Help is just a call away. But what exactly happens once you dial?
Suicide is the 10th leading cause of death in the US, according to the American Foundation for Suicide Prevention (AFSP). There are 44,965 suicides every year and an average of 123 each day. And suicide rates have risen in recent years among men and women, across all age and ethnic groups and in nearly every state, according to a Centers for Disease Control and Prevention report released last week.
Accompanying many news stories about suicide — most recently, obituaries for celebrity chef Anthony Bourdain and designer Kate Spade — is the number for the National Suicide Prevention Lifeline, which answered more than 2 million calls last year through its toll-free hotline, 1-800-273-TALK (8255). (The Crisis Text Line, an offshoot of the social change organization DoSomething.org, is also available around the clock by texting HOME to 741741.) Calls to the Lifeline spiked a reported 25 percent in the two days after Spade’s death last week; after rapper Logic performed his song titled “1-800-273-8255” at this year’s Grammy Awards, call volume reportedly tripled.
So what is the hotline and what does it actually do? Funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by the nonprofit Mental Health Association of New York City (MHA-NYC) since 2005, the lifeline offers 24/7, week-round “free and confidential emotional support to people in suicidal crisis or emotional distress,” per its website, as well as to friends and family members of people in distress.
Upon dialing the number, callers will hear an automated greeting informing them that they’ve reached the National Suicide Prevention Lifeline; they can press 2 for Spanish or press 1 to connect with the Veterans Crisis Line, operated by the Department of Veterans Affairs. The Lifeline program, working with a network of more than 160 independently operated crisis centers across the country, then tries to route callers to the center closest to them.
“People might also be wanting to connect to some more long-term help,” Shari Sinwelski, the Lifeline’s associate project director, told Moneyish. “So if they’re looking for a therapist or some sort of other program, then typically a local center is able to best help them find that information.”
There’s also a “backup” network available in case of high call volume or lack of a nearby crisis center, as well as an interpreter service for non-English speakers. And while wait time can vary, roughly 85 percent of calls get answered in about 30 seconds, according to AFSP chief medical officer Christine Moutier.
In the case of individuals who express that they want to kill themselves, “there is a range of interventions” that Lifeline crisis counselors engage in, said Madelyn Gould, a Columbia University professor of epidemiology and suicide contagion expert.
“Crisis counselors will first try to actively engage the suicidal person in a collaborative way to keep him/her safe. The crisis counselors are often able to decrease the individual’s risk to the point where they are no longer at imminent risk,” Gould told Moneyish in an email. “In about (a) quarter of the time, the crisis counselors may need to send emergency services without the person’s collaboration; but, this is not a ‘knee jerk’ reaction on the part of the crisis counselors. Lifeline crisis counselors are well trained to work with suicidal individuals and are not scared to engage with people at imminent risk of suicidal behavior.”
Training may differ somewhat from center to center, Sinwelski said, but all operators must adhere to the Lifeline’s minimum requirements. Through evaluations of its services, the Lifeline has developed best practices, she added: “The first part of those best practices are really based on creating a good rapport with the person who calls in — being able to be understanding and nonjudgmental and empathic and being able to listen to really strongly, emotionally charged things that can sometimes be difficult for people.”
“The advantage of crisis interventions is that the person is connecting with a caring and trained person who can help de-escalate the suicidal crisis and discuss options and next steps. They can also tell you about local treatment options,” clinical psychologist Jill Harkavy-Friedman, vice president of research for AFSP, told Moneyish. “Depending on the counselor, they may be able to help you develop a plan for safety. Calls can last from seconds to hours. We hope people will stay on long enough to move past the crisis moment and refocus on their will to live.”
Counselors are trained in “collaborative problem solving,” Sinwelski added, which recognizes that “the person in crisis really understands their situation best.” “Collaborative problem solving recognizes that when a person is asking for help, that they typically know the most about themselves and their situation,” Sinwelski said. “And so counselors are going to respect that and try to help the person who is calling in to learn: What do they want to see happen? What’s going to be the most helpful thing for them?”
Telephone workers may also help the caller develop a safety plan, which lays out their own warning signs (moods, behaviors or situations) that a crisis may be developing; internal coping strategies like physical activity or relaxation techniques that they can employ on their own; a list of people and social settings that can offer a distraction; the names and phone numbers of people they can ask for help; mental health professionals or agencies to contact for help; and ways to ensure their environment is safe.
“Most people who think about suicide, fortunately, will not act on it. And most people who’ve made a suicide attempt will actually go on to engage in life,” Harkavy-Friedman said. “So there’s a lot of hope here, if we can help people get through these high-risk periods.” (For every one person who dies from suicide every year, Sinwelski said, another 278 people think seriously about it and don’t kill themselves.)
While the hotline gets “many, many calls,” Sinwelski said, there’s no particular time limit governing how long a caller can stay on the line. “Each call in and of itself is an individual interaction,” she said, “and the counselor is going to take as much time with that person as the person needs.”
The Lifeline’s “#BeThe1To” campaign also empowers people to engage in five action steps with someone in their life who may be suicidal: Ask whether they’re thinking about suicide; keep them safe by reducing their access to lethal means; be there for them; help them connect with support; and follow up to see how they’re doing.
“There’s some research now where they’ve done follow-up and people really do find (the Lifeline) helpful…It really does get them through those difficult, painful moments. And (people) would be surprised that every kind of person calls — people they think who would never reach out, they do,” Harkavy-Friedman said. “There are a lot of myths, like ‘Men don’t ask for help.’ Men ask for help all the time. ‘Soldiers don’t ask for help’ — well, there’s a veterans’ hotline that’s run by them and people reach out all the time. There’s likely somebody just like you who’s reached out and gotten some help, whoever you are.”