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.
because I’ve called this suicide hotline and all they care about is people who are in crisis, not real people
I love the hot lines, so helpful to have access to a person! But I hate how many are told to “just listen”. I have no interest in talking to someone who is following a protocol. So afraid of ” giving advice” they do nothing. Thats worst. Just react, be real. Say “that sounds rough* or even ” I can’t really understand”be another human being. Offer advice thats very small, and tentative. Not just hide reactions, that feels lonely to hear.
I’ve lost count of how many times Suicide hotlines DIDNT help me. They’re honestly scumbags.
All the suicide hotline is, is a way for some rich folks to funnel tax money to themselves for no effort.
They get paid via grants from the government, and then they just have to manufacture some data no one really knows anything about to make people think they’re doing something, and they live fat and happy while you kill yourself.
They get a few church lady volunteers to tell you about how you’re going to hell and should take baths and what not, then they call the cops on you who harass you and likely will kill your dog.
Fuck you fuck the hotlines and fuck anyone who tries to push those evil fucking things. It’s all theater – they don’t help. They barely even respond to what you say and when they do they change the fucking subject to try to trick you into saying something so they can send their hit squad of pigs to kill you
Anonymous,
It’s awful that you’ve had bad experiences with hotline. And it’s important for me to point out, for the sake of others considering calling a hotline, that your experiences definitely are not reflective of everyone’s experiences. It’s a fact that many people *are* helped when they call a suicide hotline. But, as your comment attests, not everyone. I don’t mean to invalidate or minimize your feelings of anger and frustration; they are definitely understandable! Thanks for sharing those experiences here.
If nearly every single comment on your article about how suicide hotlines ARENT that terrible, is telling you they actually ARE that terrible, maybe you’re the f**king idiot.
Matt,
I considered not publishing your comment, because it goes against the site’s policy to not publish comments that are personal attacks against an individual, including me. But you raise an important issue that it might help you and other people to see addressed.
Please, never take the comments section of any article — here or elsewhere — as evidence of a true pattern in the general population. This advice applies to chat rooms, Twitter, Facebook, and anything else where large numbers of people share their opinions. You mentioned survival bias in another comment you posted, so I assume you also know about selection bias: the tendency of people to participate in these public forums for specific reasons, usually that they’ve had a negative experience, which then biases the results.
It’s an odd fact of the Internet that people tend to share their worst-case scenarios, whether about a specific diagnosis, job, suicide hotline experience, or something else. Probably someone’s done research on why this is, but my own hypothesis is that people who are angry, hurting, or otherwise struggling about their experience are more motivated to seek help from these online forums than people who are content. (Some review sites like Yelp seem to be an exception to this Internet pattern, probably because the sites aren’t focused on problems to begin with.)
I was curious to see what’s been written about the phenomenon of predominant negativity online, and this article is on point: Why You Should Never Read Online Illness or Medication Forums, and Why You Should be Skeptical of Google Search Results as Well.
Of course, as I said in another comment to you, few things in life are all-good or all-bad, so the headline above is a bit of an overgeneralization. But there is some truth in it, and I hope others who read the comments here understand that many people who comment do so precisely because they’re struggling to make peace with life, themselves, negative experiences, or even suicide hotlines, and their experiences aren’t necessarily (or usually, even) representative of everyone else’s.
What a reply to perfectly encapsulate how little you know about which you’re speaking emphatically on. That article is about physical diseases and illnesses themselves , not about people’s opinion of the treatment they are receiving. Yes the internet exaggerates points, but referencing WebMD hypochondriassm as a defence of your article/comments telling suicidal people they’re just being emotional pack-animals is almost hilariously absurd.
Matt B.,
You are correct that the article I linked addresses people with medical conditions, but the principles apply here, too. That is, the preponderance of negative comments about hotlines are not a representative sample. For example, these words by the author are spot on:
“Unfortunately, Internet illness forums often present a distorted, grim, and negative impression of most illnesses and most medications. Why is this? The main reason is because of selection and sampling bias. The groups of people who post on illness forums are not a representative sample of people with a particular illness.”
This bias applies to other situations, too, not only illnesses.
Also, the author wrote: “The forums are full of posts from the people who suffer the most. People who don’t suffer don’t spend their time posting. And people who have overcome their suffering also don’t post.”
I’ve observed the same, not only on my site but in many other contexts.
For more information about biased samples vs. those representative of the population under study, see this article from Current Epidemiology Reports: Selection Mechanisms and Their Consequences: Understanding and Addressing Selection Bias.
This has been my experience too and I feel the same about anyone who pushes these hotlines … Fuck these hotlines and the people who push them on others.
[This comment was edited to abide by the Comments Policy. — SF]
I have been suicidal for many years now and sometimes I would have multiple hotlines saved in my phone in case I spiraled to that “place” again. However, each and everytime I did this (between 5 people and different lines over the years) they have all failed me. And made my breakdowns 10x worse. Eventually I stopped contacting them all together because they gave me the same scripted crap, parroting literally every small detail I gave to an annoying point. One time I was ODing on lithium and I told the hotline lady this, she didn’t even take me seriously and I should have been hospitalized but was medically messed up and lived after that… So I don’t think hotlines work for everyone. My experiences where terrible
My experience of calling both the Samaritans hotline and mental health crisis hot line has been to make me even worse. The first time I had postnatal depression but I didn’t know it. All I knew was I wasn’t sure my son was my baby, didn’t have anything to say and sat crying all day. The bad Samaritan said ” you don’t have to feel happy all the time” Fast forward to me nearly killing my son in a psychotic break only to be stopped by my dog. I genuinely thought he was trying to kill me. For months my dog guarded and slept with my son, then a neighbour noticed something was wrong with me and took me to emergency doctor. They treated me for Postnatal depression but the shame and guilt consumed me for years.
The last time I called a helpline I said I had gone from thinking, what if I die to if I kill myself to When I kill myself. I said I can’t think of any reason to keep living and she said, have a cup of tea. It was while I was planning my suicide. I came across a suicide sight on how to do the job, and this site was more understanding of my situation than the prevention hot line.Are you going to kill yourself right now is not a one size fits all question.
I just hung up after hearing about this “new” 988 number. I needed 5min of someone telling me at 2am that things were gonna be okay and reminding me to breathe–I had a terrible experience with the old number hotline when I was 19 that ended in a misunderstanding and the cops being called. I was committed to a psych ward for 3 days and I still have a facial scar from the neglectful staff there 10 years ago.
Instead, I got a man yelling at me for 20 minutes about how uncooperative I was, wasting his time at 2am when he had other callers, saying I was putting words in his mouth and shooting down his ideas. I wasn’t, I was just struggling to understand and asking for clarification and taking a moment to process and think genuinely about his suggestions, and when I started crying, he said I wasn’t being productive anymore and unless I needed him to call 911 he was going to hang up. I beat him to it, hung up, got paranoid and emailed my therapist about what happened so that at least if the cops come, I have it on record that I’m safe and just wanted a warmline, which I didn’t even know about til after the call.
I get so furious each time–and have since I was 19–someone solemnly says suicide hotlines save lives. The U.S. medical system cares more about prolonging death than it does saving lives. Remind me that life is worth living even when it’s hard. That it’s okay to face my own mortality without fear, but that it’s not my time yet. Don’t shame me for seeking help wrangling with that odd desire to live but not at the cost of surviving. Don’t frighten me into obedience. Honestly, if I ever do take matters into my own hands, I’ll make sure to write in my note that I killed myself because of 988, lmao. Clearly there’s a bit of truth to it, no?
In all candor, reading everyone’s comments here criticizing these useless “trained counselors” has filled me with a stronger desire to live than anything that dude was screaming at me. As my therapist says, anger has a biological purpose.
Hey, folks. I hate being bipolar and depressed and struggling and lonely and independent and frightened too. I’m so glad I’m in such good company.
Let’s try and stay alive together as long as we can, and use our disgust and anger to make 988 irrelevant. If spite will keep me living, so be it. And the next person I see promoting any suicide hotlines on social media with a wide-eyed statement to “never fear reaching out” gets blocked.
Your not alone. I’m sorry.
I’ve had 15 wellness checks all hostile, 3 involuntary psych admissions all in 3 short years. I have never felt more helpless.
I have never ONCE MENTIONED SUICIDE OR THAT ANYONE WAS IN DANGER.
the worst I’ve done is call the operator on their absolute narcissism.
I called one today. Feel even worse since making that call. They give zero fucks at all
What do you mean by suicide “hotlines”? As far as I’m aware, there is one single hotline for the entire U.S. Also, the National Suicide Prevention hotline did literally absolutely nothing to help after keeping me on hold for over an hour while I waited for someone to become available. I was more suicidal after finally speaking to someone, who sat silently on the phone, refusing to engage in conversation with me. The suicide hotline was put in place to encourage suicide.
This suicide hotline is a joke. They are gaslighting us to believe that having volunteers (untrained strangers) answer a suicidal persons call for help is appropriate. It is not. You should be angry. We need to demand systemic reform! It’s not okay to say “well it helps some people so it’s good”. That is ignorant thinking! We need to put more programs in place that prevent people from getting to the point of wanting to die in the first place. It is common sense. Do let weak sensibilities rule your view. Be realistic. Demand equity. Stop making excuses and manipulating people. The hotline is not helpful. They told me they couldn’t talk to me bc there are other callers. Wtf? Not okay. Shut it down and give the funding to the people in need so they can get the help THEY NEED. It’s sick that I even need to write this out. Be adults. Be human. Use your critical thinking skills- I beg you!
I texted the Crisis Text Line recently because I was suicidal about my grandfather dying. They took forever to respond and just said “you’ll get through it” in a completely dismissive way. If you want real support, look into peer warmlines in your area.
Exactly my experience! It needs to be shut down!