Most crisis lines across the US trace calls and send police to people’s homes if crisis line staff feel someone might be at risk of suicide, according to an article in Suicide and Life-Threatening Behavior, the official journal of the American Association of Suicidology. A new policy developed in 2012 has clarified and more firmly entrenched this longstanding practice, stated the article. Even two Samaritans call centers which historically had resisted the policy have now implemented the covert practice.
The authors of the article included two directors of the Substance Abuse and Mental Health Services Administration-funded National Suicide Prevention Lifeline. The Lifeline network is comprised of over 160 crisis call centers across the US that are linked through a variety of toll-free numbers through which callers are then routed to their nearest crisis center. The article explained that the new policy uses the term Active Rescue to refer to “actions independently undertaken,” without a caller’s knowledge or authorization, that “are intended to secure the safety of individuals at imminent risk of suicide.”
According to the authors, a person is at “imminent risk” of suicide if the person states, or is reported by someone else to have stated, that he or she has “both a desire and intent to die and has the capability of carrying through his/her intent.” Nevertheless, the authors explained, the guideline was not intended to be restrictive of the helper alternatively simply using his or her own personal judgment to determine if someone was at risk.
The authors acknowledged that the practice is controversial. “(T)here has been small but significant disagreement in the crisis center community as to whether actions to save a caller’s life without his or her consent (active rescue) should be required at all. Fear of potential police intervention can deter individuals from discussing their suicidal thoughts with others, including crisis line helpers; involving the police can at times have invasive, counterproductive results.”
Perspectives of callers who’ve experienced such unwanted interventions are “mixed,” stated the authors, with some research reporting that “such an event can be experienced as punitive and damaging to self-esteem and social reputation,” while other research has reported “positive perceptions of hospital stays.”
The Lifeline network website advises that anyone can call to discuss suicidal feelings or “substance abuse, economic worries, relationship and family problems, sexual orientation, illness, getting over abuse, depression, mental and physical illness, and even loneliness.” The website assures that, “Your call is confidential and free.” Nevertheless, the authors of the article stated that callers should have an “implicit understanding” that crisis line staff with suicide prevention mandates might sometimes covertly breach confidentiality and privacy. They also cited research challenging whether suicidal feelings are “rational” or “responsible,” and stated that suicidal thinking is evidence of “cognitive constriction” that “can be successfully addressed in clinical settings” with psychiatric treatment.
The policy has been implemented “network-wide,” stated the authors. They wrote that two Samaritans centers initially resisted the policy, but eventually implemented it as well. “In some respects, this historic shift in philosophy and practice by Samaritans centers was one of the most groundbreaking developments in the policy’s implementation,” wrote the authors.
(Abstract) Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: The Importance of Active Engagement, Active Rescue, and Collaboration Between Crisis and Emergency Services (Draper, John et al. Suicide and Life-Threatening Behavior. Article first published online October 1, 2014. DOI: 10.1111/sltb.12128)
The Venus Fly Trap is a beautiful plant when you know how it works. Except of course to a fly in need of sustenance.
This is an appalling breach of trust and quite unethical. Such services ought to be transparent. If the crisis line bills itself as confidential and then secretly sends police to people’s house, it is dishonest. The ethical thing to do, if they really feel compelled to intervene, is to warn callers up front that this is their practice.
Agreed. I’ve done quite a bit of research on this, and have found that the overwhelming majority of “confidential” hotlines will send police at the sole discretion of the individual answering the call. The following is the section on suicide hotlines on http://www.thesystemisbrokenblog.org/resources/ (resources for those looking for help with child abuse, domestic violence, psychiatric abuse, sexual assault and self-injury and their respective confidentiality policies can also be found on this page):
Suicide
National Suicide Prevention Lifeline- 800-273-TALK or http://www.suicidepreventionlifeline.org/GetHelp/LifelineChat.aspx- This is a 24/7 hotline that connects callers to their nearest suicide prevention agency to speak with a crisis counselor. The online crisis chat is only open from 2:00 PM to 2:00 AM EST. Crisis centers in the lifeline network are expected to call the authorities regarding callers who are attempting suicide during the call or who they deem to be “at imminent risk of suicide” (defined as the “desire and intent to die and has the capability of carrying through on his/her intent”) and are “unwilling or unable” to consent to the emergency intervention suggested by the hotline counselor. The term, “unable,” is not clearly defined, but is often assumed to include callers who are presumed to be experiencing psychosis. While the lifeline encourages counselors to use the “least invasive intervention,” crisis centers in the Lifeline network are required to have caller ID, and emergency intervention is often employed at the discretion of the crisis counselor. More information can be found at http://www.crisiscentersblog.com/wp-content/uploads/2007/11/emergency_intervention_policy_nspl_draft_11-07-07.pdf.
Samaritans Crisis Hotlines- http://www.samaritansusa.org- This link provides information about the Samaritans’ crisis hotlines in the US and help finding the one closest to you. If there is no Samaritans hotline in your area, the Massachusetts statewide hotline (877-870-4673) and the Cape Cod hotline (508-548-8900) welcome callers from other states and countries. Samaritans hotlines tend to be the most confidential of all suicide hotlines, but individual policies differ by agency. The Rhode Island hotline (401-272-4044), the New Hampshire hotline (877-583-8336), the New York City hotline (212-673-3000), and the hotline serving Cape Cod (508-548-8900) appear to have a policy to not contact the authorities without a caller’s permission. The Cape Cod hotline has further specified that it has no caller ID and no way to trace where a call came from, and defines itself as “completely anonymous and confidential.” The Massachusetts statewide hotline (877-870-4673) will call the authorities if a caller “appears to be at imminent risk of death,” (ie. someone who calls while in the middle of a suicide attempt or while holding a loaded weapon) and more specific information about confidentiality issues can be found at http://samaritanshope.org/our-services/247-crisis-services/. The hotline serving the Greater Lawrence, Greater Haverhill, and Merrimack Valley area of Massachusetts does not use caller ID, but will, “very rarely,” contact authorities about callers.
I called a line recently then discovered they also billed my insurance unknown to me and undisclosed to me and then my insurance denied the claim indicating the service was out of network. I’m currently appealing the claim.
One of the most disgusting aspects of this policy is the fact, recently reported on MIA, that people are more like to actually kill themselves when exposed to the psychiatric “help” these practices force on them. The more exposure to psychiatry, the greater the incidence of suicide, including the appalling figure that people who spend any time in a psychiatric facility during the previous year are FORTY-FOUR TIMES more likely to kill themselves.
Yet people still have faith in the psychiatric religion. It is a religion because people’s beliefs in it are not based on reality.
I can back this up with personal experience. They CAUSE people to kill themselves.
Yes I always thought it was a religion because of its two commandments:
Everyone should be on medication.
They should always take more instead of less.
There is no scientific basis for that.
That’s the whole problem with “danger to self” category. When I went to a hospital the first thing I asked was “do you have the ability to keep me here against my will”. The psychiatrist first tried to avoid answering this questions and then she said “yes”. I left.
This is unacceptable nonsense, a breach of trust and a behaviour which puts you at odd with people whom you’re supposed to help. It’s arrogant, paternalistic and speaks volumes about the whole “psycho” complex called mental healthcare.
“Nevertheless, the authors of the article stated that callers should have an “implicit understanding” that crisis line staff with suicide prevention mandates might sometimes covertly breach confidentiality and privacy. They also cited research challenging whether suicidal feelings are “rational” or “responsible,” and stated that suicidal thinking is evidence of “cognitive constriction” that “can be successfully addressed in clinical settings” with psychiatric treatment.”
OMG… Really?
“implicit understanding”
So you lie to me by stating “Your call is confidential and free.” but it’s OK because I should know you’re a f*** liar.
“research challenging whether suicidal feelings are “rational” or “responsible,”
RESEARCH? Who are you to say if someone’s subjective feelings about his/her life quality are rational and responsible? It’s his/her life and he/she has to deal with it, not you. The most arrogant approach on the planet. There is no objective rationality to these decisions by definition. It’s just social control pure and simple – we’ll make you live a sh**y life and if you dare to end it we will stop you and punish you.
“can be successfully addressed in clinical settings” with psychiatric treatment.”
Called torture. The only time I was really prepared to die and really suicidal to the point that I’ve tried it for real and with 100% conviction that it’s the right thing to do was after I’ve received the wonders of psychiatric treatment. These people are liars, human rights abusers and criminals.
Btw, that’s what they did to me not when I called a helpline but when I made a huge mistake of going to a psychological crisis center (I didn’t want to go to the hospital because I had already an opinion about psychiatrists but I naively thought that psychologists can’t at least do me harm – really bad mistake). I told them from the get go I don’t want drugs and have no wish to go to a hospital. Result: they’ve called police and had me involuntarily committed. Along the way I also had my belongings searched by police, I had a male psychologist enter the toilet where I was with my pants down (later on he reported that I was cutting myself there which was a lie – I was doing what people do in toilets) and a friend of mine who was there with me was told to leave and forbidden to talk to me (they also coerced him to give them phone numbers of my other friends and family members and they called them without even informing me). That was one of the most humiliating and enraging experiences of my life.
But lesson learnt: stay away from any “psycho” services and keep anyone you can away from tehm as well.
Well, we can either tut-tut about another massive betrayal/rights violation or do something about it. Some things I’ve done:
–called into radio shows to educate the public
–called/written government agencies to complain
–attended protest events that get covered in the news
–written letters to prominent journalists
–called newspapers to suggest they cover stories
Success? In one case I got a newspaper to cover a story (and even editorialize) about an issue of which they were unaware. The coverage prompted constructive but minor government action. The other actions–who knows, but it’s better than feeling helpless.
“Passive ideation” and “active ideation” are the magic words that distinguish redeemable heresy from the irredeemable: penance and prison.
The stimulus of an unexpected, involuntary, inescapably escalatory encounter with the police is enough to make the “passive” uneasy. What happens when that loaded circumstance is visited upon an “active” suicidal soul?
Why does that feel less like first aid and more like animal control?