I wasn’t suggesting banning users contemplating suicide. (Do any sites do that? Is it a good idea?)
Lots of reports suggests that suicide hotlines aren’t actually much better than random like-minded people, though it’s possible that callers underestimate how helpful they were. And contacting locals is among the most likely strategies to backfire.
I want research, too, but in lieu of that, I second “lots of reports”. Also, consider this reality:
Imagine you tell someone that you’re thinking about killing yourself. Say this person decided to call 911, and you end up admitted into the mental ward of a hospital.
Unless you have very good insurance (or something has changed), they’re likely to let you out in a week. I’ve heard of this happening to countless people. It is simply too expensive to keep them in there very long.
So, a week later, you’ve:
Missed a week worth of pay (from work).
Racked up tens of thousands of dollars in hospital bills (most likely your insurance won’t pay for it all.)
Missed a week of work. Some workplaces will find a reason to fire you after that. (Not all managers care that this is illegal.)
You had to live in a place full of crazy people every day for a week.
You had to sleep in a place full of crazy people, perhaps sharing a room with one, every night, for a week.
You’ve been treated like a crazy person for a week. (Barely allowed any possessions, unable to go anywhere, living apart from friends and family, having your life scheduled by the staff, etc.)
Your new prescription may not even kick in for several weeks!
Is your situation and mood:
A. Better
B. Worse
The last suicidal person I called 911 for was not provided any services, but was charged hundreds of dollars. Apparently, they stopped by, asked him a pile of questions, he managed to avoid being taken to the mental ward, and then they charged him out the ears for the visit.
He was quite upset with me. Quite. Moral of that story: Don’t IM about suicidal thoughts while the internet connection is flaking out and then say something like “I can’t go on” and then also fail to answer the now very concerned friend’s phone call right after.
It’s enough to make me think that someone should do a study to determine whether fatalities might increase after a visit to a mental hospital.
And as for the suicide hotlines—a lot of the operators are volunteers. I wouldn’t be surprised if the number of operators who are volunteers is like 90%+. I’m sure you have to be pretty special to be a suicide hotline volunteer (nerves of steel + screening) but I doubt that most of the operators are psychologists. This could probably be verified if you were willing to look up the largest suicide hotlines and see how they source their operators. For now, a quick example of operator sourcing:
Crisis Clinic Volunteering Page:
“Crisis Line phone workers come from all walks of life and educational backgrounds.” (All educational backgrounds means lots of people who are not licensed psychologists).
It is interesting that the suicide rate for people who have just left a mental ward is over twice that of those who have just started anti-depressants, but:
A. Those who end up in the mental ward are more likely to be in that group because they actually attempted to kill themselves, or because they have a plan, whereas the anti-depressant patients and other groups of people might be experiencing suicidal ideation without an attempt or plan, or simply just depression without suicidal ideation.
B. People who plan or attempt to kill themselves are probably a lot more likely to attempt to kill themselves in the future than people who have never attempted and may not even be thinking about it.
In order to know whether admitting a suicidal person into a mental ward does more harm or more good, we’d need a study where they compare outpatient suicide rates with suicide rates in a control group. A good control group would need to consist of equally suicidal people who were not admitted into a mental ward. In order to ensure they were comparable, they’d need to track things like whether a suicide attempt was made, whether the person was on anti-depressants, etc. Also, if nobody had hospitalized the hypothetical control group, there’d be a reason for that. This reason would have to be the sort of thing that wouldn’t impact the suicide rate itself. For instance, if those people are living in a place with no legal way to hospitalize a person against their will, it might produce a great control group. On the other hand, if the control group mostly consisted of people who were not hospitalized because they are alone and have no family members or friends who care enough to call 911, this would not be a great control group.
Now I wonder if there are any places where you cannot legally be admitted to a mental ward against your will… or whether there might have been a point in the past when there was a place like this.
It’s hard to imagine that there would ever have been a place like this, but you never know.
You’re quite right that it’d be very hard to demonstrate a causal effect (and without having read the study itself—don’t have access -, I suspect the researchers didn’t even want to try).
Actually, I have no idea how that could be done in practice. For voluntary hospitalization, it would be helpful if one couldn’t be hospitalized against one’s will, but I’m not aware of a time and place where that would be the case, and don’t expect there to be any. So one can study that only outside the realm of “hospitalization-worthy” suicidality, by using patients who have been offered hospitalization, but declined it, as a control. My quick search turned up no indication of even that having been done.
And for forced hospitalization, it seems sort of impossible in principle to find a control group...
I also just found this, again I don’t have access, and unfortunately it doesn’t even have an abstract. Might be relevant, though, judging by the title.
Check for that first link on Pubmed. I was able to access the article that way.
I’m not finding this new article anywhere. The text in a Google book search where the study had been mentioned suggests that it’s probably not the type of study I’m looking for though.
I doubt this type of study exists. About the best we could do is to compare the suicide rate in an area with no legal method for hospitalizing suicidal people against their will (if that exists and the country is developed enough to keep such statistics reasonably well) with the suicide rate of a comparable area.
I looked at the results section of that abstract, but there’s an obvious reason why their correlation of an increase in suicides after hospitalization may not have Epiphany’s causal explanation.
I didn’t mean banning, just people thinking “They won’t help me, no point posting” or “Holy mackerel they’re going to call 911 on me and get me locked up” or “I would ask LW for help, but I can’t get over fretting about the reaction”.
A couple mental illness support groups I know of ban talking about planned suicides (and self-injury), mostly to avoid triggering potentially suicidal (resp. self-injurious) people. Since they point to emergency resources a lot and support non-acutely suicidal people, it doesn’t seem to be very bad, but I can’t observe the consequences.
Are these claims research-based?
The first is anecdotal. I’ve heard a lot of negative reports and very few positive ones, but there may be selection bias. Maybe hotlines are for people who are desperate to talk to anyone, so people who’d talk to me don’t benefit nearly as much.
The second… is probably wrong, come to think of it. A lot of people shriek “Never spill the beans about someone being suicidal without their consent, it could get them into arbitrary amounts of trouble, and an even suckier life won’t make them less suicidal”, but even more people shriek “Call 911 NAO” and the main evidence that the former know what they’re talking about is that they have much more personal experience.
I wasn’t suggesting banning users contemplating suicide. (Do any sites do that? Is it a good idea?)
Are these claims research-based?
I want research, too, but in lieu of that, I second “lots of reports”. Also, consider this reality:
Imagine you tell someone that you’re thinking about killing yourself. Say this person decided to call 911, and you end up admitted into the mental ward of a hospital.
Unless you have very good insurance (or something has changed), they’re likely to let you out in a week. I’ve heard of this happening to countless people. It is simply too expensive to keep them in there very long.
So, a week later, you’ve:
Missed a week worth of pay (from work).
Racked up tens of thousands of dollars in hospital bills (most likely your insurance won’t pay for it all.)
Missed a week of work. Some workplaces will find a reason to fire you after that. (Not all managers care that this is illegal.)
You had to live in a place full of crazy people every day for a week.
You had to sleep in a place full of crazy people, perhaps sharing a room with one, every night, for a week.
You’ve been treated like a crazy person for a week. (Barely allowed any possessions, unable to go anywhere, living apart from friends and family, having your life scheduled by the staff, etc.)
Your new prescription may not even kick in for several weeks!
Is your situation and mood:
A. Better
B. Worse
The last suicidal person I called 911 for was not provided any services, but was charged hundreds of dollars. Apparently, they stopped by, asked him a pile of questions, he managed to avoid being taken to the mental ward, and then they charged him out the ears for the visit.
He was quite upset with me. Quite. Moral of that story: Don’t IM about suicidal thoughts while the internet connection is flaking out and then say something like “I can’t go on” and then also fail to answer the now very concerned friend’s phone call right after.
It’s enough to make me think that someone should do a study to determine whether fatalities might increase after a visit to a mental hospital.
And as for the suicide hotlines—a lot of the operators are volunteers. I wouldn’t be surprised if the number of operators who are volunteers is like 90%+. I’m sure you have to be pretty special to be a suicide hotline volunteer (nerves of steel + screening) but I doubt that most of the operators are psychologists. This could probably be verified if you were willing to look up the largest suicide hotlines and see how they source their operators. For now, a quick example of operator sourcing:
Crisis Clinic Volunteering Page:
“Crisis Line phone workers come from all walks of life and educational backgrounds.” (All educational backgrounds means lots of people who are not licensed psychologists).
http://crisisclinic.org/get-involved/volunteer/#24hour
There is one study I’m aware of.
Ooh… click
It is interesting that the suicide rate for people who have just left a mental ward is over twice that of those who have just started anti-depressants, but:
A. Those who end up in the mental ward are more likely to be in that group because they actually attempted to kill themselves, or because they have a plan, whereas the anti-depressant patients and other groups of people might be experiencing suicidal ideation without an attempt or plan, or simply just depression without suicidal ideation.
B. People who plan or attempt to kill themselves are probably a lot more likely to attempt to kill themselves in the future than people who have never attempted and may not even be thinking about it.
In order to know whether admitting a suicidal person into a mental ward does more harm or more good, we’d need a study where they compare outpatient suicide rates with suicide rates in a control group. A good control group would need to consist of equally suicidal people who were not admitted into a mental ward. In order to ensure they were comparable, they’d need to track things like whether a suicide attempt was made, whether the person was on anti-depressants, etc. Also, if nobody had hospitalized the hypothetical control group, there’d be a reason for that. This reason would have to be the sort of thing that wouldn’t impact the suicide rate itself. For instance, if those people are living in a place with no legal way to hospitalize a person against their will, it might produce a great control group. On the other hand, if the control group mostly consisted of people who were not hospitalized because they are alone and have no family members or friends who care enough to call 911, this would not be a great control group.
Now I wonder if there are any places where you cannot legally be admitted to a mental ward against your will… or whether there might have been a point in the past when there was a place like this.
It’s hard to imagine that there would ever have been a place like this, but you never know.
You’re quite right that it’d be very hard to demonstrate a causal effect (and without having read the study itself—don’t have access -, I suspect the researchers didn’t even want to try).
Actually, I have no idea how that could be done in practice. For voluntary hospitalization, it would be helpful if one couldn’t be hospitalized against one’s will, but I’m not aware of a time and place where that would be the case, and don’t expect there to be any. So one can study that only outside the realm of “hospitalization-worthy” suicidality, by using patients who have been offered hospitalization, but declined it, as a control. My quick search turned up no indication of even that having been done.
And for forced hospitalization, it seems sort of impossible in principle to find a control group...
I also just found this, again I don’t have access, and unfortunately it doesn’t even have an abstract. Might be relevant, though, judging by the title.
Check for that first link on Pubmed. I was able to access the article that way.
I’m not finding this new article anywhere. The text in a Google book search where the study had been mentioned suggests that it’s probably not the type of study I’m looking for though.
I doubt this type of study exists. About the best we could do is to compare the suicide rate in an area with no legal method for hospitalizing suicidal people against their will (if that exists and the country is developed enough to keep such statistics reasonably well) with the suicide rate of a comparable area.
I looked at the results section of that abstract, but there’s an obvious reason why their correlation of an increase in suicides after hospitalization may not have Epiphany’s causal explanation.
I didn’t mean banning, just people thinking “They won’t help me, no point posting” or “Holy mackerel they’re going to call 911 on me and get me locked up” or “I would ask LW for help, but I can’t get over fretting about the reaction”.
A couple mental illness support groups I know of ban talking about planned suicides (and self-injury), mostly to avoid triggering potentially suicidal (resp. self-injurious) people. Since they point to emergency resources a lot and support non-acutely suicidal people, it doesn’t seem to be very bad, but I can’t observe the consequences.
The first is anecdotal. I’ve heard a lot of negative reports and very few positive ones, but there may be selection bias. Maybe hotlines are for people who are desperate to talk to anyone, so people who’d talk to me don’t benefit nearly as much.
The second… is probably wrong, come to think of it. A lot of people shriek “Never spill the beans about someone being suicidal without their consent, it could get them into arbitrary amounts of trouble, and an even suckier life won’t make them less suicidal”, but even more people shriek “Call 911 NAO” and the main evidence that the former know what they’re talking about is that they have much more personal experience.