Now Ye're Talking - to a volunteer suicide prevention counsellor

Boards.ie: Mark

Our next AMA subject is a volunteer suicide prevention counsellor with a special interest/experience in Deaf and disabled clients, who has worked on both phone and text crisis hotlines.

Please bear in mind that our AMA volunteer cannot offer any medical or counselling advice. We encourage people experiencing difficulties to talk to someone they trust and, if appropriate, to go to their GP. If you need help urgently and outside of GP hours, please go to your nearest A&E department.

If you need immediate help:
Aware’s Support Line is open 7 days per week, 10am-10pm on 1800 804 848

The Samaritan’s phone line is open 24/7 on 116 123

Pieta offer one-to-one, face-to-face support. Click ‘Contact us’ to find the phone number and opening hours of your nearest branch on their site or email mary@pieta.ie for advice on getting an appointment.

If you need non-urgent help:
Aware have a support email service at supportmail@aware.ie

There are some other useful services that you can use also listed here.

Sabre0001

Thanks for doing this AMA and also for the service you provide!

I suppose the first question to ask is what made you decide on this path and how did you get into it? In particular, was there something that prompted your special experience in deaf and disabled clients?

Are there any happy stories that you can tell from your job?

What's the uptake of the text service like? Do you find it easier or tougher to deal with someone in text form?

Any advice for someone who hopes to pursue a role like this?

All My Stars Aligned

Having done some work for the Samaritans in the past I have some idea of how difficult this can be. I don't have a question for you but just wanted to thank you for your work in a time when mental health has reached epidemic proportions.

TheZenMonkey

Sabre0001 wrote: »

Thanks for doing this AMA and also for the service you provide!

Thank you for participating!

I suppose the first question to ask is what made you decide on this path and how did you get into it?

I sort of stumbled into it, actually. In the '90s my company offered time off to do volunteer work and in the list of suggestions was San Francisco's suicide prevention hotline (SFSP). It sort of just occurred to me that I might be good at that. Although there are experiences and such from my past that in retrospect make sense, I didn't really think of that at the time.

In particular, was there something that prompted your special experience in deaf and disabled clients?

Not then. In the intervening years since I began at my current hotline, I worked with Deaf and other disabled people as an interpreter and a teacher, and then had to retire because I became disabled myself. So those interests have intersected.

Are there any happy stories that you can tell from your job?

There are lots, believe it or not, but I'll never forget one from SFSP. I was talking to a woman for a while before she mentioned that she'd just gotten up from a nap. It turned out that "nap" had been a suicide attempt. She knew she would try again if she had any more alcohol. So I gave her some references for short- and long-term help and made sure as best I could that she would be safe or call back. She didn't call back that shift.

The next time I was there, I found a note on the blllboard. It was from my caller, and it said to thank me for my help, and that I had helped to steer her in the right direction. I still have that note. (By the way, I'm changing some details in every story I tell.)

What's the uptake of the text service like?

Not sure exactly what you mean. There's data on volume (and a lot of other things) at the Crisis Text Line website.

Do you find it easier or tougher to deal with someone in text form?

Sure you ask the good questions. At first I found it to be an awkward transition, but now I'm much more comfortable with it. It's nice to be able to erase a bad answer before you send it, instead of blurting it out and wincing at the fallout. Which is not to say I never send a bad answer!

Any advice for someone who hopes to pursue a role like this?

If you're already interested, you probably have the skills and you should pursue it! You will be trained well for what you think will be the hardest parts, like handling people in immediate danger. The real hardest part is learning to detach or compartmentalize emotionally. You can't fix every caller, and you won't get closure on most of them. Additionally, you may be treated rudely, or abused, or hung up on. It's important to grow a thick skin by understanding that it's almost never personal.

All My Stars Aligned wrote: »

Having done some work for the Samaritans in the past I have some idea of how difficult this can be.

Thank you so much for your work as well! I can honestly say it is more rewarding than difficult 90-95% of the time.

LuG123

Thanks for coming on and doing the AMA. I really admire the work you do and support you provide. You mentioned that the hard part is having to detach and the lack of closure. How do you handle this yourself? Also as well as the initial training given to volunteers is there ongoing support provided?

Iwouldinmesack

Are you fluent in ISL as there is obviously a language barrier when communicating with Deaf people if you dont use it, if so where and how did you learn it ?

TheZenMonkey

LuG123 wrote: »

You mentioned that the hard part is having to detach and the lack of closure. How do you handle this yourself?

Thank you for your kind words. Part of it for me is simply experience. For example, texters to Crisis Text Line can end the conversation at any time, no questions asked, by typing STOP, the equivalent of simply hanging up the phone. This can cause a lot of consternation especially among new counselors who take it as a sign that they failed in some way.

But eventually you start to see definite patterns to those STOPs (and your fellow counselors and your supervisors will tell you the same thing). The texter is tired of the convo and doesn't feel like saying so; you asked a question they don't want to answer (doesn't mean it was a bad question!); they're not ready to talk about something that comes up; someone just walked in the room; the teacher just asked them a question; they want to go to sleep. I like to avoid counterfactuals ("what-ifs") so unless there's some definite indication that I messed up, I automatically assume it's one of the above.

It's especially hard for new counselors when you ask "Are you feeling suicidal?" and the answer is STOP. But honestly I see this as a good thing. It's totally, totally fine if the texter isn't ready to answer that question. For so many of our texters it's the first time they've ever told anyone that they're even depressed. But that question lets them know that it's a safe place to talk about suicide when they're ready. It's the same reason some people answered the phone "Crisis line" at SFSP but I always answered "Suicide prevention."

Maybe "perspective" is a better word than "experience", now I think about it. Because it's not like I'm immune to being affected by what I see as a bad conversation. It's important to take all the stuff I just said -- what you know intellectually -- and let that overcome the emotional response. This really takes time and a lot of conversations though.

Also as well as the initial training given to volunteers is there ongoing support provided?

Which is a great follow-up question to your first one. YES, there most definitely is. I can't speak for the phone line because it's been too long and I know they've been through a lot of changes. But not only is self-care a frequent topic of conversation at the text line, you are never ever "alone". There are chat rooms for support as well as debriefing from tough conversations while you're on the platform, and other counselors are always there for sympathy as well as tips and ideas for tough texters. And above that level of support there are always at least two or three supervisors online, who are there for you for any concern and especially if it looks like a texter may need emergency help.

Basically everyone is always there for one another and it makes the process much, much easier in every way. The phone line was kind of a trial by fire in several ways, and not having anything like that was one of them. If you're interested in working at a hotline of any kind, that's a really good thing to find out beforehand, I think.

TheZenMonkey

Iwouldinmesack wrote: »

Are you fluent in ISL as there is obviously a language barrier when communicating with Deaf people if you dont use it, if so where and how did you learn it ?

I'm in the U.S. so I use ASL. There was never a time I would call myself "fluent," but when I was working and playing in the Deaf community I was definitely proficient. You're right, there's a language barrier as well as a cultural barrier with Deaf people if you don't sign. When I was a college instructor, I wrote and taught my own English grammar and writing curricula in ASL for Deaf students, and that's a great place to learn just how good your signing is. Because those kids WILL tell you. And laugh at you.

I taught myself the manual alphabet when I was very small and I've been learning bits and bobs over the years. When I got serious about wanting to be an interpreter, I took a year of ASL at a college that turned out to have one of the best-known interpreter education programs (IEPs) in the country. Then I studied for two more years, including more ASL, to get my degree in Sign Language/Interpreting. And there was lots of socializing and volunteer interpreting during that time that also contributed. You need to interact with Deaf signers while you're learning; I would say that aspect is more important with any sign language than with any spoken language.

(For those who don't know, "big-D" Deaf is used to indicate people who are part of Deaf culture and use sign language. "Little-d" deaf means anyone with any kind of hearing loss, whether or not they sign.)

Iwouldinmesack

Deaf and ISL user 👠Wish you all the very best with your work and in the future.

GalwayGrrrrrl

Thank you for doing this AMA. What is your opinion on the increasing number of celebrities "coming out" as having mental health difficulties? Do you think it's good as it reduces stigma, or are some jumping on the bandwagon as it's the in-thing at the moment? I work in an acute psychiatric unit and I'm torn between these two opinions.

mfceiling

Thank you for your work...you are doing so much good and I hope you get the full appreciation for your skills.

Is the job similar to a negotiator? Do you try to build up a rapport...like get their name, age etc and build up a profile on them before you can offer advice? Are there times when the person is an immediate risk and what steps do you have to take?

Thanks again....this will be a great AMA.

TheZenMonkey

Iwouldinmesack wrote: »

Deaf and ISL user 👠Wish you all the very best with your work and in the future.

Thank you so much!

xfactorfan23 wrote: »

What is your opinion on the increasing number of celebrities "coming out" as having mental health difficulties? Do you think it's good as it reduces stigma, or are some jumping on the bandwagon as it's the in-thing at the moment? I work in an acute psychiatric unit and I'm torn between these two opinions.

Wow, that's a tough place to work, kudos to you. I'm having to think about your question for a bit. I tend to look at this in a granular way, if that's the word I want; I think if a celebrity comes out about their issues, and it spurs *one person* to ask for the help they otherwise might not have, it's a good thing. Trying not to be cynical about it, I feel that seeing people whom others admire admit to having depressions and even suicidal feelings or attempts may or may not reduce stigma in the general population (see below), but it does reduce the feeling of stigma in individuals who need and/or want help.

I'm trying to unpack the negative term "bandwagon" because I relate to that and I want to know why. I think maybe you and I are reacting to the reasons that any one celebrity may have for sharing this information? For example, my cynicism returns hugely when it happens to coincide with their album or movie that's about to come out. Or when it's someone who maybe hasn't been in the news for a while. Or especially if they've said or done something colossally stupid and it seems like a good way to deflect.

I think that aspect of it may perpetuate negative public views on mental illness if there's a sense that these celebrities are just "doing it for attention", which folks then apply to the people in their lives who are struggling with depression and mental illness. So from a top-down perspective, it may be a mixed blessing. (I'm not saying it's fair or right, it's just what happens.) But bottom-up, I have absolutely seen people inspired to come out to their friends and loved ones, or even just on social media, after a well-known person discusses their struggles. In that sense, if one life is saved, I can't condemn it, you know?

eviltwin

I've done similar work here, not in suicide prevention, but working with callers experiencing trauma. It can be very harrowing so well done volunteering. What is the supervision and support like in the States? My experience here was that there wasn't much care given to those on the front line, hope you are all well supported.

GalwayGrrrrrl

Thank you for your considered answer. Huge thanks for doing the role that you do, so critical in a time where mental health services are under-resourced ( in Ireland anyway).
I've one more question. For your Deaf clients, do you use a video chat system, and how does that work with regards confidentiality? In Ireland the Deaf community would be relatively small so people might be reluctant to use any service where they could be identified. The text service is great to provide a choice though.

TheZenMonkey

mfceiling wrote: »

Thank you for your work...you are doing so much good and I hope you get the full appreciation for your skills.

Thank you for saying so, and I'd just like to thank everyone for your very kind wishes; I'm not so good with the compliments so I am not ignoring them, just not quoting them.

Is the job similar to a negotiator? Do you try to build up a rapport...like get their name, age etc and build up a profile on them before you can offer advice?

I'd say the job is more like being a concerned friend. Most people who text in are not in immediate danger. They may be miserable or panicky or even thinking about suicide, but they don't have a handful of pills or a gun to their head. So yes, I definitely try to build up a rapport but it begins with simply listening to what they have to say, not judging them, validating their feelings, and letting them know that I hear and understand what they're saying. I also give strength IDs, like if it's the first time someone has texted in I will let them know how brave they are for taking that step. I do usually ask their name at some point -- it's different in every conversation -- but I only ask their age if I'm looking for age-dependent referrals for them. Usually it's not too hard to infer an age range from the things they talk about.

We actually try not to offer flat-out advice, because as I tell texters who insist upon it, they are the only ones who really know what's best for them. We do what's called "collaborative problem-solving", which means if they don't know what to do, I might offer a couple of suggestions and see if those lead anywhere. The answers should always feel like they come from the person in crisis and that you've simply led them to a place where they are able to make those decisions.

The only thing we do that you might call profiling is assessment of suicide risk. That entails asking a few questions like do they have a plan for how to end their life, do they have access to the means to carry out that plan, and are they going to do it within the next 24 hours. Most of the conversations I've had, phone or text, don't go past thinking about a plan. But there are, sadly, exceptions....

Are there times when the person is an immediate risk and what steps do you have to take?

Yes indeed. When the person can answer yes to all of those questions and refuses to agree to keep themselves safe by getting rid of the means, or by getting themselves to the hospital, they are considered in imminent risk and an active rescue may have to take place. This also happens if the person has already hurt themselves, say by taking that handful of pills before they contact us. In only those most extreme of cases, the counselor's job is to stay with the person and try to get as much information as we can. It's the supervisor who will look over the conversation and determine whether an active rescue is needed, and they are the ones who interface with emergency services. Every situation is different. I've had an active rescue where we knew that the police found our texter and they made it to the hospital. That was wonderful. I've also had ones where I never find out what happened. Those are probably the most difficult conversations you'll ever have.

TheZenMonkey

eviltwin wrote: »

What is the supervision and support like in the States? My experience here was that there wasn't much care given to those on the front line, hope you are all well supported.

Bravo to you for your work and I'm sorry to hear that you didn't get the support that you needed. As I mentioned upthread, while we're on the platform we get tons of support, from technical to emotional, from everyone else who's working, both counselors and supervisors. I may be sitting here by myself typing at 3am and the house is asleep, but I never ever feel like I'm alone. If you just completely freeze up on what to say, or if for some reason the conversation triggers you so emotionally that you can't handle it, there is *always* a supervisor who can either talk you through it or even take the conversation from you if necessary.

There are also a couple of different online communities for Crisis Text Line volunteers for additional support, self-care, and a real family-like atmosphere. A mostly very *functional* family, I should specify!

It differs depending on the specific place you're working, though. In the '90s, I was often flying more solo at SFSP than I was always comfortable with. I had either one or two other shiftmates, who were always helpful, but it wasn't a lot of us to deal with, sometimes, a lot of calls, and there definitely was not always a supervisor on-site (but always one on call in case of emergency, at least). In that case having people right there in the room with me was a big benefit. The management and supervisors were always terrific and I felt very welcome sharing my thoughts and feelings with them.

From what I can tell there is, overall, a lot more emphasis on caring for and supporting counselors today than there was 20 years ago, so while I did have a couple of unfortunate experiences at SFSP along those lines, I'm pretty certain things have changed for the better there.

TheZenMonkey

xfactorfan23 wrote: »

For your Deaf clients, do you use a video chat system, and how does that work with regards confidentiality? In Ireland the Deaf community would be relatively small so people might be reluctant to use any service where they could be identified. The text service is great to provide a choice though.

That is a really great point about the Deaf community in Ireland and I can see where that could be a problem! At this point we do not offer any video chat, though. It's all strictly text-based, and at SFSP there was a TTY line. Counselors are educated on the quirks of English that may crop up in a conversation with a Deaf texter (since English literacy among Deaf people in the U.S. is a travesty created by ill-meaning hearing people, but I digress), but other than that there's no way to identify someone in the d/Deaf community unless they identify themselves as such.

I think there could definitely be a place for a video hotline with the ability to sign with a volunteer, but even in the U.S. the Deaf community can prove surprisingly small, so privacy would still be an issue. Maybe counselors could somehow be matched with callers who are from different geographical locations or something. Interesting to think about.

Sabre0001

TheZenMonkey wrote: »

That is a really great point about the Deaf community in Ireland and I can see where that could be a problem! At this point we do not offer any video chat, though. It's all strictly text-based, and at SFSP there was a TTY line. Counselors are educated on the quirks of English that may crop up in a conversation with a Deaf texter (since English literacy among Deaf people in the U.S. is a travesty created by ill-meaning hearing people, but I digress), but other than that there's no way to identify someone in the d/Deaf community unless they identify themselves as such.

I think there could definitely be a place for a video hotline with the ability to sign with a volunteer, but even in the U.S. the Deaf community can prove surprisingly small, so privacy would still be an issue. Maybe counselors could somehow be matched with callers who are from different geographical locations or something. Interesting to think about.

That's interesting; could you expand on that? How would you like to see things changed?

TheZenMonkey

Sabre0001 wrote: »

That's interesting; could you expand on that? How would you like to see things changed?

That is something I could go on at length about, so I won't. It's a fraught subject, and I don't want to offend anyone on a tangent. (If I'm going to offend someone the least I can do is be on topic.)

This is a really good link from the Rochester Institute of Technology, whose National Technical Institute for the Deaf is an important educational institution. It summarizes the history well and I'm very much in favor of their philosophy regarding what kind of changes should take place and why. This is the kind of teaching I was lucky enough to be able to do, but at the college level it's a matter of fixing a situation instead of preventing one from the start.

If you'd like to discuss this further you're welcome to send me a PM and I'd be happy to do so.

Gloomtastic!

Hi, thanks for doing this AMA.

Does communicating through sign language proclude the sickos and time-wasters that seem to pollute the normal helpline channels? (my wife is a volunteer with the Samaritans)

What do you do as a day job?

Are people surprised when you tell them you are a suicide prevention volunteer?

TheZenMonkey

Gloomtastic! wrote: »

Does communicating through sign language proclude the sickos and time-wasters that seem to pollute the normal helpline channels? (my wife is a volunteer with the Samaritans)

I have only worked in crisis counseling over the phone, TTY, or text, never in sign language. I'm sorry to hear that your wife struggles with problem callers at the Samaritans. That can be frustrating.

What do you do as a day job?

I retired from teaching in 2009 due to my own disability. I do freelance proofreading and copyediting when I can get the work.

Are people surprised when you tell them you are a suicide prevention volunteer?

Sometimes, yeah. Their reaction seems to depend on their personal knowledge or imagination of what it's like to work at one. My favorite reaction (from someone who knows about my health issues) was something along the lines of "Your life is already full of misery, why would you want to do that?" The answer is because doing this is more uplifting, therapeutic, and spiritually satisfying than anything else I've ever done except teaching. ...and hang-gliding that one time.

miamee

I'd imagine that spending a lot of time speaking with suicidal or potentially suicidal people could be quite draining depending on your own mood on any given day. Do you have anything that you purposely do after a shift to decompress/distance your mind from what you've been doing/process a shift? Or is doing that naturally something that comes with experience? Volunteering in a similar service is something I'd be interested in but I'm afraid I'd take on a lot of the emotions of some cases/calls, if you know what I mean?

TheZenMonkey

miamee wrote: »

I'd imagine that spending a lot of time speaking with suicidal or potentially suicidal people could be quite draining depending on your own mood on any given day. Do you have anything that you purposely do after a shift to decompress/distance your mind from what you've been doing/process a shift? Or is doing that naturally something that comes with experience? Volunteering in a similar service is something I'd be interested in but I'm afraid I'd take on a lot of the emotions of some cases/calls, if you know what I mean?

I definitely know what you mean. If you have the empathy to want to do this, then you can be good at it, but empathy can also be draining.

One answer is that yes, experience comes into it. While you're gaining that experience, you're going to be very focused on things like how to correctly do a risk assessment, what are the stages of a good conversation and which one are you on, and basically trying to remember everything you learned in training (with hopefully a lot of support; on the text line we all help out the newbies as much as humanly possible). So it'll be the cognitive effort that's actually more draining at the beginning. If you do have a difficult convo you can't shake, at the text line you are encouraged to contact your supervisor to discuss it, or talk about it in a chat channel dedicated to debriefing, and you will get lots of support and understanding from everybody. This is all in real time.

It's also good to remember 1. Most people who call or text a crisis line aren't in immediate risk of suicide, and 2. the aim of the convo isn't to fix the person's problems, but to get them to a better place by the end of the convo. So yeah, you're going to hear some difficult stuff, but I can't even tell you how amazing it feels to know that a person contacted you in pain, and they're leaving feeling better. I find that balances out the negative aspects enormously. And when the volume is high, you almost don't have time to think about the last person's issues because you're immediately refocused on a new conversation.

(Here's a secret: it's actually easier to have a call with someone who's feeling suicidal than with someone who's just kind of unhappy and lonely and needs to talk. The first person wants to feel better. The second person will ramble for two hours if you let them, which you can't, and ending those convos can be frustrating and leave you with a feeling that you didn't accomplish anything.)

Finally, when I was an interpreter my wisest teacher told us, "Have ONE PERSON, who is not in the Deaf community at all, whom you trust completely and to whom you can tell everything." Interpreters, like crisis counselors, have an ethical responsibility to be confidential. However, we're also human. My husband was my one person since he did not socialize in the Deaf community and so would not recognize anyone from my debriefings. You won't get this advice on the text line, but I absolutely suggest the same thing, although in this case it's a lot easier to keep confidentiality. (And I'm far from the only one who does it.) I talk to him if anything -- a convo, another counselor, whatever -- was especially difficult. Getting it out like that really helps. Otherwise I pick whatever book, movie, or game will be fun but require concentration and thus provide distraction.

Boards.ie: Mark

Thanks TheZenMonkey for your time and insights, and for all the work that you do! Going to wrap this up now and we'll have another AMA live very soon.