On December 27, Vibrant Emotional Health, the Manhattan-based nonprofit administering the 988 Suicide & Crisis Lifeline, released a revised set of suicide safety policies for 988 Lifeline call centers. This policy replaces the 2011 Policy for Helping Callers at Imminent Risk of Suicide. But critics of carceral suicide prevention approaches say the new imminent risk policy bears a striking resemblance to the previous one.

Jess Stohlmann-Rainey, activist, consultant, and former crisis line director, acknowledged surface-level changes, such as the removal of the term “active rescue,” a euphemism for sending emergency services to a caller’s home without their consent.

“But in a functional way, it is not that different,” Stohlmann-Rainey, who created a guide to understanding and using 988, tells Mad in America. “The assumption that force is needed remains embedded in this document.”

The 988 Lifeline replaced the preexisting National Suicide Prevention Lifeline (NSPL) across the United States in July of 2022.

988 Lifeline’s continued reliance on involuntary emergency interventions, often involving law enforcement, has long been a target of abolitionists, survivors, and critical suicidologists fighting to eliminate coercion in suicide prevention and crisis response, creating networks of collective care and liberation instead, calling for public health-based alternatives to force.

988 Lifeline’s FAQ reports that “a small percentage” of calls will result in 911 dispatch when imminent risk is assessed as present. But as call volume rises, this will translate into increasing thousands of nonconsensual interventions.

Ysabel Garcia, founder of Estoy Aquí LLC and a psychiatric survivor, notes that 988 Lifeline’s mission doesn’t square with all-too-often deadly outcomes from involving law enforcement. Half of people killed by police are disabled, with disabled Black, Indigenous, and People of Color in greatest danger. Queer, trans, and undocumented disabled people are also more likely to be harmed or killed in police encounters.

“It doesn’t make sense to send a police officer and EMTs to a person who holds all these marginalized identities,” Garcia says. “It’s literally a death threat. Their so-called intention of ‘saving lives’ doesn’t match the impact of their policies.”

Stohlmann-Rainey points out that while 988 Lifeline has tried to further emphasize the risks of policing in this version of its policy, there are caveats. “You can put all the barriers [to coercion] in place, in theory. But as soon as you have a scared call taker who is able to call the police, they can just do it at any time, and there aren’t really any consequences. Lifeline doesn’t even necessarily know when that happens.”

As someone who has herself supervised a crisis line, Stohlmann-Rainey has firsthand knowledge of the numerous barriers to collaboration and consent, noting that current risk assessment strategies don’t account for provider fear and overwhelm.

“The amount of crisis out there is always going to outpace the number of workers we have,” she says. “You’re doing this, and maybe you can see there’s 40 calls in the queue. If this feels really high risk, and you think you’re going to end up calling 911 anyway, maybe you’ll call it sooner so that you can pick up the phone for another one of these 40 something people [waiting on hold]. And that’s not an okay decision to have to make, right? It’s the decision that people are making every day doing this work.”

Included in the appendices of the revised policy is a template for a mandatory supervisory review of calls resulting in the dispatch of non-consensual emergency services, to be held within 72 hours. Its introduction reads: “Dispatching emergency services, particularly when involuntary, is a significant undertaking and one that necessitates reflection when the inherent stress of the presenting crisis has resolved.”

The new policy also requires 988 Lifeline call centers to “investigate alternatives to emergency service interventions within the community,” and to establish collaborative agreements or memoranda of understanding with less restrictive options when possible. In the absence of such options, call centers are encouraged to advocate for them.

Emily Krebs, suicidologist and assistant professor of health and culture at Fordham University, tells Mad in America, “Yes, putting more attention on alternatives to emergency service interventions is a good thing. But as long as involuntary hospitalization is on the table, suicide hotlines remain unsafe.”

Garcia, who identifies as a suicidal person, observes that America’s crisis care system is largely driven by paternalism and the abuse of power. “When I look at anything that is a dominant crisis response, the question is always, ‘How much power can I take away from you?’”

“The entire thing is paternalism 101,” she adds. “This idea of ‘I know better than you do about your own experience, and I am entitled to act on you.’ Like the person in crisis is some sort of object—or a child, even.”

“We know involuntary intervention isn’t working,” Krebs says, citing the numerous negative outcomes that can result from forced hospitalization, including an increase in suicide risk. “As scary as it might be, suicide hotlines have to try something else.”

Krebs points to Trans Lifeline, which has created a Crisis Callers Bill of Rights, BlackLine, and Samaritans NYC as examples of crisis lines that have eliminated all nonconsensual intervention. “While this approach may indeed result in some callers’ deaths, I believe that it will allow many more people to call without fear—and will ultimately save more lives while honoring people’s autonomy.”

“Suicide hotlines must recenter consent in their policies and practices,” says Krebs. “While others in suicide research and prevention certainly believe otherwise, I argue that suicidal people’s agency is important and their desires around medical care—or lack thereof—should be honored.”

“You can’t coerce someone into wanting to be alive. Force just doesn’t work. People must be invited to live while supporters (healthcare professionals, social workers, loved ones) make their lives and world more habitable.”

Garcia questions how “voluntary” even so-called consensual emergency interventions are, especially when the threat of an involuntary response looms ever-present on the crisis line. “Coercion and violence are not always right in your face,” she says. There’s the gaslighting, the manipulation—that’s also part of the violence and coercion in the psychiatric system and crisis care system.”

“I’m not excited about any ‘change’ here,” Garcia says of 988 Lifeline’s revised policy document. “In order for us to have actual change, this entire thing will have to be erased. It will have to be dismantled. Reform is not enough. Abolition is what’s needed.”

 

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MIA Reports are supported, in part, by a grant from The Thomas Jobe Fund.

Banner image created using photos from Roger Victorino and Osman Rana on Unsplash.

10 COMMENTS

  1. I was interfered with, my choices stolen from me. I overdosed on elavil at 19. My stomach was pumped. Tubes were stuck in me. I was forced to drink charcoal.
    I knew I should die. My reasoning was sound. I’ve lived an entire life as a burden, a problem, unwanted, slowly dying from the isolation and decades of terrible memories. The people who interfered with me will have alot to answer for in the next life. I had the solution 37 years ago.

  2. Can one’s thinking alter the space that surrounds, to invite into existence a higher, richer expression of unconscious into LIFE? That perhaps surrounds one with thoughts of suicide/death? In participating with a small group of diverse citizens around the idea of a Metro Dis-Ability, Metro dis-Ability or Metro dis-ability coalition I would become patently aware of the very power in the structure of words where identity can be discovered mirroring the self. Reasoning predicated on one level of existence is fascinating to experience when one is at the doorway, and suddenly a fresh in-sight can occur, either directly are perhaps more from a bow, a curved arrow? (if you get the drift?) while trying to realize a degree of questioning? Peace, and thanks for the article and comment.

  3. “The new policy also requires 988 Lifeline call centers to ‘investigate alternatives to emergency service interventions within the community,’”

    What’s sad is that the scientifically “invalid,” DSM deluded, psychological field is so incompetent, and corrupted, that setting up an appointment with them is not considered the first alternative “to emergency service interventions within the community,” by suicide hotlines.

    “Yes, putting more attention on alternatives to emergency service interventions is a good thing. But as long as involuntary hospitalization is on the table, suicide hotlines remain unsafe.”

    Indeed, forced treatment needs to be ended.

    “You can’t coerce someone into wanting to be alive. Force just doesn’t work. People must be invited to live while supporters (healthcare professionals, social workers, loved ones) make their lives and world more habitable.”

    Unfortunately, most of the so called “healthcare professionals, social workers,” et al, were deluded by the scientifically “invalid,” big Pharma misinformed, but controlled, DSM “bible” creating psychiatrists … so they’ve been making the lives of legitimately distressed individuals less “habitable” for decades.

    “Garcia questions how ‘voluntary’ even so-called consensual emergency interventions are, especially when the threat of an involuntary response looms ever-present on the crisis line.”

    And because it’s really easy for a doctor to forge a person’s signature on a consent form, as one of my former, now FBI convicted, forced treatment doctors did, according to my expunged legal records.

    “’Coercion and violence are not always right in your face,’ she says. There’s the gaslighting, the manipulation—that’s also part of the violence and coercion in the psychiatric system and crisis care system.”

    Definitely, in a system that claims to be a “metal health” industry … the gaslighting – which is known to be “mental abuse” – needs to end.

    “In order for us to have actual change, this entire thing will have to be erased. It will have to be dismantled. Reform is not enough. Abolition is what’s needed.”

    I have to agree. The scientific fraud based “mental health” industries are corrupted to the bone.

  4. If a person makes a (credible) threat to kill someone, what happens?

    from internet….
    _______________
    What Is a Criminal Threat?

    A criminal threat involves one person threatening someone else with physical harm or death. To be convicted, the prosecution must prove:

    the defendant communicated a threat of harm to another
    the defendant intended that the communication be taken as a threat, and
    the threat was credible and specific so as to place a person in fear of harm.
    ___________________
    So threatening to kill oneself has similar consequences and should first go through the legal system to establish the facts of the case.

    A person can’t be free to threaten others or threaten to kill themselves without serious consequence.
    This is in conflict with the “please talk about your feelings” advice on thinking suicidal. It puts the person who hears the threat in a difficult position.

    Do the crime , do the time. Thinking suicidal should be put back in the closet, no sane being would consider it. Do any animals commit suicide?

    • Yes, animals do appear to commit suicide:

      https://qrius.com/humans-commit-suicide-animals/

      I think it is EXTREMELY damaging to “put thinking suicidal back in the closet.” This will make it MORE likely that people will kill themselves because they can’t talk about it! I used to work a suicide hotline and have talked to hundreds of people who said they were considering suicide. The vast majority were not “threatening,” they were simply desperate to end the pain they were experiencing and wanted some kind of help.

      I have heard of people, especially domestic abuse perpetrators or child molesters, threaten suicide when consequences ensue for their bad behavior. This is a different matter and should be dealt with much more harshly, I believe, as it is an attempt to use the threat of suicide to manipulate or control others and avoid accountability. But the vast majority of suicidal people are looking for someone to talk to and connect with.

      Of course, there are also those who rationally decide that suicide is the best next step in their lives, based on health conditions or something of that nature that has a very grim future prognosis. It would seem cruel to deny such people the right to talk over the pros and cons of their options, including suicide, so they can make the best decision they can.

    • “Do the crime, do the time”

      So you’re saying that admitting to being suicidal, having suicidal thoughts, attempting suicide, etc…these are crimes?
      Why are they calling it treatment then instead of a sentence? Why is their no trial, no public defender? Why does it involve forced drugging? Why is there this propaganda, “don’t be afraid to ask for help”?
      If it’s a crime fine but don’t lie about it. Stop with all the propaganda.

  5. In 1998, 2 employees of the local “community mental health center” called the local police, LIED, and claimed that I was suicidal. I was NOT suicidal. But, the local police used those LIES as an excuse to surround my apartment literally at gunpoint, force their way into my home, and almost literally drag me out naked in handcuffs. Actually, they let me put on pants & shoes and a shirt. I was at the time getting ready to take a shower, eat dinner, and get a good night’s sleep before a full day of college the next day….
    I was taken in handcuffs to the local hospital emergency room. There, they attempted to force me to speak to some idiot “crisis worker”, and “confess” that I was “suicidal”….
    I was NOT suicidal, and thus refused to lie & say that I was. Had I lied, I MIGHT have been put in the fairly comfortable “mental health unit”. But, because I was NOT suicidal, and refused to lie and say that I was, I was then taken under arrest to the local police station, arrested, charged, and held for $500. CASH BAIL…. I was eventually bailed out, so I didn’t have to go to the local JAIL…. But, by the time I FINALLY got back home, it was the next day…. That was almost 25 years ago….are things any better now?….
    Not that I can see. If anything, things are WORSE….
    IMHO, PROOFS that things are worse today include such abominations as “Trans Lifeline”, “Campaign For Psych Abolition”, “Blackline”, “Samaritans”, and “Crisis Caller’s Bill of Rights”….
    You people are so brainwashed and blinded, that you can’t see that these groups are nothing more than different arrangements of deck chairs on the Titanic….
    No, I can’t stop you from replying, but I’d rather you just KEEP THINKING…..
    The best advice I could ever offer to a suicidal person would be,: “Go ahead, go, just don’t take anybody else with you.”….
    If we don’t have a right to die, how can we have a right to live?….
    Think about it….