As Og is my witness, I am just asking academically. I am not suicidal. I promise!
Anyway, what, actually, do they say? Do they just give you platitudes about how people will miss you and life is precious and all that? Do they tell you to get to an ER now?
In my experience, they listen while you blabber on about whatever is bothering you, and maybe try to connect you with further counseling in the near future. In my case I wasn’t in any immediate danger of suicide, so I can’t say what happens then. Some of the people in that thread work(ed) for crisis centers; hopefully they can chime in here.
I have no personal experience with calling a suicide hotline but I have spoken with therapists about them (the therapists were co-workers of mine although I am not a therapist).
They told me the main job is to keep the person talking. Suicide is often (not always) a transitory moment where a person is at their lowest and keeping them on the phone can get them through the danger zone. Many (not all) suicides are a cry for help so just having someone listen to them helps.
Of course all cases are different and some people are more committed to suicide than others.
I called a mental health practice (a group of psychiatrists and psychologists), not a suicide prevention hotline, because I misread the listing in the yellow pages (it was back when that’s how you found stuff). The person I spoke with was trained to deal with suicidal people, so I think my experience is still valid.
She first asked questions to assess the situation. Was I alone? “Yes.” Did I have a gun? “No.” Did I have a plan? “I am going to slash my throat with a chef’s knife.” Is the knife within reach? “I put it down when I went to get the phone.”
After she determined that I wasn’t going to kill myself immediately she told me to go to the emergency room at a specific hospital. She said that she would call them to let them know I was coming. If I couldn’t get myself to the ER I should call 911.
She never said anything like “You have a lot to live for” or “Suicide is never the answer.” It was all business: get me away from immediate danger and get me help.
I worked on a general United Way help line many years ago, ca. 1975. I remember one call. A woman said she had a gun and she was going to shoot her two children and then herself. I didn’t give her any platitudes. It seemed important to me to make some kind of emotional contact with her. I wanted her to get a sense of me as a person, not just a disembodied voice. Someone in her position typically feels very alone in the world. I think I told her that I really wanted to talk to her and hear what was going on in her life that made her so sad and desperate, but that it scared me to know she had a gun right there. I asked her to take the gun outside and lock it in the trunk of her car so that I wouldn’t be so scared. She went away for a bit and came back. We talked. I don’t remember much else, but I do remember that at the end of the call she didn’t seem so desperate, and she said she was going to take the kids for ice cream. I never heard any more about it. I imagine that today, there is tracking of locations, etc., which wasn’t possible then.
No experience at all with this here. But my thought is that someone who genuinely wanted and intended to kill themselves would be unlikely to call a suicide prevention hotline. If you intended to do something, then why would you actively seek out someone whose job is to prevent you from doing that?
So I suspect that most or all people who call these suicide prevention hotlines feel like killing themselves, but don’t really want to do it. So they’re looking for someone to give them something to hang onto and for some reason to avoid doing it. So these people may be more predisposed to being talked out of it by suicide prevention operators than suicidal people who don’t call.
I have a friend who used to volunteer at The Samaritans. She had several weeks of classroom training with simulated situations before sitting with an experienced person to talk to real people. She said that, for the most part, people who phone in really just want someone, anyone, to actually listen to them. Frequently, all that was needed was a sympathetic ear, and maybe at the end, some places to go for practical help.
Every case was different but she had the awful experience of talking to someone who was sitting in the bath, bleeding to death. He refused to say where he was so she and a co-volunteer had to listen to him rambling on for some time before the line went dead. If they had a location, they would have sent the emergency services, but that wasn’t possible.
They most certainly do not talk in platitudes. In fact, they don’t talk much at all as the job is mostly to listen and only respond when asked.
This is an interesting story told by a former suicide hotline staffer. He said they had four questions they asked every caller: The Moth | Stories | Perfect Moments
They are there for the deeply unhappy as well as those contemplating imminent suicide. I had a number of sleepless nights following a significant bereavement. Awake for hours at 6 am all the friends who stayed up late and all of those who got up early were asleep. Thoughts wouldn’t stop whirling around. I had to talk to someone so I called the Samaritans. I explained why I’d called then talked for an hour about how I felt, what was going on with relatives and all the practical stuff that was going on. The person on the end of the line made some sympathetic suggestions and told me she thought I was doing OK. After that I could sleep. I am sincerely grateful that she was there to talk to.
I spent about 8.5 years out of an 11.5 year period as staff at a volunteer crisis intervention hotline. I also was part of our training staff and participated in numerous training programs for new volunteers. Our general model, regardless of whether it was suicide or not, was active listening focusing on the caller’s* feelings. Only at the end of training did we work in some problem solving but even that was more in line with the rest of the model. We didn’t give advice. Our problem solving was applying active listening in a more situational and less feeling oriented manner to help the caller reach their own decisions.
There were some pieces specific to suicide calls that we would apply as warranted:
Labeling - There’s a big social stigma against even talking about suicide. Since most suicide callers were still at the suicidal ideation stage they frequently didn’t go past strong hints. We’d ask if they didn’t outright say it. “I hear you saying you are fed up and don’t feel like you can take this anymore. Are you thinking about suicide?”
Assess a plan and if they have the means to enact the plan at hand- “Do you have a plan?” We weren’t there to traumatize ourselves by listening to someone die. “I hear you say you plan to OD on pills, are the pills in the room with you?”
Contracting - Not only a suicide specific piece but the ability to do it was necessary for suicide calls because again we weren’t there to listen to them die. “I can listen more effectively if I am not scared about you taking the pills while we talk. Can you put them in the other room so I can help?”
Tracing - It was an option not a requirement by our policy. We intentionally did not have caller ID to maintain client confidentiality and a trace in a case where we could violate that confidentiality could be lengthy. It could also be damned difficult to do if on shift alone since you were effectively trying to juggle two phones without losing the ability to support the caller. The only active (as in they already started carrying out their plan) suicide call I had I was on shift alone and didn’t try.**
Reality testing - Again not suicide specific but came up more in that environment. I used it very little in that environment. Challenging their depressed “nobody cares” by asking something jarring like who will find their body could work in some situations. It had a lot of potential to make them dig in and lose the connection that let us keep working. It was not a commonly used technique but we discussed it in the suicide lecture portion of training. I tended to use it more in other situations like challenging victim blaming during sexual assault calls.
Wrapped around all of that, we actively listened and focused predominantly on their feelings. It’s what we did.
We also accepted walk-in clients. Sometimes they were suicidal too.
** Sometime active suicide callers could be feeling a lot of regret/fear/remorse and can be gently nudged towards taking care of themselves by hanging up and calling 911 themselves. Since that fit the caller’s expressed feelings, I chose that over a trace.
I worked for several years (volunteer) for a sexual assault crisis line. I was also a trainer. Our procedures sound very similar to those outlined by DinoR. The only thing I would add is an expansion to the contracting, in certain imminent danger situations. In addition to contracting about moving to a safe place, we would also contract for time. For example, “It sounds like you are angry and upset, and have a lot to talk about. Can you agree that you won’t take any actions for the next 30 minutes while we talk?” The idea is that you’re going to talk and extend the time, but that you want to remove the immediate pressure.
Most people just want someone to talk to, and some want access to longer-term resources. We tried to provide both.
Depression is associated with poor judgement. You can’t think straight.
So, a more detailed responses to your post:
(1) Depressed people often aren’t able to nake a sensible judgement about committing suicide. Many more would commit suicide if they weren’t so dammed depressed. So they set their sights on Monday and they get themselves undressed. In the mean time, what can they do? Well, one thing some of them do is talk to people and try to figure out if they really want to commit suicide, or if they really want someone to stop them.
(2) Secondly, even if they really do have the capicity to commit suicide, their judgement is so poor that they can’t be reliably depended on not to call a suicide prevention line as part of the process. It might be obvious to you, but when I was depressed I had trouble trying to work out if a red traffic light really did mean stop, or if that was just another false belief like believing that my girlfriend actually liked me. Your expectations for reasonable sensible behaviour are entirely unrealistic…
When I volunteered for a crisis hotline, it was pretty much exactly as described above: a few sessions of classroom training, some role-playing, and then manning the phones and using active listening techniques.
Two elements of my experience I did not see emphasized above:
[ul]
[li]We had an exercise to write down all the vulgarities, dirty words and pejoratives we could think of. I was a teenager at the time and excelled at this part of the exercise – I was still filling out pages after the polite retirees had put their pens down! The purpose of this was to try to desensitize the volunteers to hearing these words from desperate callers – if you get offended or find yourself unable to get past a certain naughty or bigoted word, your focus on active listening is lost and you start making the call about your own issues, not the caller’s.[/li]
[li]We had a giant book of resources. We weren’t supposed to mention it until the callers had worked through the emotions of the moment, but for people with real, tangible problems – for example, callers facing eviction – we had a huge binder full of numbers for government assistance programs, churches, homeless shelters, therapists, food banks, and so on that we could use to point callers at resources that could help them.[/li][/ul]
I volunteered for a crisis line for a few years. The training was quite extensive (a few hours a week for a few months) and I can concur with everything Sailboat, Sunny Daze and DinoR said.
One thing I’d emphasise is that many (maybe most) of the callers weren’t presenting with a suicide-level crisis, so part of the job was to respond at an appropriate level. A typical call would start off listening to and reflecting content, and gradually working up towards reflecting feelings and exploring solutions.
The aim even with someone suicidal was to get them to a point where they had a safe plan that they had come up with themself for what to do next.
If the person was depressed, we’d include a risk assessment which might include directly asking if the person was suicidal.
Generally the levels were:
if they’ve thought about suicide, we’d work towards a positive next step
if they have specific plans, we’d get them to contract, and be happy at the end of the call so long as they agreed to call back or go to a friend if they felt they were about to do something
if they have immediate plans, we’d get them to contract just to remove themselves from danger (put the knife away, go into another room, walk to a public place) while we talked
if they wouldn’t contract at all, we took steps ourselves. Basically that meant calling our supervisor, who would liaise with the police to trace the call and send uniformed officers. This is pretty drastic, but if someone calls a hotline it is because at least part of them wants to be stopped. If they call but don’t contract, we read that as a plea to physically stop them.
Edited to ad: We were told not to offer platitudes. We would explore consequences though. “Ok, let’s say you did that. What do you think would happen?” We’d also encourage people to think of multiple options, rather than either/or “When you’re feeling bad, what sometimes works to cheer you up?” “Tell me about someone who’s usually good to talk to about this?”
If you’ve spent enough time listening to them by this point, even depressed people will try hard to find answers, rather than the “Nothing”, “No one” that they’d answer if you asked them these questions cold.
The absolute worst type of call is someone who knows the process, and has taken steps to not be traced - calling just to have someone to talk to before they die. I never had one of those calls. I burned out just on the chronically depressed people who called to chat.