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This is the part where every one piles in posting suicide hotline numbers. I would argue most of those people do not have any experience with, or understanding

by anm89 5y ago

This is the part where every one piles in posting suicide hotline numbers. I would argue most of those people do not have any experience with, or understanding of those hotlines and it's just a trite thing to throw out to show support like "fuck cancer". You should seriously understand what you are signing yourself up for if you call one of those numbers on yourself or someone else. For one you are volunteering that person for involuntary incarceration in a mental health facility for an unspecified and potentially unlimited amount of time. Need to show up to work tomorrow to avoid losing your job? That probably isn't happening. Need to pay your bills to avoid losing your house? That might not be within your capabilities for the next several months or longer. Kids need to get to school? CPS is likely going to be handling that for the indefinite future if they don't have another guardian because you aren't going to be around to do it and you are no longer fit to be a legal guardian anyway. I'd probably rather end up in Jail than in that system. Simply put, in our society indicating you are suicidal is a defacto crime and you should never do it(including and maybe especially to a psychiatrist/psychologist who maybe taking on legal risk if they don't institutionalize you after the admission) unless you are ready to suffer the consequences.

chris_wot 5y ago
This is precisely what they do. Fun fact: whilst Lifeline in Australia says that they will treat all calls as anonymous, they in fact do not. If you speak about killing yourself to a counsellor, then they will call the police and trace your number, despite whether or not you turned off caller ID. Don't trust phone counselling services. Ever.
- harry8 5y ago
  I did not know that. I would like a reference for that info if you have one?
  - aaron695 5y ago
    Lifeline Australia Limited Privacy Policy https://www.lifeline.org.au/media/igzp1al2/lifeline-australia-privacy-policy-june-2018-wfgjuucilopn.pdf https://www.lifeline.org.au/media/igzp1al2/lifeline-australi...
- q-big 5y ago
  Eaxctly. Consider this: if the providers of these suicide hotline numbers actually cared about this stuff, they would provide an as pseudonymous as possible way to contact them that makes it as impossible as possible (in a mathematical/cryptographical sense) to identify the caller (think about Tor). Additionally, the hotline operators would advocate very strongly for a right to encrypt and right of privacy. But this is not the case, which should convince any rationally-thinking person that all of these claims of anonymity are fraud.
- deleted 5y ago
  [deleted]
hermes8329 5y ago
Your post is dead on I have what is essentially a terminal illness and the fuck cancer resonates You just want to turn to those people and say "I'm dying". While they are trying to be supportive but they completely miss the mark because they don't get it Similar things can be said about people regarding addiction
- garmaine 5y ago
  Serious question. I’m signed up for cryonics myself, and in these instances I try to ask, as gently as possible, if they’ve heard of or considered cryonics as an option. I see it as potentially saving lives, although I don’t know anyone else who has actually followed through on the suggestion. But would you view this genuine suggestion to be as asinine and tasteless as I worry it sounds?
yokoprime 5y ago
I don't think jail is the other choice.
- anm89 5y ago
  I wasn't implying it was, simply stating my relative perception of the two events.
- xwdv 5y ago
  Being dead is still a better choice than being trapped in that system and carrying the stigma your whole life IMO. It becomes a permanent problem that you cannot escape.
  - akerl_ 5y ago
    It seems pretty tautologically impossible for being “trapped in that system” to be a more permanent problem than death.
    - cinquemb 5y ago
      Seems like a matter of perspective or belief, no? For the observer of death it seems permanent; whereas a corpse lacks the same ability to perceive their own death the same way as the observer after it happened (i.e. a few moments, modulo anyone's beliefs surrounding after-life) if going by measuring brain activity via something like EEG and blood flow through the body. Where as "trapped in that system" could be as long as a few decades before one eventually dies.
    - xwdv 5y ago
      A problem can follow a person all the way up until the day they die. Death is sometimes the only true escape.
- kingcharles 5y ago
  I was in jail for eight years. I would say a large majority of people are in jail due to various mental health issues.
Fr0styMatt88 5y ago
If you don't mind me asking, is there anywhere I can read more about this aspect of the system? This comment seems really extreme and it's a perspective I haven't really seen anywhere else.
- anm89 5y ago
  I'll hunt around but one thing that came to to the top of my head: https://slatestarcodex.com/2018/03/22/navigating-and-or-avoiding-the-inpatient-mental-health-system/ https://slatestarcodex.com/2018/03/22/navigating-and-or-avoi... I don't know if he's considered to be a controversial figure or not generally but he is a real psychiatrist so I'd argue he knows what he is talking about
  - Fr0styMatt88 5y ago
    Thank you very much for posting this article, I'm reading it now. This paragraph really resonated with me and with the initial thoughts I had whilst reading your comment; I'm pasting it here as I think it provides a very worthwhile perspective: "And my second excuse is that in the end, this is not an adversarial enterprise. Psychiatrists commit people because they’re scared. They’re scared because they can’t predict what the patient is going to do – and on another level, they’re scared because they might get sued if they don’t follow the rules. If patients who aren’t going to hurt themselves know how to explain that they aren’t going to hurt themselves in a way that reassures their psychiatrist, and in a way that doesn’t leave their psychiatrist legally liable for not committing them, then everybody can be more comfortable and get on with the hard work of actual treatment."
- derbOac 5y ago
  So speaking as someone who has worked in psychiatry and mental health care, I can say it's basically true. It's not the intent of those working in it, but I think like a lot of things it's sort of what has emerged through the system. I had a colleague, now retired, who was the president of state mental health associations, etc. who made the argument that most suicide treatment programs are really designed to protect practitioners and healthcare providers, not the patients. At the time I understood what he was saying, but didn't really understand it until later. The way it came up with him was more about prediction and risk. He was talking about it because there's basically no way to know if someone is actually imminently suicidal. Most people who talk about it never even make an attempt, and there are lots of people who commit suicide suddenly without saying a word to anyone else ahead of time. My colleague's point was this: if saying X is totally unpredictive of Y in reality, why react so strongly to saying X? The reason is because it's not really about preventing Y -- you can't -- it's because it legally and morally absolves you of responsibility. I feel weird writing this because it sounds so cynical, but its a sad truth about the poor state of care of our fellow human beings in contemporary society.
c22 5y ago
I agree with your general sentiment, but speaking as someone who has been in jail and also involuntarily committed on multiple occasions, jail is much much worse. All the downsides you listed apply to jail time also, but the food is more terrible, the environment more restrictive, and the opportunities for extricating yourself (if you are reasonably cogent) are greatly reduced. Also, ironically, being in jail on suicide watch is preferable to being in general population.
- anm89 5y ago
  Thanks for the perspective. I have never experienced either directly so at best I'm speculating although I've been around many people who have been through both. My basis for making that comment is that at least ostensibly you get due process in the legal system. Hope you came out the other side in a good place.
  - jkljkljkl1 5y ago
    Involuntary commitment from mental health is a min. 72 hours here, but I think you can be in and out of a drunk tank faster than that, which is usually just a few hours to sober up. I could see a bail hearing happening quick enough that you get in and out before 72 hours, but I don't know how common that is.
    - ls612 5y ago
      Arraignment in most places is max 48-72hrs after arrest (except possibly for legal holidays) and unless the crime is serious you will usually be released after that.
    - c22 5y ago
      It's true that you'll be stuck in the mental hospital for at least a week (those are 72 business hours). I couldn't afford bail, though, so I was stuck in jail for 3 months[0]. There were plenty of other inmates there in similar situations. YMMV. [0] That's how long it took for me to get a court date at which point I was released with time served (2 weeks). Getting out of the mental hospital never even required a lawyer (though I'd still recommend retaining one if you're ever in this situation).
ayngg 5y ago
I think the best part is the dance you do when looking for a therapist where you try to say you really need help, but you have to temper that severity by saying that you aren't in such bad shape that you are suicidal for fear that they commit you to protocol or something. In reality mental healthcare feels like only a slight step up from antiquated methods from days long gone. Trying the medication roulette is like spending months at a time throwing darts blindfolded to see if anything helps, hurts or does nothing at all. Waiting months to see professionals who are burned out or just trying their best to not be completely overwhelmed by the demand but are unable to give meaningful care because of how overwhelmed they are. Or not even being able to see a therapist at all because it is cost prohibitive. And then consider basically having to do that on the side while you have your other obligations that you have to tend to. I wouldn't be surprised if only a fraction of people who need help get it, and of that fraction, only a fraction of them see a benefit. It basically boils down to society not caring, or barely caring at most. In the end I suspect that the efficacy of mental healthcare has its limits, after all it is like trying to fix people after they have been broken, which is way harder than supporting people before they break, but that depends on social structures and support groups that are increasingly weak and strained.
- Aerroon 5y ago
  And the medicine dart board assumes your psychiatrist doesn't make mistakes. Ie you will have to look up the information on the medicine roulette and the combinations yourself.
- ncmncm 5y ago
  The only way, still, to determine which of a mess of conditions you have, all called depression, is to see which, if any, medication seems to help. It is as if you present with a broken bone, but they have to try splinting one after another until they hit on the broken one. And, you might actually have more than one. And, some doctors have a favorite bone, and won't try the others. Try to imagine a Random Controlled Trial protocol for a new depression medication. It is miraculous that any have been approved. It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. Splinting the left shinbone helps only a small fraction of patients who have a fracture. For validity, RCTs depend utterly on reliable sortative diagnoses. RCT fetishists (which exist, and are common) are mentally unable to process that fact.
babyshake 5y ago
Genuinely curious about this - if you call one of these numbers and say you are thinking of self harm but you are not actually going to hurt yourself and you do not want them to call whomever to your home are they likely to do it anyways?
- owisd 5y ago
  Can’t speak for all of those numbers, but Samaritans won’t tell anyone or even try to talk you out of it if you don’t want them to.
- hn8788 5y ago
  A friend's husband called one of the suicide lines and he wasn't committed or visited by the police, so it's not a 100% chance. I don't know the details of what the husband talked about, but it may have been because it wasn't a recurring problem. He'd just had an especially awful time at work for a few weeks, and eventually had a breakdown and called a hotline. He quit his job a couple of days later and has been fine since, so maybe the person on the phone can make a judgement call on whether it's a recurring issue that needs professional help, or something that is an extreme response to an isolated incident and the person will be fine after they're "talked down from the ledge".
  - jacquesm 5y ago
    Companies that drive people to suicide are really something else. I hope he showed his colleagues that there is a way out.
- anm89 5y ago
  You absolutely might not have any issues. But you absolutely might. It could come down to if the operator has had their lunch break yet. So the question is do you want to play roulette with your physical freedom.
likecharges 5y ago
Perhaps this is a regional difference, but you might be confusing the suicide hotline with a petition for involuntary admission. The suicide hotline provides someone to talk to. The person might not even know your name or address. What you’ve described is involuntary admission. Any adult can petition for another person to be brought to a hospital and evaluated, but the hospital decides if the person is admitted and/or placed on a 72 hour hold.
- garmaine 5y ago
  I think the person you are replying to is claiming that the hotline operator will initiate the process for involuntary admission, or at least start a chain of events (e.g. calling local PD for a welfare check) that leads to that outcome. (No idea if that is true, but it is the claim.)
- deleted 5y ago
  [deleted]
ChrisMarshallNY 5y ago
… and … on the other hand, actually going through with it, is about the biggest “f**k you” that can be given to a family. This is something that I have had personal experience with, in family, friends, acquaintances, and even enemies, that I wished dead, then was not so thrilled, when my wish came true. I hang out in circles that experience a lot of … “out of band” … issues. It’s a long story, and not one I feel like sharing on HN. Suffice it to say that I have seen this kind of stuff many, many times. Getting treatment for mental health issues —and there are very many types of issues, and types of treatments— is important. One way to support people going through this stuff, is to avoid feeding the “shame machine,” and try to realize that we may not have the answers, so we can help people connect with those who do.
macksd 5y ago
One of the many things needing overhauling in our mental health system. I avoided seeking help for a long time because I was interested in jobs that would likely require government security clearances, and (I don't know how true this is) I had heard from multiple sources that a history of seeking help for mental health issues may disqualify you. Which is a little backwards in practice. If there's an issue I want to address it and manage it. Because of my desire for those jobs, I let the problem fester for longer. I also found when I finally broke down and sought help (not for suicide, granted) the process of trying to take advantage of my company's resources like paying for short-term counseling, etc. was incredibly frustrating. You couldn't get a hold of the people at the company we paid for the plan, everything on their site was outdated and badly maintained, they only covered certain therapists, and they happened to be therapists who make a point of specializing in treating pretty much anything with drugs, etc. Had I been on the edge of suicide or unable to eventually just pay for the care I needed directly, I can only imagine trying to navigate this process could've finished me off, emotionally.
- Pet_Ant 5y ago
  Company resources are next to useless. They are meant to be short term and are encouraged to turn you around in a few sessions. If you can, go private, since it's more open ended and the process of over over the basics of your life story are tedious.
  - macksd 5y ago
    Agreed. I eventually found a very good counselor for my situation. But I'm extremely fortunate that I'm both very well off and wasn't suicidal. And it was very apparent to me that if I was different in either respect, I perhaps wouldn't have been able to turn things around.
- deleted 5y ago
  [deleted]
- disgruntledphd2 5y ago
  > the process of trying to take advantage of my company's resources like paying for short-term counseling, etc. was incredibly frustrating. If you can afford it at all, it can make a lot of sense to do this privately, to avoid a lot of this.
jolux 5y ago
Man, what. Psychiatrists have to commit you if they think you're an immediate danger to yourself. I'm sure shitty ones do it in situations where they shouldn't, but speaking as someone who has actually experienced being suicidal, my psychiatrist was the only person I actually fully trusted to help me get what I needed. Maybe I'm just lucky to have ended up with psychs who will take on more risk to avoid having to commit people, but it's at least a little more complicated than you imply.
- sneak 5y ago
  Suicide is a human right. Interfering with someone's basic right to self-determination is absolutely despicable, no matter how ill the person is.
  - tapan_jk 5y ago
    Cannot agree more. Just like many other acts which are punished today, but should be rather dealt with by showing support, self harm should definitely be taken off the list of acts that are treated like a crime. I can only guess, but it feels like the current approach only makes things worse for those who are already suffering.
  - mensetmanusman 5y ago
    What if that self-determination is a fleeting thought?
    - blitzar 5y ago
      Plea insanity as a defense?
  - jolux 5y ago
    It's not quite as simple as that. One of the reasons the suicide rate is so high in the US is because of how easy it is to access firearms. This suggests that peoples' propensity to commit suicide is at least somewhat dependent on their environment. Given that, do you want to make their environment more or less likely to cause them to commit suicide? I'm in the latter category. As for the concern about basic rights, I fundamentally agree. For some people, perhaps, they will never get better and in those cases we should have a path to assisted suicide. In all cases, we should do our best to help suicidal people, who are ultimately suffering a lot. I don't think most people who are suicidal want to specifically die more than they want an end to their suffering, to which they see no realistic alternative other than death (which I assure you remains quite scary even when you're really depressed.) I think giving them an escape other than death is morally obligatory and humane, where it's possible.
mindslight 5y ago
Sheesh, that's fucking terrible. I had naively assumed that suicide hotlines would ring to someone who would really listen to you and try to give you some perspective in a non-intrusive manner, which is what I imagine myself needing if I was in that position. Although I guess it's not terribly surprising to hear it's the bog standard pattern of friendly-faced leadgen that passes off execution to a misincentivized backend.
- mthoms 5y ago
  They do listen. They are well intentioned. But, they are required by law to escalate the issue if they believe self-harm is imminent.
KaiserPro 5y ago
This article is from the UK, so we should be clear about consequences for the UK audience. The Samaritans hotline (a general distress helpline) is there to listen. Nothing else. They do not provide treatment, judgement or the like. Sometimes that is enough. More importantly its anonymous. You will not be sectioned by phoning them To be sectioned (ie detained against your will), you _have_ to be assessed by a doctor within 24 hours. You need to be deemed a risk to yourself or others(by at least two doctors) before you can be held any longer. You cannot be fired for being sectioned in the UK. So whilst the UK is very far from being perfect in terms of mental health (lord knows we have a multitude of problems, some alluded to in the article) it is not as bad as described in the parent thread.
- yardstick 5y ago
  Do you still collect your normal pay while being sectioned in the UK? If not, may as well have been fired…
  - celticninja 5y ago
    Depends on the employer, but at the least you will be entitled to statutory sick pay(SSP). Most employers will cover the first 5 to 10 sick days without any changes to your pay. After a certain time period this may drop to 80% of wages and then after another defined period of time SSP kicks in, which is usually significantly reduced pay but you are paid and your job will remain open for you to return.
    - eterm 5y ago
      And to clarify further for the US audience, this first 5-10 days doesn't come out of holiday (vacation) time/pay, there isn't combined "PTO" in the UK; sick days and vacation time are treated separately. In fact, you even still accrue vacation time while off sick, I was off sick for a year and when I came back HR came to me with the news that I had extra holiday to use the next year because it been rolled over from when I was off sick. If you're sick while on holiday you can even try to claim the days back although most people don't as that's seen as taking the piss a bit.
throwaway0a5e 5y ago
>This is the part where every one piles in posting suicide hotline numbers. I would argue most of those people do not have any experience with, or understanding of those hotlines and it's just a trite thing to throw out to show support like "fuck cancer". As long as we keep rewarding it by pressing the "rightthink" button when we see it it will keep happening, just like every other cheap gesture that appeals to the lowest common denominator.
fsloth 5y ago
Have you experienced this process? There is a very good point why everyone has learned the "get help" mantra. There is only one suicide you need to do, and game is over. If that can be averted with quick intervention (as often is the case) then all the better. Interventions cannot help all suicidal persons, but being acutely suicidal means one should get help _now_. It's exactly the same thing as a with a stroke or other imminent medical emergency.
zoelow 5y ago
Feeling obliged to leave my story here: Three years ago I made a plan to take my own life. Instead of pushing through I contacted a local suicide hotline, it was completely anonymous. I just talked for a bit, but that little moment helped me to find the courage to talk to a family member and that led me to go into therapy which I completed a few months ago. Initially I was very scared telling my therapist about being suicidal, exactly sketching those horror scenarios. But when I finally talked about it, nothing happened. I remained into complete control of my own therapy the whole period. It helped me turn my life around and I'm incredibly happy I took the leap of faith to start talking about it.
- ricardobayes 5y ago
  Nice one mate, so happy for you. This must have been incredibly difficult to work through.
- 1cvmask 5y ago
  Thanks for posting that for the world to hear.
- candiodari 5y ago
  Unfortunately, judging by the prevalence of the opposing situation happening in articles (in reputable newspapers too) online, you have essentially been lucky (or never got into a conflict with your therapist). The odds of someone dying through suicide after a suicide attempt is very small (only 2%), but those odds greatly increase if inpatient treatment is provided, instead of reducing. There is a reason for that, and clearly your experience doesn't provide that reason. The stated reason psychiatrists give for this is that only the very serious cases get committed, but research doesn't back that, and for specific institutions (and you have no control over where you end up) it is definitely not true. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710249/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710249/ Suicide after inpatient treatment in a psychiatric facility is actually getting close to enter the top-10 causes of death. Whilst that doesn't directly contradict what you're saying, it comes pretty close. In the Netherlands, it is now actually true that more than 50% of suicides happen with psychiatric help, which mostly means getting locked up. Given that less than 1.5% of the population ever gets committed (but rising fast, especially for kids), that's pretty incredible. And in a bunch of published cases it isn't even the case that people were committed for a suicide attempt, but for an outburst that was then diagnosed, for example as autism. Suicide came, years later, after years of treatment, a progressively worsening situation, and months in isolation in such a facility, in one case with the person locked up without his glasses.
OJFord 5y ago
I agree with your first sentence, I find those annoying and assume that they're pointless and unhelpful, just posturing; but the rest of your comment... what?
bipson 5y ago
Great, that sounds like a perfect pitch talk discourage anyone from calling such a number or talking to someone about a difficult time in their life. I really hope you are very wrong about what you wrote, otherwise you live in a really cold and frightening place. There sure is a hotline where you can just talk to someone, without losing your job, right? right...?
- yupper32 5y ago
  > Great, that sounds like a perfect pitch talk discourage anyone from calling such a number or talking to someone about a difficult time in their life. But it's mostly true. Do you just want people not to talk about the flaws in the system? As long as involuntary detention for suicidal people is law, I would never ever ever tell anyone about any suicidal tendencies. Not being honest about what happens when you call a hotline is also horrible. "Haha! Got you! Police are on the way!" I can't imagine the dread if that happened to me, knowing my life is about to get way worse even though I'm already at my bottom. Anyone saying "well suicide is worse!" is completely missing the point.
shireboy 5y ago
I came here to post what you say not to, and was informed by your comment. Serious question though: what _should_ one say or do to help those who may be suicidal, both in the public and personal? I’ve known several people who committed suicide, and I wish I’d been able to do or say more for them. I know some now who struggle with suicidal thoughts and mental illness. What is the best, right thing to do and say both to friends/family and in a forum like this?
- mthoms 5y ago
  Every situation is unique but often it’s best not to “say” anything. It’s best to just listen. Like really listen. And offer to continue listening. Encourage others to do the same. Most importantly, Resist the temptation to give advice (unless it’s solicited). Don’t ask “have you tried X?”… instead ask “what can I do to help you get through this”.
varjag 5y ago
Top post on HN discouraging use of suicide prevention hotlines. The fuck is wrong with you people.
- Clubber 5y ago
  People need to know what could happen when they call that hotline. I'm guessing people think it goes something like this: "I'm feeling suicidal, let me call the hotline." "I called the hotline and now I feel better, everything's great." In reality, at least in the US, it could be like this and this is codified in law (Duty to Warn): "I'm feeling suicidal, let me call the hotline." "We've notified law enforcement. The police are on their way." I'm guessing the reason it isn't always done the 2nd way is because actual therapists know how bad this can be to the patient. Realize therapists are taking a legal risk in not reporting. In the US, the only tool government has for most problems is, "call law enforcement." The only tool law enforcement has it, "take them to jail." If you do some research, you come to realize what a bad tool that can be. https://en.wikipedia.org/wiki/Suicide_legislation#United_States https://en.wikipedia.org/wiki/Suicide_legislation#United_Sta... If it were me, I would call a professional therapist before calling a government hotline in the US. This is not medical or legal advice.
  - varjag 5y ago
    None of the outcomes listed are worse than the actual suicide. Afraid CPS will take your kids away? Well guess who goes to the orphanage if you bloody off yourself!
    - Clubber 5y ago
      Yes but if someone were contemplating it and they are looking for someone to help them off the edge (which is the purpose of the hotline), all these things would probably have the opposite effect. Going to jail is probably better if suicide was inevitable, but if it's inevitable, a person probably wouldn't be calling the hotline. I think if the hotline was anonymous and untraceable and directly connected a person to a therapist who specialized in that sort of thing with no strings attached, it would be an invaluable tool. Unfortunately it is not that. It certainly could be.

by anm89 5y ago

chris_wot 5y ago

This is precisely what they do. Fun fact: whilst Lifeline in Australia says that they will treat all calls as anonymous, they in fact do not. If you speak about killing yourself to a counsellor, then they will call the police and trace your number, despite whether or not you turned off caller ID. Don't trust phone counselling services. Ever.

harry8 5y ago
I did not know that. I would like a reference for that info if you have one?
- aaron695 5y ago
  Lifeline Australia Limited Privacy Policy https://www.lifeline.org.au/media/igzp1al2/lifeline-australia-privacy-policy-june-2018-wfgjuucilopn.pdf https://www.lifeline.org.au/media/igzp1al2/lifeline-australi...
q-big 5y ago
Eaxctly. Consider this: if the providers of these suicide hotline numbers actually cared about this stuff, they would provide an as pseudonymous as possible way to contact them that makes it as impossible as possible (in a mathematical/cryptographical sense) to identify the caller (think about Tor). Additionally, the hotline operators would advocate very strongly for a right to encrypt and right of privacy. But this is not the case, which should convince any rationally-thinking person that all of these claims of anonymity are fraud.
deleted 5y ago
[deleted]

hermes8329 5y ago

Your post is dead on I have what is essentially a terminal illness and the fuck cancer resonates You just want to turn to those people and say "I'm dying". While they are trying to be supportive but they completely miss the mark because they don't get it Similar things can be said about people regarding addiction

garmaine 5y ago
Serious question. I’m signed up for cryonics myself, and in these instances I try to ask, as gently as possible, if they’ve heard of or considered cryonics as an option. I see it as potentially saving lives, although I don’t know anyone else who has actually followed through on the suggestion. But would you view this genuine suggestion to be as asinine and tasteless as I worry it sounds?

yokoprime 5y ago

I don't think jail is the other choice.

anm89 5y ago
I wasn't implying it was, simply stating my relative perception of the two events.
xwdv 5y ago
Being dead is still a better choice than being trapped in that system and carrying the stigma your whole life IMO. It becomes a permanent problem that you cannot escape.
- akerl_ 5y ago
  It seems pretty tautologically impossible for being “trapped in that system” to be a more permanent problem than death.
  - cinquemb 5y ago
    Seems like a matter of perspective or belief, no? For the observer of death it seems permanent; whereas a corpse lacks the same ability to perceive their own death the same way as the observer after it happened (i.e. a few moments, modulo anyone's beliefs surrounding after-life) if going by measuring brain activity via something like EEG and blood flow through the body. Where as "trapped in that system" could be as long as a few decades before one eventually dies.
  - xwdv 5y ago
    A problem can follow a person all the way up until the day they die. Death is sometimes the only true escape.
kingcharles 5y ago
I was in jail for eight years. I would say a large majority of people are in jail due to various mental health issues.

Fr0styMatt88 5y ago

If you don't mind me asking, is there anywhere I can read more about this aspect of the system? This comment seems really extreme and it's a perspective I haven't really seen anywhere else.

anm89 5y ago
I'll hunt around but one thing that came to to the top of my head: https://slatestarcodex.com/2018/03/22/navigating-and-or-avoiding-the-inpatient-mental-health-system/ https://slatestarcodex.com/2018/03/22/navigating-and-or-avoi... I don't know if he's considered to be a controversial figure or not generally but he is a real psychiatrist so I'd argue he knows what he is talking about
- Fr0styMatt88 5y ago
  Thank you very much for posting this article, I'm reading it now. This paragraph really resonated with me and with the initial thoughts I had whilst reading your comment; I'm pasting it here as I think it provides a very worthwhile perspective: "And my second excuse is that in the end, this is not an adversarial enterprise. Psychiatrists commit people because they’re scared. They’re scared because they can’t predict what the patient is going to do – and on another level, they’re scared because they might get sued if they don’t follow the rules. If patients who aren’t going to hurt themselves know how to explain that they aren’t going to hurt themselves in a way that reassures their psychiatrist, and in a way that doesn’t leave their psychiatrist legally liable for not committing them, then everybody can be more comfortable and get on with the hard work of actual treatment."
derbOac 5y ago
So speaking as someone who has worked in psychiatry and mental health care, I can say it's basically true. It's not the intent of those working in it, but I think like a lot of things it's sort of what has emerged through the system. I had a colleague, now retired, who was the president of state mental health associations, etc. who made the argument that most suicide treatment programs are really designed to protect practitioners and healthcare providers, not the patients. At the time I understood what he was saying, but didn't really understand it until later. The way it came up with him was more about prediction and risk. He was talking about it because there's basically no way to know if someone is actually imminently suicidal. Most people who talk about it never even make an attempt, and there are lots of people who commit suicide suddenly without saying a word to anyone else ahead of time. My colleague's point was this: if saying X is totally unpredictive of Y in reality, why react so strongly to saying X? The reason is because it's not really about preventing Y -- you can't -- it's because it legally and morally absolves you of responsibility. I feel weird writing this because it sounds so cynical, but its a sad truth about the poor state of care of our fellow human beings in contemporary society.

c22 5y ago

I agree with your general sentiment, but speaking as someone who has been in jail and also involuntarily committed on multiple occasions, jail is much much worse. All the downsides you listed apply to jail time also, but the food is more terrible, the environment more restrictive, and the opportunities for extricating yourself (if you are reasonably cogent) are greatly reduced. Also, ironically, being in jail on suicide watch is preferable to being in general population.

anm89 5y ago
Thanks for the perspective. I have never experienced either directly so at best I'm speculating although I've been around many people who have been through both. My basis for making that comment is that at least ostensibly you get due process in the legal system. Hope you came out the other side in a good place.
- jkljkljkl1 5y ago
  Involuntary commitment from mental health is a min. 72 hours here, but I think you can be in and out of a drunk tank faster than that, which is usually just a few hours to sober up. I could see a bail hearing happening quick enough that you get in and out before 72 hours, but I don't know how common that is.
  - ls612 5y ago
    Arraignment in most places is max 48-72hrs after arrest (except possibly for legal holidays) and unless the crime is serious you will usually be released after that.
  - c22 5y ago
    It's true that you'll be stuck in the mental hospital for at least a week (those are 72 business hours). I couldn't afford bail, though, so I was stuck in jail for 3 months[0]. There were plenty of other inmates there in similar situations. YMMV. [0] That's how long it took for me to get a court date at which point I was released with time served (2 weeks). Getting out of the mental hospital never even required a lawyer (though I'd still recommend retaining one if you're ever in this situation).

ayngg 5y ago

I think the best part is the dance you do when looking for a therapist where you try to say you really need help, but you have to temper that severity by saying that you aren't in such bad shape that you are suicidal for fear that they commit you to protocol or something. In reality mental healthcare feels like only a slight step up from antiquated methods from days long gone. Trying the medication roulette is like spending months at a time throwing darts blindfolded to see if anything helps, hurts or does nothing at all. Waiting months to see professionals who are burned out or just trying their best to not be completely overwhelmed by the demand but are unable to give meaningful care because of how overwhelmed they are. Or not even being able to see a therapist at all because it is cost prohibitive. And then consider basically having to do that on the side while you have your other obligations that you have to tend to. I wouldn't be surprised if only a fraction of people who need help get it, and of that fraction, only a fraction of them see a benefit. It basically boils down to society not caring, or barely caring at most. In the end I suspect that the efficacy of mental healthcare has its limits, after all it is like trying to fix people after they have been broken, which is way harder than supporting people before they break, but that depends on social structures and support groups that are increasingly weak and strained.

Aerroon 5y ago
And the medicine dart board assumes your psychiatrist doesn't make mistakes. Ie you will have to look up the information on the medicine roulette and the combinations yourself.
ncmncm 5y ago
The only way, still, to determine which of a mess of conditions you have, all called depression, is to see which, if any, medication seems to help. It is as if you present with a broken bone, but they have to try splinting one after another until they hit on the broken one. And, you might actually have more than one. And, some doctors have a favorite bone, and won't try the others. Try to imagine a Random Controlled Trial protocol for a new depression medication. It is miraculous that any have been approved. It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. Splinting the left shinbone helps only a small fraction of patients who have a fracture. For validity, RCTs depend utterly on reliable sortative diagnoses. RCT fetishists (which exist, and are common) are mentally unable to process that fact.

babyshake 5y ago

Genuinely curious about this - if you call one of these numbers and say you are thinking of self harm but you are not actually going to hurt yourself and you do not want them to call whomever to your home are they likely to do it anyways?

owisd 5y ago
Can’t speak for all of those numbers, but Samaritans won’t tell anyone or even try to talk you out of it if you don’t want them to.
hn8788 5y ago
A friend's husband called one of the suicide lines and he wasn't committed or visited by the police, so it's not a 100% chance. I don't know the details of what the husband talked about, but it may have been because it wasn't a recurring problem. He'd just had an especially awful time at work for a few weeks, and eventually had a breakdown and called a hotline. He quit his job a couple of days later and has been fine since, so maybe the person on the phone can make a judgement call on whether it's a recurring issue that needs professional help, or something that is an extreme response to an isolated incident and the person will be fine after they're "talked down from the ledge".
- jacquesm 5y ago
  Companies that drive people to suicide are really something else. I hope he showed his colleagues that there is a way out.
anm89 5y ago
You absolutely might not have any issues. But you absolutely might. It could come down to if the operator has had their lunch break yet. So the question is do you want to play roulette with your physical freedom.

likecharges 5y ago

Perhaps this is a regional difference, but you might be confusing the suicide hotline with a petition for involuntary admission. The suicide hotline provides someone to talk to. The person might not even know your name or address. What you’ve described is involuntary admission. Any adult can petition for another person to be brought to a hospital and evaluated, but the hospital decides if the person is admitted and/or placed on a 72 hour hold.

garmaine 5y ago
I think the person you are replying to is claiming that the hotline operator will initiate the process for involuntary admission, or at least start a chain of events (e.g. calling local PD for a welfare check) that leads to that outcome. (No idea if that is true, but it is the claim.)
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ChrisMarshallNY 5y ago

… and … on the other hand, actually going through with it, is about the biggest “f**k you” that can be given to a family. This is something that I have had personal experience with, in family, friends, acquaintances, and even enemies, that I wished dead, then was not so thrilled, when my wish came true. I hang out in circles that experience a lot of … “out of band” … issues. It’s a long story, and not one I feel like sharing on HN. Suffice it to say that I have seen this kind of stuff many, many times. Getting treatment for mental health issues —and there are very many types of issues, and types of treatments— is important. One way to support people going through this stuff, is to avoid feeding the “shame machine,” and try to realize that we may not have the answers, so we can help people connect with those who do.

macksd 5y ago

One of the many things needing overhauling in our mental health system. I avoided seeking help for a long time because I was interested in jobs that would likely require government security clearances, and (I don't know how true this is) I had heard from multiple sources that a history of seeking help for mental health issues may disqualify you. Which is a little backwards in practice. If there's an issue I want to address it and manage it. Because of my desire for those jobs, I let the problem fester for longer. I also found when I finally broke down and sought help (not for suicide, granted) the process of trying to take advantage of my company's resources like paying for short-term counseling, etc. was incredibly frustrating. You couldn't get a hold of the people at the company we paid for the plan, everything on their site was outdated and badly maintained, they only covered certain therapists, and they happened to be therapists who make a point of specializing in treating pretty much anything with drugs, etc. Had I been on the edge of suicide or unable to eventually just pay for the care I needed directly, I can only imagine trying to navigate this process could've finished me off, emotionally.

Pet_Ant 5y ago
Company resources are next to useless. They are meant to be short term and are encouraged to turn you around in a few sessions. If you can, go private, since it's more open ended and the process of over over the basics of your life story are tedious.
- macksd 5y ago
  Agreed. I eventually found a very good counselor for my situation. But I'm extremely fortunate that I'm both very well off and wasn't suicidal. And it was very apparent to me that if I was different in either respect, I perhaps wouldn't have been able to turn things around.
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disgruntledphd2 5y ago
> the process of trying to take advantage of my company's resources like paying for short-term counseling, etc. was incredibly frustrating. If you can afford it at all, it can make a lot of sense to do this privately, to avoid a lot of this.

jolux 5y ago

Man, what. Psychiatrists have to commit you if they think you're an immediate danger to yourself. I'm sure shitty ones do it in situations where they shouldn't, but speaking as someone who has actually experienced being suicidal, my psychiatrist was the only person I actually fully trusted to help me get what I needed. Maybe I'm just lucky to have ended up with psychs who will take on more risk to avoid having to commit people, but it's at least a little more complicated than you imply.

sneak 5y ago
Suicide is a human right. Interfering with someone's basic right to self-determination is absolutely despicable, no matter how ill the person is.
- tapan_jk 5y ago
  Cannot agree more. Just like many other acts which are punished today, but should be rather dealt with by showing support, self harm should definitely be taken off the list of acts that are treated like a crime. I can only guess, but it feels like the current approach only makes things worse for those who are already suffering.
- mensetmanusman 5y ago
  What if that self-determination is a fleeting thought?
  - blitzar 5y ago
    Plea insanity as a defense?
- jolux 5y ago
  It's not quite as simple as that. One of the reasons the suicide rate is so high in the US is because of how easy it is to access firearms. This suggests that peoples' propensity to commit suicide is at least somewhat dependent on their environment. Given that, do you want to make their environment more or less likely to cause them to commit suicide? I'm in the latter category. As for the concern about basic rights, I fundamentally agree. For some people, perhaps, they will never get better and in those cases we should have a path to assisted suicide. In all cases, we should do our best to help suicidal people, who are ultimately suffering a lot. I don't think most people who are suicidal want to specifically die more than they want an end to their suffering, to which they see no realistic alternative other than death (which I assure you remains quite scary even when you're really depressed.) I think giving them an escape other than death is morally obligatory and humane, where it's possible.

mindslight 5y ago

Sheesh, that's fucking terrible. I had naively assumed that suicide hotlines would ring to someone who would really listen to you and try to give you some perspective in a non-intrusive manner, which is what I imagine myself needing if I was in that position. Although I guess it's not terribly surprising to hear it's the bog standard pattern of friendly-faced leadgen that passes off execution to a misincentivized backend.

mthoms 5y ago
They do listen. They are well intentioned. But, they are required by law to escalate the issue if they believe self-harm is imminent.

KaiserPro 5y ago

This article is from the UK, so we should be clear about consequences for the UK audience. The Samaritans hotline (a general distress helpline) is there to listen. Nothing else. They do not provide treatment, judgement or the like. Sometimes that is enough. More importantly its anonymous. You will not be sectioned by phoning them To be sectioned (ie detained against your will), you _have_ to be assessed by a doctor within 24 hours. You need to be deemed a risk to yourself or others(by at least two doctors) before you can be held any longer. You cannot be fired for being sectioned in the UK. So whilst the UK is very far from being perfect in terms of mental health (lord knows we have a multitude of problems, some alluded to in the article) it is not as bad as described in the parent thread.

yardstick 5y ago
Do you still collect your normal pay while being sectioned in the UK? If not, may as well have been fired…
- celticninja 5y ago
  Depends on the employer, but at the least you will be entitled to statutory sick pay(SSP). Most employers will cover the first 5 to 10 sick days without any changes to your pay. After a certain time period this may drop to 80% of wages and then after another defined period of time SSP kicks in, which is usually significantly reduced pay but you are paid and your job will remain open for you to return.
  - eterm 5y ago
    And to clarify further for the US audience, this first 5-10 days doesn't come out of holiday (vacation) time/pay, there isn't combined "PTO" in the UK; sick days and vacation time are treated separately. In fact, you even still accrue vacation time while off sick, I was off sick for a year and when I came back HR came to me with the news that I had extra holiday to use the next year because it been rolled over from when I was off sick. If you're sick while on holiday you can even try to claim the days back although most people don't as that's seen as taking the piss a bit.

throwaway0a5e 5y ago

>This is the part where every one piles in posting suicide hotline numbers. I would argue most of those people do not have any experience with, or understanding of those hotlines and it's just a trite thing to throw out to show support like "fuck cancer". As long as we keep rewarding it by pressing the "rightthink" button when we see it it will keep happening, just like every other cheap gesture that appeals to the lowest common denominator.

fsloth 5y ago

Have you experienced this process? There is a very good point why everyone has learned the "get help" mantra. There is only one suicide you need to do, and game is over. If that can be averted with quick intervention (as often is the case) then all the better. Interventions cannot help all suicidal persons, but being acutely suicidal means one should get help _now_. It's exactly the same thing as a with a stroke or other imminent medical emergency.

zoelow 5y ago

Feeling obliged to leave my story here: Three years ago I made a plan to take my own life. Instead of pushing through I contacted a local suicide hotline, it was completely anonymous. I just talked for a bit, but that little moment helped me to find the courage to talk to a family member and that led me to go into therapy which I completed a few months ago. Initially I was very scared telling my therapist about being suicidal, exactly sketching those horror scenarios. But when I finally talked about it, nothing happened. I remained into complete control of my own therapy the whole period. It helped me turn my life around and I'm incredibly happy I took the leap of faith to start talking about it.

ricardobayes 5y ago
Nice one mate, so happy for you. This must have been incredibly difficult to work through.
1cvmask 5y ago
Thanks for posting that for the world to hear.
candiodari 5y ago
Unfortunately, judging by the prevalence of the opposing situation happening in articles (in reputable newspapers too) online, you have essentially been lucky (or never got into a conflict with your therapist). The odds of someone dying through suicide after a suicide attempt is very small (only 2%), but those odds greatly increase if inpatient treatment is provided, instead of reducing. There is a reason for that, and clearly your experience doesn't provide that reason. The stated reason psychiatrists give for this is that only the very serious cases get committed, but research doesn't back that, and for specific institutions (and you have no control over where you end up) it is definitely not true. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710249/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710249/ Suicide after inpatient treatment in a psychiatric facility is actually getting close to enter the top-10 causes of death. Whilst that doesn't directly contradict what you're saying, it comes pretty close. In the Netherlands, it is now actually true that more than 50% of suicides happen with psychiatric help, which mostly means getting locked up. Given that less than 1.5% of the population ever gets committed (but rising fast, especially for kids), that's pretty incredible. And in a bunch of published cases it isn't even the case that people were committed for a suicide attempt, but for an outburst that was then diagnosed, for example as autism. Suicide came, years later, after years of treatment, a progressively worsening situation, and months in isolation in such a facility, in one case with the person locked up without his glasses.

OJFord 5y ago

I agree with your first sentence, I find those annoying and assume that they're pointless and unhelpful, just posturing; but the rest of your comment... what?

bipson 5y ago

Great, that sounds like a perfect pitch talk discourage anyone from calling such a number or talking to someone about a difficult time in their life. I really hope you are very wrong about what you wrote, otherwise you live in a really cold and frightening place. There sure is a hotline where you can just talk to someone, without losing your job, right? right...?

yupper32 5y ago
> Great, that sounds like a perfect pitch talk discourage anyone from calling such a number or talking to someone about a difficult time in their life. But it's mostly true. Do you just want people not to talk about the flaws in the system? As long as involuntary detention for suicidal people is law, I would never ever ever tell anyone about any suicidal tendencies. Not being honest about what happens when you call a hotline is also horrible. "Haha! Got you! Police are on the way!" I can't imagine the dread if that happened to me, knowing my life is about to get way worse even though I'm already at my bottom. Anyone saying "well suicide is worse!" is completely missing the point.

shireboy 5y ago

I came here to post what you say not to, and was informed by your comment. Serious question though: what _should_ one say or do to help those who may be suicidal, both in the public and personal? I’ve known several people who committed suicide, and I wish I’d been able to do or say more for them. I know some now who struggle with suicidal thoughts and mental illness. What is the best, right thing to do and say both to friends/family and in a forum like this?

mthoms 5y ago
Every situation is unique but often it’s best not to “say” anything. It’s best to just listen. Like really listen. And offer to continue listening. Encourage others to do the same. Most importantly, Resist the temptation to give advice (unless it’s solicited). Don’t ask “have you tried X?”… instead ask “what can I do to help you get through this”.

varjag 5y ago

Top post on HN discouraging use of suicide prevention hotlines. The fuck is wrong with you people.

Clubber 5y ago
People need to know what could happen when they call that hotline. I'm guessing people think it goes something like this: "I'm feeling suicidal, let me call the hotline." "I called the hotline and now I feel better, everything's great." In reality, at least in the US, it could be like this and this is codified in law (Duty to Warn): "I'm feeling suicidal, let me call the hotline." "We've notified law enforcement. The police are on their way." I'm guessing the reason it isn't always done the 2nd way is because actual therapists know how bad this can be to the patient. Realize therapists are taking a legal risk in not reporting. In the US, the only tool government has for most problems is, "call law enforcement." The only tool law enforcement has it, "take them to jail." If you do some research, you come to realize what a bad tool that can be. https://en.wikipedia.org/wiki/Suicide_legislation#United_States https://en.wikipedia.org/wiki/Suicide_legislation#United_Sta... If it were me, I would call a professional therapist before calling a government hotline in the US. This is not medical or legal advice.
- varjag 5y ago
  None of the outcomes listed are worse than the actual suicide. Afraid CPS will take your kids away? Well guess who goes to the orphanage if you bloody off yourself!
  - Clubber 5y ago
    Yes but if someone were contemplating it and they are looking for someone to help them off the edge (which is the purpose of the hotline), all these things would probably have the opposite effect. Going to jail is probably better if suicide was inevitable, but if it's inevitable, a person probably wouldn't be calling the hotline. I think if the hotline was anonymous and untraceable and directly connected a person to a therapist who specialized in that sort of thing with no strings attached, it would be an invaluable tool. Unfortunately it is not that. It certainly could be.