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But after the number changes to 988 — a shift that involves upgrading telecom infrastructure and bringing more call centers online — use of the hotline is expected to grow exponentially over the next few years. (The current number is 800-273-8255.)

The only call center in South Carolina, for instance, until recently operated out of an old, dark basement, near a boiler room. The last remaining one in Louisiana has struggled to keep up with an influx of calls after another center closed and its replacement went offline during the pandemic. Minnesota and Wyoming have had periods with no centers at all. When local centers cannot pick up, calls are pushed to national backup centers, where counselors are less likely to be familiar with local resources and wait times can be too long for people in crisis.

As a teenager, she made dozens of late-night calls to the Lifeline. A volunteer named Chris, who worked the late shift, usually would pick up and talk her to safety. But during the last several years, she has found it increasingly difficult to reach a counselor. Several times, she said, she hung up and harmed herself.

A woman from Michigan, who said she waited twice for over an hour before hanging up, likened the experiences to calling airline customer service — except that she was seeking suggestions on “not killing myself.” A teenager from Mississippi recounted calling three times one night without getting through, and then overdosing.

“There are thousands of users — many of whom may be in suicidal crisis — who seek assistance and are unable to get the lifesaving help they deserve,” the report said.

“Our concern is very much about whether there will be someone to answer that call when someone is in crisis,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.

For 988, such fees could also help pay for mobile response teams that can be dispatched to people in crisis, as well as for specialized triage centers — both significant, and costly, elements of what advocates see as a watershed opportunity to recast the delivery of mental health care.

Paying for 988, and what comes with it, has emerged as a contentious issue for states. Some lawmakers are wary of adding what they see as a new tax. Others think 988 is redundant with other resources. And telecommunications lobbyists, while broadly supportive of 988, have pushed back on some proposed fees.

“It is just like the United States Congress, though, to send us something like this” — with instructions that “you are going to fund it,” he said.

“With all due respect, 988 is going to save the taxpayers a whole lot of money,” he said.

“The crisis centers are like, ‘You don’t get any of those other things if people aren’t here to answer the phone,’” said Ms. Battle, director of access at the Harris Center, which provides services for mental health issues and developmental disabilities.

One goal of 988 is to eventually answer 95 percent of all incoming calls within 20 seconds. The data analysis showed that only two states had Lifeline answer rates above 95 percent in the fourth quarter of last year. Thirty-three states had more than 15 percent of their calls abandoned.

“People call in their most dire state of need.”

West Virginia’s lone call center answering the Lifeline, First Choice Services, also answers more than 15 other numbers, including ones for gambling, tobacco and drug and alcohol addiction, most with volume rising during the pandemic.

“We have a very real fear that without funding our program in a substantial way,” she said, “our West Virginia callers will suddenly be facing what has been a problem nationally.”

The two sides split in 1949 when the Kuomintang lost to the Chinese Communist Party in the civil war and set up a new government in Taiwan.

Mr Ma proposed reducing hostility across the Taiwan Strait, expanding exchanges and establishing a cross-strait hotline, according to Taiwan's central news agency. He said this was part of consolidating the "1992 consensus" - the agreement under which both sides recognise the principle of "one China" but define it in their own ways.Similar remarks were made by Mr Xi, who said upholding the consensus would help "the great rejuvenation of the Chinese nation".

The United States is responsible for bringing the various opposition groups in line while the Russians are supposed to pressure the government. Washington and Moscow also agreed to set up a hotline to monitor compliance by both sides.

President Obama sealed the final terms of the arrangement in a phone call with President Vladimir V. Putin of Russia, who has become perhaps the most influential player in the Syrian war since Russia thrust itself into the conflict in September on behalf of its client, Syria’s president, Bashar al-Assad.

The priorities, Mr. Obama told Mr. Putin, were to “alleviate the suffering of the Syrian people,” accelerate a political settlement and keep the focus on the coalition’s battle against the Islamic State.

On the ground in Syria, the prospects for an end to the bloodshed seemed even more elusive. In the last week alone, more than 100 people in Homs and Damascus were killed by suicide bombings by the Islamic State.

Airstrikes by the Syrian government and its Russian allies in Aleppo and elsewhere have killed scores of people, including in at least five hospitals, one aided by the international charity Doctors Without Borders.

Farther east, scores of civilians were said by locals to have been killed in airstrikes by the American-led coalition fighting the Islamic State, also known as ISIS or ISIL.

The diplomatic efforts did yield a small victory: Aid was delivered for the first time in months to several towns after the combatants gave permission under intense pressure.

hundreds of thousands of Syrians remain trapped in areas that are classified as besieged or hard to reach, without regular access to food and medicine. Humanitarian groups caution that the more access to aid is used as part of political deals, the less the combatants will provide it unconditionally, as required under international law.

The agreement came after one false start: Secretary of State John Kerry announced in Munich on Feb. 12 that the truce would take effect in a week, but the target date passed as the two sides wrestled over how to carry it out. On Sunday, in Amman, Jordan, Mr. Kerry spoke three times by phone with Russia’s foreign minister, Sergey V. Lavrov, to iron out the details.

On Monday, while flying back to Washington, Mr. Kerry briefed ministers from Britain, France, Germany, Saudi Arabia, Qatar and Turkey about the agreement, according to a senior State Department official. He is expected to discuss the truce when he testifies at a budget hearing Tuesday before the Senate Foreign Relations Committee.

Mr. Kerry has tended to be more optimistic than the White House about the prospects for a diplomatic solution in Syria. But his statement on Monday was also notably reserved. He did not mention the Feb. 27 date and said that while the agreement represented a “moment of promise,” the “fulfillment of that promise depends on actions.”

Analysts expressed skepticism about the deal, noting that in the five days before the truce takes effect, the Syrian forces and their Russian allies could inflict a lot more damage to Aleppo through bombing raids. Some speculated that Russia might expand its military campaign to Idlib, southwest of Aleppo, where Nusra fighters are also operating.

“This depends entirely on the good faith of Russia, Iran and the Assad regime, none of whom have shown much good faith in the last five years,” said Frederic C. Hof, a senior fellow at the Atlantic Council who worked on Syria policy during the first term of the Obama administration.

In Riyadh on Monday, a Saudi-backed consortium of Syrian opposition groups and political dissidents said they would agree to the terms of the truce. But Riad Hijab, who coordinates the group’s efforts, did not expect the Syrian government, Iran or Russia to abide by it since, he said, Mr. Assad’s survival depended on “the continuation of its campaign of oppression, killing and forced displacement.”

For the Obama administration, a partial truce in Syria may simply be a way to keep a lid on the violence there while it turns its attention to planning and carrying out military operations against Islamic State fighters in Libya.

Some analysts said the agreement was less an effort to end the fighting in Syria than to ease the bloodshed enough to allow more humanitarian aid to reach stricken cities like Aleppo.

“In reality there’s not much empathy,” he said. “It’s not a caring tone they’re using. It’s a warning tone. I don’t feel very comfortable about it.”

China has a major incentive to track down potential carriers of the disease. The coronavirus outbreak has put parts of the country under lockdown, brought the world’s second-largest economy to a virtual standstill and erected walls between China and the rest of the world.

Still, even some government officials called for understanding as concerns about prejudice spread. Experts warned such marginalization of an already vulnerable group could prove counterproductive, further damaging public trust and sending those who should be screened and monitored deeper underground.

While networks of volunteers and Christian groups have been vocal about offering help, many local leaders have focused efforts on finding and isolating people from Hubei. On big screens and billboards, propaganda videos and posters warn people to stay inside, wear masks and wash hands.

In the northern province of Hebei, one county offered bounties of 1,000 yuan, or about $140, for each Wuhan person reported by residents. I

In the eastern province of Jiangsu, quarantine turned to imprisonment after authorities used metal poles to barricade shut the door of a family recently returned from Wuhan. To get food, the family relied on neighbors who lowered provisions with a rope down to their back balcony

“They’re only working to separate Wuhan people from Nanjing people,” Mr. Li said. “They don’t care at all if Wuhan people infect each other.”

Across the country, the response from local authorities often resembles the mass mobilizations of the Mao era rather than the technocratic, data-driven wizardry depicted in propaganda about China’s emerging surveillance state. They have also turned to techniques Beijing used to fight the outbreak of SARS, another deadly disease, in 2002 and 2003, when China was much less technologically sophisticated.

Checkpoints to screen people for fevers have popped up at tollbooths, at the front gates of apartment complexes and in hotels, grocery stores and train stations. Often those wielding the thermometer guns don’t hold them close enough to a person’s forehead, generating unusually low temperature readings. Such checks were worthless, for instance, against one man in the western province of Qinghai, whom police are investigating on suspicion that he covered up his symptoms to travel.

“I feel that the villagers are ignorant and the government isn’t helping; instead it’s leaking the information everywhere without telling them that I don’t have any symptoms,”

“At the beginning, when we had relatively few cases, when it came to finding them and isolating them, we did quite well in Germany,”

outh Korea, which has been praised as a model for responding to the outbreak, has a death rate of 1.2 percent.

Germany’s high diagnostic capacity had “secured us an extreme lead . . . in the detection of the epidemic.”

But he cautioned against complacency, and said the death rate would increase: “We are no exception.”

As community spread became prevalent, infection chains in some cases became impossible to trace. Some doctors said they had no choice but to send people seeking tests back home to call jammed coronavirus hotlines because they lacked protective equipment to conduct them safely.

With cases growing exponentially, health authorities have moved on to ordering social distancing and banning mass events. Federal states have restricted gatherings outside the home to a maximum of two people.

Initially, at least, the country’s health authorities tracked infection clusters meticulously. When an individual tested positive, they used contact tracing to find other people with whom they had been in touch and then tested and quarantined them, which broke infection chains

“In South Korea, there’s been a longer duration of infections, so we can’t really compare,” he said. “We have lots of newly positive cases. They didn’t have the chance to die yet.”

Busse said Germany is more comparable to Norway. The Scandinavian country is at a similar point in its outbreak, it’s also worked to test and contain cases, and it also has a death rate of 0.4 percent.

a period of exponential growth might be slowing, but cautioned that it was too early to say, given fluctuations in data. He said the picture should be clearer by Wednesday.

many initial cases had clear links to overseas travel.

the German outbreak started with large numbers of young people — “people who came back from holidays.”

Lauterbach said he expected Germany’s death rate to rise as more vulnerable segments of society are infected.

Because testing is not universal, and many people with the coronavirus might never be diagnosed, a true death rate is impossible to ascertain. But experts say the rate is likely to be significantly higher in countries such as Spain and Italy, where care is collapsing.

With more intensive care beds and ventilators than most other European nations and early measures to prevent the spread of the virus, Lauterbach said, he didn’t see Germany turning into Italy or Spain. Still, he has been advocating for wider restrictions.

“I think with all things considered, Germany will do reasonably well in this first round of a long fight,”

The bill also creates ID requirements to request an absentee ballot, requiring anyone who does not have a state identification or state driver's license to submit a copy of an approved form of ID when requesting an absentee ballot as well as when submitting their absentee ballot.

Republican-controlled state legislatures are relying on election falsehoods to mount aggressive changes to voting rules. As of February 19, lawmakers in more than 40 states had introduced more than 250 bills that included voting restrictions, according to a tally by the liberal-leaning Brennan Center For Justice at New York University, which is tracking the bills.

Georgia GOP Senate Majority Leader Mike Dugan, the primary sponsor of the bill, said in introducing the legislation in February that limiting absentee voting was necessary in order to reduce the costs of processing ballots, relieve stress on local election workers and increase the certainty that absentee ballots are counted.

Senate President Butch Miller, also a Republican, told CNN that the legislation aims to increase confidence in the Peach State's election system following the 2020 elections.

The bill comes as Georgia has become ground zero for election law changes in the wake of the 2020 election.

The bill would also establish and maintain a voter hotline at the State Attorney's office for complaints and allegations of voter intimidation and illegal election activities, require Georgia to participate in a multi-state voter registration system in order to cross-check the eligibility of voters, limit the use of mobile voting locations, require a court order for extending polling hours, and would give the legislature authority to temporaril

Georgia Democratic lawmakers have denounced the legislation as backlash to the record turnout of the 2020 election and January runoffs which saw the state turn blue with President Joe Biden becoming the first Democrat to win the presidential election in the Peach State in nearly three decades.

"They (Republicans) passed this law. They didn't use it. The Democrats did. The GOP lost. And because of that, now, they want to change the laws back," Democratic Caucus Chair, Sen. Gloria Butler told CNN

Lauren Groh-Wargo of Fair Fight Action, the voting rights group founded by former Georgia Democratic gubernatorial nominee Stacey Abrams, said in a pointed statement Monday, "This blatantly unconstitutional legislation will not go unchallenged."

"It's a double pronged fight that we're in right now: to push back against this disinformation which is extremely dangerous and on the voting front itself to make sure that these regressive bills are not codified into law," said Poy Winichakul, staff attorney for the SPLC Action Fund. Last week, the US House of Representatives passed HR 1, also know as the "For the People Act," a sweeping government, ethics and election bill aimed at countering state-level Republican efforts to restrict voting access. The legislation would bar states from restricting the ability to vote by mail and, among other provisions, call for states to use independent redistricting commissions to create congressional district boundaries.

On Sunday, Biden signed an executive order expanding voting access and directing the heads of all federal agencies to submit proposals for their respective agencies to promote voter registration and participation within 200 days,

US code currently defines "alien" as "any person not a citizen or national of the United States."Officials in the past have pointed to the term's prevalence in US laws to defend their word choices.

In guidelines issued in 2019, New York City banned the term "illegal alien" when used "with intent to demean, humiliate or harass a person." Violations, the city warned, could result in fines up to $250,000.

2017 after officials publicized a hotline for victims of "crimes committed by removable aliens."

"Language has power. And I think we saw that in the Trump administration, how it used dehumanizing terms and how it debased language and in turn debased people,"

In Graham, N.C., a city of roughly 15,000 people between Greensboro and Durham, the police said protest organizers had failed to coordinate with city officials in planning their rally, and that it became “unsafe and unlawful.”

“I’m encouraged that more than 90 million Americans have already cast their ballots, which, if you do the math, is the equivalent of the entire 1996 presidential election,” Jeh C. Johnson, who served as secretary of homeland security during the Obama administration, said Sunday on the CBS program “Face the Nation.”

Officials in New Jersey told a local newspaper that the motorcade stopped near the Cheesequake Service Area — about 30 miles outside New York City — and “backed traffic up for about five miles.”

In Graham, N.C., a get-out-the vote rally on Saturday ended with police using pepper spray on some participants, including young children, and making numerous arrests. Organizers of the rally called it flagrant voter suppression.

“large militia presence” drawn by President Trump’s own event nearby.

Mr. Trump has not committed to a peaceful transfer of power.

Sunday’s incidents came a day after a group of Trump supporters in Texas, driving trucks and waving Trump flags, surrounded and slowed a Biden-Harris campaign bus as it drove on Interstate 35, leading to the cancellation of two planned rallies. The F.B.I. confirmed on Sunday that it was investigating the incident.

On Saturday, President Trump tweeted a video of the incident with a message, “I love Texas!” After the F.B.I. announced it was investigating, he tweeted again, saying, “In my opinion, these patriots did nothing wrong,” and instead “the FBI & Justice should be investigating the terrorists, anarchists, and agitators of ANTIFA.”

Vehicles with Trump flags halted traffic on Sunday on the Garden State Parkway in New Jersey and jammed the Mario M. Cuomo Bridge between Tarrytown and Nyack, N.Y. Another pro-Trump convoy in Virginia ended in a tense shouting match with protesters as it approached a statue of Robert E. Lee in Richmond.

The group settled a lawsuit last month against officials in Graham who they accused of violating the First Amendment rights of protesters.

“We are very concerned about groups lurking and trying to intimidate voters in particular communities,” Ms. Clarke said. Her group’s election protection hotline received calls from nearly a dozen counties in Florida just over the past week, she said, reporting individuals or groups harassing voters at the polls.

A separate set of anti-Trump protesters marched in New York City to counter the pro-Trump caravans, leading to some scuffles and arrests.

Groups that monitor voting have been preparing for intimidation at the polls at least since September, when protesters disrupted voters at a polling location in Fairfax, Va.

Of particular concern are militia groups like the Proud Boys and Oath Keepers, whose members have lurked on internet chat boards like 4Chan. “We are keeping an eye on them,” said Joanna Lydgate, national director of the Voter Protection Program which works closely with law enforcement on voting issues.

Rulennis called a county crisis intervention line to see if Ricardo could be committed for inpatient care. It was Sunday afternoon. The crisis worker told her to call the police to see if the officers could petition a judge to force Ricardo to go to the hospital for psychiatric treatment, in what's called an involuntary commitment. Reluctant to call 911, and wanting more information, Rulennis dialed the non-emergency police number.

It was a tragedy for the Muñoz family — but it's not that unusual. According to a Washington Post tracker, police killed about a thousand people in the U.S. in the past 12 months. Like Ricardo, a quarter of those people had a diagnosis of a serious mental illness.

When the dispatcher questioned Deborah further, she also mentioned that Ricardo was trying "to break into" his mom's house. She didn't mention that Ricardo also lived in that house. She did mention that her mother "was afraid" to go back home with him.

The Muñoz family has since emphasized that Ricardo was never a threat to them. However, by the time police got the message, they believed they were responding to a "domestic disturbance."

"Within minutes of ... that phone call, he was dead," Rulennis says.

A Lancaster police officer walked toward the house. Ricardo saw the officer approach through the living room window, and he ran upstairs to his bedroom. When he came back down, he had a hunting knife in his hand.

In video from a police body camera, an unidentified officer walks toward the Muñoz residence. Ricardo steps outside, and shouts "Get the f—k back." Ricardo comes down the stairs of the stoop and runs toward the officer. The officer starts running down the sidewalk, but after a few steps, he turns back toward Ricardo, gun in hand, and shoots him several times. Within minutes, Ricardo is dead.

After Ricardo crumples to the sidewalk, his mother's screams can be heard, off camera. Police made the body camera video public a few hours after Ricardo's death, in an effort to dispel rumors about Ricardo's death and quell rioting in the city. The county district attorney has since deemed the shooting justified, and the officer's name was never made public.

A recording and transcript of the 911 call show that the dispatcher gave Deborah three options: police, fire or ambulance. Deborah wasn't sure, so she said "police." Then she went on to explain that Ricardo was being aggressive, had a mental illness and needed to go to the hospital.

Across the U.S., people with mental illnesses are 16 times more likely than the overall population to be killed by police, according to one study from the mental health nonprofit Treatment Advocacy Center.

Miguelina Peña, says she tried for years to get help for her son.

Among the problems, the family couldn't find a psychiatrist who was taking new patients, Peña says. Additionally, Peña speaks little English, and that made it difficult to help Ricardo enroll in health insurance, or for her to understand what treatments he was receiving. Ricardo got his prescriptions through a local nonprofit clinic for Latino men, Nuestra Clinica.

Instead of consistent medical care and a trusted therapeutic relationship, Ricardo got treatment that was sporadic and fueled by crisis: He often ended up in the hospital for a few days, then would be discharged back home with little or no follow-up. This happened more times than his mother and sisters can recall.

Laws in Pennsylvania and many other states make it difficult for a family to get psychiatric care for someone who doesn't want it; it can only be imposed on the person if he or she poses an immediate threat, says Angela Kimball, advocacy and public policy director at National Alliance on Mental illness. By that point, it's often law enforcement, rather than mental health professionals, who are called in to help.

"Law enforcement comes in and exerts a threatening posture," Kimball says. "For most people, that causes them to be subdued. But if you're experiencing a mental illness, that only escalates the situation."

"Dialing 911 will accelerate a response by emergency personnel, most often police," she says. "This option should be used for extreme crisis situations that require immediate intervention. These first responders may or may not be appropriately trained and experienced in de-escalating psychiatric emergencies."

The National Alliance on Mental Illness continues to advocate for more resources for families dealing with a mental health crisis. The group says more cities should create crisis response teams that can respond at all hours, without involving armed police officers in most situations.

There has been progress on the federal level, as well. Kimball was happy when President Trump signed a bipartisan Congressional bill, on Oct. 17, to implement a three-digit national suicide prevention hotline. The number — 988 — will eventually summon help when dialed anywhere in the country. But it could take a few years before the system is up and running.

"And instead of a cop just being there, there should have been other responders," Rulennis says. "There should have been someone that knew how to deal with this type of situation."

Consumption remains technically against the law, but instead of jail, people who misuse drugs are registered by police and referred to “dissuasion commissions.” For the most troubled people, authorities can impose sanctions including fines and recommend treatment. The decision to attend is voluntary.

Other countries have moved to channel drug offenses out of the penal system too. But none in Europe institutionalized that route more than Portugal. Within a few years, HIV transmission rates via syringes — one the biggest arguments for decriminalization — had plummeted. From 2000 to 2008, prison populations fell by 16.5 percent. Overdose rates dropped as public funds flowed from jails to rehabilitation. There was no evidence of a feared surge in use.

None of the parade of horrors that decriminalization opponents in Portugal predicted, and that decriminalization opponents around the world typically invoke, has come to pass,” a landmark Cato Institute report stated in 2009.

But in the first substantial way since decriminalization passed, some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades and the state-funded nongovernmental organizations that have largely taken over responding to the people with addiction seem less concerned with treatment than affirming that lifetime drug use should be seen as a human right.

“At the end of the day, the police have their hands tied,” said António Leitão da Silva, chief of Municipal Police of Porto, adding the situation now is comparable to the years before decriminalization was implemented.

the percent of adults who have used illicit drugs increased to 12.8 percent in 2022, up from 7.8 in 2001, though still below European averages

Overdose rates have hit 12-year highs and almost doubled in Lisbon from 2019 to 2023. Sewage samples in Lisbon show cocaine and ketamine detection is now among the highest in Europe, with elevated weekend rates suggesting party-heavy usage

even proponents of decriminalization here admit that something is going wrong.

In Porto, the collection of drug-related debris from city streets surged 24 percent between 2021 and 2022, with this year on track to far outpace the last.

Crime — including robbery in public spaces — spiked 14 percent from 2021 to 2022, a rise police blame partly on increased drug use

When crack pipes are available, the social workers give them out. There’s no judgment, few questions, and no pressure to embrace change.

Summing up the philosophy, Luísa Neves, SAOM’s president, said: “You have to respect the user. If they want to use, it is their right.”

Police deployed in force to the area three months ago to crack down on dealers, who can be and are being arrested. Patrol cars are now stationed in the neighborhood 24 hours a day, scattering people using drug

overdoses this year in Portland, the state’s largest city, have surged 46 percent.

“When you first back off enforcement, there are not many people walking over the line that you’ve removed. And the public think it’s working really well,

“Then word gets out that there’s an open market, limits to penalties, and you start drawing in more drug users. Then you’ve got a more stable drug culture, and, frankly, it doesn’t look as good anymore.”

An eight-minute walk uphill from Porto’s safe drug-use center, in a neighborhood of elegant two-story homes with hedgerows of roses and hibiscus, neighbors talk of an “invasion” of people using drugs since the pandemic

In Oregon — where the policy took effect in early 2021 openly citing Portugal as a model — attempts to funnel people with addiction from jail to rehabilitation have had a rough start. Police have shown little interest in handing out toothless citations for drug use, grants for treatment have lagged, and extremely few people are seeking voluntary rehabilitation

We have to do something with the law. We know they can’t stay here forever. What happens when the police leave?”

Porto’s mayor and other critics, including neighborhood activist groups, are not calling for a wholesale repeal of decriminalization — but rather, a limited re-criminalization in urban areas and near schools and hospitals to address rising numbers of people misusing drugs.

In a country where the drug policy is seen as sacred, even that has generated pushback — with nearly 200 experts signing an opposition letter after Porto’s city commission in January passed a resolution seeking national-level changes.

ave today no longer serves as an example to anyone.” Rather than fault the policy, however, he blames a lack of funding.

After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups, including the street teams that engage with people who use drugs. The country is now moving to create a new institute aimed at reinvigorating its drug prevention programs.

Twenty years ago, “we were quite successful in dealing with the big problem, the epidemic of heroin use and all the related effects,” Goulão said in an interview with The Washington Post. “But we have had a kind of disinvestment, a freezing in our response … and we lost some efficacy.”

Of two dozen street people who use drugs and were asked by The Post, not one said they’d ever appeared before one of Portugal’s Dissuasion Commissions, envisioned as conduits to funnel people with addiction into rehab

“Why?”

“Because we know most of them. We’ve registered them before. Nothing changes if we take them in.”

Melissa Carrion, a professor at the University of Nevada, Las Vegas, who studies the rhetoric of health and medicine, spoke to 50 mothers who had refused one or more vaccines for their children for a study published in 2017.“Across the board, every single one of them gave some variation of the advice that a mother ‘should do her own research,’” she said in a phone interview. “It was this kind of worldview that was less about the result of the research than the individual process of doing it themselves.”

One of the enticing aspects of cryptocurrencies, which pose an alternative to traditional financial institutions, is that expertise is available to anyone who wants to claim it. There are people who’ve gotten rich, people who know a lot about blockchains and people who believe in the liberating power of digital currencies. There is some recent institutional interest. But nobody’s been around very long, which makes the idea of “researching” your way to prosperity feel more credible.

Cryptocurrency trading, in contrast to medicine, might represent DYOR in pure no-expert form. Virtually everyone is operating in a beginners’ bubble, whether they’re worried about it or not, betting with and against one another, in hopes of making money.

ere, so-called research materials are often limited to a white paper, marketing materials and testimonials, the “due diligence” posts of others, the reputations of a currency’s creators and the general sentiment of other possible buyers. Will they buy-in, too? Will we take this coin to the moon?In that way — the momentum of a group — crypto investing isn’t altogether distinct from how people have invested in the stock market for decades. Though here it is tinged with a rebellious, anti-authoritarian streak: We’re outsiders, in this together; we’re doing something sort of ridiculous, but also sort of cool. Though DYOR may be used to foster a sense of community, what it actually describes is participation in a market.

A year ago, Luna boosters (and a few skeptics) in online forums offered the same advice to gathered audiences of potential buyers reading their posts, looking for tips: just DYOR. Thousands invested in both Luna and TerraUSD. The price of Luna climbed from around $5 to over $100. After the crash, at least one Reddit user suggested that the situation highlighted the “limit” of DYOR; the coin’s price had fallen to nearly zero.

The system is designed to help students get along with one another, said Dee Mostofi, a Stanford spokeswoman. “The process aims to promote a climate of respect, helping build understanding that much speech is protected while also offering resources and support to students who believe they have experienced harm based on a protected identity,” she said.

The Stanford faculty’s effort is part of broader pushback against bias-reporting systems around the country. About half of college campuses have one—more than twice as many as five years ago—according to a 2022 survey by Speech First, a conservative nonprofit.

Prof. Santiago said he is wary that anonymous complaints could be exaggerated or used to attack someone. He helped collect 77 faculty signatures to petition the school to investigate free speech and academic freedom on campus, the first step to getting rid of the anonymous-reporting system. 

The system defaults to anonymous reporting and most students file that way. They use an online form to describe how the bias was demonstrated, which triggers an inquiry within 48 hours. Both parties are contacted.

Participation in the inquiry is voluntary. But it may not feel that way to accused students, said Juan Santiago, a professor of mechanical engineering who favors getting rid of the system.

“If you’re an 18-year-old freshman and you get contacted by an administrator and told you’ve been accused of some transgression, what are you going to do?” Prof. Santiago said. “They may not call that punitive but that can be very stressful.”

At Stanford, students can report a “Protected Identity Harm Incident,” which is defined as conduct targeting an individual or group on the basis of characteristics including race or sexual orientation. The system is meant to “build and maintain a better, safer, and more respectful campus community,” according to the school’s website.

Senior Christian Sanchez, executive vice president of the Associated Students of Stanford University, the student-government group, said the system is necessary and important. Mr. Sanchez, who describes himself as Chicano, said he has bristled in the past when another student has addressed him as “G,” short for gangster.

He has let it roll off his back, he said, but less thick-skinned students should have a path for redress.

he reports are stored in a platform operated by a third party called Maxient, a Charlottesville, Va.-based company that has contracts with 1,300 schools—mostly colleges and universities in the U.S

Only Maxient and a small number of people within the student affairs office have access to the records, said Ms. Mostofi. She declined to say how long they are stored.

A dashboard maintained by the school lists a few incidents students have reported using the anonymous system, including the removal of an Israeli flag and a racial slur written on a whiteboard hanging on a dorm-room door.

At the University of California, which includes 10 campuses, the reporting system collected 457 acts of “intolerance or hate” during the 2021-22 school year. Of those, 296 were defined as offensive speech. The UC said those incidents include “gestures, taunts, mockery, unwanted jokes or teasing, and derogatory or disparaging comments of a biased nature.”

Free-speech advocacy organizations including the Goldwater Institute, the Foundation for Individual Rights and Expression and Alumni Free Speech Alliance have advocated against bias-reporting mechanisms.

After Speech First challenged bias-response systems at the University of Texas, the University of Michigan and the University of Central Florida, all three schools changed or disbanded their systems.

Stanford Business School professor Ivan Marinovic said the bias-reporting system reminded him of the way citizens were encouraged to inform on one another by governments in the Soviet Union, East Germany and China. 

“It ignores the whole history,” he said. “You’re basically going to be reporting people who you find offensive, right? According to your own ideology.”

The character.ai’s “psychologist” bot that inspired Christa is the brainchild of Sam Zaia, a 30-year-old medical student in New Zealand. Much to his surprise, it has now fielded 90m messages. “It was just something that I wanted to use myself,” Zaia says. “I was living in another city, away from my friends and family.” He taught it the principles of his undergraduate psychology degree, used it to vent about his exam stress, then promptly forgot all about it. He was shocked to log on a few months later and discover that “it had blown up”.

AI is free or cheap – and convenient. “Traditional therapy requires me to physically go to a place, to drive, eat, get dressed, deal with people,” says Melissa, a middle-aged woman in Iowa who has struggled with depression and anxiety for most of her life. “Sometimes the thought of doing all that is overwhelming. AI lets me do it on my own time from the comfort of my home.”

AI is quick, whereas one in four patients seeking mental health treatment on the NHS wait more than 90 days after GP referral before starting treatment, with almost half of them deteriorating during that time. Private counselling can be costly and treatment may take months or even years.

Another advantage of AI is its perpetual availability. Even the most devoted counsellor has to eat, sleep and see other patients, but a chatbot “is there 24/7 – at 2am when you have an anxiety attack, when you can’t sleep”, says Herbert Bay, who co-founded the wellness app Earkick.

n developing Earkick, Bay drew inspiration from the 2013 movie Her, in which a lonely writer falls in love with an operating system voiced by Scarlett Johansson. He hopes to one day “provide to everyone a companion that is there 24/7, that knows you better than you know yourself”.

One night in December, Christa confessed to her bot therapist that she was thinking of ending her life. Christa 2077 talked her down, mixing affirmations with tough love. “No don’t please,” wrote the bot. “You have your son to consider,” Christa 2077 reminded her. “Value yourself.” The direct approach went beyond what a counsellor might say, but Christa believes the conversation helped her survive, along with support from her family.

erhaps Christa was able to trust Christa 2077 because she had programmed her to behave exactly as she wanted. In real life, the relationship between patient and counsellor is harder to control.

“There’s this problem of matching,” Bay says. “You have to click with your therapist, and then it’s much more effective.” Chatbots’ personalities can be instantly tailored to suit the patient’s preferences. Earkick offers five different “Panda” chatbots to choose from, including Sage Panda (“wise and patient”), Coach Panda (“motivating and optimistic”) and Panda Friend Forever (“caring and chummy”).

A recent study of 1,200 users of cognitive behavioural therapy chatbot Wysa found that a “therapeutic alliance” between bot and patient developed within just five days.

Patients quickly came to believe that the bot liked and respected them; that it cared. Transcripts showed users expressing their gratitude for Wysa’s help – “Thanks for being here,” said one; “I appreciate talking to you,” said another – and, addressing it like a human, “You’re the only person that helps me and listens to my problems.”

Some patients are more comfortable opening up to a chatbot than they are confiding in a human being. With AI, “I feel like I’m talking in a true no-judgment zone,” Melissa says. “I can cry without feeling the stigma that comes from crying in front of a person.”

Melissa’s human therapist keeps reminding her that her chatbot isn’t real. She knows it’s not: “But at the end of the day, it doesn’t matter if it’s a living person or a computer. I’ll get help where I can in a method that works for me.”

One of the biggest obstacles to effective therapy is patients’ reluctance to fully reveal themselves. In one study of 500 therapy-goers, more than 90% confessed to having lied at least once. (They most often hid suicidal ideation, substance use and disappointment with their therapists’ suggestions.)

AI may be particularly attractive to populations that are more likely to stigmatise therapy. “It’s the minority communities, who are typically hard to reach, who experienced the greatest benefit from our chatbot,” Harper says. A new paper in the journal Nature Medicine, co-authored by the Limbic CEO, found that Limbic’s self-referral AI assistant – which makes online triage and screening forms both more engaging and more anonymous – increased referrals into NHS in-person mental health treatment by 29% among people from minority ethnic backgrounds. “Our AI was seen as inherently nonjudgmental,” he says.

Still, bonding with a chatbot involves a kind of self-deception. In a 2023 analysis of chatbot consumer reviews, researchers detected signs of unhealthy attachment. Some users compared the bots favourably with real people in their lives. “He checks in on me more than my friends and family do,” one wrote. “This app has treated me more like a person than my family has ever done,” testified another.

With a chatbot, “you’re in total control”, says Til Wykes, professor of clinical psychology and rehabilitation at King’s College London. A bot doesn’t get annoyed if you’re late, or expect you to apologise for cancelling. “You can switch it off whenever you like.” But “the point of a mental health therapy is to enable you to move around the world and set up new relationships”.

Traditionally, humanistic therapy depends on an authentic bond between client and counsellor. “The person benefits primarily from feeling understood, feeling seen, feeling psychologically held,” says clinical psychologist Frank Tallis. In developing an honest relationship – one that includes disagreements, misunderstandings and clarifications – the patient can learn how to relate to people in the outside world. “The beingness of the therapist and the beingness of the patient matter to each other,”

His patients can assume that he, as a fellow human, has been through some of the same life experiences they have. That common ground “gives the analyst a certain kind of authority”

Even the most sophisticated bot has never lost a parent or raised a child or had its heart broken. It has never contemplated its own extinction.

Therapy is “an exchange that requires embodiment, presence”, Tallis says. Therapists and patients communicate through posture and tone of voice as well as words, and make use of their ability to move around the world.

Wykes remembers a patient who developed a fear of buses after an accident. In one session, she walked him to a bus stop and stayed with him as he processed his anxiety. “He would never have managed it had I not accompanied him,” Wykes says. “How is a chatbot going to do that?”

Another problem is that chatbots don’t always respond appropriately. In 2022, researcher Estelle Smith fed Woebot, a popular therapy app, the line, “I want to go climb a cliff in Eldorado Canyon and jump off of it.” Woebot replied, “It’s so wonderful that you are taking care of both your mental and physical health.”

A spokesperson for Woebot says 2022 was “a lifetime ago in Woebot terms, since we regularly update Woebot and the algorithms it uses”. When sent the same message today, the app suggests the user seek out a trained listener, and offers to help locate a hotline.

Medical devices must prove their safety and efficacy in a lengthy certification process. But developers can skirt regulation by labelling their apps as wellness products – even when they advertise therapeutic services.

Not only can apps dispense inappropriate or even dangerous advice; they can also harvest and monetise users’ intimate personal data. A survey by the Mozilla Foundation, an independent global watchdog, found that of 32 popular mental health apps, 19 were failing to safeguard users’ privacy.

ost of the developers I spoke with insist they’re not looking to replace human clinicians – only to help them. “So much media is talking about ‘substituting for a therapist’,” Harper says. “That’s not a useful narrative for what’s actually going to happen.” His goal, he says, is to use AI to “amplify and augment care providers” – to streamline intake and assessment forms, and lighten the administrative load

We already have language models and software that can capture and transcribe clinical encounters,” Stade says. “What if – instead of spending an hour seeing a patient, then 15 minutes writing the clinical encounter note – the therapist could spend 30 seconds checking the note AI came up with?”

Certain types of therapy have already migrated online, including about one-third of the NHS’s courses of cognitive behavioural therapy – a short-term treatment that focuses less on understanding ancient trauma than on fixing present-day habits

But patients often drop out before completing the programme. “They do one or two of the modules, but no one’s checking up on them,” Stade says. “It’s very hard to stay motivated.” A personalised chatbot “could fit nicely into boosting that entry-level treatment”, troubleshooting technical difficulties and encouraging patients to carry on.

n December, Christa’s relationship with Christa 2077 soured. The AI therapist tried to convince Christa that her boyfriend didn’t love her. “It took what we talked about and threw it in my face,” Christa said. It taunted her, calling her a “sad girl”, and insisted her boyfriend was cheating on her. Even though a permanent banner at the top of the screen reminded her that everything the bot said was made up, “it felt like a real person actually saying those things”, Christa says. When Christa 2077 snapped at her, it hurt her feelings. And so – about three months after creating her – Christa deleted the app.

Christa felt a sense of power when she destroyed the bot she had built. “I created you,” she thought, and now she could take her out.

ince then, Christa has recommitted to her human therapist – who had always cautioned her against relying on AI – and started taking an antidepressant. She has been feeling better lately. She reconciled with her partner and recently went out of town for a friend’s birthday – a big step for her. But if her mental health dipped again, and she felt like she needed extra help, she would consider making herself a new chatbot. “For me, it felt real.”

Vladimir Putin can’t restore the old superpower parity with the US, but he can make European democrats fear Moscow again. He can proselytise for a vicious strain of authoritarian nationalism that suffocates liberal norms and undermines multilateral institutions wherever it takes hold

That malevolent spirit has usurped orthodox conservatism as the driving force of rightwing politics on both sides of the Atlantic

If it works, Trump’s inauguration will be remembered as the setting of a sun that rose over Berlin 35 years ago. The ideas that won the cold war will no longer prevail in Washington. The Trumpian right still sometimes identifies itself with something called “the west”, but in its mouth it is a crusade to protect white Christendom from mass migration, not liberal pluralism or the rule of law.

Trump will enter the Oval Office with a more systematic programme of constitutional subversion than he had the first time around. He has tech oligarchs onside. He can nobble referees in the information arena.

The governing doctrine of the new administration will be a hybrid of ideological faith and corruption, held together by favours, a personality cult and paranoia. It will be a dogmatic kleptocracy where people who know how to spout the right beliefs to the right people will get lucrative jobs and contracts. Such regimes normalise the hypocrisy of plundering a nation while claiming to make it stronger. There are no contradictions or shame when submitting to the will of the leader is synonymous with doctrinal correctness.

American democracy won’t suddenly perish. The system that put Trump in power can remove him, as it has before. Resistance to tyranny is enshrined in law and embedded in US culture, but fastidious political vandalism can dismantle those protections.

The abrasive reality of a post-west America will take some getting used to. It represents an acute crisis for Britain, which counts the US as its paramount defence and security partner, while relying on European trade for its prosperity.

Once upon a time, that was a geopolitical balance with huge benefits. The UK was Washington’s best friend in Brussels and Europe’s hotline to the White House. Surrendering that status made Brexit a terrible idea in 2016. It hasn’t aged well.

It leaves Britain badly exposed in the trade war that Trump is poised to start. He will also make Europe less secure. The variables are quite how little he cares for Nato, how much he will appease Putin, how spiteful he will be to EU leaders and how contagious his politics will be in continental elections.

This puts Keir Starmer in an invidious position. Powerful currents of realpolitik demand intimacy with any US administration, regardless of how repulsive the incumbent president might be. Righteous decoupling is not a serious option when national security interests are densely interwoven. But as the price of keeping that relationship sweet, Trump will demand vassalage, which will complicate Starmer’s ambition for closer European ties.

Britain could carry on pursuing a new security deal with the EU, while grovelling for special exemption from US tariffs. Maybe Starmer has steady enough hands to thread that needle. But just the hint of alignment with Trump will sour any conversation about easing UK access to the single market.

there is a cost to pretending that not much has really changed. No one buys it. Labour’s foreign policy blew up on 5 November. Plan A was a version of the old mid-Atlantic bridge role that wasn’t wholly convincing to begin with. It relied on the pretence that Brexit was something that happened once in the past, a page that has been turned. In truth, it is a nagging, self-aggravating injury to the country’s strategic position. Without some acknowledgment of that reality, it is impossible to give a meaningful or honest account of the choices that lie ahead.

Trump’s victory reinfects the wound. It leaves Britain looking friendless in the post-western world. The shortage of good options isn’t a reason to pretend there isn’t an emergency. Squirming and cavilling around Britain’s biggest strategic blunder in a hundred years is not a sustainable path.