I recently came across a CBC News article titled Mental Health Experts Say Canada Needs a 3-digit Suicide Crisis Hotline. The US just implemented its own 988 lifeline on July 16. The article had some things that made me go hmmm, so I thought I’d write about them.
As a bit of background, the federal government voted back in 2020 to establish a 3-digit suicide crisis line. The Canadian Radio-television and Telecommunications Commission (CRTC), a federal regulatory body, did public consultation that ended earlier this year, and they’re now looking at how to implement the 988 number.
The CBC article
What caught my attention in the CBC article was what the experts they interviewed seemed to think a 988 hotline would accomplish.
Dr. Allison Crawford, a psychiatrist who is the chief medical officer for Talk Suicide Canada, told CBC, “I see this as one important access point into a mental health service that I think needs renewal.” Is it really, though? Because I don’t think it is, as much as it would be nice if it was.
Sheryl Boswell, the executive director of Youth Mental Health Canada, told CBC, “A three-digit number for mental health crisis and support is what we need, not 911 criminalizing mental health. Not police response in uniforms and marked police cars.” The CBC article also noted, “One of many benefits of a 988 number, Boswell said, would be eliminating the involvement of police for wellness checks.” Again, is it really? As nice as that would be, I think it’s entirely unrealistic.
Crisis lines aren’t health care services
I don’t know if this is consistent everywhere, but in a lot of places, crisis lines are run by non-profit organizations, and it’s volunteers answering calls, not mental health professionals. This is the case with Samaritans in the UK and Talk Suicide Canada, and it appears to be the case with the American 988 Lifeline. They’re there to provide empathy and supportive listening, not therapeutic interventions that go beyond that, and they’re independent from mental health care services.
So when Dr. Crawford is talking about an important access point into a mental health service, I really don’t think that’s the case. Sure, a crisis line might be able to tell people about some of the professional services that are available, but they’re not connected to those services and they’re not making direct referrals for their callers. People calling a crisis line are probably going to face just as much of a fight as anyone else to get access to half-decent mental health services that would actually meet their needs.
As for what Sheryl Boswell had to say, I don’t think she actually realizes what a 988 number will and will not accomplish. Crisis lines aren’t reaching out to try to track down people that others have reported concerns about, and they’re not providing outreach services go check on people in their homes. “Wellness checks” happen because someone has called the police to express concerns about someone’s safety. I’m just not seeing overlap there with what crisis lines do.
As far as I know, bringing in a 988 number doesn’t involve adding new services; it just gives people an easy-to-remember number rather than them needing to Google the number for their local crisis lines. Given that people Google things all the time, I’m curious if there’s suddenly going to be a lot of people who wouldn’t have Googled but will now be calling 988.
Emergency mental health services
Some places have professional emergency mental health services that are part of the health care system, but exactly what this might look like will vary depending on where you are. In the city where I live, this used to be handled by a program called Mental Health Emergency Services, but that’s now been rolled into the program that handles referrals for all of the community mental health programs in the city. They can be reached between 7:30am and 10pm 7 days a week for “non-life threatening mental health and/or substance use (MHSU) issue,” but they say “If you feel you or someone else might be in danger of hurting themselves or someone else, call 9-1-1 or go to the hospital emergency department right away.” Doesn’t sound like they’re too keen on dealing with actively suicidal people.
I fully support of what Sheryl Boswell is hoping for, namely removing police from the mental health crisis equation entirely, but for that to happen, that function needs to be shifted to mental health care services. Those emergency mental health services might need to be empowered to apprehend people in the community involuntarily to get them to hospital if it’s necessary to ensure their safety. Where I am, and probably in most places, police are currently needed for that. I think they’re very much the wrong people to be doing that, but someone needs to have that authority for situations where a person isn’t well enough to be able to make that decision for themselves.
Crisis lines are not a substitute for mental illness treatment
Not everyone who’s suicidal has a mental illness, but for those of us that do, a crisis line is a stopgap, not treatment. They’re very good stopgaps to have in place, but it’s crucial to actually do something about the problem that’s making someone suicidal in the first place. Crisis lines aren’t equipped to do that, nor is it a role that they’re intending/trying to play.
I’m not trying to be critical of crisis lines; I just think it’s important to understand what they can and cannot accomplish. My issue is not with crisis lines themselves and what they do; I just think it’s a problem if other people think they play a role that they don’t. It’s great to have an easy way, like a 988 number, for people to reach a crisis line, but without available, accessible, acceptable, and effective mental illness treatment, people are going to keep dying.
So, should Canada have a 988 number like the US? Sure. But we can’t rely on it to be the biggest piece in the suicide prevention puzzle, because I really don’t think people are following through on suicidal plans because they’re choosing not to Google a harder-to-remember crisis line number.
What are your thoughts on what a 988 suicide hotline may or may not be able to do?
The Straight Talk on Suicide page has crisis and safety planning resources, along with info on suicide-related topics from the perspective of someone who’s been there.