Tuesday, December 13, 2011

Can Facebook Prevent Suicides?

Facebook is launching a new suicide prevention chat hotline for those who post worrisome comments on their walls.   From an article in Newsday:

Here's how it works:

A user spots a suicidal comment on a friend's page. He then clicks on a "report" button next to the posting that leads to a series of questions about the nature of the post, including whether it is violent, harassing, hate speech or harmful behavior.
If harmful behavior is clicked, then self-harm, Facebook's user safety team reviews it and sends it to Lifeline. Once the comment is determined to be legitimate, Facebook sends an email to the user who originally posted the thoughts perceived as suicidal. The email includes Lifeline's phone number and a link to start a confidential chat session.

The recipient decides whether to respond.
Facebook also sends an email to the person who reported the content to let the person know that the site responded. If a suicide or other threats appear imminent, Facebook encourages friends to call law enforcement.


Anonymous said...

I am a suicide survivor. One of my really close friends committed suicide just a bit over a year ago. Devastating. Wasn't her first attempt, but I noticed with the first attempt, she reached out.. and was lucky. The second time? It was well thought out, she reached out to no one, and unfortunately was successful and I lost someone dear to me.

This seems like a positive thing to at least try, on Facebook. I forsee it working well for the teenage/college crowd who seem to share more on social networks than others.

rob lindeman said...

Neither Facebook, nor a psychiatrist, nor a drug, can prevent a person from killing herself. The question, as always, is the following: should the State restrict the liberty of citizens who wish to kill themselves?

wv = fiesse; A little less subtle than it should be

Dinah said...

Rob: Yes.

Sunny CA said...

When I read this, the first thing that came to mind was that there may be an epidemic of involuntary commitments to mental wards.

Idon'tdoFacebook said...

Wait, this initiative will soon be extended to those who may have a friend who makes a suicidal comment offline. All you have to do is contact Facebook with your friend's name, number and address. You will need to give them your mobile cell phone number for verification. Facebook will dispatch a team of specialists to the site. Facebook may, at its sole discretion, make a decision to hospitalize your friend, prescribe medication or refer to Twitter, which has its own share of suicidal status updates. Those referred to Twitter must be capable of expressing their despair in 120 characters or less.
Facebook will retain the name, address and phone number for the purposes of follow up. Facebook is entitled to receive and add to the profile, any record of hospitalization so that future threats can be assessed by friends, networks and Facebook. It may be possible to adjust the privacy settings for any such records, but then again, those will change without notice as per Facebook's policy.In the event that Facebook is not successful in preventing a suicide, Facebook will memorialize the account of the Facebook member and make condolence messages available for a small fee, payable within 10 days of the funeral.In the unlikely event that the deceased did not have a Facebook profile, Facebook will create one. Under the new TOS, Facebook will allow the creation of profiles for dead people, so long as they are willing to provide their cell phone number and a copy of the death certificate.

rob lindeman said...

If Dinah is right, and Facebook goes forward with this, then SunnyCA's and idontdofacebook's predictions will almost certainly come true.

wv = depwe; an individual who rats out "suicidal" friends to authorities, having clicked the appropriate privacy settings, of course.

Idon'tdoFacebook said...

Wait for it. Children's services are negotiating a deal with Facebook. They want to be notified of every post or update that contains themes such as : OMG, my parents are going to kill...got so hammered last night,
or, My parents are so mean-they NEVER allow me to go ANYWHERE!!!!!!!
This will help cut down on the needless murder of teenagers by their parents. According to Facebook, the average teen is killed by his or her parents about three times a week, and many teens are held hostage at home on school nights with only their Ipods, Iphones,Ipads, Macbooks and flat screen televisions to keep them from.......killing themselves or worse, dying of boredom.

I don't do Facebook but my kids sure do.

Anonymous said...

Wow. We have some really jaded people here. No, no Dr. or drug can prevent someone from killing themselves. Sometimes it is the social support that is the key piece. This is worth a try. If someone is reaching out, they are reaching out. Better to act on it than not. I just know that it hurts like hell to lose someone in this manner. Oddly enough, I have experienced those same feelings way too much when depression or a mixed state rears its ugly head. Sometimes you think you will reach out, other times not so much. But as a person on the outside looking in, you never know where someone's mental status is at. each situation is so individual.

Jane said...

...I think the offer of social support is a good one. I think offering to chat with the person is a good idea, because if they posted it to FB then they obviously want to talk. But I do hope people will use good sense and not jump the gun on involving the authorities. I probably side more with Rob on this issue than on any other topic. I don't think involuntary commitment would usually be the answer to a suicidal statement made on FB, and it could potentially make the situation worse. No one can know the context of a 50 word status update. I don't even know that involving psychiatry in this would be wise. Sorry psychiatrists, but I think that would be too coldly clinical in this situation. I think a kind ear is the best medicine for this. Part of my fear would be that involving the authorities might actually make the person more suicidal. Like maybe the person posts on FB, has the gun out, really isn't sure about follow through, sees the cops pull up in the driveway, and then pulls the trigger rather than be committed and have his option taken from him.

I flash to Virginia Woolf. Love that author. I remember reading that part of the reason she was not hospitalized before her suicide was because her husband, and others, were really freaked out that if there was any hint that she was going to be put in an asylum that she would just kill herself. Like in Mrs. Dalloway, when Septimus throws himself out of a window because he is going to be involuntarily committed.

That movie The Hours was actually pretty accurate as to how she was usually treated when having a mental breakdown (with the doctors showing up at the house). Her husband hired nurses to watch her and doctors were paid to check up on her rather than put her away. It's a shame he didn't put her on the same regimen before she died :( I actually think that model would be better. Like maybe have a nursing assistant watch the suicidal person at home and have an NP make checkups. I would think that would even save the system money.

rob lindeman said...

Thanks, Jane. re: Jane Austen, see also "My Madness Saved Me", a psychological biography of Austen.

If people are pouring their hearts out on FB, my suspicion is that psychiatrists and police are near the bottom of the list of folks they're trying to reach out to. Just a suspicion.

wv = disses, what usually get from my fellow interlocutors. What a refreshing response from Jane!

rob lindeman said...

confused my janes: I was thinking Virginia Woolf and wrote Jane Austen. Freudian slip?

Lisa said...

I think this is a disaster waiting to happen. I also think it really capitalizes on attention-seeking behavior (the person may well be truly hurting but a suicidal post on a facebook wall is nothing if not attention-seeking) and runs the risk of wasting time, energy, and money on non-dire issues. Not to mention of all sorts of privacy violations! What is this validation process going to look like? How will fb differentiate between a sarcastic comment from an angry teenager and something more serious without invading the angry teenager's life?

I don't know. Perhaps this is just me. But I was a severely depressed teen and college student with a few suicide (serious, alive by the grace of god only) attempts, and never, in all of those years, did I or would I ever have considered making a claim like that in a public space like facebook or other social networks.

This is an amazingly absurd initiative. Huge breach of privacy, with an astonishing potential for life-altering consequences. Huge waste of time, energy, and money.

Idon'tdoFacebook said...

I am not jaded. I just think that if a person who has 743 Facebook friends they reach out to in a status update indicating they are suicidal that the best course of action would be for at least one of those friends to call, and if necessary, alert a family member and if there are none, call 911 if it is a real emergency. I would not want to rely on Facebook to receive a message and having them send another message to a Lifeline place that then sends a message to the troubled person.
That seems like a lot of time to elapse if someone says I am sitting here with a gun. If the threat is more subtle, there are still ways to get your friend help. It is a very sad commentary on our society that we need Facebook to help our suicidal friends.

Jane said...

"It is a very sad commentary on our society that we need Facebook to help our suicidal friends."

I think this sums up how I feel on the issue the best. I would really hope that if my friend posted a suicidal comment on FB that my response wouldn't be "Well obviously I need to contact FB right away so that they can handle this." I would hope that I would call, message, whatever the person directly. And I'm certainly not a psychiatrist who has to call the authorities so I can protect myself from a lawsuit. Psychiatrists are less lucky. When they hear you are suicidal they have to have you arrested. If I hear you are suicidal, I can call, or give you my phone number, or meet up with you and try to comfort you. And if what you really want is a psychiatrist or a hospitalization, then I can have you driven there. No cop care necessary.

Anonymous said...

Some very valid points. I am coming from a stance of only having around 69 "friends." Then there was too much drama with family and I dumped my account. So you have a very valid point about someone posting their "intentions" to 2,000 of their closest friends.

I am the first anonymous poster, BTW.

Idon'tdoFacebook said...

@Jane. Psychiatrists don't have to call to have you arrested if you are suicidal. A lot of them do everything they can to see that you get hospitalized without the cops getting involved. The cops tend to show up when someone who is not trained is freaking out about the suicidal person and can't think of what to do other than call 911 which generally means the cops show up along with a fire-truck and ambulance.If you get lucky, the ambulance will take you to the hospital if that is where you need to go. If you get unlucky, the cops. The other way that the cops get involved is if the suicidal person is perceived as being or is a threat to the safety of others.
I think Virginia W would have killed herself eventually even if her husband had her watched by nurses around the clock. People who really want to do it, do. I like the idea but don't know if having private duty nurses watch a person around the clock would be more cost effective. If you think about it, the hospital manages to "watch" several patients to one nurse and at night the nursing station is pretty deserted. They give you enough meds to make sure you are knocked out for the night. The only reason I know that the nursing station is deserted is because for weeks, my meds made me sleep all day and walk the halls all night. I missed a lot of meals but that was a blessing considering the hospital food.

Jane said...

The reason I say more cost effective, is because I am working under the assumption that the person being watched wouldn't require an actual nurse. A nurse aid is only a min wage worker. Even if you went LVN, they still don't get paid all that much. Hospitals provide room and board, they have nurses, they have doctors. In my home care setting idea, you have your own food and shower. There is no doctor or nurses, except maybe an NP or PA showing up for occasional visits to prescribe something and check up on you. Think hospice. Only its for mental illness and you're not dying.

I'm not recommending this for violent people who would need restraints or something along those lines. I mean just straight up wants to die.

I would like to think Virgina could have been saved from herself. But who knows. Maybe if she had been unable to drown herself because of round the clock nursing care, she still would have found some way to end it all. But dang that probably would have taken some ingenuity.

And I am glad the cops tend to not get involved. They did in my situation. But I was lucky. They were sweethearts :) No complaints. Probably more sensitive than the average health care worker who deals with unstable people. In fact...now that I look back on it...they were actually nice than the mental health care workers. Weird.

Idon't.... said...

Hi again, Jane. In our hospitals, most of the watching is done by nurse's aides, not registered nurses. Patients see a doctor for about 3-5 minutes a day. Showers are cold water and limited by the fact that the stalls would not really fit your average 10 year old, the curtain does not close and you are not allowed one every day. You would not want one every day anyway because the whole place is soaked in urine and god knows what else. We get sandwiches in plastic that say they are best before yesterday. In other words, psych patients here get whatever is left over from the other wards that house people with "real" illnesses.
My encounter with the police was not as pleasant as yours. Most people do not get to hospital with police escort. In my case, my doc was away and people freaked. The cops were awful but so was the hospital.

Jane said...

Hey I Don't...You know, years later, I really do understand now just how lucky and blessed I was. Because my cops were awesome, and that doesn't happen to most people. Cops get a really bad rap, but mine were like the cops from Superbad. They were really friendly with me, they talked about having driven other kids to get help (they didn't treat me like a bad kid either. they really seemed like they thought i needed help and wanted to do that). They made fun of other cops. They didn't have weird power issues (unlike some some people in mental health I've encountered). I've met so many people who despise cops, but for whatever I met a couple cops who were actually kinda cool. They didn't break any laws like in Superbad, but they were like a couple of buddies. And I didn't give them one bit of trouble. They treated me nice, so I was nice with them.

Sorry about your experience. That hospital you were at should be shut down! Terrible.

rob lindeman said...

"Psychiatrists are less lucky. When they hear you are suicidal they have to have you arrested."

I disagree with the premise. The shrink rejoinder is always that they "have no choice", they must incarcerate the person making the threat. Or they argue that it is not they, the shrink, doing the incarceration, it is someone else. This is a dodging of moral responsibility.

No one compels shrinks to incarcerate suicidal people, or to turn them over to the state, if you insist on putting it that way. Shrinks do this for reason only: because they want to.

It's for their own good, isn't it?

wv = hysin; colorless, odorless, and tasteless deadly poison, a favorite of potential suicides.

Jane said...

@Rob: I think it's less noble than they want to...I think it's so much more closer to them being afraid of lawsuits. Some of the people were hospitalized were there for reasons that seemed totally unnecessary and I don't even know that the shrink who wanted the kid there thought the kid needed to be there. One kid was in there for no other reason that he wouldn't talk to the shrink who asked him if he was suicidal. That's his story at least. Another girl was more unfortunate. She copped an attitude with her teacher and said she wanted to kill herself. When I met her in our holding room, or wherever we were before being hospitalized, she was all ready to go home. When the shrink who spoke with me came out, the girl asked when her mother was coming to pick her up. The shrink was shocked. "No one told you!" she blurted out. She had the really terrible job of telling the girl that she would NOT be going home. Another shrink, who had seen the girl, told the girl that this was an easy discharge. The girl had said she was not really suicidal. And if only her mother could show up right away to take her home this would all be over and done with....But then the shrink got nervous. She changed her mind. And she didn't tell the girl. That poor girl broke down in tears and started bawling when she found out from the other shrink. She could not even talk. The shrink bent down next to her and apologized and asked if she could get her anything. She brought her something to eat because she was hungry, but that shrink just looked so sad. Everyone felt bad for the poor thing.

I think this goes way beyond people believing the patients need to be admitted. I think it's just fear of lawsuits. And if it's just the malpractice issue...I don't get why a better model isn't just thought up to handle it. Especially in an ambiguous case like with that girl, or the boy who had an attitude with the shrink and just kept his mouth shut.

BTW, the shrink that helped the girl spoke to me before that and I thought she was a b word. She earned some brownie points with me after I saw her comfort the girl. I would never have her be my shrink, but she seemed more noble after that.

Sean Paul said...

In my mind this is a long time coming. Working with teens/young adults, I see this Facebook posts as the predominant way SI is expressed.

The problem I think is how involved Facebook will be with providing avenues for appropriate care. It would be unethical to just spot individuals and then not give them appropriate mental health care. It would be great to see some larger more established suicide prevention resources shared with Facebook, especially on college campuses and at high schools.

Obviously privacy is a huge issue and we know that breaking confidentiality can have dire consequences on the therapeutic relationship. I just don’t see how this can be rolled out without a huge consortium of mental health practitioners being in line to take Facebook consults. In all seriousness, if this can be done confidentially and say the user could like chat with a professional, perhaps this could have some utility. To be honest, it makes me wince to see a company with a slovenly approach to ethical principals in general take on such a lofty, complicated subject. This seems like a reaction to the multiple high publicity rash of suicides and a CYA legal spout off rather than a well thought out and well-intended project that aims to help people in crisis.

Idon't said...

Kinda worried now about Google searches and such. I mean, they have a Street view picture of where I live, they monitor what you look for on the internet. Soon, we will not need psychiatrists to admit people to hospital. Google will do it and Facebook is launching their own preemptive strike.

rob lindeman said...

"It would be unethical to just spot individuals and then not give them appropriate mental health care".

Only someone who has not read the history of coercive psychiatry would say such a thing.

wv = unmous. Cat-like

Anonymous said...

I posted a few days ago that "sometimes I think I would make people's life's a lot easier... if I wasn't here" on my Facebook newsfeed. I got all kind of private messages from so called friends. But nothing else.. bah!

FoxUndercover Facebook said...

We know that Facebook can contribute to suicides since several cyber bullying suicides have involved Facebook. While this proposal could work, I think its really not any different than other signs that someone gives that they are suicidal. It used to be verbal comments that people needed to be watchful for, and I think today it is online. However, with Facebook, the poster is basically opening their comments to a network of friends, who don't need a button to get involved in helping. They can take the old fashioned approach of asking the person if they can help. What is more dangerous is blog sites where people may anonymously post a cry for help outside the reach of those close to them.