure to your relative and you so that you both have a clear understanding of what will take place over the next 3–10 days while a court decides on the next steps for treatment. If the emergency department’s treatment team, the patient, and you do not feel hospitalization is needed, then you should all be a part of developing a follow-up treatment plan. In developing a plan, consider the following questions:
Questions to ask your family member:
- Do you feel safe leaving the hospital and comfortable with the discharge plan?
- How is your relationship with your doctor, and when is your next appointment?
- What has changed since your suicidal feelings began?
- What can I do to help you after we leave the emergency department?
- Will you agree to talk with me if your suicidal feelings return? If not, is there someone else you can talk to?
Questions to ask the treatment team:
- Do you believe professionally that my family member is ready to leave the hospital?
- Why did you make this decision about my family members’ care?
- Is there a follow-up appointment scheduled? Can it be moved to an earlier date?
- What is my role in their safety plan?
- What should I look for, and when should we seek more help, such as returning or contacting other providers?
Creating a Safety Plan
Following a suicide attempt, a safety plan should be created to help prevent another attempt. The plan should be a joint effort between your relative and your doctor, therapist, emergency department staff, and you. As a family member, you should know your relative’s safety plan and understand your role in it, including:
- Knowing your family member’s “triggers,” such as an anniversary of a loss, alcohol, or stress from relationships.
- Building support for your family member with mental health professionals, family, friends, and community resources.
- Working with your family member’s strengths to promote his or her safety.
- Promoting communication and honesty in your relationship with your family members.
Safety cannot be guaranteed by anyone—the goal is to reduce the risks and build support for everyone in the family. However, it is important for you to believe that the safety plan can help keep your relative safe. If you do not feel it can let the emergency department staff know before leaving and see if they have any additional advice.
Going home
Make safety a priority for your relative recovering from a suicide attempt. Research has shown that a person who has attempted to end his or her life has a much higher risk of later dying by suicide. Safety is ultimately an individual’s responsibility, but often, a person who feels suicidal has a difficult time making good choices. As a family member, you can help your loved one make a better choice while reducing the risk.
Reduce the Risk at Home
- Guns are high risk and the leading means of death for suicidal people—they should be taken out of the home and secured.
- Overdoses are common and can be lethal—if it is necessary to keep pain relievers such as aspirin, Advil, and Tylenol in the home, only keep small quantities or consider keeping medications in a locked container. Remove unused or expired medicine from the home.
- Alcohol use or abuse can decrease inhibitions and cause people to act more freely on their feelings. As with pain relievers, keep only small quantities of alcohol in the home or none at all.
- Temporarily removing knives or locking them up.
- Have your teen in “line of site” at all times – so they aren’t alone in a room without someone.
When can you start to relax?
As your teen progresses with longer-term therapy or treatment, with the support of a therapist, you can begin to ease up on different parts of the safety planning. You can give your teen more independence and trust that more communication is happening.
Knowing when to loosen up on safety restrictions can be challenging if your teen is not receiving support or treatment. Ensuring that part of the long-term care includes ongoing expert advice is important. Too often, we see teens re-admitted for attempts multiple times because treatment is either not happening or they were inappropriately matched to a program that was not a fit. Ensure your teen has long-term care to minimize relapse.
Fighting over freedom and constraints
It is normal that your teen may quickly want access to former freedoms once they are at home that you are not ready for. They may want to go to parties, hang out with friends who may be unsafe, or want access to the car right away. It’s important that you make it clear when having these conversations or reminding them that these freedoms are not yet a part of the safety plan – that you are not punishing your teen—you are restricting freedoms to help keep them safe. Your teen should not be punished for having a suicide attempt. However, it is important to uphold boundaries at home that can keep them safe.
It is also important not to reward your teen by lavishing them with gifts or extra freedoms. This can set up a dangerous dynamic where the teen may believe that by threatening suicide, they can gain leverage over their parents.
We’ve seen both sides of these dynamics quite often. It is normal to have conflicting feelings after your teen has an attempt, including anger, a desire to punish or reward them, or guilt and shame. It’s important to stay loving and warm while being honest and firm. A family therapist can help guide you in striking that balance.
Resources for families:
Families commonly provide a safety net and a vision of hope for their suicidal relative, and that can be emotionally exhausting. Never try to handle this situation alone—get support from friends, relatives, and organizations.
Safety planning app for teens: https://teenlineonline.org/yyp/my3/
Psychiatric advance planning documents: https://nrc-pad.org/
For survivors of attempts and their families: https://lifelineforattemptsurvivors.org/
