Importance <p>Inpatient psychiatric hospitalizations for suicidal ideation are costly, disruptive, and relatively prevalent occurrences. Psychiatric hospitalizations due to suicidal ideation commonly result from breakdowns in longitudinal outpatient care during which patients lack adequate outpatient care and have a subsequent intensification in their suicidal ideation. In the present project, we seek to understand (a) factors preceding psychiatric hospitalization for suicidal ideation, (b) involvement in and barriers to receiving outpatient mental healthcare, and (c) if patients would have been open to receiving informatics tools delivered via an electronic health record (EHR) embedded patient portal message preceding psychiatric admission for suicidal ideation.</p> Objective <p>To explore patients’ experiences leading up to psychiatric hospitalization for suicidal ideation.</p> Design, setting, and participants <p>We conducted qualitative interviews with 21 adult patients who were hospitalized due to moderate to severe suicidal ideation and were recruited via purposive sampling. Patients were on a 14-bed psychiatric inpatient unit within a large academic medical center in June of 2025. Data were analyzed via Rapid Qualitative Analysis in July of 2025.</p> Main outcome <p>Patients’ experiences preceding psychiatric admission for suicidal ideation.</p> Results <p>Subject interviews revealed three major themes. (a) Patients reported escalations in suicidal ideation lasting between one week and three months prior to psychiatric admission. Many reported seeking services at Vanderbilt University Medical Center emergency departments, walk in clinics, and specialty clinics. This is time during which patients could have been identified and connected with outpatient mental healthcare. (b) Most patients were not receiving outpatient mental healthcare but desired it. Costs, wait times, and stigma were significant barriers. (c) Patients were overwhelmingly receptive to the idea that our health system could proactively reach out to them with informatics solutions to overcome barriers to care.</p> Conclusions and relevance <p>In the weeks leading up to psychiatric admission due to moderate to severe suicidal ideation, patients’ suicidal ideation intensified. It is possible that patients could have been identified and intervened upon during this time to arrest symptom escalation. Most patients reported that they were not receiving adequate outpatient mental healthcare. Patients reported that they would have been open to Vanderbilt University Medical Center reaching out with a Caring Contact, scheduling an outpatient mental health appointment, or providing a mental health treatment app. Future interventions, including informatics-based solutions to connect patients at high risk of suicidal ideation to outpatient care, will build upon these findings.</p>