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Steve*is a big strapping guy, well over six foot. He used to work in aircraftmaintenance and his life seemed relatively stable. But every once in a whilethings got too much for him, and then he used to call the National SuicidePrevention Lifeline (NSPL) just to have someone to talk to, even though he wasnever actually suicidal.
Oneday, during his lunch break, he was feeling “pretty down,” in his words, anddecided to call NSPL. He spoke with a call attendant for around ten minutes andthen hung up to get back to work.
Twentyminutes later, police showed up at the hangar where he worked. He hadn’t evengiven the call attendant his name, let alone his location. And he hadn’tmentioned suicide to anyone. But the officers claimed they’d been told he was inimminent danger of his life, and they escorted him to an ambulance.
Stevewas mortified.
Itwas really embarrassing and traumatizing. All my coworkers and my lead andsupervisor, they saw me get taken away.
Hewas taken to a veterans’ hospital where he was detained in “absolutelymiserable” conditions. Fortunately, his brother-in-law managed to get himreleased that same day.
Buthe was left with a $1,050 ambulance bill, not to mention the emotional scars ofhis experience. Even though he was cleared by a doctor for returning to work, threemonths later, he lost his job with no adequate explanation.
Thehotline was the most reliable place for me to get help when I needed it, andnow I feel I can’t trust that place anymore.
Steveisn’t alone in what he went through. Probably over a million people have hadsimilar experiences in the past two years, since the NSPL became 988Lifeline.Today, around 200 call centers are part of the 988 network, and while severalhundred other crisis hotlines have yet to join, most of them follow the samegeneral guidelines when it comes to summoning police or emergency services.Samaritans of NYC and the Wildflower Alliance are two of the very few crisishotlines that never trace callers without their explicit consent.
988Lifelinewas established in 2022 and is run by Vibrant Emotional Health (Vibrant), whichwon the federal contract from the Substance Abuse and Mental Health ServicesAdministration (SAMHSA). Over a billion taxpayer dollars have been invested increating a centralized crisis call center and encouraging as many privatehotlines to join.
Ostensibly,the idea is to save lives. Success is hard to measure given that data onsuicides over the past few years aren’t yet available. The American PsychologicalAssociation (APA) cites an evaluation showing that 80 percent of callers saythat they have been deterred from committing suicide—but their template forcall attendants is strikingly different from what Steve and thousands of othershave experienced. The APA writes that,
Thelifeline uses an established model of call flow that includes establishingrapport with the caller, asking about immediate risk of suicide, listening tothe caller’s story, collaborating with him or her on a safety plan, andoffering follow-up as needed. Follow-up calls take place 24 to 48 hours afterthe initial call and continue until the caller is connected to longer termservices, no longer feels at risk, or says he or she doesn’t need furthersupport.
The80-percent success claim is based on follow-up calls from the call attendant,not a follow-up visit by the police, complete with handcuffs.
Ifyou ask therapists or other mental health professionals, they’ll often playdown the likelihood of being taken into psychiatric custody following a call toa crisis hotline. Kati Morton, who calls herself a “mental healthprofessional,” recorded a video for her followers after someone asked her,“What happens when you call the suicide hotline?”
Youtube
Theywill ask you... do a basic suicide assessment. They’ll ask: Do you have a plan?What are your thoughts like? How long has this been going on? And then they’lljust try to talk you down...
Nothingreally happens,
sheclaims. But then she adds,
Ifthey’re really worried for your safety they’re going to try to find out whereyou live because they’re going to want to send a psychiatric evaluation team,people who call to make sure … that they’re okay. They just want to keep yousafe, it’s nothing scary, they’re not going to force you into doing anything,just ask you a bunch of questions, they just want to make sure that you’re okay...
Mortonthen asks for comments below the video, since “a lot of you have been helped”by such hotlines. There are almost two thousand comments, overwhelminglyexpressing frustration, anger, disappointment, and feelings of betrayal aftercalling for help only to have police turn up on their doorstep.
I’mnever calling every again, called once the guy was so sweet I opened up quicklynever once did I say I was suicidal next thing I know 3 police cars and 2ambulances banging at the door. Next thing I know I’m the in back of a policecar being transported over to some psych ward they ruined my family all inneeded was to talk now my family doesn’t trust me…
Someresponders pointed out that the whole point of a crisis hotline is to getconfidential support and that the “imminent risk” intervention policy defeatsthe entire purpose:
Ifthey can track your number … then exactly what is the motive to calling thehotline? Obviously, a person calls in order to avoid hospitalization.
Formany, especially those living with family who feel, for whatever reason, unableto confide in them, the purpose has already been defeated:
Iwant to call the help line but I don’t want to go to jail or a psych ward. Ijust want to talk to someone who isn’t my parents…
Ina report to Congress in April of this year, SAMHSA admitted that it has “noresearch” to validate its intervention policy. Research over the past decadeshas consistently shown that even the “experts” are astonishingly bad atpredicting who will commit suicide, regardless of what people say or refrainfrom saying. In fact, at least one meta-study showed that a coin-toss would bealmost as good in terms of prediction.
Furthermore,call attendants describe training that lasts just two half-days, including twohours devoted to making risk assessments. Some claim that the decision to ask911 for call tracing is based more on the attendant’s nervousness than theactual condition of the caller. Naturally, no one wants to keep everythingconfidential only to find out that someone took their life, but many anecdotalreports suggest that call attendants seem to be fishing for a statement thatcould be used to “determine” suicidality so that they can claim “imminent risk”and get 911 involved.
Natasha*called 988Lifeline when she was feeling, in her words, “depressed and kind ofwishing that I might just die. I wanted to talk to another person and maybe bereassured a little.”
Ididn’t feel like she was really hearing me. She was kind of using cannedresponses. [She asked me,] “If you were going to kill yourself, when would youdo it? And how would you do it?”
Ijust kind of gave her the first answer that popped into my head. I thought itwas kind of a weird thing for them to be asking me, because isn’t the goal totry to talk me out of committing suicide, instead of helping me make a plan?
Next,the call attendant suggested Natasha should head immediately to a psychiatrichospital, but Natasha replied that she had a class soon. Then the call attendantwanted to send police out, but Natasha said it wasn’t necessary. Thecallattendant responded. “The police can determine that.” Natasha panicked andhung up.
Fifteenminutes later, police and an ambulance arrived at her home.
Natashawas strapped to a stretcher and taken to a psychiatric hospital where she was forcedto strip completely with several people watching. She was placed in a smallroom furnished with nothing but a bed, and left there from half-past-eight atnight until half-past-eight the next morning, without anyone telling her whatwas going on.
Finally,a social worker turned up.
Iwas terrified. [He] diagnosed me with bipolar disorder. I don’t know where hegot that from. And he was trying to make it sound like I told them I had triedto overdose prior to calling the hotline. And I was saying, “No, that’s notwhat I said at all.” And he told me that now I was lying.
Exhaustedafter a sleepless, panic-stricken night, Natasha was told she would be detainedin the psychiatric unit for evaluation. She was also given two differentpsychiatric drugs and told to attend group therapy. When her 72-hour holdexpired, she was told that unless she signed herself in voluntarily for furthertreatment, a court application would be made to hold her.
Ithas very serious career implications, because when something like that goes tocourt, you’re introducing it into the public record. I knew that I had to avoidgoing to court at all costs, and my only way to do that was to sign myself involuntarily… There was nothing voluntary about this.
Twoweeks later, Natasha was finally discharged — with a hospital bill for $50,000.
988Lifelinehasn’t released any data on how often they summon police or EMS, but they claimthat this happens to less than two percent of callers. Some regions cite otherfigures, such as New Mexico, where 3.5 percent of those who call their Crisisand Access Line have police or EMS summoned as a consequence. It’s important tonote that this is 3.5 percent of all callers, including many who make nomention of suicide or even any serious issue at all. In fact, only 27 percentof their calls are related to suicidal feelings, meaning that the interventionrate for these callers is closer to 15 percent.
Accordingto a new national survey, police or EMS are summoned for around 8 percent ofcallers. However, a further 17 percent of callers have a “mobile crisis team”turn up outside their home following a call, and in many cases they too will betaken to psychiatric hospital.
Consideringthat in 988Lifeline’s first year alone, over 5.2 million people called theirhotlines, this means that police or EMS have been summoned to “check up on” arounda million people since then.
Ifthat translated to a million lives saved, nobody would have any complaints.Unfortunately, the opposite is more likely to be the truth. A large studyfollowing 100,000 people conducted between 1996 and 2017 found that during thefirst few days after being discharged from psychiatric hospital, peoplesuffering from depression are 330 times more likely than the average person tocommit suicide.
Furthermore,the lack of having a solid plan for support after discharge was associated witha higher suicide rate. As the APA notes, follow-up is extremely important forthe vulnerable. However, as many reports show, people who were involuntarilyadmitted to psychiatric hospital after a call to a crisis hotline are a)usually abandoned after discharge (especially since many were never activelysuicidal at all) and b) so suspicious of interventions following theirexperience that they shy away from any future contact with mental healthservices.
Thenthere’s c) people who weren’t suicidal before their crisis call, but becomesuicidal after being betrayed, as they interpret it, by the only person theythought they could trust.
Cathy*is a law student in her early twenties. She has been in therapy for a while dueto her adolescent experiences of stalking and assault. At one point, hertherapist suggested using 988 for times when she just wanted a listening ear.
Ijust wanted somebody to walk me through those flashbacks and do things likegrounding techniques or breathing exercises. It’s just really nice to haveanother person as an anchor.
Oneday, when she was having a tough time, Cathy called 988Lifeline. She talkedabout her feelings with the call attendant, who listened and offered supportfor around ten minutes—and then she asked Cathy where she lived. Not suspectinganything at this point, Cathy told her which city she lived in, only to havethe call transferred to a local call center.
Thenew call attendant was aggressive in her approach and demanded her name andaddress, which, given her background of stalking, was traumatic and played onher vulnerability. She also asked Cathy “over and over again” if she wassuicidal.
Iwasn’t, but I might have said something like “I want all of this to stop,”meaning the flashbacks, because I was having severe flashbacks throughout this[call]. And she just kept pressing this issue of suicidality [and how I woulddo it]. I felt like I needed to answer. I felt like I couldn’t hang up. In thesituations that I have been in with predators, I often found that the path ofleast resistance was the path that led to the least pain; so, you do what theywant.
Cathydidn’t realize that the call attendant was putting her through a riskassessment, or that replying with some kind of plan to kill herself would puther in a high-risk category. She told the call attendant that she might jumpfrom a high-rise or overdose on pills (even though she didn’t have any pills tooverdose on). The response was quick in coming: Cathy was told to headimmediately to a psychiatric facility.
Shetold me that if I did not come in, she would have to send the police to myhouse. [So I went, because] I very much did not want the police to come anddrag me out of my apartment.
Atthe facility, Cathy had her belongings taken away, including her phone, and waslocked in a tiny room with no daylight for hours. Later, she was strapped to agurney and taken to a psychiatric hospital where she was ordered to sign intakeforms.
Oneof the forms was whether I was allowing myself to be admitted voluntarily orwhether it was an involuntary admission.
Likemany others trapped in this situation, Cathy was told that if she refused to agreeto a “voluntary” stay, she would be confined for longer. She signed heragreement.
Thenfollowed four nightmarish days when Cathy, who had undergone stalking andassault as a vulnerable teen, was unable to sleep at night as the door to herroom had no lock. By day, all the inmates, male and female, were confined in acommon room where sexual harassment was frequent.
“Iwasn’t suicidal going in, but I sure was coming out,” Cathy recounts. She stillhas nightmares.
988Lifelinemay not routinely follow up on callers’ welfare, but that doesn’t mean thattheir records are lost. In fact, all the hundreds of 988 call centers storeboth the recordings and the transcripts of calls received. Why? Because oftheir value.
Vibrant,which runs 988, presents Lifeline as “a leader in … mental health crisis care[offering] confidential” conversations. Of course there are caveats.“Confidential” ceases being so whenever a call attendant determines “imminentrisk,” as noted above. But Vibrant is also careful to note in its Terms ofService, in capital letters, that talking to a 988 counselor “DOES NOTCONSTITUTE … [EITHER] MENTAL HEALTH CARE … [OR] CONFIDENTIAL” communication.This enables them to evade HIPAA confidentiality requirements. In fact, thereare no clear federal protections for call recordings or transcripts.
Ifyou believe SAMHSA, they only record calls for the purposes of “qualityassurance” and “training.” Vibrant states that, “Any information provided byyou or collected on you will not be shared or disclosed with any third party.” However,their website simultaneously states that they offer access to the recordings tothird parties “for research purposes.” Not only that, “researchers” are oftenoffered the option of listening in to calls as they occur. [wiley study]
In2022, Crisis Text Line (CTL) was the subject of public outrage when it becameknown that their for-profit branch, Loris, received millions of calltranscripts from CTL. Following the expose, they stopped passing data to Loris,but they continue to pass data to third parties.
In2023, the National Institute of Mental Health (NIMH) gave $2.1 million to twofor-profit companies that run several 988-affiliated call centers, to be usedto develop AI tools for “behavioral health.” The companies claim that they onlyuse 988 recordings to make software to “evaluate the quality of crisiscounselling.”
JasonKelly of Electronic Frontier Foundation condemns the practice. “If I’m a callerof a helpline, I don’t expect data from the call to be used to create an AIproduct. These [uses] are just totally off bounds, or should be, and should bevery clear in any policy that an organization would have.”
Howdid a network of crisis call centers become a data bank for AI and a resourcefor unnamed third parties (including Meta, since many 988 call centers have aMeta Pixel on their websites)? According to Alan Ross, director of SamaritansNYC, the only branch of Samaritans that doesn’t seek caller information from911, things started to change around 20 years ago when SAMHSA and Vibrantstarted to push NSPL toward call-tracing and hospitalization—around the sametime that psychiatry in general moved decisively toward drug-based treatmentfor “mental illness.”
Lateron, after the NSPL was established and tax funding was built into the system,private call centers were encouraged to join. All Samaritans branches otherthan Ross’ did join up. Ron White of Boston Samaritans explained theconsequences:
[Around2012,] the NSPL finally, kind of, if you will, drew a line in the sand thatsaid, “If you want to be a member of this network, you need to adopt ourintervention policies.”
Rossstill insists that there’s a place for hotlines with absolute confidentiality,despite what some people paint as the dangers.
Youneed diverse forms of access to reach the majority of people. And the greatestgap is confidentiality. People are hesitant to seek help, because they’rescared. They don’t want people to know their business, or they’re ashamed. Ican come up with one hundred reasons why you wouldn’t want to take a chance ofsomeone being able to identify you.
Thereare few options left open to those who don’t want to risk a forciblehospitalization. One option available is the Western Mass Recovery LearningCommunity (RLC) which was established by Sera Davidow. The RLC is a peer-runhotline, meaning that it is staffed by people with lived experiences ofemotional trauma rather than people who have undergone some sort of “professional”training. They never trace calls.
Davidowexplains,
Inmy experience, all that they accomplish [through tracing calls and forciblyhospitalizing people] is to continue to send this message that whatever you’restruggling with, the things that have happened to you, are so dark and soterrible that nobody can handle hearing about them.
TheRLC’s approach, called “Alternatives to Suicide,” she continues, is based onbreaking the taboo of talking about suicide.
Isthe [best] path where everyone is so terrified to talk about suicide because ofconsequences, like having the cops called on you even by confidential hotlines?Or is it the path where we know that we’re going to lose people, and we createas much space as we possibly can to be with people in darkness and talk openlyabout this and support people?
Atthe end of the day, why not simply ask truly suicidal people what they want,what will help them to continue living?
PaulaJ. Caplan PhD cites one study of suicide attempt survivors who told researchersexactly what they wanted:
Reducingstigma of suicidality, expressing empathy, active listening, range of treatmentoptions including non-medication treatments, addressing root problems,bolstering coping skills, trauma-informed care.
Inother words, nothing that a forcible psychiatric hospitalization can provide.
*not the real name
