Crisis chat chats: active rescues for suicides

When people visit the crisis chat I volunteer at, I have three options:

  1. Listen, no follow up
  2. Listen, refer to specialist for concrete help (example: a woman being abused by her husband comes in to chat.  I validate her feelings and ideally help her move to a mental/emotional state where she is emotionally ready to leave.  I then refer her to the National Domestic Violence Hotline for help with the specifics of actually leaving).
  3. Listen, call for emergency government interference. There are two circumstances I must do this: someone under 18 is being neglected or abused by a guardian (-> call Child Protective Services or equivalent), or I believe someone is likely to attempt suicide in the next 24 hours (-> call local 911 for an emergency rescue, high likelihood they are involuntarily committed to a psychiatric hospital).

Since I started I’ve called CPS twice and watched other people call two or three times, and never seen a 911 call.  However, I’ve talked to a lot of visitors who are really scared of me calling 911.  I have complicated feelings about this.

I believe people have a right to commit suicide.  I believe my visitors when they say that psych wards are stressful and leave them worse off than they were before.   Active rescues take away people’s power, and when so much of suicide is driven by a feeling of powerlessness, that’s dangerous.   I spoke to a woman with sensory integration disorder for whom a psych ward was pretty much hell on Earth.  If a person is depressed over money, an expensive hospital stay and days of missed work will make it worse.  

I also believe active rescue is really beneficial for some people, and we cannot perfectly predict who falls in that category.  I think it’s safe to say that people coming to crisis chat are more likely to benefit from/want a rescue than the general suicidal population, and I am ultimately willing to tolerate a certain number of unwanted active rescues in exchange for a certain number of wanted ones.

A non-trivial number of people use my chat service rather than the phone line specifically because they (correctly) believe it is harder for us to find their physical location, so they can reach out without fear of the police knocking down their door.  The fact that these people exist indicates to me that this is a good service to provide.  There is a big gap being suicidal thoughts and suicidal acts, and having place to bring light to those thoughts without bringing your world down around you can be the first step towards letting them go.

Thus far my compromise is that if a visitor is voicing concern about me calling 911 on them and telling me they do not want to be committed, I tell them how to avoid having me call.  They can tell me about their wish to die as much as they want, they can even tell me their plan, as long as they also tell me they don’t plan on acting on them in the next 24 hours.  Is it possible people will lie to me?  Yes.  And I would be sad if I found out there was a suicide I could have prevented.  But I would also be sad if an unwanted rescue kept someone from reaching out later.  And I suspect that the truly imminently suicidal are less likely to lie about it/be able to lie about it.  For one, lying is mentally taxing, and the very depressed don’t have the space cycles.  For two, lying requires planning, and the biggest risk for suicide isn’t depression, it’s impulsivity.  My hope is that the same impulsivity that causes suicide will cause people to tell me about it.  I also hope, but will never have the data to back this up, that I’ll be able to recognize impulsivity and make a different deal with the person.  I don’t know what I’d do in that case, I just have this gut feeling that all the people who’ve asked me this so far needed a sense of control more than they needed a rescue, and I’d act differently if I didn’t think that was the case.