Can we save lives with a three-digit suicide prevention hotline?

In a culture that has normalized dieting and body weight fixation, it’s too easy to mistake eating disorders for a harmless phase, a voluntary choice, and just not that big of a deal. The stark reality is that eating disorders have among the highest mortality rates of any mental illness and these fatalities are often due to suicide. With 30 million Americans of all ages and genders suffering — often silently — from an eating disorder, that is a lot of lives on the line. Fortunately, our nation’s top policymakers have just reduced one of the barriers to change, proposing an easier way to call for help.

This month, U.S. lawmakers enacted the National Suicide Prevention Hotline Improvement Act, which aims to designate a three-digit number, similar to 911, for those experiencing suicidal thoughts or dealing with broader mental health issues to connect to crisis support centers.


The relationship between eating disorders and suicide may not be intuitive, but the evidence is undeniable. Consider these heartbreaking statistics, culled from Current Opinion in Psychology just this month:

  • Suicide is the second leading cause of death in anorexia nervosa (AN).
  • Suicidal behavior is higher than the general population in bulimia nervosa (BN) and binge eating disorder (BED).
  • Relative to gender and age-matched comparison groups, individuals with AN are 18 times more likely to die by suicide, and individuals with BN are seven times more likely.

At The Center for Eating Disorders at Sheppard Pratt, our own patients have shared that, prior to getting treatment, a crisis hotline was a literal lifeline for them in times of severe struggle with their eating disorders and associated suicidal thoughts. Given these tragic links, we applaud policymakers who came together on this important nonpartisan issue in a divisive political climate. This lifesaving legislation holds promise to strengthen appropriate care channels for those in their greatest moment of need.


We remain cautiously optimistic as we watch for action based on this legislation. Here are three considerations to bear in mind.

This bill is not an immediate change. It tasks government bodies to conduct a study to determine the feasibility of a three-digit number, explore the effectiveness of the current National Suicide Prevention Lifeline and make recommendations to improve it. If their study concludes it is doable and worthwhile, we may see action.

Research and dialogue remain critical. Assuming a three-digit suicide prevention hotline becomes a reality, it does not preclude the need for data collection to help us understand the best way to treat eating disorders. Equally important is increased conversation about mental health to help destigmatize eating disorders and elevate healing topics such as self-worth and acceptance. September is National Suicide Prevention Month. What better time to start the conversation and keep it going?

We can learn from the past. The roll-out of 911 was not automatic. Coalescing existing systems prompted staunch opposition, particularly in major cities. It took a grant program from a charitable foundation to provide the proof of concept to justify government funding. And the pace of necessary infrastructure was creeping at best. Universal access took years. In 1979, a quarter of the population had access. By 1987, half. As of 2017, 99 percent.

Seeing a three-digit suicide prevention hotline to fruition will take the right mix of partners (count us in), modernizations in technology (e.g., texting and video call capabilities; enhancements to location pinpointing) and perseverance paired with patience. Case in point: While the first 911 call was placed in 1968, it wasn’t until 1999 that Congress designated it as the official emergency number. That’s a 30-year lag.

Let’s hope this time around, we aren’t on hold until 2048 before we mandate a three-digit national suicide prevention hotline. Those living with eating disorders, and all individuals living with mental illnesses, can’t afford to wait.

Drs. Steven F. Crawford and Harry A. Brandt are co-directors of The Center for Eating Disorders at Sheppard Pratt (