You know they’re there if you need one, but like most people, you’re probably not really sure how they work, or if they even work at all. Suicide hotlines have been around since the 1960s, but were mostly locally-based and locally-run.

But how do they work? And do they work at all in reducing suicidal thoughts and behaviors?

That was the focus of a series of studies in a journal called Suicide and Life-Threatening Behavior. Today’s Boston Globe has the story, called Wrong Answer, written by Christopher Shea.

The results were mixed.

According to two articles by lead author Brian L. Mishara […], 15.5 percent of the 1,431 calls his research assistants listened in on — at 14 crisis centers — failed to meet minimal standards for evaluating suicide risk and providing counseling.

The article focuses on what the studies found that cast the suicide call centers in a poor light:

Mishara did find that the helpers who mixed the two approaches — mostly empathetic, with a dash of problem-solving — had the best results, and that strategy can be taught, he says.

What stands out, though, is just how often the [suicide hotline] helpers failed to meet the basic standards for either approach. In 723 of 1,431 calls, for example, the helper never got around to asking whether the caller was feeling suicidal.

And when suicidal thoughts were identified, the helpers asked about available means less than half the time. There were more egregious lapses, too: in 72 cases a caller was actually put on hold until he or she hung up. Seventy-six times the helper screamed at, or was rude to, the caller. Four were told they might as well kill themselves. (In one such case, the caller had admitted to compulsively molesting a child.)

So naturally my question is, are the helpers just being poorly trained (doubtful) or is it more likely they suffer from burnout? The research doesn’t say, but it would be the most interesting question to me, because it would point to the need for constant re-training of helpers, and support and reward systems for maintaining empathy and problem-solving skills.

Do suicide helplines help?

In follow-up appointments with some 380 callers, 12 percent said the call had kept them from harming themselves; roughly a third reported having made and kept an appointment with a mental-health professional. On the other hand, 43 percent reported having felt suicidal since the call, and 3 percent had made a suicide attempt.

Again, the results appear decidedly mixed. If only 43% felt suicidal since the call, that leaves over 50% who do not. To me, that’s a pretty good number. You can’t say it’s the call that’s making the difference or not, but it seems like it’s helping at least a third of the people to seek out further mental health services.

The study, however, hardly represents a condemnation of the centers, [the researcher] Mishara insists. On balance, callers were less hopeless, apprehensive, and generally depressed by the end of calls. “The good centers are doing an excellent job,” he says, though research ethics forbid him from identifying either the good or bad ones.

Really now? I suppose that in order to get permission to listen in on the calls, he had to guarantee anonymity for the actual call centers, in case they turned out to be one of the “bad” call centers.

But that seems to put public health and safety at risk, unless the researcher did identify the bad call centers to the centers themselves, in order to help them improve. Without constant, empirically-based feedback, how we know we’re doing a good or bad job?

Interesting — and badly needed — studies nonetheless that will hopefully provide some future improvement roadmaps for call centers nationwide.