Suicide

A library recently asked me to present a workshop about being a volunteer answering a suicide hotline.  There were almost 50 people in attendance ranging in age, race, economic diversity and motive for being there.  I transcribed some of the questions people asked of me.

Why did you decide to answer a suicide hotline?  Having been raised in a private rest home for the elderly, which my parents ran out of our 19 room house, caring for and helping people has always been part of who I am, it's in my DNA.  I spent 25 years volunteering at the Stratton VA hospital and since I wasn't doing that anymore, I wanted to find another way to reach out to people who were in pain.  I also volunteered at a homeless shelter.

How many volunteers were there answering the lines?  There were at the most, five us us who were paid during the day and at night there was usually only one volunteer on duty.  There were about thirty volunteers in total.  We were open from nine in the morning to ten at night.   Now that the center has lost their funding, the lines are only open a few hours each day. 

What happens if you were on the phone with someone and your shift was over?  We all took a pledge that the caller would come first and if we were on the phone with them at the time of closing, we would remain there to finish the call for as long as it took.  I was covering for a volunteer one evening and a call came in minutes before ten.  It was a long call.  After hanging up and writing out my report, it was well after midnight. 

What was the longest call you've had?  Calls can range from five minutes to two hours.  There are many variables.   My longest call was about an hour and a half.  We also had an internet chat line.   One time my supervisor was chatting with a person for two hours when she had to leave.  She discreetly passed the chat off to another staff member who chatted with the person online for another two hours when she had to begin a training class for new volunteers.  I was about to leave and she asked me to stay and continue the chat.  I was there for about two hours when the person finally decided to end the chat because they felt that they were going to be okay.  That was a difficult chat to take because I had to read the entire chat log and continue the current conversation at the same time.  That sort of thing rarely happens. 

What kind of people were the volunteers and what was their motive for doing that kind of work?  There were many reasons people answered the phones.  Some volunteers knew someone or had a family member complete suicide so they wanted to answer the phones to help others and, to honor the memory of their loved one.  One volunteer's son completed suicide so as a pseudonym she took on the feminine version of her son's name in remembrance of him.  Others where college students looking to get something impressive on their resumé.  They usually didn't stay long.  Some were retired people looking to do something to keep busy or give back.  Some were people who were unemployed hoping that if they could prove themselves, they may get hired if an opening presented itself.  One woman was arrested for drugs and prostitution and was required to perform community service so she chose this.  Regardless of motivation, everyone found it rewarding on many levels and most of us cared deeply for the callers.  There was only one person I couldn't figure out.  He used to surf the internet during calls and grumbled when a call came in.  We were both given the task of verifying referrals and in one day I had called over a 100 people and he called about 25.  He said it was because he got a lot of calls but I checked his call log, plus, I was first in the queue that day. He kept an iPad discreetly tucked into his employee handbook and had an earphone tucked into his headset.  He spent most of his time watching movies online or playing video games.  He was the exception.   Ironically he got a big promotion.

Did anyone who called in actually take their life?  There is no way to know that.  I don't know.  We do know about some of the people whom we have saved because they call back.

Why do you say "complete" and not "commit?"  I had an English teacher who taught us Latin roots.  COM means "with" and MIT means "thread."  So for me it means to follow through with something with no indication of outcome, and it also has negative psychiatric connotations such as committing someone.  COMPLETE means "with" and "full."  It means to fully perform the task rather than follow a thread.  It is just my preference. 

Have you ever answered the phone and known the caller?  Six times.  That's why some of us with unique names take on a pseudonym.  I also answered the phone three times and saw that the callers lived a few blocks from my house.  The first thing I do when a call comes in is to type the number into our program.  If the caller has called before, a record of their previous calls will come up.  That way I can better help them by reading about their call history.  I also reverse search their number in an attempt to get an address in case the call becomes a medical emergency. 

Have you ever gotten any prank calls?  All the time.  Mostly teenagers.  I listen carefully to the background sounds of every call because those sounds can reveal a lot about the caller.  If I hear a dog or cat for instance, I can use that knowledge later in the call as a "Protective Factor."  I also listen for giggling or someone else whispering in the background.  Many prank callers aren't prepared to answer questions and you can hear a friend in the background helping with the answers.  After a while you get to know when someone is truly depressed, in crisis or prank calling.  Their tone and answer content doesn't lie.  Despite that, we treat every call as a real call.  Once we discern that it is a prank, we politely end the call because a real caller may be trying to get through.  As much fun as some of them are, we have to keep the lines open.

What is a protective factor? A reason to live.  A person who owns a pet may not kill themselves because they are concerned about what would happen to their pet if they were no longer around to care for them.  Other protective factors are family, friends, someone who is with them at the time of the call, the fact that they called, plans for the future or even religious beliefs that forbid suicide.  Listening carefully to the caller is important to help identify these factors for and to them.  It is also important to weigh these against any existing "Risk Factors" such as previous attempts, the means are there, the intent is strong, any kind of loss the caller is concerned with such as a relationship, job or poor health.  Many callers will consider suicide because of seemingly insignificant concerns but,those are usually the "final straw" and not the real problem.

How do you know the identity of the person calling?  We have caller ID but we also ask the caller for their first name.  If they don't want to give one, we tell them it is okay but I then ask for a fake name.  I like to call a person by a name throughout their call.   I think it is important to call people by name.   If they block their caller ID information, that is okay.  I once had a woman use a fake name and before she ended the call, she shared with me her real name.  That was very touching to me.

Do you ever call 911 on a person contemplating suicide?  It was our office policy not to.  Other suicide hotlines may vary.  We would call 911 if we had permission or the person lapsed into a non-responsive state.  We call those "medical emergency" calls.

Do you ever get depressed after talking to people and hearing about all their problems?  I don't.  I have the ability to drop and forget everything after each call.  I can answer each call fresh and new with every person who reaches out to us.  Our supervisors are always available to talk and debrief us if needed.  Once my supervisor was listening in on a call, for quality control, and after the call she came over to ask if I wanted to talk about the caller.  She was even teary eyed.  I have a good genetic self defense mechanism and can let things go.  It has always been easy for me to forgive and forget.  In "Star Trek: Into Darkness," Spock elegantly waxes about how his choice not to feel does not imply that he is cold.  On the contrary, he chooses not to feel because he feels too much.  Maybe that is me.

How come you lost your funding?  People don't think suicide is important or is as pervasive as it really is. Write your congressman!  A suicide center is not a money making business and our office was unable to sustain itself in this economy.  You need space, phones, computers, internet, IT personnel, heat, electricity, software, supervisors, people to train volunteers, people to seek and screen volunteers.  There is a lot of overhead that most people are not aware of.  It is not just a phone line.  Although, I do currently answer a hotline for a prison organization and they provide the phone.  It is more laid back, the calls are not recorded and no records are kept.  I am just there to  offer support and listen.  Write your law makers asking them to support these services.  There is a large portion of our population who are either depressed, struggling, thinking about suicide, or wish they were dead.  It's a sin that we are not there to help them while congress can vote themselves raises. 

Why would you record a call?  Quality assurance and training.  Each and every call is totally confidential.  No data, information or recording leaves our office.  Supervisors listen to the recordings so they can provide feedback to us in an effort to improve our service to the callers.    We also write up reports about the call so that other people who answer the phones can read the reports both for learning purposes and in case that person ever calls back.  The information from previous calls can help to steer the conversation especially if the caller is quiet and reserved. 

If someone calls after ten pm and you're not there, what happens? It gets routed to another suicide hotline office.  It is all automated.  The National Suicide Prevention Lifeline is 24/7. 

Do you ever get a caller who doesn't want to kill themselves but needs to talk?  All the time.  Most callers have ambivalence (both + strength), that's why they call because they don't want to die.  All of our callers are going though some kind of emotional pain and don't know how to make it stop.  They do have the strength and courage to call for help.  We are there to get them through the moment.

Do you get people who harm themselves in other ways such as cutting?  All the time.  Especially teenagers.  I don't know where they get this idea of cutting.  Many people think that the pain of physical cutting will take away their emotional pain.  I ask many of these callers that the next time they want to hurt themselves, instead of hitting, cutting or biting, try holding an ice cube in their hand.  They will get the pain and not scar or bruise or bleed.  It does not solve their problem but ameliorates the symptom of wanting to feel pain without doing permanent damage.  We often ask people if they want referrals to support groups, counselors, hospitals or mental health agencies.