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What a 988 Suicide Hotline Can (and Can’t) Accomplish

988 Suicide &  Crisis Lifeline
988 Lifeline

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 (if you’re feeling nostalgic for the C&C Music Factory song, it’s here), 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 (as is the case with the American 988 Lifeline, Samaritans in the UK, and Talk Suicide Canada). 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’m fully in 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 it can’t be relied upon 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?

Straight talk on suicide - graphics of phoenix and semicolon

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.

32 thoughts on “What a 988 Suicide Hotline Can (and Can’t) Accomplish”

  1. Really good points. Mental health services are very sparse in the US, with long waits and boarding in ER for youth that need hospitalization to prevent suicide. For youth and adults waits are very long for therapy and other outpatient services. I’m in Massachusetts and we are lucky to have a department of mental Health that can provide good services for some youth, but, again waits are long. I have a kiddo that is sometimes suicidal and while we will certainly make number available, it is by no means a substitute for real intervention. Crisis counselors can help to determine the seriousness of threat but can’t provide the direct services in the moment, or prevent crisis in the future. Still, I do think it is a start and we just have to keep pushing for more!

  2. You’re right, it’s not a treatment service and can’t replace the support people may need if they’re calling in the first place. I like that friends and loved ones can also use the hotline to get support themselves when they’re concerned about someone. I believe 988 is aiming to signpost and get people to local support more, which I think is a great idea.

    Good timing. I actually have a post drafted on the 988 change to publish this week. Great minds… 😉

  3. I agree with your points. The intention of the hotline is there but access still problematic. It also seems like public speakers should be informed about what services a hotline does or doesn’t provide. Wanting the police to no longer intervene doesn’t work with no one else in place. That is only a wish. And implementing a three digit number doesn’t make it come true. There’s more work to be done and informing the speaking representatives seems like a good place to start.

  4. Would people call a hotline when they’re in that state? I’ve always wondered. I’ve never been in such a state, so can’t judge it, but I’d assume that it’s the last thing I would call…? If people need it, I’m happy it’s there!

  5. This is such an important issue to discuss. Thank you for writing about it, Ashley! I volunteered for a crisis/suicide hotline when I was an undergraduate psychology student. All volunteers completed training and supervised calls before manning the phone solo, but it was nothing compared to skills and training of a mental health professional. Most of the time, we served as a listening ear for lonely people who needed someone to talk to.

  6. We think your questions are reasonable and even help debunk crisis lines. Citizens want panaceas. Everyone wants easy solutions. Trying to figure out what this service will do—and will not do—seems very important for continuing the conversation, not ending it on, “we have a National suicide hotline now, so Mental health crises are over” lol

  7. I’m fortunate to have access to a 24/7 crisis hotline that is manned by trained counsellors. It doesn’t provide much intervention (there’s stuff they can do or can’t do), and I don’t think it refers people, but I’m more willing to call it vs the Samaritans.

    My problem with it would be the fact that any random person (*cough* yes I mean C again) could potentially misuse the service to send cops on someone… because police here aren’t at all helpful for mental health crisis. I do of course understand that’s not the crisis line’s fault, but basically C misrepresentating herself and misusing psych jargon and knowledge very deliberately.

    Police here far more likely to do harm, although I do understand the necessity if someone really really really is refusing to go to the ER, however. Come to think of it, C did it to someone before me, and the individual got hauled to psych ER in handcuffs and a police car. Not sure if she even needed that.

    Ironically, C herself can’t get her brother committed inpatient, even with the police there and a Mobile Crisis Team tryijh to coax him into going.

    High crisis people can be supported by the service, I’m not high crisis.

    1. That’s good that there’s a crisis line with trained counsellors.

      The whole handcuffs and police car thing is so inhumane. It really shouldn’t be happening as often as it does.

  8. My youngest told me that the USA will now have a 3 digit crisis number. I found that interesting information to know given we live in Australia. I’m guessing it was all over social media.
    Like you I don’t believe that crisis lines are going to fix the problem as they are unlikely to link to services. But any support that talks someone off a ledge (we use that as a saying and when I wrote it I briefly reconsidered and am hoping it’s okay) is good I think.
    We have line line which is manned by trained volunteers, and a mental health crisis team which is government run. The mental health crisis team gets you access to assessment and treatment. However they website also has if it’s a ‘life threatening situation’ call 000 or present your your local hospital emergency department. I’ve done all of these except call the police over the years for myself, family members and others. None of them work particularly well.
    This is what I’ve found:
    The lifeline number can give you an immediate person to talk to. If you need to get stuff off your chest and you are happy to chat to a stranger then it’s great. Sometimes a listening ear can be a circuit breaker.
    Calling the mental health crisis team is potluck. Sometimes you get someone who can talk to you, and suggest medication tweaks and things to get you through. Sometimes you get someone who tells you that is all your head and pretending to drink a magic beverage will fix everything. This happened to someone I knew.
    But they do refer to services which can be helpful if they get back to you and you aren’t having a crisis at 6 pm on a Friday night and need to service until Monday.
    Emergency can work if you are prepared to wait hours to get seen and are willing to open up to a variety of staff members will all ask you the same questions multiple times before leaving you alone in a room for hours.
    So…as an upshot they all have their place, they all have positives and negatives (sometimes it’s just the staff in the day) but it’s probably good that the number is easier to remember. When you are in crisis googling a number might not be an easy thing to do.
    Lastly I support any changes that might might access to mental health care and support easier for all. It’s not going to fix the issue but it’s a step in the (hopefully) right direction.

    1. That’s good to have both the crisis line and crisis team options. It always baffles me why people would choose to work in mental health care when they have lousy attitudes like the all in your head thing.

  9. I see what you are saying, but suicide and crisis lines were never envisioned to be treatment centers. I was a volunteer crisis and suicide line counselor for over two years when I attended USF, in Tampa. It was was run by one of our psychology professors. Most of the volunteer paraprofessional counselors were psych majors. I found it to be very rewarding when I literally heard the caller getting better and calmer. We gave out referrals constantly. We made pacts with suicidal callers to call back the next day, after the initial call, which almost always ended successfully with the caller saying s/he would at least postpone their act. We had a legendary episode (known to those who worked as volunteers) in which a caller had a gun he was planning on using on himself. This caller was lucky enough to get a counselor who’d grown up around guns and put a plan in action to have the caller dismantle the gun as they talked. The call lasted six hours and the caller did indeed call the next night to thank his counselor. So, while these phone lines manned by non-professionals—and I’m sure they receive training as we did over three weekends—they do play an important role, and can save lives. The system isn’t perfect, but we have to start somewhere; it’s better than not trying.

    1. I absolutely agree that they play an important role. The problem I see is if people think they serve a role that they don’t (and were never intended to) play. In terms of the news article that I was referring to, I’m not sure if it was the journalist misunderstanding what the people they interviewed were saying, or if the people they were interviewed just weren’t clear on the role of crisis lines, but the article definitely gave what seemed to me to be a misleading take on what functions a 988 number would serve.

      1. I agree with you that crisis lines don’t solve the problem, but I’ve been suicidal. Trust me when you feel so hopeless to see no other way out a kind and helpful human on the other side of a phone conversation can be a lifeline.

          1. Hmm, I want to like that you commented, but it worries me that you want to not talk to people. I hope you don’t get into those states often.❤️‍🩹

            1. I think that has a lot to do with my perspective that people in charge shouldn’t look at the existence of crisis lines as an excuse not to put resources into treatment. When I get suicidal, what helps is treating my illness more aggressively, because that’s what’s producing the suicidality.

            2. I agree that they shouldn’t look at them as excuses. I think if the people in charge fully understand mental health they won’t see them as excuses, because they absolutely are not the cure. They are the bandaids.

  10. Very realistic perspective on this complicated issue. Although attempting suicide can be considered a cry for help, not many will stop in the middle of their attempt to say, “Wait, let me call that 988 number instead.” However, creating that number is better than not trying all possible avenues of intervention. Thanks for writing this! Very interesting.

  11. I have t say I agree Ashley. Crisis lines arent really equipped to deal with the bigger issues which is that a person is actively suicidal. All the volunteers can do is listen and empathise, maybe possibly direct the person to more resources if there are any available. X

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