Content note: this piece discusses the limits of what help is available to people contemplating suicide. If that’s a topic that brings up a lot of emotion for you, you may want to consider skipping this piece for today. Hang in there, lovely readers.
Last week, after two high profile suicides, my Facebook and Twitter feeds were awash with people discussing whether linking to suicide hotlines and telling people to “get help” is a good idea.
The topic deserves discussion and particularly needs some nuance, especially as posting links to suicide hotlines has become a popular thing to do whenever suicide is discussed online. As suicide is becoming alarmingly more common, and as we become more comfortable discussing depression openly, the issue is going to keep coming up. And no matter who is posting it, twitter-sized takes are never going to cover the complexity of the issue.
Here’s the problem with suicide hotlines.
Suicide hotlines are set up to do one thing, and one thing only: to get people through the moment. To provide them with someone to talk to when nobody else is available, until the moment of crisis has passed.
And there are risks to calling a suicide hotline. Most hotlines (though not all) will call emergency services if they believe that someone’s risk of suicide is high. What this means is that the police or paramedics may be sent to take a person and force them into psychiatric care against their will. This process, called “involuntary commitment” is inherently violent on its own, but can also result in sexual assault, further trauma, and even death at the hands of law enforcement. The risk is higher for people of colour. And if they’re in the U.S., the suicidal person or their family can also be stuck with a hospital bill on top of everything else.
A suicide hotline can give a suicidal person someone to talk to. I don’t want to downplay the importance of that. When someone needs someone to talk to and nobody is available, providing that service is obviously good, if it is done well. Some hotlines, such as the trans lifeline, (created by and for trans people) specifically have a policy that they will not call emergency services without consent.
But talking is not enough. If a person’s suicidality is rooted in poverty, racism, trauma, isolation, or some other form of oppression — talking alone can never solve that. It can get the person to survive to the next moment. But it won’t make the causes of their suicidality go away.
My major concern with suicide hotlines is how frequently they are used to pass the buck of responsibility for suicide prevention.
As another activist commented recently, most approaches to suicide prevention are like trying to stop someone from jumping out of a burning building while doing nothing to put out the fire. This is as true of psychiatric hostpitalization as it is of hotlines.
Suicide isn’t random. It isn’t caused by genetics or chemical imbalances. It is caused by oppression and suffering, by the very real forces in this world that are within human control. A person who is suicidal isn’t just randomly wanting to do something violent, they are responding to circumstance.
When a person is in so much distress that they are considering suicide, talking to someone about their distress can do very little, because simply talking won’t change the circumstances.
I was recently involved in supporting someone who was imminently suicidal, and in my whole life, nothing has made me feel more powerless. This person was suffering from the effects of discrimination and isolation, and was absolutely convinced that nobody cared for them. They live in a different city, and I talked to them on the phone. It may have gotten them to the next moment, but it wasn’t going to undo the years of violence they had suffered that had gotten them to where they were.
Helping this person was next to impossible, and it was only because of my years of experience of dealing with depression combined with my strong sense of boundaries that I was able to do anything at all, and I didn’t do much.
Helping someone who is suidical is hard fucking work. There is no way around that. And so of course most of us, when we encounter someone who is suicidal, will want to pass this off to a professional. So we post hotlines and lists of resources and encourage people to “get help”.
My friend Alyssa commented this week, “the theory [behind suicide hotlines] is that people need someone to talk to but the reality is that the someone they need to talk to is not a stranger at the other end of the phone. It is a community, a person who loves them and understands who they are and what they’re going through and/or a professional who can provide them with mental health intervention and guidance. Neither of which suicide hotlines can really do.”
People who are suidical don’t just need someone to talk to. They need things from their community. They might need their community to drop in on them and arrange for them to have meals while they focus on workign through their feelings. They might need help finding a job, or filling out the paperwork to receive social assistance. They might need the government to provide them with affordable housing. They might need a therapist, but they might need a friend more.
We are all, collectively, responsible for this.
Collective responsibility for mental health is an important concept. Collective responsibility doesn’t mean that each individual is equally responsible, either. It means that we have a responsibility to use our own skills and capacities in a way that is contributing to meeting people’s needs and assuring their wellbing.
If it is within your capacity to offer someone a meal, a cup of tea, your shoulder to cry on, or your couch to sleep on, please do those things before you tell someone to “get help” or call a hotline. If they’re talking to you about what they are feeling and what’s causing those feelings, offer to help them find the things they need! If you’re not used to offering that kind of support, it might be uncomfortable at first, but it’s critical.
Collective responsibility also means that people should be working as a team to ensure that support happens. No one person can effectively support a suicidal friend if they are working alone. If someone is in real distress, the whole community should be organizing itself to provide for their needs.
I want to be extremely careful how I write this, because too often what I see is depressed and otherwise marginalized people looking after each other. We bend over backwards for each other because we know what it’s like, putting our own mental health at risk in the process. There’s nothing wrong with us helping each other, but what we need is for those who are privileged enough to have more power and more ability to do something to step in as well. Right now, when I see community care happening, I primarily see depressed people are caring for other depressed people, and it’s not enough.
If you’re not someone with chronic depression, it’s really important for you to realize that the system doesn’t work. There’s no ambiguity about that. Some individuals get the support that they need from professionals and that’s great. But overwhelmingly, “mental illness” is getting worse. More and more people are suffering all the time, and the professional “help” that is available is not nearly enough.
We have to start treating this as a political issue, rather than as an individual wellness issue. We are all responsible for this.
If you’re not living with depression yourself, I’m specifically calling on you to step up. Help your friends. Listen to them. Think creatively about how to provide what people need. And treat suicide hotlines as a last resort.
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