My suspicion is that the availability of a legitimized path to the same result, but with a far less traumatizing method for both the individual and their loved ones, might allow for transitioning people into getting help when that's not the outcome they really want and provide a respectful and humane exit for those that clinically and chronically find living unbearable.

I'm not sure that the most ethical approach to life is forcing people to continue with it against their will, it is clearly not working, and by pushing the pursuit of death underground we're likely missing tens of thousands of people each year who would turn away from that downward spiral through treatment.

The people I knew that eventually committed suicide due to chronic depression spent many years thinking about it - a year waiting list for a state authorized humane option I'm sure would have been fine with any of them. But the ones that committed suicide in response to temporary circumstances didn't have any outlet other than admitting the intent to commit a crime and facing the social and economic consequences of that being outed.

Even the number of stories I've heard from survivors about the regret as soon as it was too late to take back is harrowing.

I'd have to wonder how many push the button for the nitrogen chamber (the likely method for state authorized suicide) only to regret it in the last moment where someone could successfully abort the procedure to save them. The low level of repeat attempts would be promising for the availability of "suicide with emergency break" alone.

The religious puritanism surrounding suicide has doomed us to adopt policies and attitudes towards it as a society that probably do more harm than good.

I’m not religious in any way, but the ideas you suggest in your comment make me deeply uncomfortable, because they strike me as the ultimate betrayal of the miracle of random chance that led to our existence, with an almost lackadaisical disregard for human suffering, to the point of systemizing the process of ignoring it.

If he lived in a place with compassion he could have ended it cleanly. He didn't. Where he lived killing himself would be illegal, and would have been much harder dealing with the legality than otherwise. He had life insurance that swapped when he ended his job, he had to die naturally so it would pay out for us because there's no law protecting it.

So instead he suffered for around a year. He was kind, he didn't tell us (the family) what was going on, but about a month after he had the surgery which really f*cked him up to get rid of a tumor, the tumor was back. He just told the doctors no when they tried to help further, and died after 8 months of suffering. One might consider it suicide by inaction, but for some reason that's condoned and seen as strong.

My mom didn't understand this until a few years back when her memory started going and she was losing herself, and talked about how unpleasant life was and there being some alternative. when I mentioned that dad had wanted to as well (he didn't tell her, she couldn't handle it at the time). She expressed regret she didn't live somewhere else. Then she forgot about the discussion the next day. She spends her days with about 3 minutes of memory at a time and will till she passes.

End of life isn't just about suicide. They both wanted to live, but not in the irreversible physical form they were in. Neither legally had the option. Neither actually did it though. I bet my dad would have and I don't blame him if it was socially acceptable and legal.

You appear to have a very different mental model of assisted suicide than the comment you're replying to. I might be biased by my experience, but the mental model I parsed from the comment is the one most commonly associated with suicidal young(ish)/physically healthy people, suicide appears attractive because there is some mental roadblock the suicidal person faces, their mind can't process some aspect of their enviroment/history no matter how much they try, they can't understand it, they can't ignore it, they can't make piece with it in any way. It torments them like an itch they can't scratch. They can live their life perfectly well if they only knew how to deal with this issue, but they can't, not alone. This is the type that can be helped by more (honest) publicity and attention.

Another way of phrasing this is that assisted suicide for mental issues need not be the same as assisted suicide for physical issues, so both you and the comment you're replying to can have your way, the 2 problems are orthogonal(ish).

Sometimes it's not the community that failed; sometimes the person wanted to die.

My friend Andy Ettelson killed himself by swallowing a bottle of aspirin and pulling a plastic bag over his head. He was sure he wanted to die.

His parents loved him, his friends loved him, and he had a girlfriend who loved him. He had community.

He also was bipolar, and refused to take his meds. He didn't like the side effects.

It was heartbreaking for those around him. When I got the phone call from Alex telling me that Andy had killed himself, he said, "I apologize if I sound so emotionless, but I've been waiting for that phone call from his dad for the last ten years."

We all knew that it was only a matter of time before he killed himself, and short of institutionalizing him against his will there was little we could do.

Most psychiatric medicines have horrible side effects. The problem is we don't invest anywhere near enough money into researching how our brain actually functions, what is wired wrong in people with more severe diseases or how to minimize adverse effects. Hell, most of "getting a person on meds" isn't based on science, it's "cycle through medications and dosages and find out what doesn't make the problem worse".

Not to mention getting access to psychologists, psychiatrics and other mental health care is a hellish experience on its own because supply doesn't even come close to demand and insurance to cover for that is an utter PITA even here in Europe.

We as societies fail people with mental health issues immensely. Instead, we waste our best brains on advertising, penis enlargements and iterating on insulin and epi-pens to continuously bleed people and insurances dry.

Speaking as someone who lives with a gibbering terror of death; we all die. Blanket statements that a motivation to live is essential is an attitude that endorses profound suffering.

It is an inescapable reality that at some point in their lives people need to give up their desire to live if they want peace and happiness. The debate is only about negotiating where that line gets drawn, and it is not set in stone that the answer is how old someone is.

I find your position most uncomfortable, life as a miracle absolute best thing (toxic positivity) when they are thinking from a living a better life than most people on earth can ever dream of. This is the "lackadaisical disregard for human suffering" and want them to continue this suffering because it's uncomfortable for them and they themselves are privileged since birth. Nothing is going to make people's life better for sure.

edit: and if people (without psych evaluation or capacity to provide good life) can bring someone from void without their consent and with lots of disadvantages, then people should also have the option to leave if they don't like it. They should not be forced to live the long life by privileged once.

I am convinced that a society which doesn't want to commit the resources to help the people who need help must not forbid these people to choose to kill themselves if that is the only solution they can find by themselves. Administering death is not a treatment option society should choose, but the people themselves should be allowed to do so.

If people get good help a lot of them will choose to keep living.

There is no inherant reason to life.

The biggest issue with this topic is, that it spits in your face if someone else doesn't think lifing is the only answer after becoming aware of yourself.

But lets take a view which YOU might understand: Imagine yourself without arms and legs. Only way to move around is by asking someone else. Every means of eating or switching the tv channel is by asking someone else. That person actually doesn't even like you but its the only option you can afford.

Imagine being kept alive because alive is the main goal of all of things.

Are you aware that if a medic finds a person without arm and legs (and lower body i think), there is a suggestion to try to not helpm them?

The doctor in this documentary said that in these cases its prefered to give pain relieve medication instead of helping surviving further.

I was not able to find it thou.

Lions slowly munching on their prey alive over several hours have nothing on humans who arrange for intolerable suffering to extend over years.

I don't think I agree with the suggestions, but I certainly understand them, and often find myself contemplating what a better societal solution could be. The solution space varies by cause, in some cases there's only room for marginal improvement, if any, from changing the society. That's not to say that they're not worth pursuing, or there aren't changes that would massively benefit many people...just that it's a murky ethical grey area without any obviously correct solution.

I hope you can take a minute to consider that viewpoints like the above aren't always stemming from disregard for human suffering, but through an abundance of heartbreaking empathy.

It's probably better to avoid telling someone they don't really want to do it, and erring on the side of believing they do, even if you think you happen to have evidence to the contrary.

In my opinion, mitigating it is the clearly correct choice, because facilitating it would lead to suicides of people who would counterfactually eventually regret it. Whereas mitigating it would at least lead to “false positives” that are failures to prevent someone from suicide, rather than failures to save someone from it.

Right now this option is blocked by governments around the world.

And due to the problem, that the government can't just legalize it without save guard around it, this makes a quite good case that there has to be some government involvement.

I am totally against suicide, but I thank God I'm not in a position today where it feels like my best choice. I've been on that ledge, but what it would do to my family, and fear of divine retribution kept me here long enough to realize my problems had solutions. Religion does have its merits, namely the belief that all life is valuable, and no one is beyond saving.

I'm glad it helped you turn around how you felt and come back from the metaphorical ledge. But can you be sure that there are more people for whom religions helped persuade them to find solutions rather than commit suicide, than people who never found release from their suffering and ensured many years more of it than they would otherwise had they not felt guilt forcing them to stay alive?

I've never believed in any religion so hard for me to put myself in that mindset, but I suppose it wouldn't make much of a difference to my understanding if I did since my point is that individual anecdotes can go either way. I do at least hope that more people are helped than hurt by religious pressure to stay alive (and indeed by religion generally).

Religion has had effects in either direction, I wouldn't make any definitive claim on its overall impact. I just think it has a place.

Lots of people kill themselves without seeking professional help for various reasons, the hope is that luring them into the system will help them not actually kill themselves.

And for the people who are truly suffering and for whom there is no helping, maybe it really is more humane to let them be free.

I kind of agree with this statement, but there is not a lot of places where there is significant effort spend to help people who have big problems (especially in the US).

IMO there's no way this would ever become any sort of common occurrence, because the state would never willingly give up its human capital on that scale.

"Again, when a man in violation of the law harms another (otherwise than in retaliation) voluntarily, he acts unjustly, and a voluntary agent is one who knows both the person he is affecting by his action and the instrument he is using; and he who through anger voluntarily stabs himself does this contrary to the right rule of life, and this the law does not allow; therefore he is acting unjustly. But towards whom? Surely towards the state, not towards himself. For he suffers voluntarily, but no one is voluntarily treated unjustly. This is also the reason why the state punishes; a certain loss of civil rights attaches to the man who destroys himself, on the ground that he is treating the state unjustly."

— Aristotle, Nicomachean Ethics Book Ⅴ http://classics.mit.edu/Aristotle/nicomachaen.5.v.html

[1]: https://www.canada.ca/en/health-canada/services/medical-assi...

[2]: https://exit.ch/en/englisch/engagement-of-exit/our-end-of-li...

Isn't it possible that letting suicidal people kill themselves might actually save more in "wasted" economic output trying to save people who are perhaps beyond saving (therapists could spend more time helping non-suicidal people which could make them more productive, or less therapists needed so they retrain; maybe state aided suicide leads to more deaths and therefore more time spent grieving by friends and family, or maybe it would work out pretty much the same number of deaths but years earlier, potentially with those years otherwise eating lots of economic output out of their family & friends who are both emotionally distracted and likely spending time trying to help; etc) than gained by the possibility of some economic output from the saved person, which might happen or maybe a decade of homelessness later they die before working another hour.

I'm not convinced that politicians are against allowing suicide because they know how the numbers stack up and there's a solid economic case saying to force people to live. They're doing it, rightly or wrongly, either because they believe it's the right way for society to act, or because they think that's what the voters they need believe.

But maybe you're right that, if those beliefs started to fade, the economics would be worked out, show that my thinking above is wrong and that it is most profitable to ban suicide, and it would be a motivation for some people to cynically push people back towards those beliefs? Or maybe you think that motivation already is secretly driving propaganda or political lobbying or similar?

I can think of many possibilities for people to passively and non-economically serve the will of the state in an always-online world, but I don't think it's appropriate to openly speculate about that sort of thing since it is Unknowable. Just knowing it's possible is enough for me :)

The same state that sends its youth off to die in wars? Or that executes them when it so chooses?

Suicides in the US (where assisted suicide is illegal): 45,979 (with 1.2M attempts)

Executions in the US: 17

I'm not asking to imply you've cherry picked numbers, just that giving stats like that (number of actions for a country with no defined time period) is only telling half the story, and even though that half was enough to make your point I think the other half is worth including for the sake of curiosity :)

edit: yes seems to be 2020, search of that suicides number pointed to e.g. https://afsp.org/suicide-statistics/

For myself, I'm no longer suicidal, but I don't want to be reincarnated, I don't want to go to heaven (and obviously not hell), and I simply don't want to wake up anywhere at all after I die. An endless, dreamless sleep is what I hope for.

I cannot imagine how awful immortality would be in practice. Death, in due time, is a blessing.

I think it's a very similar approach to drugs in certain countries: you decriminalize them, in some cases provide government-funded drugs, provide places with trained medical staff for people to do their drugs in, and provide excellent addiction counseling. If they overdose, there's medical staff. If the drugs are government-provided, then they're pure and not cut with problematic substances. If the person wants assistance with the addiction, they don't have a criminal record, don't have to contend with an erratic supply while they wean off / switch to something else, and have lots of non-judgemental support.

I think it's quite reasonable to take a similar approach with suicide: de-stigmatize it so it's possible to talk to people constructively, and very likely engage with many for whom there's a better path. Simultaneously, provide a way for people to gracefully exit life when that truly is the best option, instead of (for example) wasting away in a hospital in pain.

Sorry but please try to avoid creating a strong opinion if you haven't even thought about the issue in hand in more indempth than 'readily'.

Btw. for further thoughts: Imagine that getting sucidie support takes 3 years. It involves different doctors, mandatory therapy and than you have the approval to do so.

Wouldn't you think this would potentially even lead to more people NOT killing themselfs? Basically helping people to commit suicide as a form of preventing sucidie?

I would believe so.

No one just kills themselfs. The same reasoning btw. (i know it wasn't mentioned but out of personal expierience i just wanna mention it) its the same with abortion. No one just does an abortion.

Many, if not most, of these places give the operator full access to your phone number and whatever geolocation data they can get based on that. They also have policies where the operator is allowed/encouraged to call emergency services on you without your ongoing consent, or even without telling you. In my experience talking with others who have been affected by those kinds of policies, this can lead to police breaking down your door while you're naked and crying, or worse. A person in deep crisis is not likely to respond well to armed officers showing up, as the police are more likely to come into the situation looking for conflict.

Sometimes, you can call a local dispatch and just get medical services, or maybe a fire department sent first. But that's entirely up to the discretion of the dispatcher and local protocol.

There's also a relatively common experience I've heard where people who aren't actively suicidal call these lines, and the operator (I won't say counselor) is completely dismissive: "if you're not going to hurt yourself, what do you want me to do?"

Not to mention the stories I've heard where call centers just have passwords for their internal systems on sticky notes laying around on monitors...

The general field is so bleak that some other folks with peer support experience and I have started a nonprofit where one of the things we're doing is building open-source software that will let anyone create their own support line. Security and privacy are our primary concerns, ensuring that operators and callers never see each other's numbers or any kind of information.

[0] non-consensual active rescue is the practice of calling emergency services on someone without their OK

[1] The line was Trans Lifeline, which I cannot recommend supporting for other reasons at this point

That would get you dismissed from any reasonably-run suicide hotline program ASAP.

I have a friend who volunteers for a suicide hotline program here in the US. He says it's actually well run and they keep close tabs on the volunteers. Everyone who volunteers is doing it because they care. It wouldn't make sense for someone to volunteer for such a program just to be dismissive and rude to people who call in. However, I could see this happening at poorly-managed programs that use low-paid employees without proper training and supervision.

My brother is going through some stuff and got this exact response in the UK.

If you aren’t immediately about to harm yourself there’s basically no state provided resources.

"We don't have time for this" [0] comes to mind.

[0] https://www.insider.com/cop-said-i-dont-have-time-shooting-k...

edit: why am I being downvoted?

- A culture of internal anti-Blackness. During the uprising of 2020, staff and volunteers wanted the leadership team to address real issues with race inside the organization. As a member of the leadership team at the Director level, I pushed for many of the staff-led changes, but most of the team wanted to just talk about things instead of implementing policies.

- I had a bug in some software I wrote - applications for a service were supposed to be distributed based on race. A few more white people than they wanted got through. I fixed the bug immediately (it was a concurrency issue), explained it, and was met with absolute hostility - shouted at in meetings, labeled a white supremacist and removed from leadership. A plan was developed to have mediation, but after months nothing happened.

- From what I understand, they have basically gotten rid of their QA program that would review calls to make sure operators are properly trained and handling calls appropriately.

- A former staff member went missing during a mental health crisis. They said they were going to provide FMLA but fired her instead, leaving her partner and children without any financial support.

- Piss-poor answer rate. After they fired their Hotline Program Director last year, basically no one stepped up to run the hotline. Folks I've heard from have reported that many volunteers (the backbone of the hotline department) left, new volunteers weren't being processed properly.

> UPON DISCOVERY OF UNAUTHORIZED PURCHASES TOTALING $353,703 BY TWO OFFICERS OF THE ORGANIZATION THAT OCCURRED IN 2017, ON OR AROUND JANUARY 21, 2018, TRANS LIFELINE REMOVED THESE OFFICERS FROM HAVING ACCESS TO THE ORGANIZATION'S BANK ACCOUNTS AND ASSETS AND TERMINATED THEIR EMPLOYMENT AND THEIR POSITIONS AS OFFICERS AFTER COMPLETING ITS INITIAL INVESTIGATION OF THE DIVERSION. ...

It goes on to say that they didn't file a lawsuit, and criminal charges don't appear to have been pursued. What the heck happened?

[0] - PDF: http://web.archive.org/web/20190221114026/http://rct.doj.ca....

Covert action magazine.

I don’t believe I’m on a side other than that of democracy?

Is that controversial?

https://twitter.com/covertactionmag?s=21&t=zbpg0lQWdYJ70Gbhq...

cmg is directly involved in pushing disgusting lies like “Is Russia’s Bombing of the Mall in Kremanchuk Another False Atrocity Story Being Used to Justify Ongoing Military Intervention in Ukraine?” (https://covertactionmagazine.com/2022/07/01/is-russias-bombi...)

As a member of the EB, cmg apparently approves of interesting stories like “ Calls By Western Socialists For A Russian Retreat From Ukraine Amount To De Facto Support For NATO Aggression” (https://covertactionmagazine.com/2022/05/22/calls-by-western...)

cmg has also been involved in stories such as “Remember the Maine: The Alleged Russian Atrocity at Bucha Looks Like Another in a Long Line of False Pretexts for War” (https://covertactionmagazine.com/2022/05/13/remember-the-mai...)

From reading these articles, it is difficult to come to any other conclusion than that cmg is actively working to support the genocide in Ukraine. Perhaps you should treat his words like as if they were coming from William Joyce.

Hi, CTL volunteer here. I have some gripes with a few of your assertions.

It's true that CTL was caught sharing data. They have retracted that policy, and it remains unclear to me how much of the data was being shared to which level of granularity. Since then, data can be manually deleted after a conversation is concluded. I have seen this happen, and I welcome you to try again if you would like to test the system. That is welcomed.

Each counselor is required to treat each texter with empathy and the gravity that a mental health crisis requires. I do not know of anyone on the platform who would disparage a texter because his/her/their crisis isn't significant enough. If you text CTL, it is for a reason, and we want to help you through that moment no matter your background.

Another important distinction is that we are trained to risk assess each and every texter, irrespective of our intuition about their mental state. That means I treat someone testing the system like I would someone who has been flagged as an imminent suicide risk.

Supervisors monitor this evolution of the conversation closely.

The assessment is important because ultimately the decision to call emergency services comes after that rigorous assessment of the person's suicidal ideation, followed by their plan and access to means, as well as their timeline. If all those criteria are met, I contact my supervisor, and then we work on separation from means. If those criteria are not met, we continue the conversation accordingly.

I have personally walked numerous people back from the edge simply by talking to them and hearing them out; often times, texters deemed imminent risks are capable of staying safe that night after we have come up with a safety plan for them together. Calling EMS is truly a last resort and not an attempt to cast off responsibility.

In the cases when we do call emergency services, it is after we have exhausted all other options. It should be noted that access to geolocation is strictly limited to these supervisors, and in all likelihood is limited to a texter's phone number alone. It's not like they have a backdoor into AT&T, and the supervisor must make a call to emergency services directly. From what I can tell, very little information is given back to CTL. On occasion, I can see a timeline that EMS was dispatched but rarely do I ever learn about the outcome.

The success of the platform is that we can work with people to find them their own solutions. CTL was not a viable intermediary for calling 911.

All in all, I recommend other readers to treat the post above with a grain of salt. Please be aware that platforms such as CTL are frequently volunteer-staffed, and, while we all do receive 20 hours of mandatory training, we aren't psychologists and we are not allowed to act in a medical capacity in the slightest. Each counselor is expected to work within a strict purview with clear objectives. Lots of well-intentioned people are there for whoever needs support. As far as volunteering goes, this is some of the most emotionally-involved I've ever had to do, and it pains me to read reviews of CTL that paint it is a data profiteering lab of pseudo-psychologists and dismissive blowhards.

Lastly, should data privacy be a cornerstone to these services? Yes, I wholeheartedly agree. But I am glad that this service exists, and we should not miss the forest for the trees. Many of our colleagues, friends, relatives, and countrywomen are suffering right now more than ever. We should not profit on their misery, but we have an opportunity to connect with them and change their lives. To my mind, that is worth every byte of data.

My post was general, not specific to CTL.

Assholes like yourself are why I need to bring a gun to my doctor visits. I might need to murder the doctor in self defense. Way easier to get out of a hold if you do that first.

You’re out of line.

Some of the worst people I've met are the EMTs who do these calls. Some believe they are doing no harm. They are worth killing, and I am not sure whether I could avoid doing that if someone exposed themselves like that to me.

people already avoid a call to 911 because the subsequent ambulance service is unaffordable and can land you in collections. they avoid the ER for the same reason. 988 assumes anyone who needs crisis care will be able to get it, or even afford it and the ecosystem of services and medications that may ensue.

988 gives, as amber alert did, a can for politicians to kick down the road and cheerlead.

In Ontario an ambulance trip is about $40. But in the US it can be crippling.

Related to the rest of this thread, a family member was hurt at work about six months ago and needed a 12-mile ambulance ride. The ambulance company billed the company's insurance $1,400. The company's insurance actually paid a little over $300.

However, they're usually managed by air/rescue and therefor part of the fire department or equivalent.

Assuming that was under the deductible, so the ambulance provider did not get paid anything else, and $500 was the negotiated pricing for members of your insurance plan.

Hm? The insurer would've paid the difference (minus some additional discounts depending on the size of the insurer and its bargaining power). That the patient paid $500 does not in the slightest bit indicate that the insurer negotiated the rate down to that pricepoint.

Even at $500 (and let's assume that was an hour-long ride, for easy math that's maximally generous to your argument), EMTs on average make around $20/hour at best, and maybe double that for a nurse - so a fully staffed ambulance would run around $80/hour for labor. Round it up to $100 to be generous and that still leaves $400 for the ambulance itself. Ambulance itself costs up to $150,000, so earmarking another $100 would pay it off after 1,500 hours of service - so less than a year, even if it's only running for 40 hours a week. Maybe it's really fuel-inefficient and breaks down frequently, so we'll say another $100 for fuel and maintenance. Throw in another $100 to pay off $150,000 worth of equipment and medical supplies.

So of that $500 price the patient pays, we're left with $100. At the price billed to the insurer, that's an eye-watering $11,600 of what appears to be pure profit. Maybe there's some excuse for that, but to me it's pretty obvious that something's way out of whack. $500 or even a bit more than that would be reasonable if EMTs and nurses were being paid better, but they largely ain't.

I have no idea how much ambulances and personnel cost, but I do know that whatever the costs are, they have to be distributed amongst the emergency events.

An ambulance and redundant staffing is paid to be available 24/7, but there might only be 3 or 4 or 10 trips per day.

I assume there are also considerable liabilities and hence insurance costs.

That doesn't make the fact that they bill such a ridiculous amount in the first place any less unacceptable.

And if you're uninsured? Or your insurance refuses to cover it? Or it does, but with a high deductible?

My point is that the "well established practice" in question is useless at best and outright detrimental (to say the least) on society. Why even bother throwing out that number unless there's an expectation that someone would pay it?

I would have made the same statement if the government had paid the ambulance company $500, or if the government’s cost for providing that instance of ambulance service was $500.

Those workers are paid ~minimum wage, and the amortized cost of the vehicle and its equipment is not $500/ride.

The reason they charge $500, $800, or $12,000 is because ambulance firms have monopoly licenses, because you're not going to haggle over the price when one arrives, and because they can charge you whatever the hell they want, and when the dust settles, some people might even pay it.

Source: https://www.census.gov/library/publications/2021/demo/p60-27...

Again, I cannot stress enough how insane this sounds to someone from most other first-world countries.

Obviously, the $12k is ludicrous, proven by them being willing to accept $500 for people who belong to an insurance plan.

Health insurance in the US is not just insurance against a one time high cost event. One aspect of it is paying a business to gain access to lower pricing due to volume that you would be unable to get as an individual, which seemingly this person’s insurance plan did.

It only makes sense to talk about volume discounts when there is actual savings from providing volume (for example, less packaging). Many different instances of individual care do not create such savings, for anything but handling the make-work billing paperwork that this system itself generates.

This idea that individuals shouldn't be market participants is a broken assertion that underlies much of our healthcare dysfunction. In the situation you're describing, the "insurance" company has zero market leverage over the ambulance provider, and so you're championing a specious "negotiation". Meanwhile individuals that need a ride to the hospital avoid calling 911 since they have no idea what it will cost, and instead look to markets with price transparency to fill in (ie markets where they're welcome).

A straightforward healthcare reform would be to eliminate this cartel dynamic of providers having a different price for each "insurance" company, and mandate that they charge the same published prices regardless of who is paying. At that point, insurance companies would financially provide real insurance rather than their current function of bundling and obfuscating price signals. There would no longer be this "out of network" nonsense, but rather insurance coverage would be based on percentages of market prices. Insurance companies could then recommend providers that charge lower prices to save money for themselves and their customers, while still allowing their customers to be market participants when their preferences differ.

I do not assert this. I would much prefer transparent pricing and people being able to shop around.

> In the situation you're describing, the "insurance" company has zero market leverage over the ambulance provider, and so you're championing a specious "negotiation".

If this was true, then the ambulance company would not have accepted $500, and would instead demand the $12k they billed. It may be that the leverage is simply political or PR, but it must exist in order for them to come down from their fantasy list price.

I agree with your last paragraph, and that is the situation as of recent due to new laws passed about surprise billing and out of network restrictions for emergencies. As well as publicly listed prices.

Or are you at some point willing to admit that not everything should be a private, purely for profit/shareholder value, venture?

The fact that the insurance company can negotiate the bill to $500 indicates what the real price is. The $12k number is just fantasy numbers that healthcare providers throw out to start the negotiation.

That really depends on your definition of "real price", particularly considering how in a lot of developed countries that'd still be considered a pretty outrageous price to pay for such a situation, particularly while even having insurance.

It does not depend on who pays for it.

I did not intend to comment on who should or should not be liable for paying this price, simply that $500 seems like a reasonable price for an ambulance service.

btw many is cities can barely keep their dispatch for 911 staffed.

One of these things is not like the others.

There's no need for gun control once a society has implemented the other three; violence and suidice (with or without access to firearms) is a direct function of socioeconomic inequality - and I'm uncomfortable (to say the least) with disarming the very working class most impacted by said socioeconomic inequality at all, let alone before actually addressing that socioeconomic inequality.

Suicide is a direct function of depressive issues and circumstances that peaks on you at the same time you get that one too many "it's gonna be a bad day" piece of news. I'm a suicide survivor (I say survivor because I didn't attempt anything. I succeeded.) whose only alive because my bulldog lead my youngest brother to where I was outside as he had dropped by to see me. A lethal dose of methadone is 50mg. I took 500mg and washed it down with Jim Beam. I was legally dead three times (once in the ambulance and twice in the ICU). I'm not going to say it doesn't happen....giving someone with depression all kinds government reform will do exactly nothing to cure that depression. More affordable opportunity to seek mental health, sure...I'm with you. But even that is maybe 10% chance to prevent if they're down on a day when something happens. I had divorced as well as having my middle brother pass away within weeks of each other.

As far as violence? If you made everyone a millionaire today, there'd still be violence crime, hence violence to retaliate to that, tomorrow. Because people are never satisfied. And unless every physical asset was a cookie cutter model of every other item like it, people are going to be jealous of what someone else has. The best way to cure a lot of the violence is for people to leave each other alone and show some decency to each other.

Because people generally don't kill themselves or others for shits and giggles.

> Suicide is a direct function of depressive issues

Which largely go unnoticed, undiagnosed, and untreated until it's too late, in no small part due to the absolute shitshow that is mental healthcare access here in the US.

> and circumstances that peaks on you at the same time you get that one too many "it's gonna be a bad day" piece of news.

For large swaths of the American population, those pieces of bad news skew heavily toward socioeconomic circumstances. Job loss, debt (incl. medical debt), homelessness, being convicted of crimes because you couldn't afford any better than an already-far-overworked public defender... the list goes on. Even for the things outside that list, they become a lot easier to bear when you can actually afford some degree of treatment.

> giving someone with depression all kinds government reform will do exactly nothing to cure that depression

It will do everything to solve it in the vast majority of cases, and in the remainder of cases will at least prevent "I can't afford it" from being an excuse to get help.

> If you made everyone a millionaire today, there'd still be violence crime

There would be a hell of a lot less of it.

> The best way to cure a lot of the violence is for people to leave each other alone and show some decency to each other.

Which is a lot easier to do when you don't have to resort to crime for basic survival.

It implies that I support the right to self defense - including against an oppressive regime and the enforcers thereof. Specifically, it implies that I support the exercise of that right among the class of people typically excluded from it. Violence is the last resort, but it is a resort nonetheless.

"Under no pretext should arms and ammunition be surrendered; any attempt to disarm the workers must be frustrated, by force if necessary" -- Karl Marx

"That rifle on the wall of the labourer's cottage or working class flat is the symbol of democracy. It is our job to see that it stays there." -- George Orwell

"A man's rights rest in three boxes. The ballot box, jury box and the cartridge box." -- Frederick Douglass

> And if not, then why exactly do these people need guns?

Because even when a government is not actively oppressing its people, it is demonstrably (with considerable regularity) incapable of protecting each and every one of its citizens from one another. Like the saying goes: when seconds count, the police are an hour away. Every person has the right to ensure one's own safety and security, even if their government can't or won't ensure it for them.

And that's entirely ignoring things like non-combative use of firearms, like hunting or pest control or defense against predators or marksmanship or what have you. Quite frankly: the purpose for one's ownership of a firearm is the business of none but oneself.

I can potentially see this in rural areas. Not so much in urban areas, where the police are much nearer and it seems that the guns are the main conveyer of harm.

I don't think you can ignore that they are also used in offence, not just defence. I live in the UK and I don't need a gun to defend myself, because any attacker is extremely unlikely to have one either (because the penalty for even being found carrying one is so severe that it's not worth the risk for them). One of the best ways in which a government can protect its' citizens from each other is removing dangerous weapons from their possession!

I guess my question is: what are you scared of? To my mind the most likely thing to be a victim of is burglary, in which case isn't it much better to just let the robbery take place (and then claim on insurance) while being safe and unharmed than to risk being shot in an armed conflict? Seems to me you make yourself less safe not safer by bringing guns into the equation.

Unless you have a cop on every street corner (and even then), you wouldn't have enough coverage for cop intervention to be something upon which you can rely for your own safety. At best, they might catch your assailant after you're already dead.

> I live in the UK and I don't need a gun to defend myself, because any attacker is extremely unlikely to have one either

You're ignoring the vast differences in available socioeconomic safety nets between the US and the UK. The UK's still pretty shitty on those metrics (which is why there's no shortage of violent crime), but it's certainly better than here in the US.

> I guess my question is: what are you scared of?

I'm scared of my government deciding that it's time to round up everyone of $ETHNICITY or $RELIGION or $IDEOLOGY or $SEXUALITY or what have you and send them off to internment camps. I'm scared of white supremacists deciding it's time to bring lynch mobs back into fashion. I'm scared of the ownership class using the state to coerce (with increasing severity) the working class into continuing to work despite continuing to get the increasingly short end of the stick. I'm scared of theocrats deciding that "separation of church and state" is no longer necessary and therefore empowering themselves to impose their own religion (or more precisely: a very twisted and corrupted version of it) on every other American. I'm scared of GSRMs losing the rights we had just so recently won.

> isn't it much better to just let the robbery take place (and then claim on insurance)

It would be much better to deter the robbery in the first place. It would be much better than that to give people a safety net such that they don't have to resort to robbery in the first place.

It's not that it's a shit job, it's that it's a job that requires you to commit reprehensible acts, so good people can't join in good conscience. If our laws, law enforcement methods and justice system weren't horrifying, cops would be better, no matter how shit the pay or demanding the expectations.

It absolutely does not require that.

> If our laws, law enforcement methods...weren't horrifying

Give some examples and provide some practical solutions.

Are you actually required to do that as a police officer? Would it not be up to the discretion of the officer as to whether it was in the public interest to make an arrest or not? Here in the UK it would be pretty unusual for someone to be arrested for getting high unless they were causing a public nuisance, property damage, or similar.

Forty percent of Uvalde's budget was going to the police - $4.3M for 15,000 residents, or $2900/person. That doesn't include the half a million dollars for their school police force.

New York City has a budget of about $100BN, and $11BN goes to NYPD - $1300 for every single person in the city.

https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_pr...

Second, spending on police has actually been trending down for quite some time:

https://fred.stlouisfed.org/graph/?g=Q7WX

And the number of officers per capita has remained remarkably stable over time (contra suggestions that the number of police has risen dramatically). See Table 1 in this PDF:

https://bjs.ojp.gov/content/pub/pdf/nsleed.pdf

Third, we spend much more on schools than on police:

https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_pr...

Despite the prevalence of memes to the contrary:

https://twitter.com/RCAFDM/status/1532739121562656770?s=20&t...

https://twitter.com/CharlesFLehman/status/153270044228675993...

Fourth, because spending in the U.S. is split amongst federal, state, and local governments, looking purely at local budgets is often more obfuscatory than explanatory. If we look at combined state and local spending, the picture looks quite a bit more reasonable:

https://www.urban.org/sites/default/files/2020-06/state_loca...

That graph in words:

> Overall, police spending was 4 percent of state and local direct general expenditures in 2017. (This data included federal transfers; if we look at just own-source funds, police spending was 5 percent of state and local expenditures.)

> This is far less than what state and local governments spent on public welfare (mostly Medicaid in the Census accounting) and K–12 education, but more than many other services, including housing and community development (and others not listed on the chart).

Source: https://www.urban.org/urban-wire/what-police-spending-data-c...

Obviously people can disagree about how much we should spend and on what, but, generally, the U.S. spends a pretty typical amount on police, that amount is significantly less than on various other social services, and the amount has largely not been growing.

E: hard to even imagine what kind of an utterly horrible person would downvote this

https://www.ksl.com/article/46295693/when-swat-teams-are-use...

Which might not seem like a lot, but this scales up quickly considering there are more than 17,000 swat units in the US [0].

If we average the callouts to 12 per yer, per units, that's still 204.000 callouts per year on a nation-wide scale. A number that does not seem too unrealistic judging from past data I could find [1].

[0] https://www.theiacp.org/resources/document/national-special-...

[1] https://theweek.com/articles/531458/troubling-rise-swat-team...

Now go outside and start pointing firearms at people or taking hostages and you will probably be getting some SWAT attention.

The article from The Week has a WaPo source that has more detailed data on SWAT deployments in Maryland [0];

"Since the law passed in 2009, the data have consistently shown that on average there are about 4.5 SWAT raids each day in Maryland."

"• Prince George’s County alone averaged well over one SWAT raid each day in 2012 (510 in total)."

"In 2012, nearly 90 percent of the SWAT raids in Maryland were to serve search warrants."

"• Half the SWAT deployments in 2012 were for “Part II” crimes, the nonviolent class of crimes. The vast majority of those raids were to serve search warrants on people suspected of drug offenses."

So not really a lot of "pointing firearms at people" but apparently a lot of war on drugs.

Also; Around 51 deployments in Maryland didn't serve search warrants, tho it doesn't detail it further what they instead did.

[0] https://www.washingtonpost.com/news/the-watch/wp/2014/02/17/...

This 2015 article claims 80k deployments per year

And I guess it makes little difference whether it’s the SWAT team that shoots you or just regular cops.

In 2021 there were ~1,000 police shootings. 85% of shot suspects were armed with a deadly weapon. That's in a nation with a population of 334,000,000 people.

edit: and I'm even accidentally being deceptive. There were over 1000 people shot dead by police. There were more people killed by police.

There are 1,136 total killed by police in 2021. 1,055 of them were shot.

There is a rough estimate that there were about 800 non-deadly police shootings, but that's a rough guess without much data.

That percentage is artificially inflated due to LEOs having a very broad definition of "deadly weapon".

Side note....did you read about those 150 Americans they chose randomly, and then stripped them of their right to vote as well as their right to firearms? It's funny how I could spread that fake story and people would lose their minds talking about a government not long to stand. Yet, if I say that 150 unarmed Americans were murdered by agents of the state who were violating their civil liberties under color of authority you'll cite the national population and say that shows great professionalism. Oh....the FBI is about to stop tracking those stats since only 57% of total LEO reported to them for the 2021 numbers. Just 44% reported the year prior.

This entire bizzaro world of where it's patriotic to support a group of revenue generators for the state being able to murder someone because, "Well....he took a breath faster then the previous one and I was sure he had a SAW system in your pocket....so me and Fred shot him 37 times. Well....we shot at him 37 times. But a few hit him. Some random house of someone in that area luckily took all the wayward rounds for us!", meaning it takes a true patriot to understand that our rights are all based on supporting someone who will allow you to die or end you themselves if they even see a shadow that makes them think that you mean him harm and are planning his demise.

With the state collecting that data, your phone company collecting that data, your cell phone OS collecting that data, random apps collecting that data, and who knows who is on the other end of that call and what they're doing with your data.

Will you be turned down for jobs because when a company has a choice between two equal job candidates and one of them has shown suicidal tendencies at any point why should they risk that their employee will kill himself and lose money on re-hiring/re-training?

Will your health insurance company buy that data? Your life insurance company?

Could you lose your right to own a firearm?

Can it cost you custody of your children?

Will it end up leaked or "lost" on a USB drive and find itself on the internet?

Practically speaking, these kinds of things are happening every day. I would agree that it might be better to take the help and live accepting the lifelong consequences of your actions in seeking that help. A life where you lose your children, lose job offers, or have your deepest troubles exposed to the world might easily still be a life worth living.

The reality is that we've created and enabled a system that hurts people. Our communications are logged forever and we have no power to limit the ways that data can be used against us. It's only natural for people to take that into account before doing something that makes them so very vulnerable.

How would you lose a job? Your would-be employer faced with two otherwise equally qualified candidates pays a third party to run a background check that includes information lifted from your social media sites (https://www.careerbuilder.com/advice/social-media-survey-201...) and collected from data brokers.

> Data brokers will often combine all the information outlined in these two lists to build complex profiles about each of us. These profiles are used for an increasing number of purposes, from serving targeted advertising to crafting insurance policies to providing background checks for employers. (source: https://www.digitaltrends.com/web/its-a-data-brokers-world-a...).

The FTC has warned about this kind of thing (https://www.nydailynews.com/sdut-ftc-puts-background-check-s...) but it still happens.

Maybe you called the suicide hotline using your cell phone and some sketchy app (like a call blocking app or facebook: https://www.theverge.com/2018/3/25/17160944/facebook-call-hi... or even a stalker app: https://news.softpedia.com/news/stalker-android-apps-with-th...) sold your contacts/call history or maybe your phone company did it. See this example from the article here: https://arstechnica.com/tech-policy/2013/12/att-accused-of-v...

> "[T]he sale of CPNI to the government isn’t our only concern—when we did a little more poking around, we found that all four major mobile carriers (AT&T, Sprint, T-Mobile, and Verizon) have privacy policies that indicate they believe it is OK to sell or share similar records to anyone,"

It's not really a question of "how is anyone going to know?". Every communication you make is logged forever and shared (read: sold) with "partners" and turned over to the state. Someone, somewhere, will absolutely have that data. You aren't allowed to know who has it, where they got it, how accurate it is, what they are doing with it, or how/if it's being secured, but it is out there and it will follow you for the rest of your life.

https://news.ycombinator.com/item?id=32122139

I've heard over and over horror stories along those lines. Someone having a mental health crisis calls emergency services for help (and absolute best case scenario they get a very expensive taxi ride to the ER) or goes to the ER themselves. The ER pumps them full of drugs or just locks them in what amounts to a prison, does nothing to treat people or connect them with services but charge tens of thousands of dollars, leaving people in the same spot they were in before but with mountains of medical debt.

Or, someone is honest with their therapist, the therapist prioritizes not getting hit with a malpractice lawsuit so they report their patient to the police, and...see above, except worse, because the patient isn't expecting it nor did they consent to such a sudden and drastic intervention.

If we want people to get help we need to think very carefully about what getting help will cost them, because the higher that cost is the more people there will be who are unable or unwilling to afford it.

For example, imagine if an airplane pilot or anyone in a position of being responsible for a mass number of lives has previously called into suicide hotlines.

Would you feel secure knowing the pilot of your plane once exhibited suicidal tendencies? I doubt it.

Any bits of data we can collect to make accurate assessments should be collected.

This is the kind of thinking that got us into this mess. The data being collected may not be accurate, may not be interpreted correctly, and may not even be useful, but fearful people like you will happily use it for a tiny sliver of peace of mind.

Lets say the pilot on your next flight did call the suicide hotline 15 years ago after his wife and child were killed in a car wreak. Would that make him more likely to be a danger for you today than the pilot on your last flight who was currently suicidal but never called the hotline?

Lets say the pilot on your flight wasn't just going through a rough time 15 years ago, but was actively feeling suicidal on the day of your flight. Is it more likely that he would also be a mass murder who wanted to kill everyone on the plane, or is is more likely that he would kill himself later that day while alone in a hotel room at your destination city?

Thoughtcrime is a dangerous thing and our algorithms aren't so good at predicting human behavior that we should support handing out extrajudicial punishments to people based on what they might do. Those are things you should fear far more than what the mental health history of your pilot might suggest.

I really don't care, to be honest. As long as the problem has been fixed through major changes to lifestyle and/or medication, plus enough time has passed to ensure that the person is stable, the fact that they once called a hotline is irrelevant.

I might not be as vehemently against the collection of this data if there were a strict retention limit written into law, perhaps 3-5 years, alongside a solid plan to properly enforce that limit and to keep records confidential.

As written, your comment implies that people can never change and situations can never improve. People regularly change their lives drastically, especially young adults whose brains are not even fully done developing.

> Any bits of data we can collect to make accurate assessments should be collected.

I doubt that the fact that someone called into a hotline twenty years ago would allow anyone to make an accurate assessment as to their fitness to fly today. It would likely be used as a tool of oppression, and it would make people think twice before choosing to risk their future career prospects by calling into the hotline in the first place.

Permanently barring hotline callers from becoming pilots makes about the same amount of sense as permanently barring people who have ever had a broken arm from becoming pilots.

Better bar me from becoming a pilot, quick.

For example, resident physicians are known for being pushed to work 80+ hour weeks. Would any of them ever officially admit to having mental health issues? Hell no, and that's a problem from an ethics perspective and a declining level of healthcare, not to mention tragically ironic to boot.

Would they feel secure knowing their call will create a permanent record of suicidal tendencies, limiting their career for years to come? I doubt it.

Any bits of data we collect to make accurate assessments will encourage suffering people to withdraw further and remain silent instead of getting help.

"...We are trained to risk assess each and every texter, irrespective of our intuition about their mental state. That means I treat someone testing the system like I would someone who has been flagged as an imminent suicide risk.

Supervisors monitor this evolution of the conversation closely.

The assessment is important because ultimately the decision to call emergency services comes after that rigorous assessment of the person's suicidal ideation, followed by their plan and access to means, as well as their timeline. If all those criteria are met, I contact my supervisor, and then we work on separation from means. If those criteria are not met, we continue the conversation accordingly.

I have personally walked numerous people back from the edge simply by talking to them and hearing them out; often times, texters deemed imminent risks are capable of staying safe that night after we have come up with a safety plan for them together. Calling EMS is truly a last resort and not an attempt to cast off responsibility.

In the cases when we do call emergency services, it is after we have exhausted all other options. It should be noted that access to geolocation is strictly limited to these supervisors, and in all likelihood is limited to a texter's phone number alone. It's not like they have a backdoor into AT&T, and the supervisor must make a call to emergency services directly. From what I can tell, very little information is given back to CTL. On occasion, I can see a timeline that EMS was dispatched but rarely do I ever learn about the outcome.

The success of the platform is that we can work with people to find them their own solutions. CTL was not a viable intermediary for calling 911."

I've volunteered nearly 300 hours, most of those were dead of night EST. I've spoken to several hundred people, and maybe a couple dozen have been flagged as imminent risk. Of those flags, I can count on one hand those who have required a call to EMS. Mostly, I'm able to come up with a safety plan with them and get them through the night.

No counselor on CTL will say it's wrong to end his/her life. That's because one of the core values is to treat each person without judgement (on any issue they bring up, from abuse, to self-image, to drama with parents, to rape).

For example, if someone says "I am having thoughts about suicide." No counselor would respond, "Oh that's awful, you shouldn't be having those. What's wrong with you?"

Or if someone says, "I just don't see the point in life anymore." No counselor would respond with, "Oh well life is sacrosanct and you're lucky to be here, so how could you possibly think about killing yourself? Your pain can't be that bad -- just think about your family who will be so sad."

These tropes are obviously harmful in a therapeutic setting, and the judgement is so counterproductive to keeping people engaged and finding solutions within themselves, which is key because we are not authorized to act in a medical capacity or advise people on what to do.

I have had many conversations with people who are clearly in lasting and profound pain and who just don't want to continue. Chats such as these are probably the hardest to endure because some people are just so resigned to their misery, and major depression just can't be treated by text. I'd give them a hug, but well...

I just want to end on a bitter note that while it seems like a lot of growth has happened in treating mental health, unfortunately many services have gotten a bad rap or are viewed suspiciously for the fact that previous generations of healthcare workers and society writ large did not give credit to the pain and difficulty in surmounting these conditions. It is a very dark morning in America, and we must be willing to listen to and validate each other's pain. CTL is one such location where that is possible.

A close friend struggled with bipolar. She was uninsured and making close to minimum wage…calls to suicide prevention hotlines resulted in thousands of dollars in new bills from ER visits and even involuntary psychiatric care.

She was struggling to pay rent. Being discharged in effectively the same condition as before but with new debt she wouldn’t be able to pay off for years…the medical bills for involuntary psychiatric care were their own special sort of crazy.

See https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.2...

Will 988 calls be referred to 911?

Currently, a small percentage of Lifeline calls require activation of the 911 system when there is imminent risk to someone’s life that cannot be reduced during the Lifeline call. In these cases, the crisis counselor shares information with 911 that is crucial to saving the caller’s life.

So it does sound like that can happen. Though I don't know what else they could reasonably do if it sounds like the caller is imminently going to do serious self-harm.

Having some counselors stop by or something, might be cool, but the police are basically the opposite of that, at least today, at least in most places. I can't imagine a worse sequence of events to kick off.

The first person I know who committed suicide, did so after being arrested for something that shouldn't have even been illegal. But the ordeal into which he was plunged by law enforcement was too much to handle. He was very stressed out by the shame of being in the newspaper and such, but nobody realized the degree until it was too late.

The second, too. Different details but overall similar scenario; he wrote of the feeling of being ground up by this massive machine.

Want to make someone feel hopeless, start by sending police in place of counselors.

I only know two people who've committed suicide. So that's not a great track record for police making things better.

There is a difference. Actively preventing someone from committing suicide, taking them from the absolute brink of destruction, is the first step towards recovery. Intervention works.

> The first person I know who committed suicide, did so after being arrested for something that shouldn't have even been illegal. But the ordeal into which he was plunged by law enforcement was too much to handle. He was very stressed out by the shame of being in the newspaper and such, but nobody realized the degree until it was too late.

I'm sorry to hear that, but that's entirely non sequitur to my point.

> Want to make someone feel hopeless, start by sending police in place of counselors.

Intervention by police to prevent someone actively trying to kill himself results in better outcomes for the person than the person actually killing himself. Or it could be firefighters. Or a random passerby. Police are sent because they are what is available.

I asked a friend who volunteers for one of these hotlines. He says it's actually rare and the guidelines are more about people are in imminent danger to themselves or others (e.g. threatening suicide by a method that would endanger other people in the process, or worse, implying threats of hurting other people or inducing suicide by cop).

Definitely not the common or standard outcome, though.

"What's this? The caller intends to commit suicide by cop? Surely sending cops to kick down his door will put a stop to that!"

Fortunately, I only had to walk out into the middle of my street in my PJs. Sadly, my biggest concern was some trigger happy lunatic would kill my new dog, imaging a hyperactive doodle puppy as a vicious cop killing hellhound.

I'm still a little fuzzy on why a health check requires a paramilitary response. Wouldn't it be safer and cheaper to have some sweet little old lady with a clip board knock on my door?

I was raised with a sacrosanct view of 911. Do not call unless it is a bona fide emergency. This means something along the lines of a situation outside my expertise that poses a threat to life. Broadly speaking it ranges from medical, physical, security, and probably a host of other things I'm forgetting.

However, I don't have the same instilled ideas about 988. What are the sufficient conditions to place a call, for oneself and for others?

More subjectively, if you find yourself at a moment where you simply cannot think of any reason not to kill yourself, and especially if you have a fairly concrete plan, well, what do you have to lose? You can always apologize later.

Regarding 911, I called once, the real deal. I was appalled and experiencing a fair amount of shame, but realized that all social conventions had fallen away. I had found myself in a pit of agony with no way out, and there was nothing I would not have done to get out. I'm not saying you should wait until that point--many life-threatening situations do not involve agony--but if you're there, you definitely should make the call.

In another case, I called 911 for a child. I thought there was a five percent chance that she would experience an outcome that would terrorize her and maybe destroy her life. Close enough.

"911 is if you need assistance now. Non-emergency is for the paperwork the next day."

My current city is like this, but more. If you need to reach a detective to return a call, you need to call 911 and ask to be transferred. Otoh, CenturyLink has broken 911 service for days a couple times since I moved here; an alternate number for the county has been provided, which will probably work for emergencies, but maybe not for returning calls.

Where I live, 911 might not answer, though. I've had that experience.

> 911 is to be used for emergencies only. An emergency is any serious medical problem (chest pain, seizure, bleeding), any type of fire (business, car, building), any life-threatening situation (fights, person with weapons, etc.) or to report crimes in progress.

1. https://www.fcva.us/departments/public-safety-communications...

https://en.wikipedia.org/wiki/3-1-1

A good example is if you have a disabled vehicle blocking an intersection - that's a 911 call.

"If a cellular 911 caller is on, or in close proximity, to a freeway, there is a high likelihood this call will go to the California Highway Patrol dispatch center. The California Highway Patrol (CHP) has jurisdiction over state freeways and handles emergency calls on these roadways. Cellular calls often utilize towers that are located near the freeway. Therefore, some cellular calls made from city streets, but near a freeway, will be routed to the California Highway Patrol."

You definitely did the right thing, though. I've made similar calls for mattresses and ladders blocking lanes.

[0] https://en.wikipedia.org/wiki/State_police_(United_States)#S...

I suppose they could even allow an incoming emergency call to interrupt a non-emergency conversation (which would be put on hold) so that emergency calls never have to wait for a non-emergency conversation to finish.

911 calls in my major metro relatively frequently ring unanswered

If this is possible imagine if people "swatted" you with this to get you locked up somewhere.

It is scary to think about, but I think both swatting and this would be solved by authorities looking at the scene without blindly taking irreversible action. (In Florida, once the Baker Act involuntary commitment begins, it is required to continue for a couple days. Police examine the suspect before formally doing it, because it is a pretty big deal.)

That is not to say I agree (or disagree) with these calls being used for involuntary commitment, I just think the swatting problem is the symptom of an unrelated issue.

Many (most?) are anonymous and won't ask for your name, but can obviously trace a cellular phone in an emergency unless you take active steps to avoid that.

Whether they are 'joined up' is a good question. Do they know of each other's services and are they able to patch a caller through to another specialist, quickly and at no cost? Much may depend on the operator you get. People are people, and some are less well trained, perceptive, or able to act on initiative.

Most organisations are also funded by charity/donations and get less public money with each government. In the UK We've had to adapt to a patchwork of independent services because central government has been making cuts since the Thatcher era. For example, the last government shut down most of the coast-guard stations, and a week later a crew of fishermen drowned within a stones throw of a closed lookout station. That caused a scandal that led to a new organisation (CoastWatch) staffed by volunteer civilians and funded by private donations. The people literally took over the abandoned stations and started operating them on a grass-roots basis.

https://www.npr.org/sections/health-shots/2022/07/15/1111316...

You won’t get in trouble if you call 911 about suicide, but if they think it’s not urgent they may point you to other resources rather than dispatch emergency services. The suicide hotline provides non-emergency resources but can’t emergency dispatch.

Perhaps in the future, more 911 centers will be expanded to include non-emergency suicide resources, but most or all don’t have that right now.

https://en.wikipedia.org/wiki/112_(emergency_telephone_numbe...

these days we accept 111 911 999 112 as synonyms

https://youtu.be/ab8GtuPdrUQ

(2) Emergency dispatch may automatically dispatch police/fire/EMS. That may be counterproductive to (and discourage calls for) some other events that a ready access number is desired for.

(2) is this done in practice or just hypothetical?

That varies from PSAP (Public Safety Answering Point) to PSAP. Local policy dictates what the first thing said to the caller is. And while I believe it is the case that most PSAP's use "where is your emergency" as their first question these days, some still use "what is your emergency" instead. This is one of those things that people who work in public safety (especially dispatchers) love to have religious arguments about.

And just to go back to the point about emergency / non-emergency calls: people call 911 for all sorts of shit that isn't an emergency. And while I've been gone from dispatching for a while, from what I understand, this problem has only gotten worse over the years. Unfortunately 911 has gone from "the number I call if somebody is dying or something is on fire" to "the number I call if there is anything going on that I don't understand or don't like, and want to demand that Somebody Needs To Do Something About It." :-(

Source: former 911 dispatcher and firefighter, and have called 911 a handful of times over the years.

[1] https://www.youtube.com/watch?v=ab8GtuPdrUQ