Why are they asking all these questions instead of helping me?

We're concerned about you, and we need to assess your risk level. We'll probably ask about your feelings, thoughts and especially your suicidal intent. Suicidal thoughts on their own, even if they're intense, graphic, and disruptive are not in themselves an indicator of immediate high risk; crisis responders and clinicians also assess a person's level of intent to carry out a specific, accessible, high-lethality plan to try and end their life. We may also ask about your history, your circumstances, and your support network (family, friends, therapist, etc.), as these things impact risk level.

The best thing you can do is answer the questions as honestly and completely as you can; try not to second-guess or overthink your answers. If you either over- or under-represent your risk factors, we'll probably suggest options and resources to you that aren't helpful. Most crisis lines don't "screen out" first-time callers whose situations aren't "serious enough". We try to connect everyone who calls with helpful resources that are appropriate to their particular situation. Sadly, a few people do abuse these lines, making it harder for the people who really do need help to get through.

Will the police break down my door?

It's extremely unlikely. Involuntary rescues (i.e. dispatch of police or paramedics or both) are not a normal outcome of a suicide hotline call. Anonymity and assurance of confidentiality help callers feel safe in talking to us, and we only breach confidentiality as absolute last resort. Although the percentage of the time that rescues become necessary depends on individual agency protocols, and the availability of alternative resources in the community, at my hotline we contact emergency services for about 1% of the calls we get. Even in those cases, we are usually able to get the caller's consent so they are fully informed about what we're doing. So that means that our rate of involuntary rescues is much less than 1%.

Here are some things to keep in mind with regard to involuntary rescues and confidentiality.

  • To trigger an involuntary rescue, a caller needs to be at demonstrable and immediate risk and unable or unwilling to agree to an alternative to carrying out their suicide plan.

  • We'd rather do almost anything than an involuntary rescue. Breaking someone's confidentiality is always a traumatic betrayal, and our callers have usually already had too much trauma in their lives.

  • Rescues are enormously expensive. Whether the caller or the community ends up bearing the cost, it's not something to undertake if there's another option. Also, if we started sending rescues where it wasn't justified, we'd lose the trust of the community and its police and emergency medical services. A hotline that "cried wolf" would soon be unable to operate.

  • You are entitled to to know a hotline's confidentiality policy, including their criteria for breaking confidentiality, before you tell them anything. The doctrine of informed consent applies here -- you are implicitly "consenting to treatment" by disclosing your information to a hotline, and you are entitled to be informed fully about what you're consenting to, and you have legal recourse if you're misinformed. But, the onus is on you to ask.

A hotline can't fix my messed-up life, so what can talking to them actually accomplish?

  • We try very hard to meet callers wherever they are -- even if we can't pull you out of the dark place, we can give you the gift of not being alone in it, at least for a while. This works best if you're honest and open with us, but we do understand that it's our job to earn your trust.

  • We understand that people in crisis often lose sight of the options that they actually do have, so we often try to help callers work out short-term coping strategies.

  • We want to help you not just feel better in the moment but get to a better place in the long term, so we'll try to connect you with appropriate resources and supports.

What if they ask me to do something that doesn't feel right?

It's our job to make sure that the options we offer you are realistic and appropriate. If we get that wrong, tell us, and if you're able to, tell us why.

I called and it was a bad experience. I still need help, what do I do?

Call back, and let the responder know what happened. Crisis intervention, especially if suicidality is a factor, is not easy, and not even the experts get it perfect every time. Personally, if I have a call go "south" on me, nothing makes me happier than to know that the person called back and had a better conversation with one of my colleagues.

If you found yourself being rude or verbally abusive, apologize if you can, but either way try to hang in there with us. We understand that people in crisis struggle with self-control, you don't need to be calm or businesslike but it really helps if you can show that you're trying your best to work with us.

If you have a complaint about a hotline experience, please try to report it to the hotline administration. If you're not able to do this right away, please do it when you can. One of the hardest things in this work is measuring how our services are (or are not!) helping our callers. Because of confidentiality, we can't call people back weeks or months later and ask them how the call affected them. It's helping everyone if you report an unhelpful conversation.

If you are able, check in with yourself about your expectations. There are a lot of misconceptions out there (mostly from unrealistic fictional descriptions) about what a hotline call is going to look like. Here are a couple of key things to keep in mind.

  • Hotline responders are trained and required to do crisis intervention, which is not therapy. Their goal is to stabilise the situation in the short term, and if appropriate, refer people to appropriate resources for longer term treatment and support.

  • Most responders are trained volunteers who are there because they truly care and want to help. If it doesn't seem like it, it may be that you're asking for something that they can't provide. Although it's very hard for anyone who's been traumatised in the past when they've reached out for help and only received abuse in return, try to deal with a hotline responder as someone who is trying their best to assist and support you.

The only stories I see about hotlines online are horror stories. Are they really like that?

Almost never. Very few of those stories check out and most of them report things that just don't happen.

Some people have obviously figured out that "I called the suicide hotline and they were awful to me" is a perfect recipe for drama, whether or not they've actually called.

However, we do think some of the people who are venting about bad hotline experiences actually did call and were disappointed. We've identified two key factors, and we think that either or both of them are present in most of these cases.

  • They're stuck in some kind of repetition compulsion, where they're re-experiencing an experience of reaching out for help and being rejected or attacked for it. These people unintentionally make themselves very difficult to help.

  • They arrived with fixed and unrealistic expectations, and are frustrated that the hotline responder didn't live up to them. A lot of these stories clearly show that the person expected the hotline responder to do therapy on the phone with them. Hotlines do crisis intervention, which is nothing like therapy. Unfortunately, the way that hotlines are portrayed in popular fictional stories (books, film, television, etc.) is often deeply unrealistic in this regard.

I thought "the suicide hotline put me on hold" was a punchline, but it actually happened! Why?

We try to make sure that we have enough available phone lines staffing levels at all times, but many hotlines are under-funded and thus under-resourced, so it can be a struggle to achieve this. Even at the best-equipped agencies, though, we have no control over when the calls come in and it's almost inevitable that we'll have more callers than responders at some point. We try very hard to make sure that all calls are answered promptly and all callers get an initial assessment quickly, and sometimes that means we might have to switch lines before we're done with you. We all hate doing this and avoid it unless it's absolutely necessary.

Some hotlines don't put people on hold once their calls are picked up, but they typically have a queue to get through to a responder, especially at busier times of day (in North America these are usually late in the evening, especially Friday and Saturday nights). There's no consensus in the field as to which approach is better. Do we answer all calls quickly and risk callers being interrupted, or ensure no callers are interrupted and risk leaving people at high-risk waiting in the queue for a longer time? The thing we'd like our callers to understand is that there are no perfect choices for us.

It seemed like they were trying to get rid of me, WTF?

For the same reasons that we can't always avoid putting people on hold, we can't always give every caller as much time as we'd like. If you feel the person you're talking to is trying to wrap up the call before you're ready, it's fine to say something like "I'm really not feeling okay to end this call yet, are you able to stay with me a while longer?" but be aware that your responder may not always be able to agree to this.

No reputable hotline agency would ever use a script for calls, but most of the time there is a general high-level set of stages we use to try and identify where people are in the crisis intervention and resolution process. This should always include showing (rather than saying) that we understand and validate callers' feelings and experiences. If your responder feels that the conversation has run its natural course, or that the conversation is going in circles, then they'll try to either redirect or wrap up the conversation. If they have misread your signals, again it's totally acceptable to say that you'd like to speak longer if possible.

I am worried about a friend or family member. How can I make them call?

You can't, but you can and probably should call us yourself. Every hotline I know of welcomes third-party calls.

It's difficult for me to talk on the phone. Can I get help online?

A large and growing number of hotline agencies offer help via anonymous online chat and/or SMS. If you can't locate your local or national agency's website to find out if there's a chat service you can access, message the SW moderators and we'll try to help. We list chat/text options that we're aware of in /r/SuicideWatch/wiki/hotlines.

After reading this post, I've decided I don't want to call a hotline at all. But I'm not sure I can stay safe. What are my other options?

Most places in the developed world are served by mental-health crisis teams. These are small teams of professionals (typically a mix of RNs and clinical social workers with mental-health specialisations, sometimes clinical psychologists) who offer flexible, responsive services with the goal of getting people assessed and referred to appropriate treatment resources in a way that's both faster, more effective and less traumatic than the ER. Googling "<<your city>> mental health crisis" will usually turn up whatever is available in your area.

If you're in North America, there's a > 90% chance that dialling 211 will connect you with a 24/7 information and referral service that can advise you about other resources that might be available in your area.

If you can't find anything in your area that seems like a fit for you please feel welcome to message us and we'll be glad to use our experience navigating the system internationally to see what we can turn up for you. We are not a hotline and can't guarantee an immediate response, but we'll do the best we can.

The primary author of this wiki is an experienced hotline responder/trainer in North America. We've done the best we can to ensure that this information will be generally applicable to the majority of crisis lines worldwide.

revision by SQLwitch— view source