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Comment by paxys | Hacker News Reader

A single hotline experience not working for you doesn't warrant a blanket "I would never suggest to anyone to call a suicide hotline".

There are lots of studies that show that such programs are at least moderately effective (https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12...)

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There's also studies that show the more times you are committed the more likely you are to commit suicide, i.e., that psychiatric hospitals cause suicidal ideation.

Would love to see the methodology on this. I wonder how they controlled for the cofounders are addressed. it stands that more seriously distressed people are committed more.

It is like saying that the more times you are hospitalized for illness, the more likely you are to die.

Or perhaps the most suicidal people are more likely to be committed? Causation seems very hard to show here.

If incidence of suicidal ideation goes up with number of involuntary holds then it means that psych facilities are not treating the problem. That is enough: that they are provably not treating it. First do no harm means you have to be causing good; ambivalence is treated as likely harm because it is invasive.

Can people more or less easily kill themselves while in psych wards?

You mention a correlation, and then you presume cause and effect. An alternative is that the people most likely to commit suicide are more likely to be treated with multiple involuntary holds.

If psych facilities prevent suicides 50% of the time in the long term, the correlation exists for the 50% where they were unsuccessful. Psych facilities could be wildly successful, and still suicides would be more common with multiple admittances to the facilities.

I’m not saying you are wrong, but I am asking you to consider you could be wrong, before wading into such a dangerous area.

That said, I personally think calling mental health services is only for true emergencies: they are highly toxic environments where a bunch of loonies are locked up together and the nurses and doctors can also be toxic as hell. Putting an 18 year old girl under the power of a 40 year old male psychologist who demands obeisance is deeply sickening. She told me she had been previously committed “for her own safety” (I guess manic sexual behaviour), and she said she was raped while in the facility. Sometimes someone is mental as fuck and committing someone to the psych ward is necessary, but I personally would try all other avenues I could safely do so, even at risk to myself. It is a nasty situation and there usually is lots of downside risks regardless of choices made.

Evidence of suicidal ideation is a specific example (and probably the most common) of what gets people involuntarily admitted to a mental ward.

In fact, there are almost certainly more people admitted on that basis than actually have it, because if someone is not clearly a danger to themselves or others, but seriously needs help, the easiest way for emergency personnel to fudge it is by reporting a mention of suicide.

Can you provide further context on what makes you think there is significant causation in the opposite direction?

No, you prove it.

That's nonsense. You are not "provably not treating it" – you are provably not curing it.

If the people who receive the most chemotherapy sessions have the highest rates of cancer deaths, does that mean that oncologists are "provably not treating" cancer?

In those treatment there is a metric that indicates success. For this it is not so clear, the main indicators saying "does not knowably prevent death and raises possibility of future death."

The same metric exists here. Various cancer survivor rates are measured by the average number of years someone survives after diagnosis, regardless of the rate of remission. How many years of life does treatment buy a patient, given the kind of cancer and the stage at which it is discovered?

Your argument is "more people who are suicidal enough to warrant involuntary commitment end up killing themselves than people who don't reach that point, therefore commitment causes (or at least does nothing to prevent) suicide," which is absolutely illogical.

This is beyond "I don't understand 'correlation != causation,'" and is into either "willful ignorance" or "I enjoy hearing myself talk" territory.

Prove what?

Look at the methodology - borderline laughable. Tells us no more than his anecdote does, for there are a million other potential explanations - including that it isn't calling those hotlines that helps, but knowing that one can, which dovetails nicely with research on the benefits of friendship. Some things you simply can't test.

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