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Suicide help lines
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."
Posted by Tyler Cowen on September 13, 2007 at 07:45 AM in Data Source | Permalink
Comments
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?
Posted by: cfw at Sep 13, 2007 8:36:30 AM
Due to human nature, my guess is that a big problem is that people may be working long hours (and some may be wrong for the job altogether). Helpers should be limited (by the non-profit, not by government) to working only very few hours on the help-line (they may choose long shifts but then only rarely, or they may choose short shifts more often, but with a cap on a weekly or monthly basis).
I think human nature leads people to sympathize less with one person due to interactions with others (we "learn" from past experience - sometimes correctly sometimes incorrectly). If one isn't overdoing it on these help lines, one can be rational and recognize that just because the last two callers were obviously using the help line just for sympathy or for sadistic reasons or whatever, and didn't need help, the next one may truly be on the verge of suicide. But, after many long hours and many days in a given month, a person can get cynical and uncompassionate, and really screw up.
Posted by: liberty at Sep 13, 2007 8:43:47 AM
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
Posted by: Jim at Sep 13, 2007 9:03:43 AM
I was a suicide hotline volunteer for several years. I'm sure that training for such volunteers isn't uniform (although I believe we were trained from some sort of standardized curriculum), but I know that we were trained, explicitly, to ask at the beginning of the call whether the caller was thinking about suicide-- using those words. Where we went from there dependexd on their answer. Any indication of suicidal intent warranted a side call to the local 911 operator to trace the call. Maybe our training and procedure was unique, I don't know.
Posted by: richard m at Sep 13, 2007 9:09:21 AM
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.
Posted by: mike at Sep 13, 2007 10:54:16 AM
mike: "how would a for-profit suicide hotline work?"
That was my first thought, Mike. Would someone screen the calls and route them based on how much the suicidal person was willing to pay? After providing a valid credit card, one could get:
- a recorded Tony Robbins message for $10;
- another suicidal caller who has been on hold for $20;
- a student for $25;
- a psychology student for $40;
- a sultry-voiced woman for $50.
Isn't the problem with free suicide lines that a lot of just plain lonely people use them?
Posted by: John Dewey at Sep 13, 2007 11:03:49 AM
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.
Posted by: Bruce G Charlton at Sep 13, 2007 11:31:00 AM
mike:
Yup, we got those, too. You quickly get to know the "regular cast of characters" and how to handle them - in fact, when turning over to the next shift you'd usually give a heads up if one of the habitual chatters has been calling (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 shift turnover would include "Footman is calling again" :-).
Bruce:
The difference here is this is not psychotherapy, not even of the "brief therapy" kind. This is pure crisis intervention, and as such is pretty much run by scripts learned during training. That may sound shallow, but interestingly enough it works, AS LONG AS YOU STAY ON SCRIPT. Which, according to the original newspaper article, many volunteers may not be. The volunteers aren't there to give advice, delve into the caller's psyche or "fix" them. They are there to (a) assess the danger, and (b) get them to real help ASAP. Period.
Actually, the most depressing thing to me wasn't the suicidal callers - I knew where they were coming from and could work the script pretty damned well. The bummer were the wives calling from phone booths in the middle of the night with their children huddled around them while "he" was out driving around looking for them so he could beat her again. The domestic violence stuff really takes a toll on the volunteer. Especially because it SO follows the script on their side - "I know if I can just be better, he will love me", etc. All we could say was "I think you need help - can I give you the number of a shelter?...I understand, and I think you need help - can I give you the number of a shelter?...Yes, and can I give you the number of a shelter?" Knowing full well when you hung up that the odds were long in favor of her returning to him and getting beat yet again. What I WANTED to say was "Stay right there, I'll be there to pick you up and take you to a shelter" but that would be going off-script, and training drilled into our heads that was more harmful, because if you started saying "The guy is a dick for beating you, you should leave him" then she WILL start defending him, and ultimately you just increase the odds even more of her going back to him.
Like I said, THAT was depressing.
Posted by: Jim at Sep 13, 2007 11:43:28 AM
"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.
Posted by: Jacqueline at Sep 13, 2007 11:57:00 AM
Jacqueline,
As a friend of mine says, "It's not that it takes all kinds - it's that there IS all kinds".
Anyway, nobody was ever rude to him - the male volunteers wouldn't have to put up with for very long, because he'd just ramble a bit and hang up. The female volunteers would talk to him nicely for a few minutes (sans discussion of footwear) and then ask if he was in any sort of crisis. He would say, "No", and then they'd say, "Well, we need to keep this line open for emergencies" and he'd be OK with that and try again a few weeks later. I figure he was always trolling for the newbie volunteer that hadn't been warned and who would actually talk about her shoes.
Posted by: Jim at Sep 13, 2007 12:03:22 PM
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.
Posted by: Kevin Postlewaite at Sep 13, 2007 12:15:57 PM
There are for-profit suicide hotlines. They are provided as part of Employee Assistance Programs (EAP) behavioral health hotlines.
Posted by: mf at Sep 13, 2007 1:47:29 PM
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.
Posted by: John Dewey at Sep 13, 2007 2:21:42 PM
mike: "how would a for-profit suicide hotline work?"
How about a suicide insurance supplement to life insurance? The life insurance company runs the hotline and has a financial incentive to save you.
Posted by: nick at Sep 13, 2007 3:24:50 PM
Don't life-insurance companies not pay out in the event of suicide?
Posted by: Nick Tarleton at Sep 13, 2007 3:49:59 PM
Don't life-insurance companies not pay out in the event of suicide?
I believe there's a statute of limitations on that. Somebody who buys life insurance and then commits suicide (or murder, for that matter) is scamming the insurance company. Once the policy has been in place of a while (a year IIRC) then the presumptions change.
Posted by: triticale at Sep 13, 2007 4:12:52 PM
"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?
Posted by: Tim Worstall at Sep 13, 2007 5:33:05 PM
mike: "how would a for-profit suicide hotline work?"
My insurance company has a 24-7 mental health crisis line. They assess whether or not you're in any immediate danger and get you referred to appropriate mental health services. I wouldn't be suprised if there were some general access ones ran by larger mental health clinics too.
Posted by: MattXIV at Sep 14, 2007 5:07:05 PM
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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