If you or someone you know is thinking about suicide, help is available. Various resources are listed at the bottom of this article.
When the 988 Suicide and Crisis Lifeline launched last month, many mental health providers, researchers and advocates celebrated. Although a national suicide hotline had existed for years, there was finally an easy-to-remember three-digit number for people to call, they said. The abbreviated number will serve as an alternative to 911 for mental health emergencies.
But not everyone felt the same way. Some advocates and people with experience in the mental health system took to social media to express concern about 988 and warned people not to call it.
An Instagram post said, “988 is not friendly. Don’t call it, don’t post it, don’t share it without knowing the risks.” The post, which had garnered nearly a million likes by early August, described the risks of police involvement, involuntary treatment in the emergency room or psychiatric hospital, and the emotional and financial toll of those experiences. Listed
Other posts on Instagram and Twitter expressed similar concerns, saying that the hotline sends law enforcement officials to screen people at risk of suicide without their consent, and that people in the LGBTQ+ community and communities of color, in particular, may be forced into treatment.
So is 988 a serious mental health resource or cause for concern? We decided to dig into these questions, find out how 988 works and explain what you need to know before dialing.
Why are some people saying not to call 988?
We reached out to the creators of some social media posts to ask them directly.
Liz Winston, who wrote an Instagram post calling 988 “not friendly,” said she wanted people to understand all the possible outcomes of calling so they wouldn’t be blindsided by the “traumatizing system” she experienced.
Last summer, Winston was having suicidal thoughts and went to a hospital in New York. He had hoped to speak with a psychiatrist but was instead involuntarily detained in the psychiatric wing of the emergency room. He said he received no counseling in the 24 hours he spent there and the experience was “extremely traumatic”.
Winston didn’t call the hotline, but he said those who do may find themselves in a similar situation. It is true that when police respond to calls of people in mental health crisis, they often take them to emergency rooms or mental hospitals.
“I understand the urge to rescue people in crisis, but the reality is that the services that exist make the problem worse,” says Winston, who works in mental health peer support and has started an online support group for people recovering from involuntary treatment. from
Research shows that suicide rates increase dramatically in the months after people are discharged from psychiatric hospitals. Those who were sent involuntarily are more likely to attempt suicide than those who choose to go, and involuntary commitment may make young people less likely to express suicidal feelings in the future. Some people also get stuck with big bills for treatments they don’t want.
Emily Krebs, a suicide researcher and assistant professor joining Fordham University this fall, said that in the United States, involuntary treatment is seen as a necessary part of suicide prevention, but other countries don’t see it that way. The United Nations has called forced psychiatric treatment a human rights violation and asked countries to ban it.
Like Winston, Krebs wanted people to be fully informed before deciding to call 988. So he Wrote on Twitter That 988 “may send the police if deemed necessary.”
It can be dangerous, he said, given that 1 in 5 fatal police shootings in 2019 involved a person with mental illness. Some years, the share has been even higher.
What does 988 say about how it handles crisis situations?
988 officials say they recognize the risks of involving law enforcement officers in mental health emergencies. That’s why 988 was created as an alternative to 911, said John Draper, executive director of the hotline and vice president of Vibrant Emotional Health, the organization tasked with operating it.
“We know the best way for a person to be safe from harm is for them to be empowered and choose to be safe from harm,” says Draper. He said that sending the police is the last resort.
Counselors who answer the phone or respond to texts and online chats for 988 are supposed to be trained to actively listen, discuss callers’ concerns and wishes, and collaborate with them to find solutions. Draper said most calls about suicide go down without law enforcement. Instead, counselors talk through people’s causes of death and causes of survival; Callers need to connect with supportive family, friends, religious leaders or others in their community; Refer callers to outpatient treatment; Or set up a follow-up call with 988.
Only when the caller cannot or will not cooperate with the safety plan and the counselor believes the caller is likely to harm himself or herself immediately, should emergency services be called in accordance with hotline policy.
At that point, Draper said, “We only have the choice to let go [harm] “We are doing everything we can to keep them safe.”
In previous years, before the 988 number was launched, emergency services were dispatched in 2% of the hotline’s interactions, the service said. With about 2.4 million calls a year, that means emergency services were called for about 48,000 calls. These services can be mobile crisis teams, made up of people trained in mental health and de-escalation, but in many rural and suburban communities it is often the police.
Contrary to some information circulating on social media, 988 cannot identify callers’ geography, Draper said. When emergency services are called, 988 call centers share the information they have about the location of the person contacting the hotline with 911 operators — typically a caller’s phone number, including the area code, or a chat user’s IP address — to help individual first responders locate them.
Starting this fall, Draper said, 988 will update its policies to require supervisors to review all calls that result in the use of emergency services. 988 counselors nationwide will also receive additional training on options for involving law enforcement and the consequences callers may face if police respond.
So should I use 988 or not?
We know it’s not satisfying, but the honest answer is: it depends.
The 988 hotline is the country’s most comprehensive mental health crisis service and can provide vital support to those in distress. If you are thinking about suicide but haven’t taken action against it, 988 is unlikely to call law enforcement without your consent. Instead, 988 counselors can provide resources, referrals and a kind ear. However, if you are in imminent danger and act on plans to kill yourself, the police may be called, and you may be involuntarily taken to the hospital.
Sonia Richardson, a licensed clinical social worker who owns a counseling agency that serves mostly black and brown clients in Charlotte, North Carolina, said she didn’t immediately tell her clients about 988 when it launched. Although he is a member of his state’s 988 planning committee, he said he needed time to build trust in his own service. When he learned at a recent committee meeting that less than 5% of the 988 calls in North Carolina led to a law enforcement response, he felt reassured.
“There’s probably going to be problems with the 988, but it might be one of the safer options for us,” Richardson said. With suicide rates rising among black Americans, communities need more ways to save lives, he added.
If I don’t want to call 988, do I have other options?
Although the United States does not have a national, government-run mental health hotline that promises not to call the police without callers’ consent, few alternatives to 988 aim to reduce law enforcement involvement.
“Hot” line is an option. They are usually staffed by “peers”, who have experienced mental health challenges. They focus less on crisis intervention and more on emotional support in crisis prevention. You can find a directory of hot lines by state here.
Below are other hotlines and resources This is not a comprehensive list, and some resources may restrict their services geographically.
American Journal of Psychiatry, “Involuntary Commitment: Billing Patients for Forced Psychiatric Care,” December 1, 2020
Harvard Review of Psychiatry, “Suicide Risk After Hospital Discharge: A Review,” July/August 2019
Instagram post by Liz Winston, July 16, 2022
JAMA Psychiatry, “Suicide Rates After Discharge from Psychiatric Facilities: A Systematic Review and Meta-Analysis,” July 2017
KHN, “Part of the ‘Free Britney’ Story That Could Happen to Anyone,” September 29, 2021
KHN, “US mental health hotline network expands, but rural areas still lack care,” July 28, 2022
National Suicide Prevention Lifeline, “Policies to Help Callers at Imminent Risk of Suicide,” December 2010
Phone Interview with Emily Krebs, Suicide Researcher and Assistant Professor Soon to Join Fordham University, July 27, 2022
988 Phone interview with John Draper, Executive Director of Suicide & Crisis Lifeline and Executive Vice President of Vibrant Emotional Health, National Network, August 2, 2022
Phone interview with Liz Winston, peer support worker in New York City, July 26, 2022
Phone Interview with Sonia Richardson, Social Worker, Suicide Researcher and Counseling Agency Owner Charlotte, North Carolina, July 28, 2022
Slate, “Who’s Listening When You Call the Crisis Hotline?” April 1, 2022
Social Psychiatry and Psychiatric Epidemiology, “Investigating the Impact of Involuntary Psychiatric Hospitalization on Youth and Young Adult Trust and Help-Seeking Pathways to Care” March 9, 2021
Suicidality and Life-Threatening Behavior, “Perceived coercion during psychiatric hospitalization increases risk of suicide attempt after discharge,” June 4, 2019
Treatment Advocacy Center, “Undercounted and Overlooked,” December 2015
The Trevor Project, “What 988 Means for LGBTQ Youth,” July 16, 2022
Twitter thread By Emily Krebs, July 17, 2022
988 Suicide and Crisis Lifeline, Frequently Asked Questions, accessed August 3, 2022
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.
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