If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.
People in public safety walk into unknown situations every shift, but they rarely walk in blind. There is dispatch information, a size-up, a plan. Walking into a clinic for your own depression can feel like the opposite: no information, no plan, and a lot of worry about what happens next.
For police officers, firefighters, EMS crews, corrections officers and dispatchers who have been living with depression, especially depression that has brought thoughts of suicide, it can help to treat a first appointment like any other call. Get the information first. Ask your questions before you commit. You are allowed to interview a clinic the same way it will be getting to know you.
Is it time to ask at all?
You do not need to have everything figured out before you ask a question. These signs suggest a conversation with a clinician is worth having soon:
- Thoughts of death or suicide, even if they come and go
- Feeling like dead weight to your family or your crew
- No longer caring about things that used to matter to you
- Changes in sleep, appetite or drinking that you keep explaining away
- A sense of being cornered, with no picture of the future
A medic in her late twenties does not need to have talked to anyone before. A retired officer who has tried treatment more than once can ask again. Both are reasons enough to pick up the phone.
Questions about privacy
This is often the first thing first responders want to know, so ask it first. A clinician you choose on your own sits outside your department, and health privacy rules generally limit what a clinic can share without your consent, with narrow exceptions when someone's safety is at risk. It is reasonable to ask any clinic, before you book:
- Who can see my records, and what would ever be shared without my permission?
- How is billing handled, and what shows up on insurance paperwork?
- Is this visit connected in any way to an employer process? (It is not the same thing as a department fitness-for-duty evaluation, but ask how they describe it.)
Questions about the visit itself
Every clinic works a little differently. Useful things to ask about ahead of time:
- How long the first visit lasts and what it covers
- Whether they ask about suicidal thoughts, and what happens if you say yes
- What kinds of treatment they provide, and what they refer out
- Whether appointment times can work around rotating or overnight shifts
- Whether a spouse, partner or friend can come along
On the second question, it helps to know in advance that if you are in immediate danger, a clinician's first job is your safety, which may mean connecting you to emergency care. That is what you would do for anyone on a call.
For the people around you
If someone you work with or live with is showing these signs, you can help by asking them plainly whether they are thinking about suicide, and then by helping them get answers to questions like these. Offering to make the first call with them can matter as much as the question itself.
Depression can be treated, and recovery is possible, on the job or off it. Therapy, medication, sleep, peer support and time all play a part.
Where Spravato may enter the conversation
One question an adult with depression and acute suicidal thoughts might ask a clinic is whether a newer prescription treatment is something they evaluate for. Spravato (esketamine) is a nasal spray the FDA has approved, taken along with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is also approved for treatment-resistant depression. It is not a crisis treatment: it does not replace emergency care or a hospital stay when one is needed, and it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It is given only in a certified clinic under a safety program called the Spravato REMS. The patient takes it there under supervision, stays at least two hours to be monitored, and does not drive until the next day after a full night of sleep. It is never dispensed for home use. Whether it fits is a clinician's decision after an evaluation.
Once your list is written down, the remaining step is to call. Some clinics that offer this treatment begin with a free 30-minute consultation, which is a good place to put those questions to a real person and find out whether an evaluation makes sense. Bring the list, and bring someone with you if you like.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.