Content: Discussion of suicide, depression, police involvement in responding to crisis.
Trans and non-binary folks, and especially trans survivors of violence, often experience high levels of depression, anxiety, post traumatic stress, and other mental health challenges. In crisis situations, we sometimes don’t know where to turn, so we call crisis lines to reach out for someone to listen and care. Trans folks who have experienced prior trauma in their lives may feel especially isolated or unable to talk to their friends about what they’re experiencing, so they may be more likely to lean on supports like crisis lines. However, reaching out to any kind of supportive services can be challenging at a time when trans people are facing increasingly hostile anti-trans legislation and attitudes.
The 988 Suicide and Crisis Lifeline (previously The National Suicide Prevention Lifeline) is a 24/7 call and text line that provides “free and confidential support for people in distress.” The three digit dialing code aims to make it easier and more accessible for anyone to reach a counselor trained in supporting folks experiencing suicidal thoughts, substance abuse, and mental health crises. The lifeline is also available for people to call about a loved one experiencing a crisis.
The lifeline is a national resource, available for anyone in the US to access, with the goal of connecting people with supportive resources in their area. While the 988 Suicide and Crisis Lifeline takes a step toward making mental health care more accessible for all with the easily-memorable number and 24/7 availability, advocates who work with marginalized, underrepresented, or underserved populations, including trans folks, LGBTQ populations, people of color, and people living with disabilities have raised concerns about how 988 operators respond to “imminent risk.”
“The new 988 lifeline number aims to divert mental health, suicide or substance abuse crisis calls from 911. However, if a 988 operator determines that a caller presents an imminent risk to themselves or others, operators could still engage emergency response teams that may include police officers.”
Although the lifeline is advertised as “confidential,” this confidentiality may be broken if an operator decides that a caller is at “imminent risk of suicide.” An operator may trigger an “active rescue,” which involves accessing a caller’s location and calling emergency services, with or without the caller’s consent. The intention here is to remove someone from immediate danger. But in doing so, people experiencing mental health crises, particularly those with other marginalized identities, may be further victimized by non-consensual emergency services and law enforcement.
“Calling 911 is all too often a death sentence for mad, neurodivergent, mentally ill, and disabled people.”
For trans people who may be living with an abusive partner, the risks associated with law enforcement or sensitive crimes unit may place that individual at even greater risk of immediate or future intimate partner violence. The intimate partner may attempt to sway emergency responders to either hospitalize or not hospitalize the caller as a way of exerting power and control over their partner.
Trans folks are often already subject to nonconsensual “treatment,” such as conversion therapy, that attempts to change someone’s gender identity or sexual orientation. It may be particularly triggering for trans people to come into contact with unwanted emergency services, as this might mirror previous traumatic experiences. Similarly, survivors of violence have had control taken away from them. In a mental health crisis, it’s even more difficult to be in a place where control is again taken away, which can worsen mental health challenges.
Research suggests that while coercive measures like involuntary hospitalization might prevent someone from acting on their suicidal thoughts in the short term, they may actually contribute to increased suicidality in the long term. This is especially true for people with marginalized identities and previous trauma histories, who may face re-victimization by service providers.
People with mental health challenges are more likely to be killed by police than those who don’t. According to a 2015 report, “the risk of being killed during a police incident is 16 times greater for individuals with untreated mental illness than for other civilians approached or stopped by officers.” This is especially true when they’re also “people of color, trans people, immigrants and/or members of other marginalized groups.” A 2020 Prison Policy Initiative study and survey found police threatened or used force against Black and Latinx people twice as often as white people.
“Sending police into the homes of black and brown individuals in mental health crisis created especially serious dangers of brutalization, violence, and criminalization. Similarly, transgender individuals frequently found law-enforcement encounters to be so traumatizing and victimizing that trans individuals would not seek help from a hotline service where they could feel threatened by a potential police encounter.”
These dangers mean that calling 988 may not be safe for people with mental health challenges, disabled people, people of color, immigrants, transgender people, and survivors of violence. It’s particularly concerning that the risk of “active rescue” is not explicitly described in 988 advertising. Instead, the label of “confidential” suggests the opposite.
Some Twitter users have also raised specific concerns about the implications of the lifeline’s geolocation and non-consensual active-rescues. One user speculated that calling 988 may have unintended consequences for trans youth in states with anti-trans legislation that criminalizes gender-affirming care, suggesting that trans youth could be outed to parents or service providers.
It’s unclear what types of resources 988 operators might direct trans callers to. One transgender caller described being connected to an “anonymous trans chat room for chasers” after calling 988 to get mental health support.
One Twitter user who worked for 988 described some of the shortcomings of training: “They’re not teaching people shit about trans people, not even basic how tos on pronouns, nothing.” Although the 988 website specifically says that counselors can support LGBTQ+ callers, experiences of trans callers and operators suggest that the training offered does not adequately inform operators on how to support trans/nonbinary callers.
These accounts suggest that despite the efforts of the lifeline to offer confidential support to people experiencing mental health crises, the use of geolocation to send non-consensual emergency services has a high likelihood of further victimizing trans people, survivors of violence, disabled people, and people of color. Gaps in training on marginalized identities may lead operators to direct trans and nonbinary callers to resources that are more harmful than helpful, which may exacerbate mental health crises. Before calling 988, it’s important to be aware of the potential for causing harm and victimization, and to know what other resources are available for people with marginalized identities.
Alternatives to 988
BlackLine: 1 (800) 604-5841
BlackLine “provides a space for peer support, counseling, witnessing and affirming the lived experiences to folxs who are most impacted by systematic oppression with an LGBTQ+ Black Femme Lens.” BlackLine offers both calling and texting services, and prioritizes serving Black, Indigenous and People of Color. BlackLine’s national team can help connect callers with “local services, housing, domestic violence shelters, and medical attention.”
BlackLine’s co-founder, Vanessa Green, has described the importance of being able to get support from someone who shares your identity, mindset, and experiences.
Trans Lifeline: (877) 565-8860
Trans Lifeline provides 24/7 peer support for trans and nonbinary people in crisis. Calls to Trans Lifeline are fully confidential, and operators will never call 911, emergency services, or law enforcement without the consent of a caller. All volunteer operators for Trans Lifeline identify as trans or nonbinary, and go through a 36-hour training program that emphasizes informed consent and awareness about what happens when 911 is called.
TrevorLifeline, a part of The Trevor Project, offers 24/7 counseling through phone call, texting, or web chat for LGBTQ+ youth under age 25. Counselors are trained to listen without judgment, and have an understanding of the challenges that LGBTQ+ youth face.
It’s important to note that because of the population that TrevorLifeline serves, there are some instances where operators may decide to contact emergency services. TrevorLifeline operators will make disclosures to law enforcement, state authorities, or emergency services in instances where “you are at imminent risk of death or serious injury (i.e, if you have suicidal desire, a plan, access to means, and an imminent timeline)” or if “a minor or vulnerable dependent adult has been or is currently being subjected to emotional or physical abuse or neglect.”
Although this is not a suicide line, RAINN has a history of providing trans and LGBTQ-affirming care for survivors of sexual assault or dating violence. Their crisis support services include an online chat hotline, a Spanish online chat hotline, and a telephone hotline: 800-656-HOPE (4673).
Although 988 aims to make mental health support for those in crisis more accessible across the US, major drawbacks around confidentiality, “active rescue,” and gaps in knowledge about marginalized populations mean that it may not be a safe-enough option for trans people, survivors of violence, disabled people, and people of color. Some people may want to take the risk of calling, knowing there is a possibility of interacting with law enforcement or emergency services. It’s important to be aware of the potential risks when calling 988, and especially before calling 988 on behalf of someone experiencing a crisis. It’s a good idea to be prepared by adding crisis lines like BlackLine, Trans Lifeline, and TrevorLifeline to your contacts in case you need to get help quickly.
Action items: what you can do
While it’s disheartening to learn about the potential harms caused by this new mental health resource, this knowledge can help to mitigate violence against people with marginalized identities and support trans survivors in accessing inclusive, affirming mental health care. Here are some action steps you can take to prepare for crisis situations when you may need to support someone in accessing mental health support:
1. Add alternative crisis line numbers to your phone contacts.
In a crisis, you may not have time to search for the number of an alternative crisis line you’ve heard about. Take some time to add the above alternative hotlines to your phone contacts so you have easy access when you need it.
2. Make a safety plan.
If you have someone in your life who you support with their mental health, consider sitting down with them and making a safety plan in case of a crisis situation. This website walks you through the process of setting up a safety plan for suicidal thoughts. Are there specific people this person would like you to call in an emergency? What crisis lines or local resources are they comfortable with you accessing for them?
3. Find out what happens when 911 is called in your state.
Sometimes, it may be necessary to call a crisis line that notifies emergency services of a dangerous situation, or to call 911 yourself. In some states, a person can refuse services when an ambulance arrives and not be charged. Do some research about what happens when 911 is called in your area. (Remember you can share what you learn with other community members, so all of you are empowered with information!)
4. Become a Certified Peer Support Specialist or Mental Health First Aider.
A peer support specialist is a person with “lived experience” who has been trained to support those who struggle with mental health, psychological trauma, or substance use. A mental health first aider is a community member trained in identifying signs and symptoms of mental health challenges and supporting people experiencing a mental health crisis. Consider getting trained in one of these areas yourself, or reaching out to trained community members who may be able to help out without contacting 911.
5. Get trained to carry naloxone.
Naloxone is a drug that can be used to reverse opiate overdoses in emergency situations. Anyone can get trained to carry naloxone in case of emergencies, and training may even be offered at your local drugstore.
6. Practice self-care.
Supporting someone else in a mental health crisis can be emotionally draining. Having mental health supports in your own life is essential while supporting others. Check out this resource for developing a self-care checklist that works for you. Some other practices you might find helpful are forest bathing, or these videos on tapping, grounding, routines, and moving.
Want to learn more about shifting responses to suicide and crisis and alternatives to “active rescue?” Check out this webinar with Jess Stohlmann-Rainey on Liberatory Responses to Crisis and Suicide.