Inside the National Suicide Hotline: Preventing the Next Tragedy

As U.S. suicide rates rise, experts are divided over which strategies save more lives

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Draper is the National Suicide Prevention Lifeline’s soft-spoken, goateed, pony-tailed director and a whole-hearted advocate for early treatment. Talk to him and you realize why he’s in this field, something, he says, chose him. Draper speaks calmly but with purpose. He looks you in the eye. He routinely uses your name in conversation.

In the 1980s, Draper was part of a mobile crisis team, a group of clinicians that goes into the homes of people who are psychiatrically ill but unable or unwilling to get help. He says he soon came to the realization that the country’s mental health system operated behind bricks and mortar, “where it waits for people.”

“It says, ‘Ok, you’re mentally ill?’ I’ll see you Tuesday at 9 a.m. Hope you can make it.’ The system is not set up for the convenience of the user,” he says. “And as a result, two-thirds of the people with mental health problems in this country never seek care. So here was this program that goes into people’s homes. I was like, man, this is the way it should be.”

A decade later, the Mental Health Association of New York City established a 24/7 crisis information and referral network and hired Draper. Several years later, the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services and now funds the national lifeline with $3.7 million annually, assessed callers who had contacted crisis centers like New York’s and found that most of them felt less distressed emotionally and were less suicidal after the call. Draper calls it a groundbreaking finding.

LifeNet came into its own in 2001 when it became a central resource for those affected by the Sept. 11 terrorist attacks, which in New York City was just about everybody. People were reporting depression, anxiety and other traumatic responses in massive numbers. LifeNet’s call volume and staff doubled, and it’s never gone down. That time in the spotlight positioned the hotline to administer the national suicide prevention lifeline starting in 2004.

Today, Draper and his staff oversee a network of more than 160 independently operating call centers around the country. Call 1-800-273-TALK, and you’ll be routed to the call center closest to the phone number from which you’re calling. The staff helps develop risk assessment standards for operators around the country so they can consistently and quickly determine the seriousness of a situation over the phone.

Draper expects call volume to increase again this year. About 8 million adults in the U.S. are thinking seriously about suicide, but only 1.1 million actually attempt it. So when Draper sees the volume actually reaching that 1.1 million number, which he expects it to this year, he views it as a good thing.

“If your calls are increasing, does that mean more people are in distress?” he says. “That’s not necessarily true. It means more people may have been in distress all along but didn’t know this resource was there. So the more we promote awareness of this resource, once it gets out, then it stays out there.”

The problem for people like Draper is definitively determining whether suicide prevention efforts are working. The only way you ever know if you’re saving someone’s life is if they come out and say so, and that makes it difficult to truly gauge the effectiveness of the lifeline or any other prevention program or service.

“The lifeline is a valuable addition to our efforts,” says Dr. Lanny Berman, executive director of the American Association of Suicidology (AAS). “It’s indeed a resource for people in suicidal crisis to reach out immediately and get help. Whether it is effective in saving lives remains to be seen.”

But some of the available data seems to indicate that the lifeline is having a positive effect. Studies done by Columbia University’s Dr. Madelyn Gould have found that about 12 percent of suicidal callers reported in a follow-up interview that talking to someone at the lifeline prevented them from harming or killing themselves. Almost half followed through with a counselor’s referral to seek emergency services or contacted mental health services, and about 80 percent of suicidal callers say in follow-up interviews that the lifeline has had something to do with keeping them alive.

“I don’t know if we’ll ever have solid evidence for what saves lives other than people saying they saved my life,” says Draper. “It may be that the suicide rate could be higher if crisis lines weren’t in effect. I don’t know. All I can say is that what we’re hearing from callers is that this is having a real life-saving impact.”

LifeNet, downtown Manhattan, 10:15 a.m., Wednesday, June 5

Dely Santiago puts on her black Sennheiser headset and takes a look at the queue. Five callers waiting to speak with an operator. A dozen others on the line.

Like its hometown, New York City’s suicide prevention call center never sleeps, and Santiago is one of 50 employees that keeps it running day and night. Santiago, 29, has been working in the mental health field since she was 18, as a behavior modification specialist and a psychotherapist. She began working for LifeNet in 2009 as a crisis counselor and is now an operations manager, primarily tasked to supervise operators – but she still takes calls.

Santiago uses just one phone, but 14 separate hotlines feed into it. There’s the National Suicide Prevention Lifeline, of course, and LifeNet, New York City’s local mental health and substance abuse line. But there’s also Spanish LifeNet; Asian LifeNet; Project Hope (for victims of Hurricane Sandy); BRAVE (an anti-bullying line); a Disaster Distress Helpline; an NFL Lifeline (for those with football-related mental health issues). Many of the operators are trained to answer all of them.

This morning, Santiago’s first call is from OASAS Hopeline, the New York state hotline for substance abuse. While she never knows exactly who’s calling, she always knows which line is coming through. If a LifeNet call pops up on her caller ID, it’s often someone reaching out for basic information about clinics or resources in the area. That’s low stress. But if it’s the National Suicide Prevention Lifeline, she takes deep breaths before answering so she can stay calm. This one, the state’s addiction line, is somewhere in the middle.

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