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FRAMINGHAM, Mass. — Don smiled when he saw who was calling. He usually works the overnight shift at a suicide hotline call center outside Boston, so he knew she’d be surprised to hear his voice on a Saturday afternoon. When he said hello, the caller answered the mandatory first question before he could even ask it: No, she wasn’t feeling suicidal today. She’s been calling the crisis line regularly for years for support, so she and Don have a rapport. “What, are you having a party for 988?” she joked.

In fact, they were. Don and the other staff and volunteers showed up in person on Saturday not only to field calls, but to celebrate — complete with a 988-frosted cake — the launch of the new, shorter dial number that connects people around the country in crisis with trained mental health counselors standing by to help. 

The national line is answered by a sprawling network of over 200 local, independent centers that also answer calls to their own direct lines. Each state now has at least one center to handle calls to 988 that come from its own area codes. The call-takers, who are primarily volunteers, are trained to de-escalate deeply emotional situations over the phone, and try to connect people to more comprehensive mental health support when they’re in acute crisis. 

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988 cake
On July 16, volunteers and staff at the Call2Talk center in Framingham celebrated the launch of the new 988 number for the national hotline to prevent suicide. Kayana Szymczak for STAT

It’s work that crisis call centers have been doing for years. But the easier-to-dial number — and the flood of attention it has brought to the lifeline — will, experts hope, encourage more people who need support to seek it. 

On Saturday, as calls came in, the assertions of active listening floated around the room. “You sound like a strong person.” “That’s not your fault, what happened to you as a kid. And you’re a good person.” “It’s okay, you can cry.” “You sound concerned.”

At any given time, two to four people were on the phone at the Framingham center, named Call2Talk. Some of the call-takers work full-time in behavioral health services, while others volunteer for the lifeline because of how rewarding the work feels.

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“We’re not here on earth rent-free,” said a call-taker named Jane, who, like other volunteers, is only being identified by a first name to protect their anonymity while answering calls. “I’m making my contribution to the rent.”

The work of call center staff and volunteers will grow all the more important as use of the national hotline picks up. Eileen Davis, director of Call2Talk, said the number of calls over the first weekend of 988 was already almost double what they receive on a typical weekend. And while some call centers said they didn’t see any change in volume with the launch of the new number, the Department of Health and Human Services expects the volume of calls to the national line to double in the first full year. That kind of surge could tax a mental health care system that’s already severely strained, and direly underfunded. 

As Steven Adelsheim, a physician and researcher at Stanford University, put it: More pressure from hotline callers only emphasizes the need to shore up the system of care that supports them. “We would never say, once we found someone with asthma — ‘Sorry, we don’t have enough providers to take care of you, so we’d rather not know,’” he said.

Call2Talk mental health helpline
Notes from callers who have found support from the Call2Talk center hotline. Kayana Szymczak for STAT
Volunteers and staff field calls to both the local Call2Talk number and the national suicide prevention hotline. Kayana Szymczak for STAT

Call2Talk has been open for almost a decade, and about a dozen people — including Don, the night manager — have been working there about as long. Unlike many call centers across the country, Call2Talk operates almost completely in-person. The main office is a small but welcoming space, with tight desk stations clustered around a plush, oversized armchair. And the atmosphere on launch day for 988 was lighter than one might expect for a hub that handles life or death situations. 

At one point, a group of call-takers stood around the armchair debating the best donuts in the area, while a colleague sat nearby, deep in conversation. It’s emblematic of the kind of camaraderie and solidarity that helps call-takers get through difficult and often emotionally taxing shifts. 

And no matter what’s going on in the office, the moment a call-taker signals that they need quiet, the room snaps to attention. 

“For the vast majority of callers, the call is the intervention in itself, and that’s what’s so powerful about the lifeline,” said Colleen Carr, director of the National Action Alliance for Suicide Prevention. Someone doesn’t need to be suicidal to call 988 — call-takers often speak to people about grief, addiction, trauma, anxiety, depression, and more. In many cases, what people need is simply company, or affirmation. 

On Saturday, one call wrapped up right at the end of the call-taker’s shift. Just minutes later, a new call came into another station. It was the same person the last call-taker had been on the phone with, who wanted to say thank you for the conversation.

Whether someone calls regularly or is reaching out for the first time, the call-takers believe it’s important to make some time for people who need to talk, even if they aren’t in acute danger — especially when one conversation could be exactly what keeps them out of acute danger. More often than not, call-takers can suggest something for the caller to do to help them feel better, a step as simple as a shower or a walk to change their frame of mind.

But when someone is in true danger the moment they’re on the phone, “all bets are off,” said Eddie, a retired police officer with a thick New York accent who fields calls at the Long Island Crisis Center.

a photo of headphones, a clipboard, and a cellphone on the desk of a call2talk volunteer
Volunteers and staff at Call2Talk can provide a valuable ear to callers in crisis. Kayana Szymczak for STAT

Typically, call-takers are cautioned against sharing personal information about themselves to keep the focus on the caller. During one shift, though, Eddie found himself talking to a retired firefighter who had been at the World Trade Center on 9/11 and was in an acute suicidal crisis. Eddie broke from custom. He told the caller about how he understood, as a former officer, that there are things you can’t unsee. He may not have understood the caller’s exact situation, but he could hear what he was saying. “There was a bond then,” Eddie said and the caller allowed him to call emergency services.

There are some crises that call-takers can’t address alone. Two Call2Talk callers in an acute crisis on Saturday night needed more comprehensive care than a phone call could provide. Both times, the callers collaborated with call-takers to find the best course of action, which might include sending a mobile crisis unit to make an in-person clinical assessment, or referring them to other behavioral health services, Davis said. Davis said it’s uncommon for police to be involved in responding to calls that come into the center, a possibility that has sparked concern. Out of the 100,000 calls that Davis’ team will take this year, less than a handful of calls typically require that they contact emergency services without the caller’s consent — it only happens in situations where the caller has expressed they are in immediate danger of ending their own life and don’t want to seek further help.

In these cases, “the call centers are only as good as their referral networks,” said Polina Krass, a pediatrician and researcher at the Children’s Hospital of Philadelphia who wrote about the potential for 988 to de-criminalize mental health. If mobile crisis units are not available, a trip to the emergency room can result in an expensive bill and weeks-long waits for inpatient care.

At another Long Island center, the Family Service League’s Diagnostic, Assessment, and Stabilization Hub (DASH) has licensed behavioral health professionals who answer calls to both the national lifeline and their local line, with support from mobile crisis teams and their own treatment alternatives to hospital-based care. Jeffrey Steigman, who leads DASH, believes this holistic approach is the proof of concept that mental health crises can be appropriately treated without the police. But since police do still receive calls that involve a mental health crisis, DASH also started a program to divert relevant 911 calls to their own crisis line.

The eventual goal for the 988 Suicide and Crisis Lifeline is for each local call center to have access to a similar network of mobile crisis units and other options for safe intervention when a caller is at immediate risk. But few states already have those resources set up, or reliable streams of funding to build and maintain them. 

In Wyoming, which has had the highest suicide rate in the country in recent years, there are two crisis lines in the state that split the answering duties for the entire state by time of day. “Wyoming has won the race that nobody wants to win,” said Ralph Nieder-Westermann, who runs Wyoming Lifeline. As a big state with a small, widely dispersed population, he said, it’s proven difficult to roll out mobile crisis units that have been successful in dense areas like New York.

Even small call centers with lower call volume can struggle to keep up with demand for their services. Wyoming Lifeline, which answers calls for the entire state between 2 a.m. and 4 p.m. daily, received 111 calls in June, the most they’d ever gotten. They missed 16 of those calls — but that’s an impressive rate compared to the national state averages.

In theory, no calls will go unanswered — if every call-taker at a local center is busy, then calls are routed to national backup centers. Like Call2Talk, many centers have been able to hire staff for the first time with the influx of federal funding funneled to the states, though many also told STAT that more money is needed to meet the overwhelming need. 

Even before the 988 rollout, some call centers said they were already busier than ever before. Call2Talk team members said that before the pandemic, they’d occasionally have lulls without any calls coming in during a shift. That doesn’t happen anymore. They are working to build their staff and volunteer numbers to closer to 10 people answering calls at any given time, which would almost double their current average. 

While the number is new, the people wearing the headsets are the same trained, passionate listeners. One call-taker in Framingham told STAT that she is a survivor of a suicide attempt. She never shares that information with callers, preferring to keep the focus on them and their needs. But the experience is always part of who she is when she’s listening.

If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.

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