Trans Lifeline's Safe Hotlines Study: The Need to Advance Non-Carceral Mental Health Support Strategies

Background and Purpose:

Crisis hotlines are a key resource for people who experience mental health crises. In 2022, 988 became accessible nationwide as an easy-to-remember number to access the National Suicide Prevention Hotline and related resources. Although it is advertised as an alternative to 911, many 988 calls – and other hotline calls – are re-routed to 911, where callers may experience police involvement and carceral responses such as arrest or involuntary commitment.

In spring of 2022, a group of researchers and community members came together to design a mixed methods research project for the Safe Hotlines project. The purpose of the survey was to learn about the experiences and opinions of people who have sought support in the U.S. during difficult mental health situations, including a crisis, distress, and/or suicidality. We were interested in learning about help seeking experiences with hotlines or any other resource.

Methods:

In Phase 1, a survey was conducted (n=210) to hear directly from people about their help-seeking experiences during mental health crises. Convenience sampling strategies were used to invite hotline and non-hotline users to participate and to oversample folks with marginalized identities (due to the disproportionate impact for these populations).

In Phase 2, interviews were conducted with a subsample of survey respondents who sought help from crisis hotlines. They were asked questions about their experiences calling crisis hotlines, seeking help from other sources, what an “ideal” hotline experience might look like, and whether they received police or emergency medical responder involvement (with or without consent) when they contacted the hotline.

Results:

In our final sample, 50.3% sought help from a crisis line, 77.2% sought help from their personal network, 45.6% sought help from community or alternative care, 73.6% sought help from professionals (like therapists or doctors), and only 14.5% sought help directly from 911 or other emergency response services (ERS). Yet ERS became involved for 19.8% of crisis hotline callers, 28.6% of those who sought help from their personal network, 15.8% of those who sought help from community or alternative care, and 14.3% of those who sought help from professional care. Among crisis hotline callers, 70.6% reported a harmful experiences with ERS, which was highest among all help-seekers.

Our results reveal the harms and profound long-term impacts of carceral responses to mental health crises for marginalized people including involuntary hospitalization, arrest, forced medication or sedation, discrimination, violence or abuse, financial hardship, job or housing loss, school interruption, and post-traumatic stress symptoms after the intervention. When asked about what ideal hotline experiences could look like, participants advocated for more transparency (i.e., being informed about ERS involvement), consent for geolocation, and eliminating police involvement in crisis response services.

Conclusions and Implications:

The study results highlight the need for peer support and similar community-based anti-carceral responses, and the need for full consent and transparency for hotline users.