Background: Suicide hotlines are commonly used to prevent suicides, although centers vary with respect to their management and operations.
Aims: To describe variability across suicide prevention hotlines.
Method: Live monitoring of 241 calls was conducted at 10 suicide prevention hotlines in California.
Results: Call centers are similar with respect to caller characteristics and the concerns callers raise during their calls. The proportion of callers at risk for suicide varied from 3 to 57%. Compliance with asking about current suicide risk, past ideation, and past attempts also ranged considerably. Callers to centers that were part of the National Suicide Prevention Lifeline (NSPL) were more likely to experience reduced distress than callers to centers that were not part of the NSPL.
Conclusion: Because callers do not generally choose the center or responder that will take their call, it is critical to promote quality across call centers and minimize the variability that currently exists. Accrediting bodies, funders, and crisis centers should require that centers continuously monitor calls to ensure and improve call quality.
Keywords: California; crisis hotlines; evaluation; live monitoring; suicide prevention.