The majority of people who call feel alone, or they really are alone. They feel disconnected from everyone in their lives. Sometimes the trick is just to connect them with someone in their life they haven’t connected with recently. —David Westbrook
A young woman sat on the Vista Bridge in Portland, Ore., this summer, legs dangling over the side of the high, arched concrete span that connects major hills across a deep ravine, a Portland landmark and a favorite spot for suicides. There is no water underneath.
But the woman's mind kept returning to a sign she had seen on the pedestrian walkway. The sign read, “Let us help you cross this bridge,” and it offered a toll-free number, 1-800-SUICIDE. The sign had been placed there by Lines for Life, Portland’s suicide prevention hotline.
Lines for Life is on the front lines of suicide prevention, the go-to call center for Oregon and a chunk of southern Washington. All calls to the national suicide hotline, 1-800-273-TALK, in that area are automatically routed to Lines of Life, as are a handful of other numbers.
Oregon is in the middle of a suicide pocket. All 10 of the worst states for suicide risk are rural Western states. Utah ranks 10th, tied with Arizona, according to the American Association of Suicidology. According to the statistics, suicide is overwhelmingly a white male problem. Rates for nonwhite males are half that of white males, and rates for women are 75 percent lower.
Last year, Lines for Life fielded 16,000 suicide risk calls and 35,000 calls total, which included calls about substance abuse and others from military vets or their families.
Despite its prominence in the suicide prevention community and strong track record, Lines for Life walks a fiscal tight rope. With funding dependent on corporate donations and local governments, the program struggles to keep its largely volunteer operation in place, especially in an era of economic stagnation and weak tax revenues.
If Lines for Life is understaffed or goes under, calls will automatically be bumped to neighboring jurisdictions, many of which are also financially stretched.
“We can’t afford to advertise our alcohol and drug or suicide lines,” said Lines for Life CEO Judy Cushing. “We are barely keeping the doors open here. So we just hope that people get the number somehow.”
Making the call
The woman on the Vista Bridge did make the call that night, and yes, operators were standing by.
A trained listener answered, and a long conversation followed. Steven Canova, the operator, finally persuaded the woman to swing her legs around and jump down to safety on the inside of the bridge. A crisis intervention team had already been called and was waiting at the end of the bridge.
“Steven literally talked and walked her off that bridge,” Cushing said.
Ten days later Conova came into Cushing's office and said he had just gotten off another call from the woman. This time, she called to say thank you. She was out of the hospital, was on her way to getting better and was going home to live with her parents.
Making a plan
"We get 16,000 calls a year. Each one is handled slightly differently," said David Westbrook, COO of Lines for Life and a pioneer in Oregon suicide prevention. “I don’t want to say most people don’t want to die. I would say that most people are ambivalent about dying.”
The objective in every call is help the caller form a real plan and then, if the caller is game, follow up with them on it, Westbrook said. The conversation may go something like this: “When we hang up here, you are going to call your Aunt Betsy who lives two miles away, and she is going to stay with you until your counseling appointment.”
Lines for Life operators are trained not to rush to find solutions. They listen patiently to the bad stuff first. They listen to reasons for dying before they suggest reasons for living.
“That’s a piece that very few people who aren’t trained are comfortable hearing,” Westbrook said. “It’s the muck, it’s the mud. We actually spend a lot of time listening to the reasons they want to die.”
In the course of the negatives, a positive sometimes emerges. “ ‘I want to die, but I’m concerned about my mother. What will happen to her?’ ” Westbrook says, citing one example. The key at that point is to work with that window of opportunity and expand it, Westbrook said.
“The majority of people who call feel alone, or they really are alone. They feel disconnected from everyone in their lives," Westbrook said. "Sometimes the trick is just to connect them with someone in their life they haven’t connected with recently.”
Crisis lines have been around for more than 50 years, Zeller said, but only recently has their efficacy been proven. For a study published in 2007, researchers at Columbia and Rutgers universities spoke directly with callers after the intervention. Most remarkably, Zeller said, 12 percent of those interviewed spontaneously reported that the call had saved their lives.
The study concluded that “seriously suicidal individuals reached out to telephone crisis services. Significant decreases in suicidality were found during the course of the telephone session, with continuing decreases in hopelessness and psychological pain in the following weeks.”
Perhaps equally persuasive are the police officers who come to them for training, and later on their own time to volunteer.
"The crisis negotiation team at the Portland Police Department volunteer here because we train them how to de-escalate with a severely mentally ill person," Cushing said. They have also trained other police and fire departments.
Police love them in part because they can reduce the burden on 911 responders. "When you push the buttons for 911," said Tom Parker, Lines for Life communications director, "you unleash everything.” Lines for Life is able to be more gradual and less costly in its response.
The difference between a 911 call and a suicide intervention is critical, and it's a skill set that police are anxious to learn, Parker said.
A national network
Lines for Life belongs to a network of 163 such operations around the country, said Eileen Zeller, a suicide prevention expert with the Substance Abuse and Mental Health Services Administration.
The national effort is coordinated by the umbrella nonprofit National Suicide Prevention Lifeline, which receives a grant from the federal government to oversee the local networks and monitor for quality control. The NSPL network is set for a landmark year in 2013, on pace to field more than 1 million crisis calls for the first time.
“Without the NSPL there wouldn't be a suicide prevention lifeline,” Zeller said.
NSPL oversees training and certification, samples calls to monitor quality and works with national suicide experts to write and improve standard procedures.
“We probably have the most extensive suicide risk assessment standard in the country,” said Dr. John Draper, project director for NSPL. “It is the industry standard now. We also have the most extensive policy on imminent risk.”
Nurturing and improving services with the 163 networked agencies requires constant effort. “We’ve had to replace some because they simply didn’t have the funding to keep going,” Draper said.
When local calling centers run out of funds, other crisis centers have to pick up the slack, and when that happens NSPL helps fund the centers that have to carry the additional burden.
“The more local public health officials can see to the funding of their local crisis centers, the more people can be helped in their community,” Draper said.