“As for suicidality, this is a tough one for me. We get many patients who have been suicidal or have made a suicide attempt. They are placed on a hold for a short period- meaning they have to stay in a locked facility. Often within a day or two, most of these folks leave as they are no longer suicidal. I think it makes sense to have a place that can act as a sanctuary for people who are in extreme distress and are not thinking clearly. By taking a day or two to reflect, they often change their minds. Is that a service, or a harm to someone who is contemplating suicide?” I’ve come a bit late to this discussion but I want to respond to the points that you raise because I myself was harmed by people making these same arguments. First of all, what you call a ‘hold’ I experienced as a kidnapping under threat of violence. The loss of autonomy was traumatic in and of itself. By all means, let the hospital be a sanctuary for those who seek it out in a time of crisis. It was not a sanctuary for me because I felt violated and threatened by virtue of being held there. Point #2. The vast majority of people who consider suicide do not end up killing themselves. Three months before I was committed, I had a plan to commit suicide. If I had been put on a locked ward at that particular time, I might have honestly believed that the forced intervention saved my life. Maybe today I would even be out there making speeches about how involuntary commitment can prevent suicide. But that’s not what happened. No one knew about my plan, no one stopped me, and I had all the means, motive and opportunity that I needed. And yet I’m alive to write this comment. Because I realized on my own that I couldn’t go through with it. And that was a powerful and important piece of self-knowledge that I gained from the experience. In hindsight, I can tell you with 100% certainty that a forced commitment at that time would not have saved my life and would have denied me an important avenue of personal growth. Yes, in the period before I made the decision there was a risk to my life. This is what is sometimes referred to as the dignity of risk. Point #3: If you are suicidal when committed and you change your mind, you will tell the doctors that you are no longer suicidal so that they will release you. If you are suicidal when committed and you do not change your mind, you will tell the doctors that you are no longer suicidal so that they will release you. If you are ambivalent about suicide when you are committed and the experience is so traumatic that you deeply regret not having taken your life when you had the chance, you will tell the doctors that you are no longer suicidal so that they will release you. I was the third case. I will always remember the young doctor who met me after my intake and informed me in no uncertain terms “we are saving your life”. It was the moment I realized there was no one to protect me in that hospital and my only option was submission. Later on her words echoed in my head as I attempted to commit suicide. If this doctor remembers meeting me at all, she probably still believes she helped save my life. There was no visible violence in our encounter, and an outside observer might even have concluded that she had helped me. But the fundamental psychological damage from being so totally powerless and invalidated was deep and destructive. Using coercion is a dangerous strategy. The power imbalance inherent in the system forces those who have been harmed by it to hide the damage. I am not the only one.