Critical Condition

The Controversy Over 1-800-SUICIDE

The Department of Health and Human Services (HHS) does a lot of good, including investing billions of dollars every year in medical research. Unfortunately, HHS is a huge bureaucracy, and its arrogance sometimes leads it to trample on worthy private-sector initiatives.

One such grotesque example of HHS stealing defeat from the jaws of victory involves the national suicide-prevention hotline. Eleven years ago, Reese Butler’s wife took her life after suffering severe post-partum depression following the stillborn birth of their only child. Rather than cursing the darkness, Butler sold their home and, using the proceeds from his wife’s life insurance policy, created the Kristin Brooks Hope Center (KBHC) in her memory.

Butler discovered a patchwork of hundreds of local suicide prevention hotlines providing help and counseling. He consolidated these by routing them all through one toll-free, easy-to-remember number, 1-800-SUICIDE, creating the National Hopeline Network.

 

Since its creation, the Hopeline Network has routed more than three million hotline calls, in the process saving untold lives. But instead of cheering all the good work of this private-sector initiative, HHS is striving to eliminate KBHC’s involvement with the network it created — all in an effort take over the network on behalf of the federal government.

The government first got involved back in 2001, when Butler secured funding from Congress to pay for certifying and organizing the local crisis centers. He didn’t imagine that, by accepting government funds, he would risk losing the very program he designed in his wife’s memory to help so many others. An agency deep in the bowels of HHS called the Substance Abuse and Mental Health Services Administration (SAMHSA) was put in charge of administering the grant.

Even though a SAMHSA study showed that the suicide-prevention hotline was saving lives, the agency decided to pull the funding from KBHC — and then asked KBHC to “donate” the number 1-800-SUICIDE to the federal government. Deeply concerned about its callers’ privacy, KBHC declined to cede control of the number to the government, opting instead to continue its work entirely with private donations.

But SAMHSA delayed paying $400,000 it owed KBHC, making the nonprofit temporarily fall behind in its payments to the phone company. Then SAMHSA launched its own competing suicide-prevention hotline with a new contractor (using 1-800-273-TALK, a line that never received anywhere near the traffic of 1-800-SUICIDE). Next, SAMHSA asked the Federal Communications Commission to temporarily transfer the 1-800-SUICIDE number (as well as two other numbers KBHC owns) to SAMHSA’s control on the grounds that the hotline might cease operations due to KBHC’s financial troubles.

The FCC agreed, and temporarily transferred 1-800-SUICIDE to SAMHSA in January 2007. That transfer is set to expire this week, on October 14, 2009, and so the FCC is considering whether to make the transfer permanent or to return the number to KBHC.

Today, KBHC’s finances are strong. It is paid up in full to all its creditors, has two years of operating expenses in the bank, plus an additional $1 million in pledges — more than enough to operate the hotline without disruption. (Additionally, throughout the period of SAMSHA “borrowing” 1-800-SUICIDE, KBHC has continued to operate its eleven other hotlines without incident.)

But SAMHSA, wanting to permanently wrest control of the number from KBHC, continues to question the nonprofit’s financial fitness — arguing that it costs SAMHSA three or four times as much to operate the lines as KBHC says it pays. (This is yet another reason to get the government out of the way, since the private sector usually operates more cost-effectively. When you can’t just print money, it does tend to concentrate the mind!)

Not only that, but SAMSHA aides finagled to have HHS Secretary Sebelius and Veterans Affairs Secretary Shinseki sign a joint letter to the FCC stating the importance of suicide prevention for veterans and, therefore, urging the permanent transfer of 1-800-SUICIDE to SAMSHA. It’s doubtful either secretary saw the letter or was given a full explanation of the circumstances. The FCC has no expertise in suicide prevention, nor does it claim any. But when faced with competing claims about how much it costs to operate the hotlines, and in receipt of a letter signed by two Cabinet secretaries, what would you do?

This small organization, founded to honor the memory of Kristin Brooks, who tragically took her own life, does immense public good in helping others reject that irreversible choice; it does so mostly at its own expense, with the help of private donations.

All it wants is to have its property returned so that it can continue that work.

—  Mary Claire Kendall, a Washington-based writer and commentator, served as special assistant to the assistant secretary for health, U.S. Department of Health and Human Services, 1989-93.

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