In 723 of 1,431 calls, for example, the helper never got around to asking whether the caller was feeling suicidal. And
when suicidal thoughts were identified, the helpers asked about
available means less than half the time. There were more egregious
lapses, too: in 72 cases a caller was actually put on hold until he or
she hung up. Seventy-six times the helper screamed at, or was rude to,
the caller. Four were told they might as well kill themselves.There were 33 evident on-line suicide attempts, yet only six rescue
efforts, sometimes because the caller ended the communication. In one
case, a caller who’d overdosed passed out, yet the helper hung up.
Here is the full story, by Christopher Shea. I am curious how much of this problem is due to the non-profit structure of the institutions running the lines and how much is due to the behavioral quirks of human beings faced with the suicidal tendencies of others…
From the comments: "Also, how would a for-profit suicide hotline work? Call a 900 number if
you’re having suicidal thoughts? I find it hard to imagine that a
for-profit suicide hotline system would generate *more* suicide
prevention, though maybe I’m wrong."
Assuming the lack of questions about
“do you feel suicidal” and “what do you have to do the deed” is wrong seems like a stretch. Even if you lined up a therapist who said yes this was wrong, I suspect I could line up a therapist who could say (with good support in literature) that this was ok. The hostage negotiator is in a similar situation, or one trying to negotiate with a terrorist. If actual deaths are at 2-5%, these folks are getting “pass” results 95-98% of the time, yes?
I have been on both sides of the equation when I was younger. In my teens and early 20s I was suicidal, and almost succeeded with one attempt (which actually “scared me straight”, luckily enough). In thankfulness for living, I volunteered on a suicide hotline in Kansas City, MO, in 1990-1. We went through very rigorous training, multiple weekends worth (because it was actually a mental health hotline and we got calls about things besides suicide – lots of domestic violence calls, for ex., for which we had eight hours of training for just that alone).
Asking the questions “Do you feel suicidal?”, “Do you have a plan?” and “Do you have the means to accomplish it?” are all standard training practice. Asking them won’t push a depressed person into a suicidal state, and asking them usually WILL get the truth out of a suicidal person. The next steps usually involve (a) keeping them on the line and talking, (b) making a verbal contract with them for them not to kill themselves, at least not tonight (this actually works), and (c) getting the call traced if it seems necessary. For a volunteer working the phones alone, that may mean needing to make another call – hence the putting someone on hold, perhaps, although now days who knows? Perhaps they have some way to request that via computer while talking to the person on the phone.
The fact that it is run by non-profits using volunteers may or may not be the issue – the non-profit I volunteered for at the time, and the two food pantries I now volunteer at were staffed by incredibly dedicated, incredibly under-paid employees and lots of really involved volunteers. What would be more interesting to me would be not the overall stats of this series of hotlines, but the stats in individual cities – that could pinpoint issues with training, staffing or whatever in specific locales, whereas perhaps other parts of the system shine.
My two cents,
Jim
Not suicide, but my wife worked on a domestic violence hotline for a while, and lots of the calls were people who just wanted someone to talk to. They’d get the same callers over and over and over again and knew from experience that these people weren’t in danger. I wonder if this is part of the issue. Maybe richard m and Jim can comment on that.
Also, how would a for-profit suicide hotline work? Call a 900 number if you’re having suicidal thoughts? I find it hard to imagine that a for-profit suicide hotline system would generate *more* suicide prevention, though maybe I’m wrong.
I have reviewed this topic for publications in the past, and would regard the observation as probably due to the well known fact that psychotherapy differentially attracts people who have themselves suffered psychological problems, and may therefore still be prone to them.
While some psychotherapeutic schools of thought argue that previous client status is an advantage, I feel it is usually a disadvantage.
In particular, there is a tendency in psychotherapy (dating way back to Freud) for therapists to be seeking psychological benefit for themselves from the practice of psychotherapy.
This problem of psychotherapy ‘attracting the wrong kind of people’ may help explain why so many studies of ‘confessional’ psychotherapy (I am excluding psychological therapies, such as behavioural and cognitive therapies) have shown either zero benefit, or negative results – where psychotherapy actually does harm rather than good (even leaving-aside the problems of sexual seduction by therapists, which is a very common problem too.)
So – even though a person or an organization *wants* to help suicidal people, and advertizes themselves as doing so – they may still be doing more harm than good.
“I remember one that would only want to talk to the female volunteers, and would eventually try and get the conversation to turn to what footwear they were wearing”
So they were basically trying to use the suicide prevention hotline for phone sex?! And I thought people on the internet were warped.
A suicide hotline could be for-profit without being paid for by the caller. The government, for example, could pay. Or perhaps one of the religious establishments that believe suicide is a mortal sin (good suicide hotlines may even turn out to be the cheapest way to save souls). I’m not saying that this would work well or better than the current system.
mf: “They are provided as part of Employee Assistance Programs (EAP) behavioral health hotlines.”
Oh, you’re so right. I had forgotten about this benefit my employers have provided. Maybe because I never use them. I just keep on behaving badly.
Don’t life-insurance companies not pay out in the event of suicide?
“Suicide help lines”
I’ll admit I have a very dark sense of humour but…Ahem.
The behaviour described does seem to help people with their suicides.
Or is that not quite the point?
The problem with any emergency hotline is that you are going to have a high occurrence of calls that aren’t high in danger to themselves or others. I am sure that the helpers get tired of talking to the same people who abuse the hotline.
I don’t think the issue is whether or not the hotline is nonprofit. The problem stems from the fact that there is just a high number of suicidal people out there, that aren’t necessarily seriously considering suicide, they just can’t afford to get the proper medical attention they need. The real issue is how expensive healthcare is and only the wealthy can afford the proper care/precautions/ medicine needed. While there is medicaid, very few exceptional / qualified doctors accept medicaid patients who can’t pay the doctors what they are actually wanting to charge.
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