Best Practices

The Lifeline provides mental health professionals and crisis centers in the Lifeline network with innovative best practices and resources in the field of suicide prevention and mental health.

Research and Evaluation

We are often approached by researchers to collaborate on new research and evaluation projects. We appreciate opportunities to further our understanding of crisis lines and their effectiveness, in addition to other suicide prevention-related topics.

We are currently revising our external data collaboration process. Please check back for our new system by Summer 2023. In the meantime, if you are looking for data to complete a time-bound grant application, please contact us.

Resources and Publications

Suicide Safety Policy

In December 2022, the Suicide Safety Policy was released as an update and replacement of the Suicide Risk Assessment Standards and the Helping Callers at Imminent Risk of Suicide Policy. The Suicide Safety Policy (2022) ties together the need for consistent, uniform assessment of safety/risk and clear unified parameters for assisting callers/chatters and texters at highest risk, and requires that 988 Lifeline network centers:

Utilize the Safety Assessment model to connect and assess the immediate safety of individuals seeking support, listen to and clarify an individual’s story, collaboratively develop a plan for safety, and offer follow-up as needed.
Utilize active engagement, this encompasses behaviors undertaken by crisis counselors to effectively establish a connection with individuals seeking support from the Lifeline. “Engagement” refers to the building of an alliance that facilitates connection and makes it possible to collaborate with, and empower, the individual to secure their own safety, or the safety of the person they are reaching out about. The word “active” reinforces the need to focus on engagement in phone- or text-based crisis counseling, consciously and intentionally.
Utilize least invasive interventions and take all action necessary to prevent a person from dying by suicide. In doing so, centers must actively collaborate with individuals at risk to support their own safety and prioritize alternative interventions to 911 emergency service interventions.
Engage emergency services involuntarily only as a last resort and when a voluntary intervention is not possible.
Formalize collaborative relationships with mobile community crisis services and emergency services.

Suicide Safety Policy

Follow Up

Research indicates that follow-up with hotline callers and people recently discharged from an emergency department (ED) or inpatient setting has positive results for both consumers and providers of mental health services. Given that suicide risk is highest one week after discharge from an inpatient setting, the 24/7 availability of crisis centers’ services are invaluable. For medium to high risk callers, studies show that centers help to minimize ideation, hopelessness, and psychological pain. Further, crisis center follow-up before a service appointment is associated with improved motivation, a reduction in barriers to accessing services, improved adherence to medication, reduced symptoms of depression and higher attendance rates. Follow-up by crisis centers is also cost effective; it reduces utilization of emergency services and offers diversion to more appropriate services for patients who do not require admission to the hospital.

In a 2015 review of crisis center practices, of 134 centers sampled, 91% (122) provided some form of follow-up service. Programs ranged from follow-up services for frequent callers, monthly check-ins for high risk callers, ED/inpatient discharges, high risk callers, and third party calls.

Follow-Up Matters

Follow-up with Callers and Those Discharged from Emergency Department and Inpatient Settings

One Pager: Crisis Center Follow Up to Save Resources and Lives

More Publications

Helping Lifeline Callers Who Are at Imminent Risk of Suicide: The Importance of Active Engagement

The Return on Investment of Postdischarge Follow-Up Calls for Suicidal Ideation or Deliberate Self-Harm

NENA Suicide/Crisis Line Interoperability Standard

Establishing Standards for the Assessment of Suicide Risk Among Lifeline Callers

Suicide Prevention on Bridges: The National Suicide Prevention Lifeline Position

Support for Suicidal Individuals on Social and Digital Media

Call Center Metrics Part 1: Service, Efficiency

Follow-up with Callers to the National Suicide Prevention Lifeline: Evaluation of Callers’ Perceptions of Care

Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: Evaluation of Caller Risk Profiles and Interventions Implemented

Third-party callers to the national suicide prevention lifeline: Seeking assistance on behalf of people at imminent risk of suicide

National Suicide Prevention Lifeline crisis chat interventions: Evaluation of chatters’ perceptions of effectiveness

An Evaluation of Crisis Hotline Outcomes Part 1: Nonsuicidal Crisis Callers

An Evaluation of Crisis Hotline Outcomes Part 2: Suicidal Callers

Comparing Models of Helper Behavior to Actual Practice in Telephone Crisis Intervention: A Silent Monitoring Study of Calls to the U.S. 1–800-SUICIDE Network

Which Helper Behaviors and Intervention Styles are Related to Better Short-Term Outcomes in Telephone Crisis Intervention? Results from a Silent Monitoring Study of Calls to the U.S. 1–800-SUICIDE Network

National Suicide Prevention Lifeline: Enhancing Mental Health Care for Suicidal Individuals and Other People in Crisis

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