Recently, I learned that the National Suicide Prevention Lifeline can trace your call. I didn’t know this. But the thing I did know about the Lifeline, and other suicide hotlines is that they can save your life. It is not surprising to me that the Lifeline uses every tool at its disposal to save lives, and I guess tracing calls is one of those tools. Some people have a distinct problem with this. I suspect they are missing a certain perspective when the Lifeline traces calls: they are missing the perspective of someone who is actually trying to save a life.

A Suicide Lifeline Can Trace Your Call, Says Mad in America

A couple of weeks ago, Mad in America published a piece by Rob Wipond called, “Suicide Hotlines Bill Themselves as Confidential — Even as Some Trace Your Call.” As is typical of everything from Mad in America, it takes an antipsychiatry stance and provides horror stories to back that up. That’s their thing.

As the title of the piece suggests, Wipond has an issue with suicide hotlines billing themselves as confidential and then tracing people’s calls. This is a fair point. Places like the Lifeline do say in bold letters that they are confidential. Tracing people’s calls does seem to suggest otherwise in some cases.

Wipond spins a tale of the evil suicide hotlines that are money-motivated and call the police on callers willy-nilly. He suggests this is harmful, particularly in cases where it results in psychiatric treatment without consent. And yes, that is a perspective you would always find on Mad in America.

He also says that people like me run “promotional” stories on them and that makes suicide hotlines more popular. He seems to suggest that this, too, is sinister.

But let’s unpack this a bit from a different perspective. Let’s look at it from the perspective of someone who is trying to save lives. Let’s look at it from my perspective.

Suicide Hotlines Do Everything They Can to Save Lives

In my case, I run two blogs on bipolar disorder and on Bipolar Burble, specifically, suicidal people reach out to me all the time. Typically, this is through comments that read like suicide notes. Readers never see these as I don’t allow them to appear online. I also get suicidal outcries on social media and through messages. I’m a bastion of such things, so I have a lot of experience with it.

And let me tell you, when a person comes to me and says they’re going to kill themselves, they first thing I do is tell them to get help. Get. Freaking. Help. Why do I do this? I do this so they don’t die. That’s my goal. My goal isn’t to shunt them to a particular number to support an organization and secure funding. My goal is not to have the police at the individual’s door. My goal is not to have them treated without consent. My goal is always to save their life. That’s it. Simple. And I would never, ever tell someone not to call the Lifeline because they possibly might trace the call. That’s ridiculous. People should not die because of the risk of a suicide hotline doing their very best to help them. Literally, the Lifeline calls in the authorities only when they feel danger is imminent. In other words, the Lifeline is just trying to save their life too.

Wipond actually has a quote in his story that pretty much sums up the concern:

“Bart Andrews sits on executive committees of the AAS [American Association of Suicidology]and the NSPL [National Suicide Prevention Lifeline], and is Chief Clinical Officer at a Missouri NSPL crisis center. He supports call-tracing, and says people need to understand how much call-attendants struggle with feelings of ‘moral liability.’

“‘You’ve got to ask yourself, which problem do you want to deal with? The person being dead, or them being angry that the police come out to make sure they’re safe?’ says Andrews. And families sometimes sue. ‘You’re not answering to the person you didn’t call the police on. If they end up dead, you’re answering to their loved ones.'”

And seriously, when I think about the choice between a really angry person and a dead person, I pick the person who is angry 10 times out of 10. They can hate me forever. I’m fine with that. But I don’t want their dead body at my feet. If I thought that I didn’t use every arrow in my quiver to try to get help for someone — suicide hotlines included — I could not live with myself.

And that is what an operator at the Lifeline is dealing with — a possible dead body. All they’re trying to do is avoid that.

How Many Calls Does the Suicide Lifeline Trace?

Wipond isn’t able to say how many calls the Lifeline traces unequivocally but the number he does find is that authorities are called in 2% of calls. This is the same as a suicide hotline in Canada. Now, I assume that in that 2% is also a significant number of calls where the person agrees to the calling of additional help — because, yes, operators on helplines do attempt to get consensus on these things long before they unilaterally make the decision to send someone out. And yes, callers do agree to this because they know they need help. It is brave and it is often necessary.

So what we have then, is less than one call in 50 resulting in the calling of authorities without the caller’s consent. That doesn’t seem like a lot to me. Again, if the person on the line says they are going to kill themselves, how could you prefer not tracing the call and just letting them die? Because that’s what we’re talking about. Not tracing the call and the person dying. That is not an outcome that is okay with me.

Treatment Without Consent After a Lifeline Call

Now, of course, as someone who is on an antipsychiatry site, Wipond has to mention how terrible treatment without consent is. I understand. It can be awful.

But there’s a teeny tiny percentage of people who are brought into a hospital that are actually kept without consent. Most of the time, people can’t get a bed. Hospitals don’t want these people. They certainly aren’t eager to take ones who shouldn’t be there.

So we have 1-in-50 calls that end up with authorities being called. A percentage of those end up with the person going to the hospital. And a fraction of those are actually admitted. And a fraction of those are admitted without consent. So what I’m saying is that we’re not talking about a huge number of people. Believe me, is not easy to get a person admitted to a hospital. Ask people who have been turned away after asking to be admitted. Ask the parents who are desperately trying to get help for a psychotic child but can’t. These people will tell you that treatment with or without consent can often be nearly impossible to get.

And I should mention that while Wipond paints a horror show of being treated without consent, many people who have been treated without consent actually emerge from treatment grateful. They are grateful they are no longer floridly psychotic. They are grateful they are no longer hurting the people in their lives. They are grateful they are alive. So, I fully acknowledge that treatment without consent can be horrible for some people, but it certainly isn’t for everyone. It’s actually a useful tool in some cases.

What to Do to Save Lives Instead of Tracing Calls

Tracing a call without agreement isn’t ideal. I’m the first to admit that. If you were talking to a LIfeline operator and the police showed up at your front door it would be jarring, to say the least. But what is the alternative? Near as I can tell, Wipond thinks that lawyer Susan Stefan has a good idea as to an alternative.

He writes:

“Stefan describes call-tracing as a ‘short-sighted’ policy, especially since many people she interviewed said they’d never again feel safe calling. ‘Rather than “stop people from killing themselves,” I think we need to rephrase the goal, and have it be “reduce people’s suffering and help them achieve a life they want to live.”‘”

Okay, there are two points there. First of all, Stefan says that people don’t feel comfortable calling a suicide hotline again. I get that. I also get that they’re alive to have that feeling.

Secondly, Stefan says we need to “reduce people’s suffering and help them achieve a life they want.”

Do the words “well, duh” mean anything to you?

Of course that should be the goal. That is the goal of what I do every day. I try to educate people about mental illness to make their lives better. I try to suggest ways of getting the lives they want. That is what I want for everyone.

But even if some magical program were put in place where that was actually possible on a large scale, you still have the problem of what to do in an emergency. Believe me, when someone calls the Lifeline and they are asking for advice on improving their employment situation, that’s not when the authorities are called. They are called when the person’s life is at risk. No matter how effective we are at helping people get better lives (and yes, obviously society needs to improve in that regard), there are always going to be emergencies where it makes sense to call in additional help and I have yet to hear an alternative for what to do in that situation.

Tracing Calls Makes Sense. Saving Lives Makes Sense

Look, if I had the ability to trace emails or comments and get help for the people who write acutely suicidal messages that refuse to get help themselves, I would do so. That’s the truth. I believe in saving lives. I believe in saving every life. Just ask suicide survivors how they feel about not dying. Most of us are pretty grateful that didn’t happen. And most of us know that it’s worth a great price to save someone else’s life.

So yes, it must be awful to have the police show up at your door. (And as I’ve written before, we need to defund the police so there are people who can deal with these types of situations more effectively.) I also acknowledge that operators don’t always judge the situation perfectly and sometimes the authorities get called inappropriately. (This is mentioned in the article.) And I’m also sure that the police aren’t always great and that sometimes hospitals are awful. The mental health system in the US is broken, no doubt about that. None of that, however, provides a reason not to do everything you can to save a life. None of that provides an alternative to sending help to the people who need it. I’ve, personally, done it and I would do it again.

Yes, I wish we lived in a world where people in mental health crises were treated differently, and better. But while we’re wishing for things, I also wish we lived in a world where people didn’t feel the need to kill themselves. We do not live in these worlds, we need to deal with the world we’re in.

So as long as people are trying to kill themselves and people can do anything about it, I think we should. It’s our job to be our brother’s keeper when he cannot. It our job to save lives that are in risk. There’s nothing sinister or evil about that.

P.S. I think it’s important to mention here that people providing other forms of help, like psychotherapists, also break confidentiality at times — at times when your life is at imminent risk. Therapists may be more open about this point, however.