What it's like to work at a suicide prevention hotline in Memphis

This story is a collaboration between HuffPost and High Ground News.

Karen Crouch’s son never told her that he was contemplating suicide.

“He never said that he felt like he was losing a grip. I could hear it in his voice,” she remembers.

He was diagnosed with brain cancer at 15 and went through treatment immediately. But when he turned 21, the seizures — a symptom of his cancer — began resurfacing. They got worse when he drank.

“He would call in the middle of the night and tell me after he’d been drinking about how he felt like a failure and like he let me down.”

At the same time, Crouch was battling breast cancer. One day in December 2007, while Crouch was in the emergency room, she tried calling her son but go no answer. She dispatched a family member to check on him — they phoned later to tell Crouch they’d found him dead in his home.

“Needless to say, I checked out of the hospital and went straight to the apartment. Bald head and all,” she said. “Here I am going through all this stuff, all this poison going through my body, and all I can think about is how he’s in a safe place now.”  

Crouch found healing in volunteering at the Memphis Crisis Center. As a phone operator at the nonprofit’s 24-hour suicide prevention line, she offers empathy and compassion to some of the Mid-South’s most vulnerable people.

A volunteer since 2010, she joined the board in 2013 and also mentors volunteers in training.
“I knew that was how I needed to help,” said Crouch, who also works as an office manager at a local landscaping firm.

The crisis center is a small office space in the heart of Memphis with four phones and nearly 100 volunteers who work in shifts. The local crisis line serves a footprint in Tennessee, Mississippi and Arkansas, but volunteers are also connected to a couple national hotlines and field calls from across the country. There’s usually only one volunteer per shift, so the work is busy yet solitary.

Across the country, the suicide rate is up more than 25 percent, per a June report from the Centers for Disease Control and Prevention. In 2017 alone, volunteers at the Memphis Crisis Center handled 21,000 calls from Mid-Southerners in distress and de-escalated situations ranging from domestic abuse to self harm.

We sat down with Crouch to discuss a typical day at the crisis center and the challenges this local organization faces on the eve of its 50th anniversary.

What are the overarching problems the Memphis Crisis Center is trying to confront? Why is it necessary?
The reason it exists is so people can reach out for help. A lot of people don’t feel comfortable going to family or friends and letting them know they do have a problem. Sometimes, it is easier to go and talk to a stranger.
Call operators are not allowed to give out any personal information. You’re not to have any outside contact with the callers. It’s supposed to be strictly anonymous; otherwise, people wouldn’t talk to us.

What do you find, broadly, are people mostly calling about?
It depends on the season and what’s going on in the community. When you have a suicide that is publicized, we see an uptick in calls for suicide and people feeling like that. During extreme weather, cold or hot, people are looking for shelter. Holidays are tough — you usually see a real big uptick because people are feeling lonely and feeling like they can’t reach out.

We also handle calls on topics like adult abuse, child abuse, addiction, substance abuse, people with clothing and housing needs, children and adolescent issues, employment issues, calls related to HIV, LGBTQ, senior issues and rape crisis.

What are some steps that you go through to de-escalate a situation?
We don’t read from scripts. It’s all off the cuff. Speak from your heart.
In a critical situation, I ask if you have pills, can you put them away in a drawer or flush them? I ask if there is anyone else in the house with you? Can a relative or friend come over? Can you reach out to a neighbor to sit with you while you’re feeling like this? Then I say, “Well if I was there, if I could reach through this phone, I would give you a hug.”

I’ll try to get them to do some breathing techniques to get them to calm down. Especially, if they’re crying and it’s hard to understand them, I tell them to take some breaths and tell them we’re going to get through this.

What are the most important points you share with new volunteers when you facilitate training?
I tell them it’s not about their opinion; it’s about getting help to the person they’re talking to. So, listen and wait to see where their struggles are.

And we’re not professionals, but we can connect them with professionals. We’re just there to listen and help.

When a caller needs a professional, how does the crisis center operator connect them?
We use a program called iCarol. Depending on the nature of the call, the operator might click a link for medical issues, for example — that will give you a list of about 10 to 15 places the caller can contact. And it will bring up several options where you can put them in touch with different agencies if they don’t have insurance or money.

I definitely think we need some more mental health options. There are several facilities in town and in the tri-state area that are good, but sometimes it seems like there isn’t enough.

How did your family react to you joining the Memphis Crisis Center three years after your son’s death?
When I first started, I was working every Saturday and Sunday. So, I would work eight to 10 shifts a month, and I would spend a lot of time mentoring.

My daughter at first, she thought I was crazy. She said, “How can you do this and talk to people about suicide and everything so soon?”

I said I want to help somebody else so other parents don’t have to be in my shoes and feel like I felt. Just being able to talk to someone else and help them is healing for me. And after a while, my daughter finally came to me and said she was proud of me. Then she started referring the crisis center to people she knew that she thought we could help.

What’s an average day like at the call center?
We’re 24-hours, but I would say busiest time is probably between 5 to 10 or 11 p.m. Sometimes you get a spike. It can be driven by something on the news, and all of a sudden a lot of people are calling — especially if it’s a celebrity suicide. The day after Labor Day, we got more than 65 calls.
The shortest volunteer shifts are four hours. Overnight is about seven and a half hours. There’s a TV to occupy volunteers when they’re not on calls. No special offerings for overnight shifts, but we do have snacks.

A call can go from five,10 to 15 minutes. If it’s a critical call, like a suicide call, you could be on the phone for 30 minutes to an hour or more. As long as it takes.

Can you tell us about a call where you feel like you really made a difference in someone’s life?
I saved a person. I had one person in particular that was former military. He was paralyzed from the waist down, in a wheelchair, and I think he was in his late 50s, early 60s. He was at the end of his rope. Had a shotgun across his lap when he called, and he was ready to take his life.
I talked to him for a couple hours. At the end of the conversation, we went through all of the ups and downs of dealing with the post-traumatic stress. I actually had him laughing at the end of the call.

How do you know when a call was successful and it’s time to hang up the phone?
When they’re breathing good and start talking about other things, then I wrap it up by saying “Is there anything else I can help you with today?” If they say no, I say, “if you think of anything, give me a call back. There’s always someone here 24/7. Please reach out. That’s what we’re here for.”

How has the approach to crisis management changed since you’ve been a part of the center?
We’re having more and more sessions for the volunteers that are directed at certain things and specialized, like talking about child abuse or the elderly. I think they try to have a training every two months so you can come in and brush up on what’s the newest way to deal with this. We added one on opioid addiction. That’s a big one these days.

What are some of the challenges the crisis center faces?
It would be nice if we had twice the volunteers we have now. The ultimate would be having two volunteers on each desk, at least on the primary shifts during the day. I’ve had five calls come in at one time and you’re just one person trying to triage all of this.

Funding is always an issue. A lot of our funding comes from grants from local philanthropy.

What are some things you wish people better understood about the stigma around suicide and asking for help?
As far as other people are concerned, I wish they all understood that it’s okay to reach out, and it doesn’t make you any less of a person to reach out. There are lots of people willing to help all over the country. All you have to do is ask.

If somebody asks me for help, not only do I give them one resource, I give them two, three, four and I tell them try those and if it doesn’t work, call me back. We’ll get some more because we’re going to keep trying and go through every resource we have to get you the proper help that you need.

Because of the way people feel about suicide, and because there’s a stigma around it, I’ve had people ask me, “Do you think your son is in hell?” Absolutely not. I said the God I believe in forgives everyone — all they have to do is ask. He knows when someone is sick. He knows if they have mental issues, and my son had issues.

How does your organization cope with the emotional toll the work may have on volunteers?
For most volunteers, the experience is extremely rewarding, but we realize it can take an emotional toll. This is one of the reasons we emphasize the importance of self care in the training process. We want the volunteers to have the tools they need to maintain their own mental health.  

We realize that the emotional well-being of volunteers is paramount in providing quality service. We try to get together once or twice a year and have a potluck where all the volunteers come in and bring food and drinks around the holidays.

Of course, there are volunteers who develop compassion fatigue and other forms of burnout over time and sometimes they have to take time off from their service with us.

The administrative staff makes themselves available 24/7 for volunteers in case they need to debrief after a difficult call.  

This interview has been edited for length and clarity.

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.
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Read more articles by Madeline Faber.

Madeline Faber is an editor and award-winning reporter. Her experience as a development reporter complements High Ground's mission to write about what's next for Memphis.