To preface this, I'm still agitated from earlier today because my therapist decided to do yet another suicide assessment...and I'm sick of them.

I don't think suicide assessments are effective tools when screening patients with BPD. Since our emotions can vary in intensity from minute to minute, hour to hour, the assessment isn't, as I see it, an accurate overall picture. 

Today my therapist noticed how ridiculously anxious I was, and he later said "you were crawling out of your skin". I made some 'vague' statements about suicide/self-harm and that was my downfall. I hadn't taken the one medication that helps control my anxiety and the thoughts of suicide and self-harm. I told him that, and I said I had it with me. I wanted him to tell me to take it, but he wouldn't, he made me make the decision on taking or not taking it. At that point I was trying to do damage control, so I took it. We proceeded with the assessment, the med kicked in halfway through, and I completely changed. It was noticeable, and by the time we finished I was in a completely different frame of mind than an hour before. I successfully avoided the hospital. 

While taking the medication helped in this situation, this hasn't always been the case. I've been to the ER before where I sit there for several hours, get the med and psych screenings, and then am discharged because I'm no longer in any 'immediate danger'. 

I think BPD needs to be screened differently in regards to suicide. Since a lot of us struggle with chronic suicidality, answering questions of "do you have a plan?" is, to simply put it, unfair. And admitting there's some form of an established plan ups the chances of hospitalization. So, what can be done differently? I've started to use the terms "active plan" and "inactive plan". The inactive plan relates to my chronic suicidality, it's already there and will always be there, however I have no intention to act on it. The active plan refers to a new plan, or previously inactive plan, that I'm taking steps to develop or refine the details. There's an obvious intention to act on the plan, and this is when I'm not in a good space mentally/emotionally. 

Another issue that surrounds suicide assessments with BPD is how familiar it can become. Answering the same questions over and over, completely multiple assessments, it becomes fairly easy to manipulate the scoring. This is a part of what I refer to as damage control, having the score low enough to avoid hospitalization but at a moderate level to avoid obvious straight-up lying. Part of it is intentional, of course, I recognize I can be a manipulative POS at times. But another part is my BPD kicking in and I end up, at times, sabotaging someone's attempts to help me. It's another way to push people away, and I haven't figured out a way around this one. Professionals are always going to err on the side of caution because of the potential ethical and legal ramifications that may occur. Unfortunately, this leaves a large portion of those with BPD in the situation that can actually be detrimental to treatment. Indirectly it seems to further some of the BPD symptoms (avoidance, self-sabotage, manipulation, etc.) that are trying to be treated. 

Has anyone ever thought along these lines and/or have suggestions on how to address these issues?