CW: Suicide, Mental Health

#FuckTheStigma time.

(Tl;dr: The suicide hotline is problematic, and the way people are talking about it isn’t great either).

Let’s talk about the suicide hotline.

I have PTSD. Suicidality is something I’ll always have to fight off during dark times. I’ve dealt with it since I was in fifth grade. Chronic mental illness means getting to know that particular demon pretty well.

Before I dig into the hotline, I’d like to clear something up:

Suicidality is a spectrum. Sometimes it’s an intrusive thought that you have no intention to act on, but there’s a nagging in your mind that keeps proposing it as a solution. Sometimes it’s a strong desire because you’re just really tired of fighting the illness off and it seems like the only way to give up, but you’re still open to fighting it off. And sometimes it is a critical all-hands-on-deck affair when every cell in your body is screaming at you to do it.

That last version is the only one I feel the need to consider hospitalization for. The others are things I’d bring up with a therapist (if I could afford one), or maybe alert some friends so they could be on watch. But unless I think that my chances of losing the fight are higher than 90%, to be perfectly honest I’m not going to put myself in the position of infinite more hospital bills.

In the past year, I’ve been everywhere on that spectrum. That’s a scary thing to admit, but I think it’s important that we start talking about it. For those of us with chronic mental illness, suicidal thoughts are surprisingly common. Sometimes they last an hour, and sometimes they last months.

Which brings me to the hotline.

When someone is chronically ill, there is no one phone call that is going to do much to help them. That’s like telling someone with a chronic physical illness to go to the doctor. Sure. If you’re facing a medical emergency, go to the doctor. But you’re probably going to feel like crap a lot, and a doctor can only do so much in one visit. Plus, if someone’s in a truly dire medical emergency, you probably don’t want to send them to the plain ol’ doc. You know long wait times are. You want them to die in the waiting room?

I’ve called that hotline. Well, I’ve done the chat version, because when I’m at that point the last thing I will ever do is pick up the phone and talk to a stranger. I can’t even do that when I’m 100% healthy.

The shortest amount of time I’ve ever had to wait to connect with someone on that chat line is 45 minutes. Usually, I wait for over an hour and then just give up. And I’m practiced at dealing with this particular type of emergency. If teenage me were living alone, facing this crisis, and the best option she had was that suicide help chat? I don’t like thinking about that.

I’ve had a few times where I’ve waited it out and gotten through, and to be perfectly honest… they were pretty damn rude and short with me. Not exactly what you need when you’re completely raw and grasping for ammunition in that fight. I’m not the only one who has had that negative experience. (Check out the comments for Lane Moore’s stand up routine about this).

The other issue with suicide helplines? Some of us can’t afford a hospitalization. Part of my crisis this winter was surrounding debt and my fear of needing hospitalization again once I lost insurance. Adding debt to that wasn’t exactly my healthiest option.

I know, I know. “Better to be in Debt than Dead!”

Remember above, where I mentioned that not all suicidal moments really need that level of treatment? There are times when help would be really, really nice, but I avoid it for fear of getting involuntarily sent to treatment.

Also, I was suicidal as a kid and as a teen. Through most of that I didn’t have access to phones or computers that I could use without my parents knowing. Given the amount of abuse I got in reaction to the time someone called CPS on them, dealing with a hotline would have been actively dangerous for me. I’m sure there are people in abusive adult relationships in the same boat.

So what ARE the solutions?

Look, I don’t know. Being able to talk openly about this stuff and erase the stigma around it helps. And that means not making suicide seem so alien every time someone is killed by it. Yes, it’s absolutely heartbreaking when people die from suicide. But please stop talking about it like it’s this unfathomable completely unheard of and always fatal thing. I know that if I weren’t so scared of the stigma (and of people overreacting and/or calling it in so I’d end up in a hospital), I would have been more open in the past when I needed help. Remember – there’s a spectrum. I’d guarantee at least a handful of folks who read this are somewhere on that spectrum right now, but they’re not talking about it because they’re scared of the reaction.

So this is for you, suicidal friends. Here are some steps towards creating your very own “shit I feel suicidal” action plan. And non-suicidal friends, do this too! I firmly believe that these action plans are as important as first aid kits, wills, etc. Don’t wait till you’re in crisis to make one:

1. Identify a handful of friends or family members who you can count on. Reach out to them and let them know you’re adding them to your plan.

2. Make some sort of group chat or group email chain or what have you with these people. The key is to make the barrier of entry for asking for help as low as possible. It doesn’t have to be a formal group chat, but honestly, I find that works really well.

3. Consider keeping that group chat active all the time. I have a few friends who live nearby who I relied on when my brain was at its worst this winter. Sometimes I’d just post asking for advice or sanity checks on decisions. Sometimes I’d celebrate progress. Sometimes I’d ask for someone to keep me safe from myself. That last one was easier because it didn’t feel like it was coming out of nowhere.

4. Are you in a pretty rough space already? Set up an emergency alert you can send with almost zero (or less than zero) effort. I have an ITTT applet that will email two of my closest friends if I tell my Google home a code phrase. I could be lying on my floor sobbing and all I’d need to do is say “buy flowers” (the default code phrase) and it would let them know I need help. (Bonus: this is good for other safety reasons, too).

Need it to be even less effort than that? Have inaction be the trigger for alarm. There are apps that will check in on you regularly. If you miss the check in, it’ll tell your friends to see if you’re okay.

5. If you’re in actual mortal danger levels of crisis (or anywhere close to that) GO TO THE EMERGENCY ROOM. Don’t call a hotline. Go to the emergency room. They will keep you safe and send a psych out to assess you. Yes, you risk being hospitalized (fun fact: suburban hospital doesn’t do involuntary, so that’s my hospital of choice), but this is the point where ‘better in debt than dead’ does actually apply. If you want my lowdown on how (aside from debt) hospitals aren’t actually that bad, let me know.

One more thing: It’s okay to not be the person someone can go to when they’re suicidal. It’s okay to recognize that trying to hold someone else up would have you both crumble. I’m not in a place where I can handle someone else’s crisis and I know that. If someone were to reach out to me, I’d help them out until I can refer them to another mutual friend (or one of my friends who I know would help), or if it seemed dire I’d make sure they got to the ER. Anything more involved than that, and we’d likely both be needing help. Take care of your friends and loved ones, but do not light yourself on fire to keep someone else warm.

I’m going to post a bunch of resources in the comments. Feel free to add your own!