Despite the headline, I don’t see a single specific problem described in the blog post about California’s Proposition 1, which is on the ballot for this Tuesday’s election. It’s not clearly for or...
Despite the headline, I don’t see a single specific problem described in the blog post about California’s Proposition 1, which is on the ballot for this Tuesday’s election. It’s not clearly for or against, ether. But here are some things I found interesting:
It is supposed to (to the best of my knowledge):
Use an existing revenue stream (a 1% tax on millionaire income that funds mental health services, to the tune of $2-3.5 billion a year) to get a large bond (read: debt) to pay for building housing and institutional facilities for people who are homeless and have mental health and substance abuse problems. These funds will have quite specific requirements; like that 50% of the housing that is built needs to be allocated for veterans (who make up roughly 7% of the homeless population in California).
Divert $1 billion annually from a bunch of existing mental health programs (which will probably close down as a result) into these new funding priorities.
So one of the immediate things you notice is that although the prop bills itself as only increasing funding, it does decrease funding in areas that aren’t mentioned on the ballot in order to do so.
…
See, this is at the end of the day, a piece of legislation. Drafted by policymakers (likely, the staff of the California governor or the politician who formally introduced the bill into the legislature), the ballot measure is simply a request to the voting public to approve the long and complicated bill (actually two bills) that the elected politicians have already agreed upon and voted to pass. Aside from the part where California has to take on debt to do this (which they have to by law get approved by voters) this wouldn’t have even hit a ballot paper at all.
…
One of the reasons Prop 1 is being introduced and moving money around in the background is that 20 or so years ago a big bill was introduced that taxed people with millionaire-income a little bit and created a giant fund to give to counties to fix their mental health systems, and it has been 20 years and nobody at the top really has any idea of how well it has been working and so one has to assume it hasn’t been working particularly well, or at all.
It already funds around $3 billion worth of stuff a year, so if it were gonna massively lower the suicide rate or homelessness rate or addiction and overdose rate you would have expected it to happen already and the results to be pretty clear. Instead, it seems like there are mostly a bunch of new programs that maybe sorta work well for some particular group of people who happen to be involved in the programs currently but who can tell, because the counties can’t tell the legislators how well it’s working anyways?
…
Ironically, the one problem I think this has a chance of solving is the ‘the system has tonnes of tiny programs that make it hard to navigate and no one can tell how good they are or even how many people they’re helping, particularly en masse’ problem; purely because all those complicated little programs will be cut. A tonne of ‘innovation’ funding will be cut too, funding which was meant to be a way to systematically experiment to find better alternatives to the status quo, but which in 20 odd years hasn’t turned up anything that has both worked better and been attractive enough to the government that they’ve wanted to fund it on a mass scale (except maybe early psychosis programs, but even those are tiny).
Also, here is a post by the same author where she writes about the difficulty of evaluating mental health care programs. A story from when she worked on a suicide hotline:
Also, here is a post by the same author where she writes about the difficulty of evaluating mental health care programs. A story from when she worked on a suicide hotline:
One relevant thing to know about suicide hotlines is that, at least on the one I volunteered at, for a major US city, about 80% of calls come in from regular callers–people who are not at risk of suicide, at least not anytime in the near future, and who may not even be particularly upset–but who call to have a chat. They may be socially isolated by mobility constraints, by mood problems, or by personality patterns that make it hard for others to talk to them. Or, they may be talkative people who have learned that they can call the suicide hotline once they have exhausted the goodwill of their friends. We would get to know them by name, enforce call limits so they couldn’t call more than four times a day, and document their calls like any others.
So I protested to the shift supervisor–why do I need to make a detailed call note (including a suicide risk assessment, details of the kind of distress they were experiencing, and a summary of the interventions I used) when this person calls four times a day and always says the same thing? I said it was a waste of time–none of my fellow hotline counsellors would ever read those notes, because nothing ever happened in the call interesting enough to warrant looking up later. (I mean this in the extreme sense. There were multiple callers who would call and tell exactly the same story from decades ago in every call, so you couldn’t easily distinguish one call of theirs from another).
From my perspective, helping these callers was a distraction from the purpose of the hotline–to help people survive when they wanted to end their life. I was happy to write detailed call notes when I did talk to someone who was at risk; knowing that, as happened several times, those notes might come in handy to a counsellor who encountered the same person again in a crisis and needed crucial context.
After almost an hour of back-and-forth, he revealed the stakes. The call notes, one for each incoming call, created a record of the number of calls the hotline received–and when it came time to renew the government grant that funded the salaries of the full-time employees of the hotline, the absolute number of calls was what mattered.
The aggregated statistics did not distinguish between four calls with different people, each with a weapon in their hands, who were talked down from the brink of suicide and kept alive through the compassion and rapport-building of their hotline counsellor, or four calls with the same guy who got bored of talking to his friends and wanted to bitch about his roommate for a few minutes before heading to the gym.
Is this good mental health care? Eh. Who knows. Is this helping more people stay alive who are at risk of suicide? Almost certainly not. And yet, these extra calls and the associated detailed documentation work were essential to the survival of the service. (I eventually negotiated a truce with my supervisor–I would create call records for these calls, but put the bare minimum of effort into writing them. As long as they recorded the date, time, and suicide risk, he said, he was happy.)
I have a lot of feelings about this that I want to come back and add but the idea that hotlines or helplines are only there for the person with a knife in their hand is frustratingly incorrect....
I have a lot of feelings about this that I want to come back and add but the idea that hotlines or helplines are only there for the person with a knife in their hand is frustratingly incorrect. And in what world is it better to hang up on isolated people and ban them from calling to that you can be less "distracted" for the hypothetical "perfect" suicidal person?
Some skepticism is warranted when reading a story told by a stranger on the Internet, but I think that's a misread of what she was saying? We don't know what these callers were really like, other...
Some skepticism is warranted when reading a story told by a stranger on the Internet, but I think that's a misread of what she was saying? We don't know what these callers were really like, other than what she told us. If you don't trust that then you might as well ignore it entirely.
It's true, though, that measuring the worth of a hotline in "lives saved" is simplistic. There might be some other ways of measuring secondary benefits. But that means doing even more measurement. Just evaluating the primary goal is pretty hard already.
I don't think that I'm being "skeptical" I'm taking the author at her word and disagreeing with her conclusion. Hotlines and helplines are not only intended to help someone with a weapon in their...
Some skepticism is warranted when reading a story told by a stranger on the Internet, but I think that's a misread of what she was saying? We don't know what these callers were really like, other than what she told us. If you don't trust that then you might as well ignore it entirely.
It's true, though, that measuring the worth of a hotline in "lives saved" is simplistic. There might be some other ways of measuring secondary benefits. But that means doing even more measurement. Just evaluating the primary goal is pretty hard already.
I don't think that I'm being "skeptical" I'm taking the author at her word and disagreeing with her conclusion. Hotlines and helplines are not only intended to help someone with a weapon in their hands. First, most attempts don't involve a weapon. But secondly, most people who are suicidal are not yet to the stage of wanting to make that attempt. The whole point of a hotline is to keep them from getting there.
The type of person she describes is prone to social isolation due to their behavior. The person that calls 4x a day may have called once when needed desperately, and kept calling ever since. They may have found their only social outlet and they may also have found the closest thing they have to a friend who won't abandon them. That is not a worthless phone call. Failing to take those calls would likely lead to an increase in suicidality among those people.
She claims that these calls were a distraction from helping the people who she considered worthy of using the resource. Were they? Or were they just annoying? And her demonstration that it's all about the money reads a bit more to me like a boss who needs volunteers trying to find some way to get this person to do their job.
Every call needs documented. So you document it even if you think it's a stupid call. Yeah that demonstrates need and all, but it also ensures that if someone starts streaming live on Tiktok that they called 988 and the person didn't help them so they're gonna kill themselves, your ass is covered.
I dislike the declaration of who is worthy of getting help or not. And the line put limits on those "distraction" calls anyway. So someone had probably run the numbers on that already. I've sat with people for hours who were suicidal and sat with people for hours who were drunk or who just needed to talk. And while I have set limits when I need to, when I'm called out of my literal bed at 2am to go talk to someone, I don't complain that they didn't really need help. I don't care if they're attention seeking support seeking. That's the point of the work.
So yeah, I'm skeptical about the conclusions she drew, not her claims.
That's correct, I was more detailed in my follow up comment but that doesn't mean it isn't still a net gain to provide that socialization to the people calling that the author describes as...
That's correct, I was more detailed in my follow up comment but that doesn't mean it isn't still a net gain to provide that socialization to the people calling that the author describes as distractions. I trust the administrator of a hotline to set limits (which they did) or refer to other resources (which the author makes no reference to) as needed based on the number of more urgent calls they get.
Despite the headline, I don’t see a single specific problem described in the blog post about California’s Proposition 1, which is on the ballot for this Tuesday’s election. It’s not clearly for or against, ether. But here are some things I found interesting:
…
…
…
Also, here is a post by the same author where she writes about the difficulty of evaluating mental health care programs. A story from when she worked on a suicide hotline:
I have a lot of feelings about this that I want to come back and add but the idea that hotlines or helplines are only there for the person with a knife in their hand is frustratingly incorrect. And in what world is it better to hang up on isolated people and ban them from calling to that you can be less "distracted" for the hypothetical "perfect" suicidal person?
Some skepticism is warranted when reading a story told by a stranger on the Internet, but I think that's a misread of what she was saying? We don't know what these callers were really like, other than what she told us. If you don't trust that then you might as well ignore it entirely.
It's true, though, that measuring the worth of a hotline in "lives saved" is simplistic. There might be some other ways of measuring secondary benefits. But that means doing even more measurement. Just evaluating the primary goal is pretty hard already.
I don't think that I'm being "skeptical" I'm taking the author at her word and disagreeing with her conclusion. Hotlines and helplines are not only intended to help someone with a weapon in their hands. First, most attempts don't involve a weapon. But secondly, most people who are suicidal are not yet to the stage of wanting to make that attempt. The whole point of a hotline is to keep them from getting there.
The type of person she describes is prone to social isolation due to their behavior. The person that calls 4x a day may have called once when needed desperately, and kept calling ever since. They may have found their only social outlet and they may also have found the closest thing they have to a friend who won't abandon them. That is not a worthless phone call. Failing to take those calls would likely lead to an increase in suicidality among those people.
She claims that these calls were a distraction from helping the people who she considered worthy of using the resource. Were they? Or were they just annoying? And her demonstration that it's all about the money reads a bit more to me like a boss who needs volunteers trying to find some way to get this person to do their job.
Every call needs documented. So you document it even if you think it's a stupid call. Yeah that demonstrates need and all, but it also ensures that if someone starts streaming live on Tiktok that they called 988 and the person didn't help them so they're gonna kill themselves, your ass is covered.
I dislike the declaration of who is worthy of getting help or not. And the line put limits on those "distraction" calls anyway. So someone had probably run the numbers on that already. I've sat with people for hours who were suicidal and sat with people for hours who were drunk or who just needed to talk. And while I have set limits when I need to, when I'm called out of my literal bed at 2am to go talk to someone, I don't complain that they didn't really need help. I don't care if they're
attention seekingsupport seeking. That's the point of the work.So yeah, I'm skeptical about the conclusions she drew, not her claims.
That's correct, I was more detailed in my follow up comment but that doesn't mean it isn't still a net gain to provide that socialization to the people calling that the author describes as distractions. I trust the administrator of a hotline to set limits (which they did) or refer to other resources (which the author makes no reference to) as needed based on the number of more urgent calls they get.
I'm glad you got the help you needed!