This week’s post is by Hollis Easter, who works at a suicide hotline. This is a condensed version of a recent post on his blog, where he writes frequently about mental health issues. “If you ask me why I’m not just over it already, I will ask you why you haven’t learned compassion yet,” he wrote this month about some of the annoying questions around depression. “What more important lesson is there?”
My work on suicide prevention really began in 2004 when I took a full-time job as a program director at a suicide hotline in northern New York. Our field has done a lot in the last 10 years. Here are some of the things that make me glad, and some thoughts about where we should head next.
People are openly talking about suicide more than ever
This is the biggest one. You see forums on the net, media guidelines, support groups, task forces and counseling guidelines. People who struggle with thoughts of suicide have a much broader selection of ways to find help. Whether they want anonymous or personalized help, it’s out there.
And people are talking. People say the word. If we can’t talk about the problem, we can’t fix the problem, and our world has started talking in a big way.
Suicide awareness coalitions are growing
Our regional coalition has been meeting for at least a decade, but that’s pretty unusual. New York’s Office of Mental Health is now paying staff to go around and support regional coalitions, based on the idea that local people often have the best ideas about how to organize and change the local cultures.
Coalitions are fantastic because they’re small enough that they usually do their work based on real people who actually know and care about each other personally. We’ve organized awareness walks, funded dozens of suicide intervention trainings, and helped thousands of people to talk directly about suicide.
Crisis hotlines are alive and kicking
I love crisis hotlines. They’re among the most efficient ways to reach vulnerable people. Our hotline offers 24/7 coverage, with an additional professional staff of mobile crisis counselors, on about $250,000 a year. For a county that’s bigger than Delaware and Rhode Island put together.
Hotlines are better trained than ever, thanks to initiatives aimed at providing tools like ASIST (Applied Suicide Intervention Skills Training), QPR (Question, Persuade, Refer), the Lifeline curricula, Connect Postvention and more.
I believe the average crisis hotline volunteer in this country has more suicide intervention training, on average, than the average therapist with an MSW or master’s in counseling. That’s something to be proud of.
Live Through This and voices for attempt survivors
For a long time, the suicide prevention world didn’t like to talk about attempt survivors. They were made to feel like black sheep in the community, sometimes feared, rarely welcomed.
This has to stop. And it’s beginning to. Thanks to courageous people like Dese’Rae Stage of Live Through This, Leah Harris and others, the voices of attempt survivors are getting heard.
Our community desperately needs their knowledge. They’re the people who know what being suicidal feels like. By including them, our efforts and credibility get a whole lot stronger.
The American Association of Suicidology also deserves a lot of credit for choosing to support these people in telling their stories here.
Professionals have started using Twitter to meet weekly. We talk, we share stories, we disseminate good ideas.
It’s all about speeding up the rate at which others can pick them up and run with them. Recently, I got to be interviewed on #SPSM (Suicide Prevention Social Media), the Twitter chat for this field. It meets at 10 p.m. Eastern on Sunday nights, at the Twitter hashtag #spsm. Join us!
NSPL and Veterans’ hotline
The National Suicide Prevention Lifeline is a free suicide hotline that’s available at 1-800-273-TALK from anywhere in the U.S. Ten years ago, there wasn’t any such hotline in wide use. Now, there are several. There’s a hotline just for veterans that’s embedded within the NSPL line; just press 1 after NSPL picks up.
I have some concerns about the centralization of power and funding in the hands of a few giant hotlines because some do threaten the funding of smaller ones. But on the whole, they’re a really good backup.
CrisisChat and CTL
This may come as a shock, but a lot of people prefer texting or chatting over talking on their phones. Calling someone on a phone is uncomfortable for some people, and our field has gotten on board with that.
I was part of the team that got CrisisChat.org rolling. CrisisChat was one of the first groups to offer SMS- and text-based crisis counseling and suicide intervention to people living anywhere in the U.S. Now CrisisTextLine is carrying the torch forward.
Mandated suicide intervention training for clinicians
We tell people to seek out trained caregivers if they’re thinking of suicide, and that’s a good idea, but the embarrassing truth is that most states don’t require any suicide intervention training for people earning degrees in social work or counseling.
In my years as a suicide intervention trainer, I’ve lost count of how many times clinicians have come up to me to offer thanks for the training, saying it was more than they had received in their entire graduate programs. This stops me in my tracks when I hear it at the end of a 16-hour ASIST program, but it leaves me gobsmacked when I spend two hours teaching QPR and find that it blew clinicians’ hair back.
We should expect mental health professionals to be prepared for helping suicidal people.
American Association of Suicidology and the National Action Alliance for Suicide Prevention
I prefer local initiatives over national ones when it comes to helping individual people, but it’s critical to have national frameworks in place for sharing ideas, stabilizing funding and paying for research. Local groups do a lot of things really well, but we’re too close to the problems to do a great job interacting with federal systems, insurance, research grants and the like.
So what’s next?
Here are some of my thoughts and concerns.
I think funding stability is the Achilles’ heel of our field. A lot of the organizations are near the edge financially, and there isn’t always enough money to keep the lights on. More tragic is that when that happens, the people with wisdom and experience often leave and don’t return.
Suicide hotlines take calls about a cornucopia of issues. We’re being asked to support larger and larger groups of people on smaller numbers of dollars.
It’s wonderful that we’re encouraging so many people to call hotlines. But without additional supports in place, mistakes will creep in. We need money and other resources, and we need it now.
Self-care for caregivers
We need to figure this one out. I’ve seen too many people burn out amid the constant pressure of this work. People get into it because they’re passionate, because they’re smart, because they really care. There’s so much beauty in that.
But we, both within the suicide prevention world and in our culture at large, lionize people who work too hard and don’t take care of themselves. Until we change as a culture, we’re going to keep valuing short-term work output over long-term sanity and survivability. We have to stop that.
Access to care
We need better ways of making mental health care available and affordable, especially in rural and poorer areas.
In my area, a lot of people work multiple jobs, and they can’t routinely take time off without losing them. How the heck are they supposed to go to medical appointments and counseling sessions? Until health care is available to everyone, and at a price everyone can afford, people are going to keep slipping through the cracks.
Breaking down barriers to care needs to be a priority for the next 10 years. Let’s do it.