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.
Have you ever been suicidal or had suicidal ideation and called a suicide hotline? If your answer is no, you have exactly no authority to speak on their effectiveness. “But doctorate!” Exactly. You’re standing on their side of the line, so of course you’re going to support them. “But research studies!” Has it ever occurred to you that the people who responded positively in those polls might not have been suicidal or even depressed, but were in fact, just sad? A friendly voice giving you platitudes IS helpful, if you’re sad. Or at the end of the call, when asked if they would take the survey, how many of the frustrated, demoralized, and possibly even livid people who hadn’t been helped actually stuck around to make beeps for them? I know I’d just hang up on their audacious asses at that point.
I called a suicide hotline exactly once and ended up in prison for 2 weeks. Certainly not going to make that mistake again.
The mental health system in this country is laughable. No one involved has any idea what will actually help, because the field is still young and the subject so complex. And this article is a perfect example of the field’s flailing in the dark. The good bit about this article is that the comments section has a lot of good anecdotes I can use as fuel for the novel I’m writing on the subject of how garbage our mental health system is.
I first had suicidal thoughts at age 8 as I had been extremely mentally abused since I was 5. At age 9 I called my first hotline. They put me on hold for an hour and then ended the call on me. I was dejected and didn’t call for another year or so. The second time I called, I was almost 11 and given the advice of “you’re still young, you’ll be fine.” then she asked me if I had an actual issue and hung up. I cried all night and started self harming shortly after. The last time I called was when I was 13. The call ended on me after I said “hi I need help” and was audibly crying, to which I called back and no one answered. I agree with what people are saying about being so angry you don’t commit. I was a child, failed multiple times by these people who are supposed to be there for help. The helpline number was plastered all over my schools walls and I had to see it knowing that they had already failed me 3 times as a suicidal child. I now have a therapist at age 21, but I refuse to ever contact a helpline, and will continue to encourage people to seek out other forms of mental help. These hotlines work for some people, but everyone I’ve talked to who’s used one has been told disgusting disrespectful things, hung up on, and/or “received help” while the operator responded like a bored 2nd grader.
Why hotlines receive so much?? Every time that I have called, perhaps 4x total in my life.
They proceed to lecture, judge you, condescend you, make hostile comments such as “ you have the suck it up mentality, because of xyz “ another one is “ you are not the only one “
as though I need to be told something that is a serious FOREGONE conclusion!! Theres more, but these are my two main reasons for hating to ask for help, especially when calling a crisis, ie help hotline!!
Logically, and realistically, the only thing a hotline *can* do for you is listen and be attentive. The fact that police involvement is even a consideration is frankly stupid. The police can’t force you to continue living, and their “help” isn’t going to do your mental state any favors.
[This comment was edited to abide by the site’s Comments Policy. – SF]
suicide hotlines do nothing to help people with money.
social safety net in good old shitty US are gone!!!
This is why we have soo much homeless.
The American Dream
“The American Dream is the national ethos of the United States, a set of ideals including representative democracy, rights, liberty, and equality, in which freedom is interpreted as the opportunity for individual prosperity and success, as well as upward social mobility for oneself and their children, achieved through hard work in a capitalist society with few barriers.”
So how many of you are experiencing “the opportunity for individual prosperity”
or “upward social mobility for oneself and their children”
I’m not seeing it in our society, are you?
“achieved through hard work in a capitalist society with few barriers”
More like a unchecked capitalist society & all I see are barriers in society.
people need to demand more from society because what we are getting is not cutting it anymore!!!!!
The American???????? dream has become a nightmare!
There’s also the fun experience of getting a suicide hotline operator who skips through all the BS and just flat out tells you to do the deed. That’s happened to me three times, on three different hotlines, in two different states.
Then of course there’s the fun of getting to the hospital E.R., either under your own power or because you were drug there by authorities summoned by the “help” line people, and then being left to rot in the waiting room for hours. Got to sit in the waiting room for eight hours at one point before I finally determined that doing so was worse than dying or continuing to suffer, and just walked out. No one stopped me. No one cared. No one bothered to check up on me despite having all of my contact information.
I spent a year as an unpaid phone volunteer on a suicide/crisis prevention hotline in California. We received about 40 hours of training on a variety of relevant topics. The paid staff were deeply dedicated to helping callers. I never had occasion to call the police, but I did see it happen once or twice during the year I spent on the hotline. For us, at least, it was a last resort used only when the caller said they were about to harm themselves imminently, they were alone, they had a plan, and they had the means.
Nevertheless, I did quit after completing the one year I agreed to prior to training. I quit for two primary reasons. First, we were expressly forbidden to give advice of any sort, except referrals to other services. Callers would sometimes implore me, “Please, just tell me what to do!” I was required to respond with something like, “I believe you have the ability to handle this. What do you think you should do?” This was often frustrating for the caller and me.
Second, the vast majority of the callers were not suicidal. These “familiar voices” often were isolated, lonely people who simply wanted someone to talk to and maybe vent to about their frustrations. They often wanted to stay on the phone as long as possible, but we were instructed to limit these calls to 10 minutes each. Some had a list of hotlines and warm lines and they would work their way down the list, making 10 minute calls to each. Frequently, my entire four hour shift was familiar voices. While I did like talking with these familiar folks, and I came to care deeply about them and their circumstances, that’s not what I signed up for on a suicide prevention hot line.
From reading the comments in this thread, I see a lot of hostility towards these hotlines. Let’s face it, their effectiveness is limited because suicidal ideation is a DIFFICULT problem to solve in the best of circumstances, and talking to a well-intentioned volunteer stranger on the phone is unlikely to add long term value. Our job was to keep the caller “safe for now” – meaning during the immediate crisis- and to encourage them to find someone to be with them until the immediate crisis waned. I believe this approach is potentially useful for callers in immediate emotional crisis, but of limited value for those suffering from persistent, debilitating suicidal ideation.
Stacey, thank you for your work on this vital topic.
Michael,
Thank you so much for sharing your experiences and impressions. You provide a greater context than my article did. It’s a bit ironic: Many people detest hotlines because the counselors give advice they don’t like, yet you’ve demonstrated how it can be constraining not to give any at all. And I appreciate your pointing out that hotlines’ effectiveness is inherently limited in many cases, because suicidal individuals typically face complex, difficult-to-solve problems. Perhaps that’s yet another reason some people hate hotlines: they called with hope of solving their problems, when hotline counselors don’t have a magic wand. (If only!)
Last, I want to thank you for your words of appreciation for my work. 🙂
You should be ashamed of yourself for writing this absolutely bullshit article. I have called hotlines numerous times and it has NEVER made anything even close to better or helped in any way and mostly I ended up feeling worse off than before the call.
You are perpetrating a fraud and you discount people with real experience dealing with these failure hotlines to bolster a system that doesnt work but you likely profit off of somehow. I am disgusted how you ignore and downplay the horrific treatment so many have experienced and posted about. You are everything wrong with mental healthcare in this country, stuck in your old ways that havent helped anyone and ignoring the people who are going through it.
Anonymous,
Wow, you have very strong opinions about this. I’m sorry you’ve been hurt by hotlines. The article does acknowledge reasons why people dislike them, so it’s hardly a puff piece. (And no, for the record, I don’t profit off of hotlines in any way.)
It’s truly unfortunate that you’ve never been helped when you’ve called a hotline. At the same time, research shows that many people are helped. Is there a reason why you believe your experiences apply unilaterally to all the millions of people who use hotlines every year?
Anyway, I do appreciate your sharing your viewpoint — and my having the chance to respond. Thanks for sharing.
I am glad you responded to him/her. I have to say when I called maybe 3 times many many years ago the experience was not a good one but that doesn’t mean that all those who answer the call are not professional, able, etc.
Carol (not sure how to reply directly to you, so this might reply might appear in the wrong order),
Thanks for sharing. I understand how someone’s experiences with hotlines (or anything, for that matter) may be uniformly negative. But it’s also true, as you note, that it doesn’t mean those experiences are true for everyone.
With that said, I’m sorry your experiences with hotlines haven’t been helpful. I hope you found good help in other ways.
As a reporter I’d have thought you would understand survivor bias. What do you assume happened to the people these suicide hotlines DIDNT help?
Matt,
That’s an excellent question! Survivor bias is definitely an issue in many studies, and it’s true that some people who were unhappy with suicide hotlines may have ended their life, thus depriving researchers of the opportunity to interview them. But statistics put the situation in perspective. In the U.S. in a single year, almost 50,000 people die from suicide. Meanwhile, in a 10-month period, the 988 Suicide and Crisis Lifeline provided services to people across 5 million calls, texts, and chats. Assuming everyone who died by suicide had used the hotline (which is extremely unlikely), that still would mean that almost everyone who used the hotline survived and were able to give their opinion.
Based on another comment you left (which I’ll reply to soon), I see that you’re very angry with me for not unilaterally condemning suicide hotlines. I don’t understand why you, and many others, take such an all-or-nothing stance about them. Is it really that hard to believe that hotlines actually help some people among those 5 million calls, texts, and chats in a 10-month period? (6 million a year, if we extrapolate.) I find it hard to believe that that would not be the case. When millions of people use a service, there will be highly negative reports and highly positive ones, too.
Like just about everything else in life, hotlines aren’t all good or all bad. For the people they help, I’m grateful. For the people who don’t feel helped – or who even feel hurt – by hotlines, I offer my sympathies. I hope they find good help, wherever that may be.
I don’t care if you can help a thousand people feel nicer(?) in their life, if the price of that help means you indirectly have to murder someone else, you should at the very least be ashamed of the hole where you morality should be.
I’ve been calling them for about 10 years, I would say. Obviously I’m still here! But it’s a mixed bag with the responders. Some are the coolest people you’ll ever want to meet and you wish that person was your girlfriend. Others are dull, are slow and don’t listen to you – they interrupt.
Others just say nothing, so you’ll tell them something that was incredibly difficult to share, you’ll pause and eventually say “Are you still there?” And there will be more silence, because the person is NOT there – they are daydreaming or distracted or what-have-you, but they certainly didn’t hear what you’ve just said – and then they’ll say “I’m still here.”
At which point I say “I gotta go. Thanks for your time! Bye.” And I hang up and call back and try and get someone cool.
Farkle,
Thanks for sharing your experiences. Your description mirrors what I’ve heard from many others: some hotline counselors are great, and some still have a lot to learn. It is, as you said, a mixed bag. Sort of like many things in life, right? I always urge people to please try again if they have a bad experience, because every counselor is different.
In any case, I’m grateful you’ve been helped on some occasions and especially that you’re still here. 🙂 Thanks again!
What’s keeping me from calling 988 is the simple fact that I’ll probably end up in a locked ward, potentially after being handcuffed and dragged to an ER in the back of a cop car. I’ve been traumatized by that too many times now.
So, I ended up chatting with 988 last night. I guess about the only thing that was moderately helpful was I ended up nodding off waiting for their replies… that is, until the police arrived an hour later and I had to convince them that I’m fine.
The replies I got were just canned variations of “I understand that you’re in pain”, that “you’re strong for reaching out” (felt like anything but that) plus constant prodding for me to tell them that I’m safe. Truth is, I don’t know if I’m “safe”, but I let them know being put in lockup or having the police arrive wouldn’t help. I have no desire to be alive, yet guilt and cowardice has so far kept me here.
So, was it helpful? Not in the way you would expect. A well trained chat-bot could probably do much better.