A phone call at three in the morning comes as a siren, especially when you work at a crisis hotline. I was alone. Newly awakened, lying in a pull-down Murphy bed in the university counseling center, I pressed the phone against my ear.
“I have a bottle of pills, and I want to take them now. I want to die.” Sobs punctuated the caller’s words.
“You must really be hurting,” I said. “Can you tell me more about what’s going on?”
The caller was a graduate student in a counseling field. After struggling with depression for months, she condemned her goal of becoming a therapist as absurd. How could she help others who had mental health problems when she suffered so many herself?
The pain she felt now could be a gift later, once she was a therapist, I told her. It could help her understand, empathize, and be fully present with clients who want to die.
More sobs. More snuffling into the phone. “You really believe that?”
As a graduate student in social work, I had to believe it. Only a year earlier, in 1996, I’d also wept in my apartment late at night, tormented by the thoughts drumming inside my head: People would be better off without me. Things will never get better. Nobody could ever love me like this.
I was on that chat line for the national suicide hot line. Just expressing some depression over a health issue I was going through at the time. I stopped the chat and thought it was over.
About an hour and a half later the police forced entry into my home.
Saying they were concerned about something I texted on line?? Really
. texted on line to 741..
My god.. I almost shot these officers doing their job responding to a crisis call that was not a crisis. They rushed into my house.
This text counselors clearly over reacted.. And people could have died..
I’m really sorry that happened to you. I constantly tell people, at least in the U.S.A., if we disclose SI (suicidal ideation) or other SH (self harm) to a crisis hotline counselor, we must complete a crisis plan to avoid a welfare check or psychiatric hospitalization. Do not end the conversation early! A crisis plan identifies things we can do other than harming yourself or making a suicide attempt. When our plan is unfinished, we don’t have a plan to take alternate actions other than harm ourselves. You discontinued your conversation halfway through so your crisis plan wasn’t finished. Hotline counselors, at least at all the traditional coercive hotlines and peer warm lines that I’m familiar with, are not allowed to reach out to you again so that you’ll finish your crisis plan and avoid a welfare check. You didn’t finish your crisis plan, so you still fit the definition of “imminent risk” of harm, even if you have no intention of acting on your SI. A supervising mental health professional that works for the hotline decided that you met the criteria for a welfare check and virtually anyone will with an unfinished crisis plan,
When crisis hotlines first started, they were just neighbors helping neighbors. Nowadays there’s always a supervisor that is a licensed mental health professional. It’s about as closely connected as you can get to the mental health system.
An unfinished crisis plan for SI/SH is a guaranteed welfare check by the police. Which is exactly the opposite of how we should be responding!
Read more about the concept of imminent risk in the best practices section of the national suicide prevention lifeline‘s website . So many people feel betrayed when a welfare check happens. This is a huge part of the problem because then we say I will never use a crisis hotline again. 99,9% of crisis hotlines and peer warm lines are coercive and will do welfare checks. There are very few non-coercive crisis intervention options out there that refuse to involve the authorities.
I encourage people to use their non-coercive crisis intervention options instead. One is the wildflower alliance peer support line, formally called the western Massachusetts recovery learning center’s peer support line. You do not have to live in Massachusetts to use them. Go onto their website to find their latest hours of operation.
Another is the IPS suicide prevention group (based on IPS intentional peer support model.) More details are in an article on Mad is America called deadly serious.
https://www.madinamerica.com/2018/08/deadly-serious-talking-openly-suicide/
Unfortunately, the reality is, as soon as we tell another human being (as opposed to telling it to a pet or writing it in a journal), we are at risk of receiving a response that we find unhelpful or harmful.
If we don’t make it safe for people to disclose SI and we always fear a welfare check or psychiatric hospitalization, we won’t disclose it. It then becomes harder for people to cope and more people attempt suicide or die by suicide
That article is, IMO, biased anti-psychiatry, playing on the false narrative of “the mainstream practice of reporting, detaining and drugging”. That’s fear mongering.
There is a very low rate of crisis calls leading to any physical intervention; it doesn’t happen in 90+% of crisis calls.
It paints a misleading picture of therapy and treatment and generalizes from a personal perspective.
It’s valid to feel upset by personal experiences, or to hope for alternatives and change to crisis services, or to support peer services. But again I believe the article link is misleading and wrong to discourage use of crisis lines.
I hope Ms. Freedenthal will read and comment or consider to remove the link entirely.
Nah,
Thanks for bringing this to my attention. I understand your concern that the article discourages the use of crisis lines and thus could lead to people choosing not to seek help. I share that concern, but I also think people have the right to know the risks of calling a hotline, if they want to avoid having the police come to their home. I don’t know about the figure you cite indicating that in 90% of hotline calls, the counselor doesn’t call the authorities. I do know that figure drops considerably when the counselor judges the caller to be at imminent risk for suicide: this study of callers to the National Suicide Prevention Lifeline found that the counselor called the police in almost half of cases (46.8%) where suicide seemed imminent. In 60% of the cases where the police were called, it was without the caller’s consent.
I wish this weren’t true, but sometimes when the police are called, terrible trauma ensues. One study looked at the 2,000 fatal police shootings that occurred in 2015 & 2016. In 25% of cases, the person killed by police had a mental illness, and in 40% of those cases, the shooting occurred after a family member or friend called 911 requesting help. Of course, police shootings are the worst case scenario, but being taken away by the police against one’s will, even without any injuries, can be traumatic. That trauma often is outweighed by the need to protect a person from dying by suicide, but I don’t think we can say it always is; sometimes, the police are called when less invasive measures would have been fine. (This article gives a keen example of someone who was traumatized in this way, though the call was initiated by their therapist, not by a hotline. The article isn’t available online, so please email me at speakingofsuicide@gmail.com if you’d like me to send you a copy.)
People need information about the risks and benefits of any kind of service in order to make an informed decision about whether to use it. I still think people should call the National Suicide Prevention Lifeline at 800-273-8255 if they need help. Nobody should have to struggle with suicidal thoughts alone, and research indicates the crisis hotlines help many people.
As the commenter above states, if someone calls the hotline and participates in creating a safety plan, that ought to allay the counselor of concerns about their immediate danger and almost certainly will result in the police not being called. The study I cited earlier states that in 44% of cases where the hotline counselor thought a caller was at imminent risk for suicide, they created a safety plan with the caller and didn’t call 911. So the earlier commenter’s advice to stay engaged long enough to create a safety plan seems like wise advice.
This was many many years ago but I called a suicide line. I had been calling but feared saying anything precisely because I was afraid they would trace the call and call police. This time I told her I had taken some action and her reply was “youve called here before havent you” in what sounded like an accusatory tone. I immediately hung up. That one time has put me off calling them in times of crisis, Even though it was long ago. I wonder how trustworthy much less empathetic the folks who do give of their time to do this work, are
Lee,
Thanks for sharing your experience. As is true in so many places, the quality, style, approach, etc. of counselors at the hotline – and elsewhere – can vary. I always recommend to people that if they don’t like how one counselor worked with them, to please try again (and again, and again…as necessary) because the next one might be a great match. I do know many people who have been helped by calling the National Suicide Prevention Lifeline and other hotlines, so if you do need that again in the future, I hope you’ll consider it.
Many of us who have sought help in the past will not be surprised at all at the attitudes you’ve encountered from people in your industry. Dealing with that, you should understand why many think we’re better off without that kind of “help” entirely.
A better system is required to remove the bad practitioners IMHO, those who impose those stigmas. It’s as simple as that. If you found out someone in your circle was a Nazi and attended pro-Hitler rallies every Sunday, would you assume you needed to win them over or would you remove them from your circle? A mental health professional who does not respect the types of people they are supposed to treat is more along the lines of that. They don’t need to be convinced. They need to go.
What I’ve gathered from talking with other depressed people is that problems from the patient POV are nearly always related to the attitude or lack of follow up from the practitioner, rarely the meds or techniques. And this comes down to what you observed, that the respect and empathy really isn’t there in many cases. We’re not regarded as adults who can have independent, intelligent thought.
But this kind of talk never leaves the depression forums. Sure, you can make these observations and people will listen, because you’re now a respected member of society regardless of what your past is. And that’s good. But those of us who remain over here are “unreliable narrators”. If you were to show this post to people you worked with they’d almost certainly speculate on my mental state and judgement, given what this site is, rather than take the words seriously.
All this results in a situation where no-one whose opinion matters ever asks if a specific mental health professional is the problem, and if they should really be practicing or not.
I’m not sure the issue of attitude is ever going to get fixed, as you can’t truly teach grown people to respect someone who they have always felt contempt for. My real hope is that one day the meds will become so good that the human element in mental health treatment will be removed or severely reduced. Science and tech has treated us pretty well in other areas, so who knows?
I believe that every person has the right to commit suicide. I feel it is not a selfish act but an opportunity for the person to relieve themselves of all the pain and suffering they are feeling. Living sucks and when you have nothing to live for it is the best way out
Thanks Stacey for rewriting this. Im not sure how much it helps (at least me) to know others feel the same way but to put out the information that this is more common then we tend to think, and that ‘professional’ doesnt automatically mean no struggles may well be a new thought for many folks.
Oh, Stacey … I know from what you’ve written before about your suicidal feelings but to read them once again brings tears. But it also brings a feeling of joy – that someone so many of us chronically suicidal people look up to can write so well about her feelings gives me hope that maybe we can help just one more person make it through their rough night (or life.)
At my antique 74, I seldom drop into the depression of “I want to die!” but recently ran through a bout. Once again I’m “on the other side” of that bout but have to wonder how many more I can take … but then at 74, I have to wonder how much more of me I can take.
At the very end of your beautifully written article you mention a new book in progress (my interpretation), I’d sure like to be able to see that while I still have the mental capability to read and understand it…
Dragon,
Thank you for your kind words. I always enjoy getting feedback from you. And I especially am touched by the joy of hope that you describe. So sorry to hear you went through a rough time again, and so glad you made it through. Take care.
I looked high & low for this site because I had commented on my feelings toward suicide , about 2 years ago . Now , at 76 , my feelings toward suicide has gained strength & it was important to read other’s views to validate my own feelings . I was so lucky to , indeed , find the site again & posted a comment to someone , looking for an ” Easy” way to suicide . Looking over other comments , I wanted to comment again about how Difficult it is to go to a therapist & realize that , if you confess to having suicidal thoughts , you run the risk of being ” Baker Acted ” .
As I sought out a therapist , I was told at the beginning of our 1st session , ” I have to inform you of the fact that , By Law , I must report the possibility of your intention to commit suicide”
REALLY ?? And you expect a patient to pour out their anguish with the knowledge , they might be hauled off to the loony bin ??? I realized I would never be able to trust in Anyone to tell my true thoughts & feelings , if I couldn’t tell it to the therapist . As it turned out , I never divulged my deep suicidal thoughts , but because of a misinterpreted idea , on the part of over zealous coordinator … I was Baker Acted !! I was fortunate to find a therapist who catered to my spiritual side & that calmed my suicidal tendencies for a good amount of time .
As my health problems increased , so did my feelings of wanting to die . I know I can never achieve my death by my own hand & resigned to just pray that I don’t wake up the next morning . But Alas … here I am … another day . I will continue to cry & lament the days that are before me . The many doctor visits , the 24/7 tending
to my symptoms , the total stripping of my personality & confidence, leaving me to mask my true feelings & play act , when I really want to Scream ” I’m dying in increments, slowly , with no hope of getting better ” . I wish I had the Courage to take my own life … but I don’t . I’ll continue to “Act” strong , while I’m really a whimpering baby inside .