After an AttemptA Guide for Taking Care ofYourself After Your Treatmentin the Emergency Department

AcknowledgementsThis brochure was originally developed by the National Alliance on Mental Illness( in partnership with the Suicide Prevention Resource Center ( Grant Number 1.U79 SM55029-01 from the Substance Abuse and Mental HealthServices Administration (SAMHSA), U. S. Department of Health and Human Services(HHS).DisclaimerThe views, opinions, and content of this publication are those of the author and do notnecessarily reflect the views, opinions, or policies of SAMHSA or HHS. The listing of nonfederal resources in this document is not comprehensive, and inclusion does not constituteendorsement by SAMHSA or HHS.Public Domain NoticeAll material appearing in this publication is in the public domain and may be reproduced orcopied without permission from SAMHSA. Citation of the source is appreciated. However,this publication may not be reproduced or distributed for a fee without the specific, writtenauthorization of the Office of Communications, SAMHSA, HHS.Electronic AccessThis publication may be downloaded at mended CitationSubstance Abuse and Mental Health Services Administration. After an Attempt: A Guide forTaking Care of Yourself after Your Treatment in the Emergency Department. HHS Publication No.SMA18-4355ENG. Rockville, MD: Center for Mental Health Services, Substance Abuse andMental Health Services Administration, U.S. Department of Health and Human Services.Revised 2018.Originating OfficeSuicide Prevention Branch, Center for Mental Health Services, Substance Abuse and MentalHealth Services Administration, 5600 Fishers Lane, Rockville, MD 20857, HHS PublicationNo. SMA18-4355ENG. First printed 2006. Revised 2018.Nondiscrimination NoticeSAMHSA complies with applicable Federal civil rights laws and does not discriminate onthe basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con lasleyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color,nacionalidad, edad, discapacidad o sexo.

Recovering From aSuicide AttemptThis brochure was created to help you as you begin to work through the challenges thatled you to attempt to take your life. It offers information about moving ahead afteryour treatment in the emergency department and provides resources for more informationabout suicide and mental illnesses.TodayToday may feel like the hardest day of your life. You have seriously thought about or perhapsattempted to end your life. You may be exhausted. A common experience after surviving asuicide attempt is extreme fatigue. You may be angry. You may be embarrassed or ashamed.The attempt itself, the reactions of other people, transportation to and treatment in anemergency department or other health care facility—all these can be overwhelming to youright now. But, recovery is likely, and all the feelings you are experiencing right now can getbetter.After the Emergency DepartmentAfter you have been treated for a suicide attempt in an emergency department and thedoctors believe you are medically stabilized, you will either be discharged (released) or youwill be hospitalized.If you are discharged after your suicide attempt, the staff in the emergency departmentshould provide you with a plan for followup care.The exact steps for followup care will vary with each person, but your plan should include: A scheduled appointment in the near future with a mental health provider (suchas a psychiatrist or other licensed therapist). Make sure that the name and contactinformation for the provider is given to you before you leave the hospital and that yourappointment will occur as soon as possible. Information on any treatments that you received in the emergency department, such asmedications, and what, if anything, you will need to do about those treatments after youleave. Referrals to local and national resources and crisis lines for information and support.See the back pages of this brochure for more information.1

Once you have a plan for followup care that you understand and are comfortable with, youand, if appropriate, a family member should work closely with a therapist to ensure thatyour plan is meaningful and effective.If the emergency department staff feel that you need more immediate care or longerterm care than the emergency department can provide, you will be referred for inpatienthospitalization. If hospitalization is necessary, you and your family, if appropriate, can beginto work with the hospital to develop a plan for the next steps in your care. Hospital staff(usually a social worker) should help you with this process.What if You Don’t Want To Go to the Hospital?People generally have the right to consent to or refuse treatment. However, if the emergencyphysician believes you are a danger to yourself or someone else, he or she must considerhaving you hospitalized involuntarily for a limited period of time. Laws about commitmentvary by state. If you have questions about your rights as a patient, you should contactyour local Protection and Advocacy organization. These are legal centers that are funded toprotect the rights of persons with mental health needs. You can either go to their nationalWeb site at or call the office at 202-408-9514 to inquire about the Protectionand Advocacy center in your state.Next Steps: Moving Ahead and Coping With Future Thoughts of SuicideRecovery from the negative thoughts and feelings that made you want to end your life ispossible. You may get to a place where you never have thoughts of suicide again and youcan lead a happy, satisfying life. You also may learn to live with these thoughts in a way thatkeeps you safe.After you leave the hospital there are several things you can do to help in your recovery. Itmay feel hard and overwhelming right now, but over the next few days, following these tipscan help turn things around.Create a safety plan. You and your doctor, or other licensed therapist, should work togetherto develop a safety plan to help reduce the risk of a future suicide attempt. When creatinga safety plan, be honest with yourself and your doctor to ensure that the plan meets yourneeds and that you feel comfortable with it. Although everyone’s safety plan is different,some common things that may be in your plan include: signs that may indicate a return ofsuicidal thoughts or feelings and what to do about them; when to seek additional treatment;and contact information for your doctor, therapist, or a trusted friend or family member.Keep a written copy of your safety plan nearby so you can refer to it as needed.Build a support system. A support system is a key part of recovering from a suicide attemptand preventing another one. It is important that you have at least one person in your lifewho can be your “ally.” This must be a person you trust and can be honest with—especiallyif you start to have thoughts of ending your life again. Family members or a close friend2

can serve this important purpose. A member of the clergy, mentor, or colleague also could behelpful to you at this time. Having more than one ally can be a great asset, as well.Keeping your ally informed about your thoughts, feelings, and wishes can help in yourrecovery and may help prevent another suicide attempt. You will have to be honest withyourself and with your ally to make this work. Even when you are feeling alone, alwaysremember that there are people in your life who care about you a great deal and are willing tohelp.Learn to live again. When you are recovering, the world can look like a pretty bleak place. Itmay take a little while before your life starts to feel comfortable again. One thing you can doto help is to get back into a routine. Eat at regular times, exercise regularly, and go to sleepand get up at the same time each day. Try to join in your usual activities a little at a time, andadd in more when you feel comfortable.If you continue to have thoughts of suicide, reach out for help immediately and contact yourally, a doctor, or a crisis hotline (see the back pages of this brochure for listings). Remember:The emergency department is open 24 hours a day, 365 days a year to help you if you havethoughts of suicide or if your medical team is unavailable to provide you with the neededcare.Listen closely, and carefully consider the support and advice you receive. It is important tobe honest with yourself, your doctor, or others about your feelings so that you get the bestpossible care.Sometimes being under pressure and having thoughts of suicide can make it difficult for youto make the best decisions, and at those times, other people may have a more realistic view ofyour situation than you do. Your ally can help you work through these confusing and isolatingthoughts and feelings and help keep you safe.Everyone’s recovery is different. Some people have persistent thoughts of suicide. For others, suchthoughts may accompany certain moods or circumstances. Here are some steps you can taketo prevent negative and destructive thoughts in the future and to keep you safe. You also maywant to consider adding some of these steps to your safety plan. Remove the means for hurting yourself from your environment: Work with your ally to removemethods of self-harm. It is better not to have these things around while you are recovering. Ifyou use medication, keep only a few days’ supply on hand and ask someone else to hold ontothe rest. For other means of self-harm, place them in someone else’s hands for a while; youcan always take back these items when things feel more settled. Identify what sets off or starts these thoughts for you: It may be an anniversary of a painful event,for instance, or seeing a knife in the kitchen. Plan to minimize the effect of these triggers on3

“Since the timeI was in theER, I haveyour life. Sometimes you can avoid them or train yourself to responddifferently, or you can involve your allies ahead of time to help youface a difficult situation. Remember that life events do not cause asuicide, but they can increase the risk of an attempt. Learn about mental illness: Someone who has had or is living withsuicidal thoughts may be suffering from a mental illness such as bipolardisorder, schizophrenia, or major depression. Contact a doctor or seethe back pages of this brochure for more information about mentalillness and treatment.experiencedthoughts ofsuicide, butluckily Ihave a strongsupport systemin place.”Quote from anational survey ofindividuals whoattemptedsuicide. Learn about crisis hotlines: Hotlines provide you with a trained personto talk to when you are having suicidal thoughts. This person will listento you and help you choose another path. The person you talk withmay work with you on your safety plan, so have that plan close by whenyou make the call. If you do not have a safety plan in place, the crisisstaff will help you create one. See the resources listed at the back of thisbrochure for more information on crisis lines. Participate in a mutual peer-support group: There are many types ofsupport groups, and you may wish to participate in one in your area.Learning from others and sharing your experience can make a bigdifference in the way you think about your life. It also may help save thelife of someone else. The resources listed at the back of this brochure canlink you to a number of peer-support centers in your area. Get involved in life: Finding a hobby or enjoying a favorite pastime—such as listening to music,watching your favorite movie, or collecting things—is a great way to help you cope when thingsget tough. Hobbies or activities that involve interacting with others are an especially good idea.Whatever your interests may be, make sure you have access to the things you enjoy. That way,if your negative thoughts come back, you can turn to something that brings you comfort andenjoyment.Remember—there are reasons to live and make things better. You can survive, and even thrive,despite the way you feel at times. Recovery is likely.4

To learn more about suicide, healing, hope, and help:If you’re in crisis or distress anytime, day or nightNational Suicide Prevention Lifeline: 1-800-273-TALK (8255).Live chat: www.suicidepreventionlifeline.orgVeterans Crisis Line and Military Crisis Line: 1-800-273-8255 (press 1).Text to 838255. Live chat: http://www.veteranscrisisline.netThe Trevor Project: 1-866-488-7386. For lesbian, gay, bisexual, transgender, andquestioning (LGBTQ) young people. http://www.thetrevorproject.orgWebsites for Suicide Attempt SurvivorsNational Suicide Prevention Lifeline’s “With Help Comes Hope” website has informationfor survivors, friends and families, and clinicians. It has survivor stories, self-care tips, “7things attempt survivors wish their friends and families knew,” a therapist and support groupfinder, videos, and n Association for Suicidology is a professional organization with an “AttemptSurvivor/Lived Experience” division, where attempt survivors have a collective voice in thefield of suicide s/suicide-attempt-survivorsNational Action Alliance for Suicide Prevention is a public/private partnership thatadvances the National Strategy for Suicide Prevention. Its Suicide Attempt Survivors TaskForce wrote The Way Forward: Pathways to hope, recovery, wellness with insights from lived from SAMHSAOrder or download from the Substance Abuse and Mental Health Services Administration’s(SAMHSA) Store ( Click “Treatment, Prevention & Recovery” andthen “Suicide Prevention.”A Journey toward Health and Hope: Your Handbook for Recovery after a Suicide Attempt.Guides you through the first steps toward recovery and a hopeful future after a suicideattempt. Includes personal stories from survivors who share their experiences as wellas strategies, such as re-establishing connections and finding a counselor to work with.(SMA15-4419)5

Stories of Hope and Recovery: A Video Guide for Suicide Attempt Survivors. DVD of threepeople who tell about their journeys from attempting suicide to lives of hope and recovery.(SMA12-4711 DVD)A Guide for Taking Care of Yourself after Your Treatment in the Emergency Department(Spanish version also available.) (SMA18-4355ENG / SMA18-4365SPAN)A Guide for Taking Care of Your Family Member after Treatment in the EmergencyDepartment (Spanish version also available.) (SMA18-4357ENG / SMA18-4358SPAN)A Guide for Medical Providers in the Emergency Department: Taking Care of SuicideAttempt Survivors (SMA18-4359)Free Apps from the Apple App Store and Google PlayMY3 Safety Planning App. Stay connected when you are having thoughts of suicide.Virtual Hope Box. Helps with coping, relaxation, distraction, and positive thinking.Finding a TherapistSAMHSA’s Behavioral Health Treatment Locator is for people looking for treatmentfacilities for substance use and for mental health problems. 1-800-662-HELP (4357) orhttps://findtreatment.samhsa.govA Journey toward Health and Hope (see “Free from SAMHSA”) has an excellent section onfinding a counselor.Information about Suicide and Suicide PreventionSuicide Prevention Resource Center. This SAMHSA-funded national resource center hasa wealth of information about suicide and its prevention. www.sprc.orgNational Action Alliance for Suicide Prevention. Public-private partnership thatadvances the National Strategy for Suicide on.orgNational Council for Suicide Prevention. National coalition of leading nonprofitorganizations working to end suicide in the United States. http://thencsp.org6

Information about Mental Health and Mental IllnessSubstance Abuse and Mental Health Services Administration (SAMHSA). A partof the U.S. Department of Health and Human Services (HHS), SAMHSA’s mission is toreduce the burden of substance abuse and mental illness on America’s communities.www.samhsa.govNational Institute of Mental Health (NIMH). A part of HHS and the NationalInstitutes of Health, NIMH’s vision is to transform the understanding and treatment ofmental illnesses. www.nimh.nih.govDepression and Bipolar Support Alliance. Provides hope, help, support, and educationto improve the lives of people who have mood disorders. www.DBSalliance.orgMental Health America. Dedicated to helping all Americans achieve wellness by livingmentally healthier lives. www.mentalhealthamerica.netNational Alliance on Mental Illness (NAMI). Dedicated to building better lives for themillions of Americans affected by mental illness. www.nami.orgPsychiatric Advance DirectivesPsychiatric Advance Directives are legal documents that can be prepared in advance bypeople who are concerned that they might be subject to involuntary psychiatric treatmentor commitment in the future. http://www.nrc-pad.org7

Revised 2018 SMA18-4355ENGFirst printed 200610

After you leave the hospital there are several things you can do to help in your recovery. It may feel hard and overwhelming right now, but over the next few days, following these tips can help