Suicide hotline shares data with for-profit spinoff, raising ethical questions
politico.comMy impression of these services are that they are simply available so people can feel they have "done something" about someone who seems suicidal by giving them the number, then wash their hands of the rest of it. Not that someone else's mental health puts any particular obligation on you, but that's the dynamic I see play out. I've called these services twice over the years when I was young and naive and had friends I was worried about, and their entire objective is to trick you into giving them details so they can sic the police on these people and ruin their lives with an involuntary hold in the psych ward. One of the calls was more of an advice call, as in I (then 16 years old) was trying to ask them what I should do, and when I refused to give them the person's address the person on the line straight up asked me "what do you want me to do?" I don't know! I was a scared 16 year old kid and you're supposed to be the one who knows that! What is the point of you answering the phone!
I'm sorry to hear you had these shitty experiences :( FWIW, I agree with some others who say that it differs between hotlines and it does depend.
I volunteer at one (working at software doesn't provide enough meaning as far as activities go, and this does, as a side thing), and we are very strict about not forcing advice (or rescue) on anyone. (I had to go through multi-month trainings, practice, then supervision etc., we have ongoing seminars and equivalent of QA, etc.) The primary goal is provide emotional support and to give the caller a safe space where they can be heard, openly express and talk about their feelings and thoughts. We are there expressly not to solve any issues they are having. If they need it and consent to it and give an address (the calls are anonymous), we can call an ambulance; but even then the preference is if the caller does that.
I can tell (with some statistics and also lots of feedback) that the support does address the callers' emotional needs to be heard (sometimes to organise thoughts, understand their emotions, to speak to a real human and feel less lonely, etc.)
I had a whole rant on hotlines, but I honestly didn’t know there were good ones. No one in my support group had a positive story about hotlines.
I am extremely glad good ones exist. If you have a list, I’ll share it with my support group.
Edit: removed my horror story… we don’t need another one on this thread.
I unfortunately don't have a list for the US, I'm based in the Baltics (Lithuania). I've heard good stories from US hotlines but don't know any particular names.
Trans Lifeline [1] calls that practice "Non-consensual rescue" and they're very strongly against it.
> The organization’s hotline does not engage in non-consensual active rescue,[15] meaning operators never call 911, police, or emergency services on callers without an expressed request and consent, based on research associating involuntary hospitalization with increases suicide attempts after discharge.[16][17] Additionally, they believe that calling the police on transgender people in crisis, particularly trans people of color, causes more harm.
Former Technology Director for TL here - I maintained and deeply extended their hotline software. We took confidentiality and anonymity very, very seriously. Operators never, ever see the phone number of the caller, and vice versa. Only admins can even look up a caller by phone number. There were other technical measures as well, but I'm not going to give them up in a public forum, hope that's understandable.
Just wanna say thank you for your work.
Thank you, ketzo. Unfortunately I'm no longer with the org and can't say for sure that they wouldn't ever try to do something like this. I'm working with a new group now on open source peer support software that also values privacy.
That is an excellent qualification to make. You only know as much as you've seen and what happens after you turn your back is hopefully more of the same or better but that is no guarantee. Kudos for seeing this sharp.
Can't help but have flashbacks to The Incredibles where Mr. Incredible was sued by a person he saved from suicide because that was involuntary...
The same conundrum comes up with the medical forms that ask one to self-report any post-partum depression, or any time you can be found mentally unfit (e.g. at your job, like in 2015 Germanwings pilot-murder-suicide) so that the bureaucracy descends to irrevocably alter your life. As a society, we still haven't figured out a way that allows a suicidal person to get their time-out, while ensuring that that intervention won't impair their future.
I’ve actually found crisis lines to be fairly helpful. Sure, they have little real world power but the people I have spoken to have been calm and reassuring, which more often than not has been what I needed. A few people I’ve spoken to have been particularly memorably great, and I wish I could buy them all a beer.
This isn’t to dismiss those who’ve had bad experiences. I just wanted to offer a different perspective.
I worked at a suicide hotline in Canada. The problem with what you are saying is that, as far as I know, there is no unified organism for suicide prevention centers and hotlines in North America (there are associations, but they don't seem to demand a unified process).
This means that, while your experience totally sucked, it can't be generalized. Most people I've talked to from all over the country genuinely want to help. I assume it's the same in the US. But some centers offer very little training, and their legal means probably vary a lot by location.
That said, there is a lot they can do beyond calling an ambulance, but it still comes down to talking and guidance, no one can physically force people to get better, except maybe some institutions (debatable).
This is more of a reason for reverting police funds to other efforts, such as people that can help in cases like you brought up. Law enforcement has just become a huge bucket that encompasses too much.
OP's hot take isn't reality. Worked at a suicide hotline for a year.
The fundamental purpose of suicide hotlines is to take burden off emergency services, and to give folks a coping mechanism which doesn't involve 911.
90% of callers are frequent fliers, calling weekly to daily. In the year I worked there I only had 2-3 calls which required serious treatment.
that doesn't mean it is invalid either.
When reddit added a "get help" message for suicide hotlines it was a way for 'nice' people to tell you to kill yourself without a death threat.
Kind of how old church ladies used to tell you they will pray for your immortal soul to not end in hell.
I have a feeling that those two groups are related in the biological sense.
How is telling someone to KTS a death threat?
The same way "Will no one rid me of this troublesome priest?" was.
You have to understand that this is a poorly paid phone job for the person on the other end.
They don't have a PhD. They are not top 1% intelligence, top 1% compassion and top 1% drive to help others. They are just people who applied for a job, got it and are following a script or whatever little training they've been given.
When you're younger, you think there's adults who know a thing or two. Then you grow up and realize that's 0.0001% of the population. Everyone else knows how to do a couple of repetitive tasks and repeat sentences they heard other people say, not much more than that.
In fact they may not even be employed; a relative of mine had to do a few shifts on such a hotline as part of a community service sentence for a non-violent misdemeanor.
Haha my mind cannot believe this to be true and yet it'd take some 4D chess to have made up such a strange, specific lie.
I'm not like, broadly familiar with community service as a punishment across the globe, cultures, and time, but the way I'm familiar with is a mandate of X hours and its on you to find a place to volunteer and get them to sign off. So its not like the court told them to do this particular act of penance, which yes would strain credulity, it was self selected.
I'm not sure why people don't believe this...? It was in California in the early 2000s and it was offered as an alternative to litter-picking and, if I recall, work at a soup kitchen. Said relative chose it because of the travel time since they lived far away from the jurisdiction where they were sentenced. I'd ask for more details but they passed away a few years later.
I don't often find people able to articulate their views on the suicide topic, and also aren't comfortable talking about it.
The best thing I've heard though is that there is a large subset of suicides that are spur of the moment decisions. And so an option like a suicide prevention hotline is to serve as a distraction and circuit breaker to get the afflicted human onto something else. That also means there is no use case where you call the hotline on someone's behalf.
Basically same experience. Even the mental health hotlines can be the same way. Unless you tell them you plan on killing yourself they say there is nothing they can do to help.
Yeah there's been 4 or 5 times where I really wanted someone to talk to, but I'm just not a suicidal person, so it feels weird to tie up a suicide hotline for my petty problems.
So then you go to a therapist and they're like "You have to want to change".
I don't know about that. I used to have friends. I don't want to change, I want to have friends again!
Considering how much therapy costs, I've joked about just hiring prostitutes to be my friends for hourly pay. Why can't the gig economy meet that demand, huh? I'll pay $15 an hour to share my opinions on Linux with another trans girl while she pretends to listen. That's an entire work shift for the price of 1 hour of therapy!
>Considering how much therapy costs, I've joked about just hiring prostitutes to be my friends for hourly pay. Why can't the gig economy meet that demand, huh? I'll pay $15 an hour to share my opinions on Linux with another trans girl while she pretends to listen. That's an entire work shift for the price of 1 hour of therapy!
If you talk to escorts a surprisingly large chunk of their clientele does exactly that. That said $15 is no where near enough to have to listen to someone talk about how great Arch is.
In New Mexico we have a non-profit staffed by volunteers trained in listening. It is not a suicide hotline exactly, they welcome anyone who feels like they need to talk. It's anonymous. I had several friends who volunteered there some years back; they'd get calls from old people who were lonely, stressed out students, all kinds of people. I don't think you have to be New Mexican to call. http://www.agoracares.org/ 505-277-3013 855-505-4505
You don't need to pay to talk about Linux, silly. There are plenty of people (Including trans girls (hey that's me)) who'd listen for free!
Funny you should mention that, I have thought about similar things. There a few trans related discords for techies. That helped me.
> their entire objective is to trick you into giving them details so they can sic the police on these people and ruin their lives with an involuntary hold in the psych ward
This is 100% untrue. Their objective is to prevent suicide. If you intend to harm yourself, and nobody is around to make you safe, yes, they bring people in to enforce safety and yes that is often law enforcement. They will take the suicidal person to an ER, where the ER staff will do an assessment, and then may opt to put you in an involuntary hold if a licensed psychiatric provider deems it is necessary. But it is more likely that even if you do need hospitalization, they will recommend a voluntary hospital stay. Most care providers look to give people the least restrictive care that still gets the job done.
It is also important to note that you called on behalf of friends but refused to give out any info. There is very little they can do in that case. You are not the one at risk. You do not control the environment of the one at risk. You won't tell them who is at risk. I can understand why they got frustrated. I can also understand why you are frustrated. But none of those frustrations make your assertion true.
Two sentences in that piece are particularly amazing taken together:
>"Data science and AI are at the heart of the organization — ensuring, it says, that those in the highest-stakes situations wait no more than 30 seconds before they start messaging with one of its thousands of volunteer counselors[...]"
>"Others questioned whether the people who text their pleas for help are actually consenting to having their data shared, despite the approximately 50-paragraph disclosure the helpline offers a link to when individuals first reach out."
They better start offering a speedreading course together with their suicide prevention service because otherwise that's hard to reconcile. In all seriousness, milking suicide prevention data in any shape or form to make more money, can we go any lower? There is only one legitimate way to handle data here, for law enforcement or medical professionals, otherwise delete it.
I'm not sure, if you're an organization targeting people in distress for suicide prevention help, you can pretend that those people are in a state of mind to agree to any disclosure to terms of use.
Yep, humans are really good at rationalizing decisions made for other reasons. I'm sure the people doing that have convinced themselves that it's totally ethical because they're "saving lives" (using some twisted definition of "save")
AI power text line for suicide seems horrible to me. Every time I am hit customer support and need to face AI first my stress level increases. AI powered virtual assistant seems like the worst thing that happened to customer support in the recent decade. Every time I listen to a presentation by some exec how introduction of AI assistant improved some performance metric of a customer support dept, I actually feel bad for customer and for tech industry, that helped bring this change closer.
> can we go any lower?
They can always offer estate planning services right there in the chat. I bet some lawyers would jump on this ad placement opportunity.
> There is only one legitimate way to handle data here, for law enforcement or medical professionals, otherwise delete it.
What about research? It would be hard to navigate and share it responsibly even with research facilities, but it is a very legitimate use case and potentially useful.
This is quite disgusting. If there is one place where your privacy should be guarded it is there, plenty of places will forcibly admit you (at huge costs) if they see you as a suicide risk.
> plenty of places will forcibly admit you (at huge costs) if they see you as a suicide risk
How's that legally done?
Is suicide even a crime in most countries? I don't think it is.
Not most countries, but it is illegal in some... see: https://en.wikipedia.org/wiki/Suicide_legislation
In NZ I do know the cops like to kick you when you're down. Let's say you've climbed a scaffold that's around a building and you want to jump but you are saved (as you had been on the phone with a suicide help line, and they passed the details to the Police), you get done with a trespass charge and can be convicted. I really hate reading stories like this - way to kick someone while they're at rock bottom, potentially making them actually do it so they don't have to go to court, get publicly shamed and potentially getting a criminal record.
Many cultures have a long, ingrained history of making suicidal people's lives intentionally worse as a misguided attempt to discourage suicides. A book that discusses this phenomenon that I found helpful was Al Alvarez' book "The Savage God"; Alvarez was a friend of Sylvia Path, who felt compelled to explore the issue in terms of the narratives we tell ourselves and each other about it.
In Western Christian countries, there are recorded cases of people who attempted suicide unsuccessfully being brought before the court, convicted, and sentenced to death by hanging. Reality here seems more like an extremely dark monty python sketch.
Some Western cultures also buried victims of suicide at public crossroads, a little like the bodies of murderers would be intentionally made spectacles. One view of this an explicit attempt to make it harder for their spirits to find their eternal resting places.
I cannot recall if it was in Alvarez' book where I learned it, but in my research I gathered that among some Iwi (Maori tribes) there was a culture of burying members who had killed themselves just outside the walls of their Marae (Meeting-house grounds), where their resting places would be trampled over as a sign of disrespect and societal rejection.
Even today, we see something of this view in institutions like universities etc, whose response to suicidal issues is often one that makes that persons life harder, eg communicating to a suicidal student that any further attempt on their life will result in them being expelled from their study program. I feel like for people on the receiving end, the 'message' being communicated here is one of rejection, and the threat of humiliation following any subsequent unsuccessful attempt.
I didn't know that about Māori actually, and I am one... heh.
Those universities you mention really need to take a hard long look at themselves because that's just fucking disgraceful. Jeez.
In Florida we call it the "Baker Act"
I remember watching the movie “I Care A Lot” starring Rosamund Pike and Peter Dinklage. (*SPOILERS*)
In that movie as well, Rosamund’s character got old people institutionalised by making bogus reports from a doctor and sold off their property. I didn’t really like the movie but I thought it was kind of unrealistic that the government could really do such a thing (as her character explains the state can step in and essentially put a person in rehab/old age care center if they are given evidence that the person is “unstable”. Rosamund’s character played the system by manipulating the courts). I thought that part was unrealistic but I guess I was wrong.
Scary isn't it. People used to think sexual desire in women was a 'mental illness'. I wonder what we're committing people for today that will embarrass us in the future.
Incarceration over cannabis is already seen as embarrassing. Mental health care overall, but especially drug addiction will be looked at as positively medieval. The barriers to treatment for ADHD. The disastrous state of treatment for people, but especially women with autism. Hell, the way women are treated by some mental health professionals, it might as well still be the dark ages where hysteria was considered a valid diagnosis.
> The barriers to treatment for ADHD. The disastrous state of treatment for people, but especially women with autism.
I'm going to put "treatment" in huge quotes. Do these people need treatment or do they need society to stop bothering them and accept them the way they are?
I've walked away from tasks for a second and completely forgotten about them. I don't absorb training and can't hold a job. I've made it through about two books in my adult life. All of my programming projects end somewhere between the initial idea and the first problem I have real trouble with.
What does any of that have to do with society bothering or accepting me?
I have ADHD. I can achieve more of what I want to achieve when I am on my medication. I prefer not to take it on Saturdays, as a day of rest kind of thing, but otherwise I think the treatment is quite beneficial, and think "treatment" is entirely the correct word.
The idea that there isn't such a thing as a condition causing malfunctions in mental processes, and that all such things are just differences in preferences and such that merely need to be "accepted", doesn't make a lot of sense to me. If someone gets brain damage which damages say Wernicke's area, and causing Wernicke's aphasia. It would be quite silly to say that this isn't a problem or damage which could make sense to treat.
I see no reason that this should change when the differences are more subtle and such.
Now, that being said, I do think it makes sense to basically always defer to the person's own evaluation of whether they need treatment. If someone claims they don't need or want treatment, forcing them to receive "treatment" is, uh, in almost all possible situations, very bad? (note : this doesn't mean "in almost all situations in which this actually ends up happening.". I don't know about those cases. But the danger of like, classifying political opponents as being mentally ill and as needing treatment, is such a terrible danger, that norms should forbid anything within a very large conceptual distance from it.)
Various laws, such as the Baker Act in Florida, it’s so bad it’s used like this in sentences: “Yeah, Sally was baker act’ed last week, she’s still in”.
Illegal stuff happens.
Shocking, I know.
Whenever someone says that you should trust psychiatrists and the huge number of other similar professions I just point out that forcible admission is not rare and that they will share anything that they deem a 'risk', such as "I will shoot John if he chews with his mouth open one more time."
If you want to get someone to listen to your problems without telling them to anyone you can't do better than the catholic church:
>Priests may not reveal what they have learned during confession to anyone, even under the threat of their own death or that of others.
https://en.wikipedia.org/wiki/Seal_of_confession_in_the_Cath...
Ironically enough the apparatchiks of the Communist Party of Poland would often use uncorruptible priests to vent. Ones they had used the secret service to vet by entrapping them.
Thats thinking outside the box though probably not good advice. I've been to more confessions that I can remember. I can tell you the vast majority of priests are going to mostly keep the topic to religion and joining the church and working on your relationship with god/praying. If you are suicidal this probably is not going to help in any meaningful way.
I suppose you can probably find a priest that is willing to talk but that may take some time and eventually they are going to start cold shouldering you if you don't join the church.
Not the first recent controversy around this organization.
https://www.theverge.com/21293176/crisis-text-line-ceo-racis...
>> Others questioned whether the people who text their pleas for help are actually consenting to having their data shared, despite the approximately 50-paragraph disclosure the helpline offers a link to when individuals first reach out.
Clearly people contacting them are in a state of distress. I bet none of them read that, and many would not be considered legally able to agree to the terms due to their mental state. But IANAL
Is there a single institution left in this world that isn’t corrupted?
I've thought for awhile the solution to a better funnel for mental health is to allow multiple organizations to be the ones answering the phone, and implementing their own protocol - process for hiring or accepting volunteers, the training they receive, the script they follow - if any, and then free or for-pay offerings or programs they may know of and feel that person may be a good candidate for. Basically A/B testing and then at least you have a variety of data to analyze to see what the outcomes are.
I think what's mostly lacking though is an intermediate in-person program that's pre-psychiatric ward, an intensive-supportive environment, where the go-to isn't medications - probably where medications aren't prescribed - but basically in-person to determine a person's full state, and see what amount of short-term and/or long-term care they need to feel stable enough, if not good, on their own again. This requires money of course, and the sooner we can get people into these programs then the less dis-ease progression occurs, and arguably people will be easier to help.
Does anyone know of any such program or protocol, where care/treatment cascades and/or escalates and/or continues in-person in wide variety of breadth and depth depending on each person? I feel the current go-to with medications is generally that the medications are a hammer, so everything looks like a nail, but if multi-disciplinary teams (not just a psychiatrist trained in medication) rallied around a person and they had a whole toolkit worth of options then outcomes would be magnitudes better - and without causing additional harm.
Since when did making profits become unethical? What is unethical is giving away traceable customer information like phone numbers or locations of the texts. I certainly hope all that data is stripped. Otherwise then yeah it's unethical
> when did making profits become unethical?
It's literally a nonprofit. If they earn a profit or facilitate some other profit earning enterprise it is unethical, by definition. In a just world it would also be illegal and prosecuted.
I hate to burst your bubble but even nonprofits have to make profits (aka money) to stay afloat and pay bills and "get the word out". If you want to argue over accounting terms rather than the popular sense of the word then you probably have the wrong debater as I don't argue over edge case semantics on HN, I leave that for other nerds.
Does anyone apart from Crisis Text Line benefit financially from Loris? If so it's clearly unethical. Even ignoring the kind of service that CTL is and the extra ethical considerations that entails, the founders of and investors in Loris are using the work of volunteers at a non-profit to bootstrap a company that they will profit from without clearly explaining this to the volunteers and users of the service in advance. Evidently not illegal, but pretty clearly unethical.
Not to mention that they've said that Loris hasn't reached the contractual threshold to actually pay any money to CTL yet...
Edit: Even if it is CTL taking all of the profits from Loris I would consider that unethical without clearly informing everyone involved of how the data from the interaction would be used, and a 50 paragraph privacy statement doesn't count as "clear"