Hey Dr. Reid,


Interesting perspective you bring to the table, and again, I note that your experience focus's on when something actually has gone wrong.

Your points are of course great - it would be best to have well trained, fully educated, very experienced personnel to handle the details of suicide evaluation and prevention.

In all honesty though, I have to shake my head here. Show me any community in the US that takes good care of their financially poor mentally ill population? How much resources do we give to this population who needs a lot of resources?

Reality is - the suicide and crisis hotlines operate on a string budget. Often there is only one MFT associated with the line, and the rest are volunteers like me - without a degree, but with the desire to talk to mentally ill, suicidal people or people in crisis, even let those folks wake us up at at 3am, because they are having a bad night.

Most of us really wants to be there for folks in crisis, and we have some training, I think the training I got was pretty damn good. That still doesnt change the fact that we dont have a degree.

In my experience the less well trained of the suicide and crisis hotlines are mainly focused on a quick suicide assesment, and giving out resources. The best of the hotlines have volunteers who take the time to talk to, listen to and care about the callers. They are not all equal. In the cases were we - admittedly uneducated - volunteers take the time to talk to someone in crisis, often making these calls hour long, or longer, I think we make a big difference. I also think that we do a good job at keeping an eye out for actual suicide risk, vs suicidal ideation. In the cases where there is little immediate risk, but quite a bit of ideation we usually contract to call us back when / if it gets unbearable. I have gotten a lot of those calls that start out "I promised to call back if its unbearable, and it really is unbearable, I want to use x weapon now - I just cant handle any more". Would they have called without a contract? Maybe! One thing is for sure - with the contract they know that their call is welcome, and they have an actual plan to fall back on when they are completely overwhelmed and their cognitive processes might not be the greatest.

You also say that more should be done to take care of those callers that have been referred to the hospital for treatment. I couldnt agree more! I have been in a couple of situations where someone I had talked to for an hour and a half, had committed because I KNEW there was a high risk, and then that person was released within 72 hours. One of those ended up in a completed suicide. I was mad as hell at the hospital, the doctors, and the system. Again it comes down to resources, and laws and bureaucracy. Still - yelling at the hospital or the doctors in this case wont do one ounce of good. The system needs to be rebuild from scratch if we are to have any hope of making it better! The doctors couldnt have retained this person any longer - the 72 hours were up, and getting this person committed for long term psych care would have been an uphill battle. Besides this person really was intent on suicide no matter what, and quickly learned what not to say.

So, anyways - your points are well taken and very good of course. I just dont see how you plan to make the changes needed to the system?

Da Friendly Puter Tech