Calls to Suicide Prevention Lifeline Surge Amid Under-Resourced Centers

On the day of Anthony Bourdain’s death by suicide, calls to Community Crisis Services, Inc. (CCSI), a crisis center that answers calls to the National Suicide Prevention Lifeline, went up 500 percent. Across the country, counselors scrambled to field the spike in calls. Tim Jansen, the center’s executive director, brought in extra staff and answered calls himself. It wasn’t enough.

In the half hour it took Jansen to drive home, he heard the Lifeline number announced seven times on the radio. He checked his phone, watching as calls at the center queued up, knowing that after a long day, he “wasn’t in the mental place to be able to dial in and help them.”

On July 23, the House passed the National Suicide Hotline Improvement Act, which seeks to evaluate the effectiveness of the Lifeline and the feasibility of implementing a 3-digit dialing code like 911, a number that could be easier to remember than the current 10-digit number. But some local crisis center directors that field Lifeline calls and advocates say this could place more pressure on an overwhelmed and underfunded network.

Now, the bill sits on President Donald Trump’s desk, awaiting action.

Already, calls to the Lifeline are on the rise. Over the next four years, the Lifeline expects 12 million calls, the same number of calls it previously received for the 12-year period between 2005 and 2017.

Local Crisis Centers on the Front Lines

CCSI is housed in an unassuming, one-story orange brick and glass building. Tucked behind slightly overgrown, dark green shrubbery at the end of a peaceful residential block in Hyattsville, Maryland, CCSI acts as one of more than 150 local crisis centers across the country that answers calls from the Lifeline.

The building’s quiet exterior belies the activity inside. In the main “bullpen,” as Jansen calls it, overlapping conversations from counselors fill the room as they type rapidly, and with a quiet urgency, into call reports on their dual-monitor desktop computers. Occasionally, a single voice rises above the others, punctuating the regulated hum and rhythm of the room.

“You know, somebody who’s never been in that position, somebody who’s never struggled with their mental health might not be able to understand when you say ‘I’m frustrated and I know I’m taking it out on you, but it’s not your fault,’” a counselor says.

Colorful cork boards refer to homeless shelters and bear prominently displayed phone numbers for social services. A plastic Mickey Mouse phone and an early 20th century rotary wall phone decorate a window that looks out onto the side of the tidy, gray stone house next to the center.

A counselor sits at her desk, recommending to a caller ways to cope in moments of crisis: snapping a rubber band, drawing on your legs, listening to music. She shares her own struggles with anxiety. “If I’m out in a public space, and I just get overwhelmed, I just kind of find somewhere I can sit down and write.”

Sometimes ripping up that writing and throwing it away can serve as “another release of ‘this is me throwing away my anxieties’ or those inspirational things you hear all the time,” she tells the caller with a chuckle.

Another counselor starting her shift places her Frappuccino on her desk, puts on a bright pink headset, and begins talking to a caller. “It’s okay to struggle, you’re human,” she says.

Counselors at CCSI normally answer around 40-50 calls per shift. Most shifts are eight hours.

The camaraderie of the room is palpable. Jansen, who has trained people in crisis intervention for 20 years, circles his staff at work, chatting with one counselor about her upcoming trip to Las Vegas and listening to calls. “It’s so awesome to hear my training words come out of people’s mouths,” he says.

Current Funding and Lifeline calls

Some centers, like CCSI, are “national backup centers,” which are meant to handle their local volume of calls along with overflow calls from other centers across the country.

The Lifeline receives around $5.3 million a year in an infrastructure grant from the Substance Abuse and Mental Health Services Association (SAMHSA). From that, crisis centers receive an annual stipend of $1,500, and an extra $1,000 if they collect data on veteran calls to their center. Backup centers receive $17,500 quarterly plus $10 for every call over 3,000 they answer through the backup routing system.

According to James Wright, the Lifeline project officer for SAMHSA, this amount is mainly meant to offset the costs of accreditation, a process required for operation within the Lifeline network. It assesses if the center is achieving base level practices and standards in their services.

The stipend is “more of a gesture,” said Wright. It’s not intended to serve as direct support for centers’ work. “I’ve never heard a single crisis center report back to me and say that $1,500 a month supported the calls being answered,” said Wright.

To accommodate the rising call volume, Dr. Draper, the director of the Lifeline, says local crisis centers need more resources–and that a lack of resources contributes to centers leaving the network or shutting down. From 2008-2012, nine centers dropped out of the network and from 2013-2017, 23 centers dropped out. Just this year, three centers shut down.

Remaining centers do what they can to stay functioning. This often means taking on extra contracts, like running local crisis lines, to support their suicide prevention work.

Crisis Call Center, a Lifeline backup center in Nevada, operates a sexual assault support service program and a substance abuse hotline. They also provide child protective service reports and take elder protective service reports after hours. Rachelle Pellissier, its executive director, says they have to “cobble together” these different funding streams to offset the costs of the suicide prevention calls they take.

“We really need about $1.1 million to run this organization,” said Pellissier.

Centers like Provident in Missouri rely on their local United Way. The money they receive from the Lifeline, even as a backup center with more support, “pays for maybe two salaries of my 15 person team,” said Jane Smith, the director of life crisis services for Provident. “We’re a money-losing entity at Provident.”

If backup centers are unable to take a call, that call is routed from one backup center to the next, until a counselor can talk. “All the calls can be answered. The only question is, how long do people wait?” Draper said.

For January to March of 2018, the average wait time for a caller after the Lifeline’s automated greeting was 36 seconds at a local center and 88 seconds at a backup center. “It’s simply a supply and demand challenge,” Draper said.

Distance, Low Pay, and Pressure

Answering calls from all across the nation at backup centers can create barriers to getting help. With no local centers serving Minnesota, for example, all callers in the state are routed to an out-of-state backup center. It’s a solution that both increases the call volume pressure on backup centers and makes it difficult for centers to connect callers to resources in their area.

At CCSI, a counselor asks, “Do you have any community centers in your area or anything like that?”

In an emergency, it’s often more difficult to initiate an “active rescue” for someone who may be at imminent risk of attempted suicide because of the lack of an established relationship between the center and the out-of-state law enforcement.

Sometimes, counselors get this response from police: “‘Well, if they’re going to do it they’re going to need to do it. We’ll hear about it on the news,’” said Jansen. He says those responses typically occur a couple of times a week.

The stress of the job and the pay can drive high turnover rates for counselors in some centers. Even taking a day off can make answering calls more difficult for other staff. Counselors often “feel concerned for their fellow staff members” when they’re out of the office because “they know the impact that them not being there is going to cause,” said Victoria Graham, chief program officer at Action in Community Through Service in Dumfries, Virginia.

Gene Dobrzynski, the assistant call center director at CCC, sees a direct link between lack of funding and staff turnover. He says with more funding, the center could hire more staff and counselors’ mentality of “I gotta be at my desk because there’s going to be another call coming in” could be eased. “They could get a little bit of relief and be able to walk away,” he said.

Low pay for counselors is also a function of funding woes. “Let’s be serious, we’re paying frontline staff $11-12 an hour to do this crisis intervention, this life-and-death work,” said Pellissier.

In Arizona, Adjusting to Increased Calls

Not all Lifeline centers feel the same strain: Crisis Response Network in Arizona, for example, receives Medicaid funding and other social service funding from the state.

Like other centers, they’ve also seen an increase in calls. In June of 2017, Crisis Response Network and La Frontera Empact, another Arizona-based crisis center, fielded around 2,800 Lifeline calls. This past June, it was more than 4,400 calls. Unlike many other centers, they were able to increase their staffing to adjust to the increase in calls. At the busiest part of its day, Crisis Response Network might have 30 people on the phones.

Crisis Response Network also has “compassion rooms” where staff can go “to decompress after a tough call,” said Alex Zavala, its chief experience officer. Ocean noises play in the background and staff are encouraged to take a break or meditate.

The difference between Crisis Response Network and Crisis Call Center is stark. At Crisis Call Center, they can’t afford to replace the constantly-used chairs in their office when they wear down or clean their bathrooms as much as they’d like.

The numbers reveal Crisis Response Network’s success. Based on numbers collected from June 2017 to June 2018, less than 1 percent of callers hang up or lose their call before a counselor answers them. The center attributes this to its “consistent and stable” funding that allows for effective staffing with changing call volume, said Sarah Schol, the senior director of contact center operations.

Seeking to solve unknowns in suicide prevention
The circumstances of each call center are wide-ranging, and so are reactions to the National Suicide Hotline Improvement Act.

The leadership of several centers told the NewsHour Weekend that a 3-digit number for the Lifeline would probably allow people to more easily access the help that they need. But the accessibility is a double-edged sword for centers like Crisis Call Center–they want more callers to have access to the Lifeline, but “do not have enough capacity to take the increase in calls,” said Pellissier.

Draper says “it’s a fair presumption that [a 3-digit number] would increase calls, we just don’t know by how much.” But not everyone agrees that a 3-digit number would mean a greater volume of calls. Graham says that she couldn’t predict that, while Crisis Response Network believes an increase in call volume is possible, it doesn’t see a change to a 3-digit number impacting their day-to-day operations.

The bill’s lead House sponsor, Rep. Chris Stewart (R-UT), told the NewsHour Weekend that the legislation seeks to “increase awareness of resources and save lives,” and co-sponsor Rep. Eddie Bernice Johnson (D-TX) added that “ease” in access is critical. Sen. Joe Donnelly (D-IN), who co-sponsored the bill in the Senate, believes the legislation will examine if there’s a “simpler way” to “help in moments of crisis,” according to his office. Sen. Orrin Hatch (R-UT) did not respond to request for comment via email.

John Madigan, the Senior Vice President of Public Policy for the American Foundation for Suicide Prevention, said he hopes the bill’s study will answer “the million dollar question” of the current suicide prevention network’s reach and “holes” in the system.

Meanwhile, local crisis centers will continue to draw people who feel called to act and those who need to call.

Jansen entered the world of suicide prevention when he was 25 years old, after coming out as gay. He felt “fortunate” not to “lose people in [his] life.”

“I started thinking, ‘Gosh what happens when folks don’t have somebody?’” he said. Then, he saw an ad for crisis counselors. A few weeks later, he was a volunteer. Now, he’s spent 13 years as executive director at CCSI, which also takes backup calls for the Trevor Project, an organization that helps LGBTQ people in crisis.

Sometimes, on those calls, Jansen tells callers what it was like for him to come out–the fear he felt and the unexpected acceptance he found.

“I think when somebody needs to hear that you can actually come to the other side of it, hearing that somebody has done that can be powerful,” he said.

If you are having thoughts of suicide, go to SpeakingOfSuicide.com/resources or call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).