If you use social media, it might shock you to know that suicide hotlines do – yes, really – actually help many people.
Seriously.
I swear.
This is shocking news, I’m sure, because according to tweet after tweet on Twitter, if you call a suicide hotline, they do one of only three things:
- Tell you take a warm bath or make some tea
- Put you on hold
- Call the police and have you carted off to a hospital.
I’m here to tell you the facts about calling a suicide hotline. If you don’t have time to read the whole post, here’s the summary:
If you call a suicide hotline, the counselor will probably help you in some way. Research shows suicide hotline counselors do help many people, and usually do not call the police.
Every counselor is different. There are thousands of suicide hotline counselors around the country, some great, some not-so-great; some skilled listeners, some advice givers; some with years of experience, some doing their first gig ever; some with hundreds of hours of training in counseling, some not so much; some volunteers, some paid.
Calling a hotline is kind of like dating: Did you go on one bad date and then swear off dating forevermore? Personally, I gave dating a go for 20 or so years before I finally met my mate. And I’m grateful I didn’t give up, because he’s a swell husband, father, and co-conspirator in getting the cats to pay attention to us. But back to the point…
Suicide Hotlines Help (Mostly)
Like most things in life, suicide hotlines aren’t perfect. They don’t help everyone. But they help most people, in some way.
A research team reviewed 31 studies on the effectiveness of telephone and text hotlines for people in crisis. Their findings make a compelling case for hotlines to get more love:
- All 11 studies that measured a caller’s emotional state at the start of a call and at the end found “significant improvements.”
- In 12 studies that measured callers’ satisfaction with the hotline, the average rating was 78%, with a range of 29% to 100%. OK, that low of 29% is disheartening, but what about the study where 100% of the hotline users were satisfied? Statistically speaking, the glass is way more than half full.
- Six studies asked users if they’d recommend the hotline to others, and 91% said yes.
This is what one hotline caller says about her experience (not in the research cited above, but in a comment to another website’s post):
“I have called 800-number hotlines on multiple occasions, when it was 2am and the darkness was pressing in, and it really did help me to have a presence on the other end of the line who could hear my anguished sobs without making me worry I was a burden. They are definitely why I’m alive now.”
That commenter went on to say, “Some people aren’t able to ask anyone for help. I’ve been there. But some people do reach out, and in those times, anonymity can be such a saving grace. That’s why I support hotlines. They do save some lives.”
Look again at the last line: They do save some lives. It’s true.
In this study of callers to the National Suicide Prevention Lifeline, callers’ suicidal intent, hopelessness, and psychological pain all went down from the start of the call to the finish.
So, Why the Hate for Suicide Hotlines?
You don’t have to look far to find viral vitriol against suicide hotlines. Like this tweet:
There are many more tweets like that one, too. Hundreds, probably. Maybe even thousands, if you want to go through Twitter and count.
What is it about suicide hotlines that gets people so riled up? Several things, I think:
Most suicide hotlines call the police…sometimes.
Usually, suicide hotline calls do not result in the police being summoned. But some do. One study found counselors “initiated rescue procedures” in 13% of calls. People placed an estimated 2.1 million calls to the Lifeline’s centers in 2020. That means the police were called about 273,000 times.
The proportion of calls to police goes up markedly for people a counselor believes are at imminent risk of suicide. In a study of actions taken for such callers, counselors contacted police without the caller’s advance knowledge or consent in 25% of cases.
When a counselor judges a caller to be at “imminent risk,” the counselor believes the person will most likely die by suicide within hours or, at most, a few days, without immediate intervention. And even in those extreme situations, 3 of 4 people judged to be at imminent risk were helped in other ways, without police or paramedics showing up on their doorstep.
Having the police come to your home or workplace and take you to the hospital can, no doubt, be traumatic. There’s a small but significant risk, first of all, of getting shot to death by the police. In the U.S., one out of ten police shootings occur after a concerned friend or family member called 911 out of concern for their loved one’s mental health.
Most people aren’t shot, obviously, but police involvement can be traumatic in other ways. If the police believe you pose a danger to yourself or others, you might be handcuffed or strapped to a stretcher and taken to a hospital against your will for a psychiatric evaluation. The hospital might charge a hefty bill. And you might end up admitted to a psych hospital against your will for a few days (or, less commonly, longer), which also is expensive.
These actions might be justified if your life truly is at stake. You might even feel grateful later to the counselor for saving your life.
But sometimes, hotline counselors panic. I’ve heard or read of someone calling a hotline because they were having suicidal thoughts but no plan or intent to act on them – and still the hotline counselor called the police. For an especially sobering account, see this Mad in America article: Suicide Hotlines Bill Themselves as Confidential—Even as Some Trace Your Call.
“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,” wrote one commenter on this website.
Why Do Hotlines Call the Police?
In the U.S., in order to be a part of the National Suicide Prevention Lifeline, a hotline must have a “rescue” policy.
The American Association of Suicidology (AAS), which accredits suicide hotlines, has the same requirement. It states in its accreditation standards manual:
“An active rescue … should be implemented if a person’s life is in danger even when the person will not or cannot assent. Because we also value a person’s privacy and self-determination, ideally, the intervention is done with the person’s consent. When that is not possible, the intervention will occur without the person’s consent or knowledge, only after all other options have been exhausted.” (I bolded those key words.)
Typically the hotline counselor talks with the caller about how to stay safe. This could involve making a safety plan, going to the hospital voluntarily, or getting someone else involved. But if the caller’s not willing or able to do that and the counselor believes the caller’s in immediate danger of suicide, the counselor may well call 911, which then typically dispatches police or paramedics.
The Lifeline’s rationale for requiring “active rescue” is that by calling a suicide hotline, a person is asking for help. “Rescue is a response to a cry for help and may often involve taking extraordinary actions to save a life,” the hotline accreditation standards manual states.
By the way, a call to the Lifeline, at 988 or 800-273-8255 (TALK), routes you to the suicide hotline closest to you. If you call a hotline directly, without going through the Lifeline, it still follows the Lifeline’s procedures if it’s accredited. So, when I refer to Lifeline counselors, I’m really referring to counselors at almost every suicide hotline in the U.S.
Do Any Hotlines Not Call the Police?
Most suicide hotlines in the U.S. belong to the 988 Suicide & Crisis Lifeline network. To avoid needing a rescue policy, a hotline can choose not to be accredited. A notable, but uncommon, example is the Trans Lifeline, which has a policy of not calling the police unless the caller asks.
The Trans Lifeline’s website states, “Trans Lifeline does not engage in non-consensual active rescue. Since our founding, we have been divested from the police. That means that if you call us and are in crisis, we will not call 911 or the police — unless you explicitly ask us to.”
The Trans Lifeline explains its reasoning in detail in this post, “Why No Non-Consensual Active Rescue?”
Foregoing accreditation can have financial consequences. In a list of the advantages of accreditation, the American Association of Suicidology states, “AAS-accredited programs have additional credibility with funding agencies and insurance companies.”
Like the Trans Lifeline, there are some peer support lines, often called “warmlines,” that have no accreditation and no policy requiring them to call the police if someone’s in immediate danger of suicide and won’t take steps to stay safe. The Wildflower Alliance Peer Support Line is one example.
How Can You Avoid Having the Police Called?
In general, a hotline counselor will consider you to be at “imminent risk” for suicide – and thus requiring rescue against your will, if you can’t collaborate on a way to stay safe – if you make clear you want to kill yourself, you intend to try soon, and you have the ability to do so, according to the National Suicide Prevention Lifeline’s Policy for Helping Callers at Imminent Risk of Suicide.
To avoid having a hotline counselor call the police, you can avoid giving them a reason to. That is, don’t say anything to indicate you’re in peril of ending your life imminently. Also, complete a safety plan if the counselor proposes one, and say you’ll follow it.
Now readers, if you are having thoughts of killing yourself very soon, I do recommend being honest about them. As a therapist, I very much want clients to be truthful with me about their suicidal thoughts.
But I’m also a realist. I know many people are terrified of someone calling the police to forcibly take the person to a hospital. (If you have any doubt, check out any of the 500 or so comments on my post, Will I Be Committed to a Mental Hospital if I Tell a Therapist about my Suicidal Thoughts?)
To me, advising you to watch what you say is “harm reduction,” in the same category as giving clean needles to people addicted to injectable drugs: You wish the person would do the ideal, safest thing, but at least you can make it so they’re in less danger.
It doesn’t need to be all or nothing. That is, I’d rather you call a hotline, be careful not to give the appearance of imminent risk, and connect with a trained, caring counselor than never call at all because you fear the police will come.
I happen to think talking with someone who’s trained to truly listen (no small thing, by the way) can help you. You can, at least for a bit, not be alone with your pain. You can talk things through and maybe – hopefully – come to a point where you feel enough hope when the call ends that you do stay alive.
The possibility of police involvement isn’t the only reason some people hate suicide hotlines. Here are a couple more:
Some suicide hotline counselors give condescending advice.
It’s frustrating when you’ve suffered from major depression for many months, tried a half dozen antidepressants, read a zillion self-help books, gone to therapy enough to pay for your therapist’s next overseas vacation, and the hotline counselor advises you to take a warm bath. Like, that’s really going to cure my depression. Like, why didn’t I think of that?
I get it, being told to take a bath can feel ridiculous – to some people. But not to everyone.
When I was an emergency room social worker, I often reminded patients’ worried family members to drink water and to eat. They weren’t stupid. They knew that the human body requires water and food to stay alive. But in those moments, while they vigilantly waited to hear whether someone they loved would live or die, they were focused on only one thing, and it wasn’t drinking or eating. The gentle reminder to attend to bodily needs did make a difference for many people, because they simply had forgotten.
People in crisis often get trapped in tunnel vision. They forget the obvious things that can help. And if the advice to take a bath isn’t useful? Ignore it. Hotline counselors are trying to help. That’s all. They might have some bad ideas, or obvious ideas, or ridiculous ideas, but they’re coming up with ideas for you to accept or reject as you please.
And, who knows? Some of the ideas might work for you.
But advice-giving can derail listening, which brings me to another reason some people have a negative experience when calling a hotline:
Some suicide hotline counselors don’t listen.
A suicide hotline counselor ought to listen to you, respond with empathy and compassion and curiosity, help you feel heard and less alone, and let you speak without immediately offering rebuttal, advice, reassurance, persuasion or anything else that puts you and the counselor on opposite sides of a potential argument. (Usually, that is. Obviously there are exceptions.)
Ideally, when you speak with a counselor who’s not bossy or judgmental, you experience the space for your own wisdom to bubble up while in connection with someone else. You end up giving yourself advice, essentially. And you trust that advice more because it came from you, not a stranger, though a stranger’s keen listening skills might have helped you get there.
If you don’t arrive at solutions yourself, it can be helpful for a counselor to give advice if you’ve already had the space to be heard and listened to without judgment (barring an immediate, significantly life-threatening crisis that requires an immediate response).
Advice around safety planning tends to be especially useful. Advice around baths and tea-time? That depends on the person, but clearly a lot of people don’t like those kinds of recommendations, based on angry social media posts to that effect.
Why do suicide hotlines recommend a bath so much? Or tea?
When someone’s in crisis, advice can help them get through the moment. I suspect that the take-a-bath advice comes near the end of the conversation, when the counselor asks the caller what they’ll do when the call ends. Based on my own years working at hotlines in the 1990s, it probably goes something like this:
Counselor: “Now that we’re nearing the end of our call, what will you do when we get off the phone?”
Caller: “I don’t know. Just sit here, I guess.”
Counselor: “What could help you do to feel calm or give yourself some pleasure?”
Caller: “I can’t think of anything.”
Counselor: “What about a warm bath, would that help?”
Is that so bad? The person might say, “No, that won’t help” or “For f’s sake, I don’t even have a bathtub.” OK, so a bath’s out. What are other possibilities?
It’s not like someone says, “I have major depression, I want to kill myself, I’m in so much pain that I can’t bear it another moment,” and the counselor says, “You’ll cure your depression and stop feeling suicidal if you take a warm bath.”
At least, I hope not.
Wait, it does happen, apparently. One person said when she turned to a hotline for help with her incessant suicidal thoughts, the counselor suggested that “the cure for my problem would be to go get my nails or hair done.”
Not good, right? Indeed, if the counselor truly did suggest that a manicure or hair cut would cure a person of suicidal thoughts, that reflects a poor understanding of the deep stress, psychological pain, trauma, substance use, mental illness, and social injustices that typically trigger suicidal thoughts.
A suicide hotline counselor is trying to help callers survive, moment by moment, not to cure a person’s longstanding problems in a single phone call. If getting a manicure helps someone stay alive for more moments, fantastic! If not, maybe a bath will help.
Just kidding – sort of.
Kidding, because advice to take a bath can feel like telling someone who’s been shot to take an aspirin.
Not kidding, because baths do help some people relax, distract themselves, experience pleasure, and more. And whatever helps, helps.
My advice about suicide hotlines:
If a hotline counselor doesn’t help you, please try a different one. As I said earlier, there are many hotline counselors, and the next one will probably be better.
Or the next after that.
Chances are high you’ll find some value in calling, because, as the research shows, most people do.
If you prefer to text…
The Lifeline offers services via online chat. Additionally, the Crisis Text Line offers help by text; you can access them by texting HOME to 741741.
Have you called a suicide hotline?
What was your experience with the hotline like, good or bad? Was it in the U.S., or elsewhere? If you’d like to share, please leave a comment below.
Copyright 2022 by Stacey Freedenthal, PhD, LCSW. Written for SpeakingOfSuicide. All Rights Reserved.
I sent 988 an email LAST MONTH and still haven’t gotten a reply
Anonymous,
That’s so disheartening to hear. It makes me wonder if your message actually went through to the appropriate person. That said, I am not aware of 988 providing services by email. I just asked ChatGPT, and it stated, “988 does not provide email-based immediate crisis counseling. Their ‘Contact Us’ form is for questions/feedback—not for real-time crisis help.” I would hope that someone would reply to a general inquiry, but I have no idea what kind of backlog they have.
If you were wanting help related to suicidal thoughts, you can get it by calling 988, texting 988, or using their online chat form.
ive tried multiple hotlines and text lines and theyre either closed or dont pick up.
“usually” do not call the police.
That ‘usually’ isn’t enough to take the chance, especially in the US where the ambulance they force you to take can cost you thousands, if the police don’t just shoot you.
the last time I called the suicide hotline they just tried to get me off the phone as soon as possible, they did ask me if I had eaten and I said I hadn’t and they said they hoped I would get something to eat and that was the end of the call. I’m not saying it isn’t helpful advice, or that they were trying to be condescending. But it definitely came across like I was wasting their time, and that they needed me off the phone asap to help someone who had actual problems. It was a terrible experience, and the worst part is that they didn’t even really do anything wrong, it’s just me. It made me realize that my struggles aren’t actually worth recognizing, that there wasn’t any point in talking to other people about wanting to kill myself because it didn’t matter, because I didn’t matter. I wish I had a better experience, and I have nothing against the lady I talked to, I’m sure she was also having a rough day. But I did not feel like she actually cared, I just felt like she wanted to get me off the phone. I feel worse than ever, I think I might [kill] myself, idk.
[This comment was edited to abide by the site’s Comments Policy. — SF]
Dear Anonymous,
I’m really sorry that your experience was so painful. I’m sorry that you are hurting so badly. I hope that you do not hurt yourself, and I hope that you have moments and experiences that let you see your genuine worth. But I know it can be very hard. I’m truly sorry.
hey, thanks for replying, I’ve been doing pretty bad recently but trying my best, going to therapy and taking my meds, I feel better now than I did when I wrote this, as the feelings have somewhat passed. I have actually had good experiences with the suicide hotline in the past when I was much younger, a good 4 or 5 times, and they always listened and helped talk me down, I think it was unfair of me to generalize that it’s a bad service all the time. And the person I got most recently really was trying their best, and wanted to help, even if it didn’t really seem that way to me, I don’t want to die and I don’t want to hurt myself again, I’ve been down that road already. Things can seem pretty dark but sometimes I will have a good day, and it feels like it’s worth it. Sorry to worry you, and I hope you are doing ok as well, to anyone reading this just know you are not alone, and that things can get better even if it doesn’t seem like it.
while it might not feel like it, the way you feel does matter (and coming from someone who has struggled with my friends telling me to eat despite refusal because of an eating disorder and other tendencies) it’s normal to feel that way when you feel rushed when venting, and while it might not feel too special coming from some stranger on the internet, I hope you don’t, it’s hypocritical of me to say this but, there are those who care for you and will listen you just have to find them and when you do you’ll start feeling important again, so please have a good day
Have you considered that people don’t want an “active rescue” might refuse to call because of that? Might it be preventing people from calling, due to risk of further trauma, debt, loss of personal freedom and civil liberties afterwards?