Somebody brings breakfast on a tray, and it's the most ordinary thing that's happened since yesterday afternoon. Nothing around it is ordinary. There are questions still to answer, a discharge to arrange, and people in the corridor who don't know what to say to anyone.
The weeks after a suicide attempt do have a shape, and nobody sets it out for you before you go. So here it is, stage by stage, with what each part often looks like in Ontario and what you're allowed to ask for at every step. If someone is in danger right now, call or text 9-8-8 or call 911.
Stage one, the emergency department, the first 24 hours
What happens after a suicide attempt starts with the body. If there's an injury or an overdose, the emergency physician deals with that first, and nothing else is discussed until it's stable. Plan for a long stay. Emergency departments triage by risk to life, and that cuts both ways on the clock.
Once the medical side is settled, a mental health assessment follows. Doing it will be a crisis worker, a psychiatric nurse or a psychiatrist on call, depending on the hospital. The questions are direct. What happened, what you were thinking, whether you still want to die, what you can reach at home. They sound blunt because vagueness helps nobody at that hour. Suicide prevention guidance stresses that direct questions are safer than guessing.
Three outcomes are normal from there. Home with a plan and a referral. A stay for observation. Or admission, voluntarily or under the Mental Health Act, when the risk is judged too high for the night ahead.
Cost: the emergency visit is covered by OHIP, including the psychiatric assessment.
A word about tone. Some staff are wonderful, some are tired and brisk, and the brisk ones aren't passing judgment on anybody. If you're the family member, write down the name of whoever does the assessment. It's useful a week later when you're trying to find out what was decided.
Not sure what any of this means for your family? Put it to a counsellor in a free 15-minute consultation before anything else gets decided.
Stage two, the safety plan before you leave
Safety planning means building a short written document with you rather than handing you one. It's the step nobody should skip, it happens before you leave, and there's no wait attached because it's part of the visit you're already in.
Cost: nothing. A safety plan usually covers the following.
The warning signs that arrive before a crisis, in your own words.
Things you can do alone that take the edge off, listed specifically.
People and places that distract you, named, with numbers filled in.
People you can tell outright that you're struggling.
The professionals and crisis lines you'd phone, written out in full so nobody is searching for a number at three in the morning.
Making the home less dangerous, which usually means somebody else holding the medication and anything else that was used or considered.
Leaving the hospital after an attempt without one is worth pushing back on. If nobody offers, say "can we do a safety plan before I go", to the crisis worker or the nurse rather than the intake clerk. Photograph it. Paper gets lost in week one, which is when it's needed. CAMH's suicide information is a clear place to read more about warning signs and support.
Stage three, the first week home and the follow-up call
The first week home is quieter than anyone expects and harder than it looks. The emergency is over, the adrenaline is gone, and what's left is an ordinary Tuesday with a very large thing sitting in the middle of it.
Ask before discharge whether somebody will phone to check in, who, and when. Follow-up care after a suicide attempt is where the system thins out, so a confirmed call beats a hoped-for one. Hospital follow-up practices vary by site, so ask for the schedule in writing before you leave.
What helps that week, roughly in order. Sleep, since nothing else works without it. Another person in the house, or calling round daily. Medication and anything else risky kept by somebody else, which isn't a punishment and isn't forever. One short outing a day.
What doesn't help. Long conversations about why. Deciding your future on day three. Alcohol. WHO's suicide fact sheet notes that connection and practical support matter most in the stretch right after a crisis.
Stage four, connecting to counselling within two weeks
How soon should counselling start after an attempt? Sooner than it usually gets arranged. The stretch right after discharge is where arrangements fall through the gaps, because the crisis services have handed you on and the next service hasn't picked you up yet. That handover is the part worth pushing against.
There are a few routes in Ontario, and you can walk more than one at once.
Public routes through OHIP can include a reassessment and, where needed, psychiatry. Those paths cost the client nothing at the point of care, and waits vary by region, so start early even if you're also looking at private counselling.
A hospital outpatient program, if the discharge paperwork names one. Cost: covered. Ask on the day rather than the week after.
A private counsellor, which is what we are. Our individual sessions are $130 to $200, plus a one-time $50 setup fee, and our student therapist rate is $0 to $80. We don't have a waitlist, which is the whole reason this door exists beside the others. In many cases we can bill your insurance directly, depending on your plan and your therapist, and nobody has to write you a referral.
Stage five, the first month after a suicide attempt, what progress looks like
Progress in the first month is not feeling better. That sets the bar in the wrong place and makes an ordinary bad Thursday feel like failure.
What it actually looks like is this. Sleep settling into something recognizable. The gap between an urge and an action widening. Telling one more person than you'd planned to. Keeping an appointment you didn't feel like keeping. Saying out loud that the thought came back today, to somebody who doesn't panic when you do.
The thoughts coming back is normal, and not a sign the plan failed. A thought returning and the danger returning are separate events, and the safety plan exists for that gap. IASP resources on suicidal thoughts make that distinction clear for families too.
If you're the person it happened to, you're also handling other people's reactions, which run from smothering to strange silence. Our guide to talking about suicide safely is written for them, and forwarding it beats explaining. Our page on teen suicide warning signs helps when the person you're supporting is younger.
Where to turn in Ontario when risk is live
We aren't a crisis service. When things are acute, use these first.
If there's danger right now, phone 911 or get to an emergency department.
9-8-8 Suicide Crisis Helpline, call or text 9-8-8, 24/7, anywhere in Canada.
Here 24/7, 1-844-437-3247, for Waterloo Region and Cambridge, 24/7.
In Ottawa, the Mental Health Crisis Line, 613-722-6914, 24/7.
For ongoing care after the acute stretch, private counselling can start quickly. Depression often sits under or beside a suicide attempt, and our depression counselling page covers that side of the work.
What families can do at each stage
At the hospital, bring a charger, a medication list and a notebook, and ask who to phone with questions.
In the first week, be present without hovering. Ask plainly rather than watching for signs. "Are you having thoughts of suicide today" is safe to say out loud, and it plants nothing that wasn't there. IASP gathers guidance families can use without having to invent the words.
In the first month, take the boring jobs. Lifts to appointments, insurance forms, dinner. Practical help lands better than encouragement.
And look after yourself. Supporting somebody through this is exhausting and frightening, and you're allowed to say that to a counsellor of your own. Plenty of our clients are the relative rather than the person in the story.
Counselling after a suicide attempt
Our counsellors see people in person in Waterloo, Kitchener, Cambridge and Ottawa, or by video anywhere in Ontario. Sessions with our therapists are $130 to $200, and there is a one-time $50 setup fee. Sessions with our student therapists are $0 to $80. Many extended health plans cover counselling, and in many cases we can bill your insurance directly, depending on your plan and your therapist. You won't need a referral, and we don't have a waitlist.
Once the immediate danger has passed and you want somewhere to put all of it, book a free 15-minute consultation and begin where today leaves you.