4 Alternatives to the ER If You Feel Unsafe With Suicidal Thoughts

“Can you keep yourself safe today?”

What happens when the answer to that question is no? When someone with suicidal thoughts says, “Actually, I’m not sure I can keep myself safe.” Or, “I actually don’t feel safe right now.” What do you do then — whether you’re the person feeling unsafe or someone else is telling you they don’t feel safe?

Do you call 911? Go to the hospital?  

I’m betting that’s what most people would say. And that is absolutely necessary in some cases, I don’t want to dismiss that. I’ve had to go the ER, and there were times that was the best call. But there have been plenty of times I’ve not wanted to go, and have been able to work with my therapist or providers on alternative options. Of course, if someone wants to go to the hospital — by all means, go.

But I know one of the most common reasons people are scared to speak up about their suicidal thoughts, is fear of hospitalization or fear of the police showing up at their door. For people of color, this fear is often heightened by the inherent danger calling the police poses. Similarly, for people with medical trauma, the idea of going to a hospital can be too triggering to entertain. There are so many legitimate reasons people choose to stay silent about their suicidal thoughts.

So, what else can you do?

I think there are a few options.  

1. Call a crisis line.

While this might seem like common sense, people can be so alarmed by a confession of suicidal thoughts and feelings of unsafety, they jump straight to 911. Crisis counselors on the other ends of the National Suicide Prevention Lifeline, the Crisis Text Line, and other hotlines are trained on how to help someone struggling with suicidal thoughts. They will go through a risk assessment and help determine what the best next step is. 

That being said, I know some people don’t like hotlines, or maybe you did call a crisis line and you’re still feeling somewhat unsafe, or there’s a long wait time on the line. I think there are still a couple more options.

Note: Many hotlines have chat-based options if you’re not comfortable talking on the phone (shout-out to my all my peeps with phone anxiety). 

2. Remove any means to carry out suicide.

If someone has thoughts of suicide, the next natural question is, “Do you have a plan?” If someone says yes to this, that does not automatically make them a danger to themselves. People who live with chronic suicidal thoughts sometimes have generic plans they always keep in the back of their mind. That doesn’t make them an immediate danger to themselves. Someone might have an idea of what they might do. That doesn’t make them an immediate danger to themselves. 

If someone tells you they do have a plan (and they tell you what that plan is), the next question is if they have the means to carry out that plan. Do they have access to whatever they plan to use? Are they planning to obtain access? 

If they do have access, are they able to remove it from their environment? Or have someone else remove it? Is there somewhere they can go where they don’t have access? Are they willing to give it to someone? Do they have intent?

In my opinion, that’s one of the most important steps to ensuring safety, (crisis lines will also likely go through these same questions with you). If a person can’t remove means and/or promise to stay safe (and there is intent), then yes, I think that’s when hospitalization needs to come into the conversation. 

Note: I recognize these are not easy things to do. Having to ask someone to pick up or take things from me so I stay safe and alive — those are some of the hardest conversations I’ve ever had. But I’m so thankful I have people in my life who are willing to do that for me.

3. Ensure the person with suicidal thoughts is not alone.

If someone who is suicidal doesn’t know if they feel safe or not, they should not be alone. Period. I recognize this is easier said than done. Confessing suicidal thoughts to someone itself is hard. Admitting you don’t feel completely safe can be even harder. Having to then ask someone to stay with you, or if you can stay with them, can feel like all too much. Feelings of isolation, being a burden, and thoughts people would be better without you often come with suicidal thoughts. If that’s the mindset someone is in, reaching out can be terrifying. 

But I’ve found, at least in my life, being around people is one of the most important things when I’m in that space. It’s often the last thing I want, but the thing I need most. If I’m with someone or around people, I can’t hurt myself. The mere presence of another person who feels safe, can be everything — in my life, it’s been life-saving.  

It’s not about having the right words, or saying the right things. It’s just about being there, even if it’s in silence. Not being alone doesn’t have to look like calling someone and asking them to come over, either. For me, sometimes that means going to a coffee shop or walking around a grocery store. Just a place where there are other people around.

Note: Your well-being and safety come first. If you cannot be there for the person — for whatever reason that may be, that’s OK. Helping them figure out other options can be just as meaningful. 

4. Call a therapist or a mobile crisis resource.

Depending on the therapist, some will let you text or call them if you’re feeling unsafe. Having a professional who understands that person’s suicidal thoughts and behaviors can be a great resource if they are available. If they’re not, check and see if the area has a mobile crisis team. This is typically a local team of social workers, peer advocates, nurses, etc. who provide free face-to-face crisis intervention services. This can be a good option if the individual needs more professional support, but does not want to go to a hospital. A mobile crisis team can work with the person who is suicidal to provide crisis care and help determine next steps. 

And again, if someone wants to go to the hospital or feels like they need to call 911 — do that! I just want people to know there are other options sometimes. There are ways to get creative. Fear of hospitalization shouldn’t be the thing that keeps someone from reaching out. Because even though conversations around suicide are increasing, there is still such a lack of understanding around it. Personally, I have an immense fear of telling someone I don’t feel safe — admitting that feels like I’m asking for police to show up at my door. But there are people who understand. There are people who are willing to listen and take the time to understand. There are people who want to be there. Let them.

At the end of the day, your safety is the most important thing. You don’t have to do this by yourself. You don’t have to feel like isolation is your only option because you’re scared of what might happen if you speak up. Reach out, advocate for yourself, let people be there for you. You’re worth fighting for, whether you believe that right now or not.