Some years ago, after I got out of the military, I called a suicide prevention line for veterans, however, the connection was so bad, the operator couldn't hear me unless I shouted. Not wishing to do that, I told her I ending this call and would perhaps call back at another time.

My phone rang seconds later. "Now, I can hear you!" she said.

I didn't ask her to call back, and I didn't want her to. Moreover, she might have been able to hear me, but communication wasn't getting any easier, since she asked me three times what instigated my depressive episode, and I explained three times that there was no particular incident. It just happens sometimes.

Frustrated with this conversation, due to this operator's evident cluelessness, I simply said that I'm ending this call.

"Wait! We need to be sure . . ."

"That's not important," I replied, and hung up.

The cops were banging on my door minutes later. I thought they would never leave. They were calling me on the phone when I refused to answer the door.

So, I would no longer use the Veterans' Crisis Line for any reason. Nor would I recommend it for anyone.

Why is anyone surprised about this? The call is recorded in case of liability: the representative actually could tell the caller to kill himself or herself, OR the disturbed caller could threaten the rep.

Calls to suicide hotlines are not confidential, any more than Facebook is private. I frequently have kids (teen age) brought involuntarily to my psych unit feeling lied to and betrayed, and trusting no one, because they made what they thought was a confidential call to a crisis line. While talking to a counselor the police showed up at their home, detained them against their will, escorted them out of their house in handcuffs ("these are just for your protection") and took them away in a police car "to get some help". This is usually witnessed by everyone in the household, including children the caller might have hoped to shelter from the drama; and in full view of the neighbors. Now everyone in their household is aware, upset and scared - and often unsympathetic and angry at the caller; and their neighbors, peers at school and everyone else in the gossip chain know that they have a "mental problem" and had to be taken involuntarily to a mental hospital. It happens to adults the same way; some have made the mistake of calling during a break at work.

I can't even estimate the number of kids I've taken care of who thought they could seek confidential help from a counselor or teacher at school - because that's what they've been told - and ended up being manhandled and searched by school staff and police, handcuffed, and taken away in a police car, as if they'd done something bad, all in front of their peers.

The practice of mental healthcare and the treatment of people with mental illnesses is still about thirty years behind the science and research (the "evidence gap") Most of the people working in mental health facilities, including psych nurses, mental health techs, clinical therapists, case managers, are taught on the job by people who've been "doing it that way for twenty years" and who also learned on the job from people who'd also been "doing it that way for twenty years" and indignantly insist "I'd think by now I have it down" (which tells me they haven't felt the need to learn anything new in a long, long time).

It would cost massive amounts of money and effort to catch the system up with the science, but there's little incentive to do it. It's already a lucrative business as it is, and the stigma of mental illness is still huge. There's not much sympathy for people with mental illnesses, and not much motivation to offer them more expensive and effective treatments, or even just humane treatment.

People with mental illnesses are still treated as though they're guilty of mental illness rather than victims of it. In any other field of medicine, if the patient doesn't get better it means the treatment plan has failed, and the fault is the treatment team's, not the patient's. Psychiatrists and psychiatric nurses are the only healthcare professionals I've ever worked with who can get away with blaming their patients when their treatment plans fail and their patients don't get better. Mental healthcare still isn't very effective. Guilt, shame, coercion and punishment are still routine interventions - though most providers know better than to document that in the notes.

I know a veteran who struggled with issues related to his combat experience in Iraq and Afghanistan, but refused to seek help from the VA because any mental health counseling there would be put into his service record and be a black mark in it. He refused to seek help from a private counselor because the military might find out about it and it would go into his service record.

He's retired now and still refuses all entreaties to seek help, instead drinking heavily to calm his demons.

The US military has always been a few decades behind on mental health. In WWI, the way the Army dealt with "shell shock" was to send the soldier home branded a coward.

By World War II, it hadn't gotten much better. The German Army actually had a more nuanced view of the stresses of combat and a better solution for them.

The Wermacht, like many European armies, used the regimental system, taking its recruits from geographic areas and keeping them together. So, a solider suffering from what we now call PTSD was taken aside and told his friends and neighbors were counting on him. He was later taken back to his unit, where his friends and neighbors watched out for him. Units that were exhausted were taken out of the line and replacement soldiers from the same geographic area were then assimilated into the unit. The soldiers used the down time to get to know each other and find out how much they had in common - i.e., ancestors, favorite hang-outs, etc. Veterans gave the newbies advice and prepared them for what to expect.

The US Army, on the other hand, used what it called the "Repo Depot," a mass of soldiers inserted piecemeal into units to replace losses on the fly. These were strangers thrown into combat among strangers.

Since the first two weeks of combat are the most dangerous, as one has yet to learn how to conduct oneself. Since replacements were inserted during active operations, there was no downtime to get to know the new guy and to pass on survival tips to him. As a result, veteran soldiers left the new guy on his own as a newbie could get you killed with a stupid mistake. Feeling abandoned, the new guy did not feel any shame in "letting down" his fellow soldiers. After all, they weren't his friends and neighbors; they were the bastards who left him to die.

The US Army had, as it had in all wars up to then, vastly underestimated the casualty rate and, as a result, was forced to use soldiers not trained in combat in combat roles. The movie Fury shows the absurdity of the Army's replacement policy as part of the plot, with Shia LaBouef playing a clerk/typist thrust into a tank unit among strangers with no time for assimilation. His fellow tankers don't want him there because he'll get them killed.

This brutal replacement policy led to massive desertions during the Hurtgen Forest campaign, a botched operation that should have marred Omar Bradley's reputation as "the GI General." Private Eddie Slovik was later executed for deserting during that campaign.

Paul Fussell covers Slovik's story and the butchery of the Hurtgen Forest campaign in his book The Boys' Crusade, drawing on his own experiences in World War II.

By the Korean War, the US Army was beginning to admit the existence of something real in what it then called "combat fatigue." The Army, and the US military in general, is still years behind on mental health issues.

A *between a rock and a hard place*issue.

How do you locate people who honestly need help?. And still maintain confidentially, protect the system from fake calls, scammers, and put checks on the people manning the lines, and answering the calls?

Answer is, you can’t. But the law requires that you tell people when they are being recorded, so there is that.

Do suicide hotlines actually help? Or is this another one of those: We need to do something. This is something. Somebody else is paying for it. Let’s do it. ?

A suicide hotline should probably not be run by any level of government, just sayin.

My guess is that the calls are being monitored in case the po-po "need" to go steal the caller's guns, or it could even (dons tinfoil hat here) be an indirect attempt by the Malthusian population control crowd to up the number of suicides to try to get to their goal of only 500 million people on the earth.

I don't see any good coming from this change. The people responsible for inserting this message WILL have blood on their hands.

"The Army, and the US military in general, is still years behind on mental health issues." - Conan.

True. And yet compared to government and most private for-profit and nonprofit mental health care organizations the VA is a leader in advancing and exploring new treatments for PTSD, major depressive disorder and other mental illnesses. Other than the use of new drugs, which are only a little more effective than the old drugs, care and treatment of people with mental illnesses is about thirty years behind the times.

People with mental illness are still treated as if mental illness is a crime (read Patrick's account above of his experience with the system) If someone with a serious mental illness reaches out for help there's a high risk that he'll lose his freedom and his dignity, along with his job, family, friends, home, and physical health. It's hard enough for them to hang on because of the mental illness itself; the treatment often makes it impossible.

As long as government or highly profitable private mental healthcare enterprises have the ability to use coercion and force with impunity against people who decline their services there's no need for them to entice or satisfy their patients with more effective treatment or kinder, more humane care, or even a little respect. And there's good reason for people who might benefit from even the treatment that's available now to stay as far away from it as they can.

It is also to catch people like one of my H.S. teachers. He told us the story twice to show us something and that something is totally forgotten. As part of his teaching Certification he had to volunteer at something and he ended up on the suicide hotline. He by his own assessment was not very good at it. What got him kicked out (and almost kicked out of the teaching program) was he said something like "That is a really reason to not commit suicide. Tell me the real reason you haven't done it." The person called and complained. Those weren't his exact words.

"Do suicide hotlines actually help? "

Sigh... I wrote a big long post about this yesterday, and it died a fiery death in the hell known as 500 Internal Server Error. The short answer is that it doesn't seem to have been studied much. I found one study indicating that suicide hotlines themselves are somewhat effective, but another study that said that anti-suicide publicity campaigns are not effective and might even have slight negative effects.

I think that conversations with suicide hotlines should be legally privileged:
1. No person can be charged with a crime based on what they tell a suicide hotline.
2. Recordings and phone records of suicide hotlines are not subject to subpoena.
3. Data from suicide hotlines can be published only if it is anonymized.

When someone wants psych help (and even more when someone calls a suicide hotline) it is because he feels that some other person or situation has taken away his control of his life, his fate.

Thus we cannot expect that person to trust any system that is built around restraining him, and is likely to take away his civil rights and lock him up just for having his feelings.

This is why I believe the whole "mandatory reporters" business needs to go away, at least when applied to adults. There needs to be someone the hurting person can talk to for advice without any possibility of such an intervention occurring. Until that change is made, the hurting person really can't trust anyone.