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Nonetheless, we can still use our imaginations and our common sense to hypothesize about the limitations of the current system and possible alternatives.

I think there are two questions worth considering: first, are suicide hotlines generally accessible or useful to people who are actively suicidal?

At the same time, however, you also have to find a way to squeeze in a suicide risk assessment—hopefully, not with a bald non-sequitur like but in some more fluid and natural manner. I can’t speak for every operator at every call center, but in my own experience, I would estimate that fewer than 10% of the people I’ve ever spoken to have expressed any immediate desire or intention to end their lives.

The purpose of the risk assessment is to enable the person to talk about their suicidal thoughts, in case they’re unwilling to broach the topic themselves, and also to allow you, the operator, to figure out how close the caller might be to taking some kind of action. ” you work your way up to greater levels of specificity: “have you thought about you might take your life? Well over half of callers, I would estimate, answer “no” to the first risk assessment question. So who’s calling suicide hotlines, then, if not people who are thinking about killing themselves?

They are people with psychiatric issues that make it difficult for them to form or maintain relationships in their daily lives, or cognitive issues that have rendered them obsessively focused on some singular topic.

Given the social and religious stigma that continues to be associated with thoughts of suicide, we might posit that the higher-risk a caller is, the anxious they are likely to be.

They may perhaps be reluctant to agree to a follow-up call when asked, and nervous to call the hotline again if they suspect they might be part of some study.

They’re more intimate than you would have in daily life, where an arbitrary set of social niceties constrains us from talking about the things that are close to our hearts. Operators at most call centers are forbidden from revealing personal details about themselves, offering opinions on specific subjects, or giving advice on problems: all of which tend to be central features of ordinary human conversation.

With practice, and a sufficiently lucid and responsive caller, you can sometimes make this bizarre lopsidedness feel a bit less awkward.

The prevailing theory is that suicide hotlines are catching people “upstream,” so to speak, before they find themselves in a crisis state where suicide might start to feel like a real option for them. If we take “suicide prevention” as the chief purpose of suicide hotlines, we soon find that the effectiveness of hotlines is very tricky to assess empirically.

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