Most crisis lines across the US trace calls and send police to people’s homes if crisis line staff feel someone might be at risk of suicide, according to an article in Suicide and Life-Threatening Behavior, the official journal of the American Association of Suicidology. A new policy developed in 2012 has clarified and more firmly entrenched this longstanding practice, stated the article. Even two Samaritans call centers which historically had resisted the policy have now implemented the covert practice.

The authors of the article included two directors of the Substance Abuse and Mental Health Services Administration-funded National Suicide Prevention Lifeline. The Lifeline network is comprised of over 160 crisis call centers across the US that are linked through a variety of toll-free numbers through which callers are then routed to their nearest crisis center. The article explained that the new policy uses the term Active Rescue to refer to “actions independently undertaken,” without a caller’s knowledge or authorization, that “are intended to secure the safety of individuals at imminent risk of suicide.”

According to the authors, a person is at “imminent risk” of suicide if the person states, or is reported by someone else to have stated, that he or she has “both a desire and intent to die and has the capability of carrying through his/her intent.” Nevertheless, the authors explained, the guideline was not intended to be restrictive of the helper alternatively simply using his or her own personal judgment to determine if someone was at risk.

The authors acknowledged that the practice is controversial. “(T)here has been small but significant disagreement in the crisis center community as to whether actions to save a caller’s life without his or her consent (active rescue) should be required at all. Fear of potential police intervention can deter individuals from discussing their suicidal thoughts with others, including crisis line helpers; involving the police can at times have invasive, counterproductive results.”

Perspectives of callers who’ve experienced such unwanted interventions are “mixed,” stated the authors, with some research reporting that “such an event can be experienced as punitive and damaging to self-esteem and social reputation,” while other research has reported “positive perceptions of hospital stays.”

The Lifeline network website advises that anyone can call to discuss suicidal feelings or “substance abuse, economic worries, relationship and family problems, sexual orientation, illness, getting over abuse, depression, mental and physical illness, and even loneliness.” The website assures that, “Your call is confidential and free.” Nevertheless, the authors of the article stated that callers should have an “implicit understanding” that crisis line staff with suicide prevention mandates might sometimes covertly breach confidentiality and privacy. They also cited research challenging whether suicidal feelings are “rational” or “responsible,” and stated that suicidal thinking is evidence of “cognitive constriction” that “can be successfully addressed in clinical settings” with psychiatric treatment.

The policy has been implemented “network-wide,” stated the authors. They wrote that two Samaritans centers initially resisted the policy, but eventually implemented it as well. “In some respects, this historic shift in philosophy and practice by Samaritans centers was one of the most groundbreaking developments in the policy’s implementation,” wrote the authors.

(Abstract) Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: The Importance of Active Engagement, Active Rescue, and Collaboration Between Crisis and Emergency Services (Draper, John et al. Suicide and Life-Threatening Behavior. Article first published online October 1, 2014. DOI: 10.1111/sltb.12128)

National Suicide Prevention Lifeline