This was an independent research proposal that was presented at the Health and Human Rights Conference, Feb 2025, Queen's University. There is a small literature of research on this topic for the US 988 service, but none so far for the Canadian 988 service. This topic had occupied my mind for more than a year until the HHRC opportunity came along to write a research proposal. I'm not actively working on this right now, but hope that someone picks up this topic to critically evaluate the status-quo in the crisis line industry in Canada.
Emerging
Crisis Line Technologies and Structural Violence – Critical Review and
Policy Implications - Perspectives from a (retired) 988 Responder
Introduction – Large-scale crisis line services offer
unprecedented accessibility for on-demand mental health support in multiple
modalities. These services aim to offer rapid support and emergency
intervention for mental health crisis. However, organizational agendas favour
protecting organizational liability, publicity and survival at the expense of
user wellbeing and autonomy. Powerful surveillance tools are used to implement
paternalistic and opaque practices. These practices may constitute structural
violence against marginalised users through inappropriate profiling and
unnecessary emergency intervention, under the benevolent guise of ‘active
rescue’. Such practices risk exacerbating the distress and suicidality of
service users.
Objectives – To critically evaluate the practice of nonconsensual emergency intervention [NCEI] (‘active rescue’) on service users and inform relevant policies with the aim of protecting user autonomy and wellbeing.
Methods – The CAMH 988 service is used as an archetype due to its national scale, adherence to industry standards and technological invasiveness. Trans Lifeline is used as a comparison due to its unique practices of avoiding ‘active rescue’, contrary to the industry standard. Existing research on crisis line services, and bioethical theories of autonomy are used to formulate a critical literature review. Informed by critical comparison and evaluation, policy changes are suggested with the aim of protecting user autonomy. Existing knowledge gaps relevant to policymaking are highlighted.
Equity Implications – Dismantling structural violence inherent in crisis line services could restore user autonomy, dignity and safety in such virtual spaces. Clarification of active rescue policies may improve the quality and consistency of crisis line services and reduce the burden of moral distress on service providers. Such policy reforms may shift industry standards towards a focus on user autonomy, away from the current model of paternalism and organizational agendas.
Further reading (ordered by relevance)
Trans Lifeline, Interrupting Criminalization, American University School of Public Affairs, & Fordham University Center for Community Engaged Learning. (2024). The problem with 988: How America’s largest hotline violates consent, compromises safety, and fails the people. https://translifeline.org/988-report
Zeavin, H. (2020). The third choice: Suicide hotlines, psychiatry, and the police. In The distance cure: A history of teletherapy (pp. 201–230). MIT Press.
Oexle, N., Frölich, D., et al. (2021). Investigating the impact of involuntary psychiatric hospitalization on help‑seeking and self‑stigma: A longitudinal study. Frontiers in Psychiatry, 12, 624606. https://doi.org/10.3389/fpsyt.2021.624606
Simon Fraser University. (2025). The association between involuntary hospitalization and willingness to seek help among sexual and gender minority youth and young adults (Master’s thesis). https://summit.sfu.ca/item/3999
Jones, N., Gius, B. K., Shields, M., Collings, S., Rosen, C., & Munson, M. (2021). Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care. Social psychiatry and psychiatric epidemiology, 56(11), 2017–2027. https://doi.org/10.1007/s00127-021-02048-2
Calton, T., Cheetham, A., D’Augelli, A., et al. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in Public Health, 7, 399. https://doi.org/10.3389/fpubh.2019.0039
van der Feltz‑Cornelis, C. M., Sarchiapone, M., & et al. (2020). The effectiveness of crisis lines in suicide prevention: A systematic review. Frontiers in Public Health, 7, 399. https://doi.org/10.3389/fpubh.2019.00399
