My opinion is that your attitude about this is too categorical.

I have been in a position where I called a friend because I was frighteningly close to actually doing it. This is after many years of very aggressively pursuing professional mental help in therapy / outpatient settings (which all my close friends are aware of).

If my friend had called 911 after I asked them not to, I would have considered it a betrayal. It would have set in motion a set of events that would cause extreme distress for me, and (I am fairly certain) not provided any greater relief than the years of medications and talk therapy I was already pursuing.

And it would have breached the trust I feel in one of my closest friends in a way that I'm not sure could have been recovered. I believe this would have put me on a path towards having distance from my friends, and being more imperiled overall.

If I couldn't trust my friend not to call 911, I never would have called them. Unless that national suicide hotline above promises absolute confidentiality and not involving authorities, I guarantee I will never call it.

Everyone is different and I'm not giving any advice here. I'm just glad my friend didn't take the hard-line stance on this that you do.

I agree. People talk about "professional help" like it's categorically a good thing. Unfortunately, that's not always the case.

It is incredibly important to understand that many inpatient facilities are profoundly hostile environments for some patients, despite claims of a "therapeutic milieu" (which is somehow exactly the same for both depressive and manic disorders; sure, of course that's credible /s). Based on my experiences at the only two such facilities in my metro area, I would be very, very, very hesitant to ever admit to suicidal ideation in the future. The idea of going back to such a place is enough to make me consider the risk of "going it alone", even knowing that doing so could be a fatal mistake. Comparisons to imprisonment are not exaggerations: it absolutely did feel like punishment, like I had no rights, like the staff merely treated me as a "problem" rather than as a patient or client. Some of the "professionals" were not worthy of the term, particularly the "clinical social worker" types (some of whom expressed, with complete confidence, deeply weird and absolutist "theories" of mental illness that correspond to no credible theory that I've read about in reputable literature).

(punchline: my depression was almost certainly caused by a chronic physiological disorder, one which neither facility screened for; most of the "treatment" I received was probably exacerbating my condition instead of improving it)

I guess if I had to make this venting "practical" I would say this: if you ever have a close friend or family member in an inpatient facility, and they tell you that they really, really need to leave because it's a bad place, believe them. No one else will.

This too is an issue that medical advice to friends and family regarding suicide covers explicitly: to wit: do not commit yourself to confidences regarding suicidal impulses. You may need to break those confidences to ensure the safety of those you care about, and the commitments may harm your own judgement about your best course of action.

There are a variety of things you can do before calling 911; "call an ambulance NOW" is not the message I am trying to send.

If you're someone I know well enough to judge the credibility of a plan to kill yourself (which could mean "complete stranger" is the plan is particularly credible), and I become aware of such a plan, I would feel obligated to ensure you saw a doctor, with the word "ensure" chosen carefully.

At this point I feel like I'm replying to comments on these threads more out of habit and standard message board compulsions than anything else, and, given that the topic we're discussing is sensitive, I'm going to force myself out of the thread now.

> If you're someone I know well enough to judge the credibility of a plan to kill yourself (which could mean "complete stranger" is the plan is particularly credible), and I become aware of such a plan, I would feel obligated to ensure you saw a doctor, with the word "ensure" chosen carefully.

The scenario I am describing to you is one in which I was seeing a doctor, regularly (once a week). I was already getting help. The only assistance I was not getting was inpatient, take-your-rights-away-for-a-while forceable assistance.