9-8-8 (part two): What happens when you call or text?

Transcript

Transcript

[Healthy Canadians logo with pulse sound]

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Megan Beahen: Welcome to Healthy Canadians, your space for nuanced conversations and expert insights into the health topics that matter to us all. I'm your host, Megan Beahen. With me, Alex Newman, co-host and producer.

Alex Newman: Hi, Megan. So, today is part two of our two-part series on 9-8-8, the Suicide Crisis Help Line. In the first part, we talked about defining it, what is it, who is it there to serve, and all of those things, understanding the service better. But today, we're going to dig in a little bit more into what actually happens when you call. Who do you speak to? What things can you access? And what that all looks like.

Megan: That's right. I think it's going to be a bit reassuring to let people know what that experience really is and who you might be talking to. So, we're talking again to Dr. Allison Crawford and a responder from the helpline.

Alex: Absolutely. So, before we jump in, though, just a quick word from us. Although Healthy Canadians is produced by Health Canada and the Public Health Agency of Canada. What we discuss won't always reflect the official policies or positions of the government of Canada, but that's okay. These are conversations, not news releases.

Megan: Let's keep talking about 9-8-8.

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Megan: Maybe we can talk a little bit about what exactly happens when you pick up the phone to call or to text. So, let's say I get on the phone, I'm calling, Aaron picks up. You gave us a little bit of an idea what you offer, but could you tell us in practical terms, what does that conversation kind of look like?

Aaron: Yeah, that's a good question. As what I would say, usually, which can be a non-answers, every call is different...

[Laughter]

Aaron: But in general, in terms of the general structure that we've been trained in with 9-8-8, and what I usually go through, is that when you're calling after you get through the question of which service you want to access, "Are you First Nation, Indigenous, Métis, or Inuit?". And just those questions, you'll be greeted with a responder that'll say something like, "Hello, 988 Suicide Crisis Help. What are you reaching out for today?".

For me as a responder, I'll take the time to, again, give people the space to express what's going on, to give people that empathy, that compassion, that understanding, and just that space to express, to offload the things that they're going through. And after getting an understanding of what's going on and to give the caller the space to talk about what's been going on, most often I would usually paraphrase and say something along the lines, "That sounds like a lot of things that are going on right now... thank you for reaching out to 9-8-8, and I'll do the best I can to support you with what you're needing in this call".

So, once that happens, then I'll segue, usually into risk assessment. So, for example, I would sometimes say, "Hey, just to check in with you, I just want to learn more about what's been going on. Can I ask, have you had any thoughts on suicide in the past few days, including today?" Also, after they answer that, the other question would be, "Have you done anything to harm yourself today?".

So, those two questions are questions that all responders will be asking, regardless of the nature of the call. And the reason why we ask those questions is for us as a responder to understand the context, again, as the level of safety, right? Where that will help inform us in terms of how we approach the call. Because I know that some people would be like, "No, why are you asking those questions?". Well, for me as a responder, I just need to know so I can help you out as best I can.

As I previously mentioned, too, if there's any other risks that come up, like domestic violence, child abuse, self-harming, other risks, I'll ask those questions. Just like, "Hey, just to check in, too you mentioned these things". Just want to understand and just exploring those further. Once that's done, I then go into asking, "Hey, what are you needing from this call?". Where if someone's looking just for resources to support someone else, or if there's someone that is currently having thoughts of suicide and just want that emotional support, that's where I could get a gage of what they're needing from this call.

But in terms of, let's say it's like an emotional support call, that's where I go through that strengths-based approach, where I'm talking about coping strategies. "Hey, it sounds like, has this happened before?". If they have happened before, okay, what have you done before in the past to help you out with this situation? Also, kind of explored alternative options where it's like, "Hey, I know that you're thinking about suicide right now. What are some other ways that we can manage with this situation that's going on?".

Other things that I'd be doing is that validation piece, whereas, again, giving them the space, giving them the recognition that their experience is valid, right? That's where giving them that understanding that "I am here with you right now" and that "You don't have to go through this alone". Again, that piece that I mentioned of how this might be the first time they're reaching out is my through-line theme throughout this entire call is because I want to give them the space to know that this is a space that, again, instead of having to keep it inside and to have them struggle alone to feel that isolation, to feel that this disconnection, this is a space for a connection, right? This is a space for that empathy and that perspective-taking.

Because again, as Dr. Crawford mentioned, we have a lot of different tools. But I think equally as important is that connection and is that empathy and that relationship building in terms of the rapport building between me as a responder and them as a service user, to let them know that they are not alone. That itself helps so much in the calls that I've had. A little tangent, but in terms of some calls I've had where for them to tell I just needed someone to know that I mattered, that changes things, right? That changes people's outlook to know that they matter and that they are worth something and that there is someone out there that cares for them, right? That itself can be that life-changer.

Once that experience is explored and all that and that they're feeling a lot better, again, I offer that safety planning piece where if they mention anything related to suicide, that's where I offer if they want to develop a safety plan. People may not be as aware. Again, that's something that, as me as a responder, that's my sign. It's like, "Hey, we can talk about safety planning. This is important".

Just a little brief overview of what that involves is where it's a six-step safety plan where if you're having thoughts of suicide, this plan is something you can go through that can help keep you safe. It's individualized, right? Where we have a general structure of what that safety plan is, but that's where it's collaborative. I'm working with the service user to figure out what works for them and meeting them where they're at. But also, this is individualized for them and their life to make it so that they have that buy-in. They are willing to enact this safety plan when they're having these thoughts.

In terms of this safety plan, high-level overview is like, "Hey, what are the warning signs or the triggers for your thoughts suicide? What are your internal coping strategies? What do you do to distract yourself when you're stressed out? Do you listen to music, podcast, yoga, exercise?". That kind of thing. The next step would be, "Is there any people or is there any places that you can go or talk to distract yourself? Is there any people in your life that you trust to talk about this when you're in crisis? Is there any professionals or agencies that you can talk to during this crisis?".

Lastly, "Is there any way that you can restrict access to lethal means?". That's where if someone has a specific means to end their life, is there a way for us to either remove that from the premises or to make it harder for them to access so that they have the time to be like, "Oh, yeah, I have a safety plan. Let me have a look at that". Or like, "Oh, hey, I should probably connect with 9-8-8 because someone reminded me that this is why I'm doing this. Let me connect with them first before I do anything". That's that collaborative safety plan.

As well, an option that we have, too, is that we can offer some follow-up calls, again, based on the consent of the service user, where we can connect with them and check in on their safety, or if they want us to check in on them in the future, just to make sure, "Hey, how's things going since you last connected? How's your safety plan going? Is there any adjustments that we have to need to make to help this be better for you at this time?".

Once that's done, then I check in with them, just like, "Hey, how are you feeling now at the end of our chat or text?". Then once that's done, I just let them go upon their day. Most often, a lot of service users say, "Thank you so much for doing what you do". Even if they don't say that, I can just tell just by the tone of their voice from the beginning of the call to the end of the call, that it was an important interaction.

That's why I do what I do is to know that this is, again, sounds corny, but it is life-changing work. A little snapshot of just what a general structure of a call goes. Of course, there's different variations that happens. Hopefully, that helps people feel that comfort to know that that's what we should go through and that it's not about... it's like there's some structure with some flexibility in there, and that's how responders approach their work at 9-9-8.

Megan: It doesn't sound corny at all Aaron. It sounds beautiful. I think you gave a really good idea of what would happen. Really important details that make it a little bit less intimidating if you're planning to call, right? And so, thank you for that I think it's also probably comforting to know that if you called in, you could talk to that same person again or that person might check in with you again, right? So, every time you call you don't necessarily need to talk to a different person. Yes but...

Aaron: It might. We can't guarantee, although I will say that in terms of all, probably can't guarantee that's the same person...

Megan: Right.

Aaron: So that's where, just to give you that little piece, where kind of whoever's on shift at that time...

Megan: Right.

Aaron: Or was on shift that would be the person who makes the call. But in general, that's where we kind of want to facilitate that brief continuity of care, right? Where it's if we are concerned of someone where they have a safety plan, but there's still quite a few risks that we're kind of a little bit weary about. So, that's where we, even for us to check in, "Hey how are you doing?".

And I think something that I would say as well that hopefully can help people feel more comfortable calling in is where I am very aware, and I think Dr. Crawford is aware of this as well, is where people sometimes are afraid of calling or texting or just connecting with these services because they're afraid of emergency services...

Megan: Right.

Aaron: kind of intervening. And for me, what I can say is where emergency services is our last resort.

Megan: Okay.

Aaron: It's not our first resort. That's where, to be honest, there are a certain percentage of calls where we may need to activate emergency services but that is where it is our last resort. As responders and for us, even for me, it's where we do not take any joy in activating emergency services. We don't have a button to say, "Hey, emergency services" that's not how it works. We have things in place that we work through to make sure that we can support them in the least intrusive way.

So again, that's through just the model that we go through it's like, "Hey, is there coping strategies? Is there things that you do in your life that can help you out? Is there that safety plan? Can we collaboratively develop a safety plan with you to stay safe? Can we offer you a follow-up call? Is there a way for us to check in with you to make sure that you are safe?". So, there are things in place that we do before we reach that emergency services.

Again, as a service, we have that obligation to make sure that we're protecting your safety and the safety of other people, but it's also balancing the understanding that we want to make sure that this is the least intrusive way because, again, we are aware that emergency services can be traumatic for people. Kind of when they are involved with mental health sometimes so, that's where for us to try to do in the least intrusive way. Yeah so, I just want to also put that out there because...

Alex: It's an interesting point because I mean as much as it's very important for us to be having this conversation to, you know, I'm thinking of someone who might be listening who might be thinking they want to call, but it's... I can imagine it's a bit of a leap to make that decision to call for help.

So, I mean, both hearing the experience around what happens when you call is really helpful, but also some reassurance around stuff because yeah, and maybe Dr. Crawford you could speak a little bit to the privacy side of things too. And what are those responsibilities? And when would someone, a responder, need to trigger emergency services for example? Or privacy in general, what someone can expect when they call?

Dr. Allison Crawford: Yeah, well first, I just want to say that Aaron, wow! You hit all the notes of all of the things, but I think responders are also very skilled. They know that these are the things that's helpful to cover in a call because we know that those things are associated with good outcomes on calls, but they're able to weave that together in a conversation. I don't think that any responder really loses sight of that importance because the conversation itself is what establishes the connection and that empathy. They're doing all these things in the background, but I think that's really... and that also came through in what you were saying Aaron.

In terms of privacy, we take that so seriously on 9-8-8 because we know people are calling in their most distressed and often vulnerable moments. Everything that- first of all, people don't have to give any information that they don't want to give. So, we ask all kinds of questions, but it's really up to the person calling or texting what kind of information they want to provide. We also, within the network of providers, we have security of the information and don't share it outside of that network except under very exceptional legal circumstances, but privacy is very important.

And at the same time, on 9-8-8, we believe in saving lives and we believe in intervening. So, we know that in only a very few percentage of calls or texts, sometimes people need more than the responder can provide, and as a last resort we will involve emergency services. Again, just giving them enough information to intervene to save that person's life. So, it's really when someone's life is at immediate risk.

Alex: Well, thank you for that. I think it's important to understand, right? That because it's a potential barrier for someone to call.

Dr. Crawford: At the same time, I also think, you know, having 9-8-8, it gives people an alternative where they would have previously, or their family would have previously, used 9-1-1. So, this gives people an alternative that often works without... actually, that almost always works. It's really less than or it's around 2% of calls where we involve 9-1-1 so, in all those other 98%, the responders are able to help that person.

Megan: Thank you. So, 9-8-8 is one way to support someone who's in mental distress. Are there other things as well that people can do?

Dr. Crawford: Oh absolutely. So, when we're trying to support someone else, I think that we've talked a lot today about listening. So, asking, listening, being with... those are really-being with in a non-judgmental way. So sometimes, I think one of the unique things about 9-8-8 is not assuming people's experience and not jumping in with advice.

And that's something that we can all learn from, you know, that often we want... we care about people. We want things to be better for them so, we want to jump in with, "Well have you tried this?", "Have you done that?", "Well, this worked for me". Or, "These vitamins worked or this... have you?...", which can come across a) in a very overwhelming way and b) as, it's probably not what we intend, but can come across as judgmental. You know, if you did something else you would feel better.

Sometimes, just listening and validating, you used that word Aaron, validating someone's experience, you know, it's understandable what you're feeling. It's understandable what you're going through. So, I think that being with and listening without overly giving prescriptive advice, yeah.

Aaron: Yeah, and something I would say too is I can imagine that some people who may not be as familiar with crisis intervention feel they're not doing enough when they're just listening or just being with someone where they're on edge of their seat like "I want to tell them what to do!". But it's kind of counterintuitive, right? Where it's if you give them the space, if you kind of back off and just, "Hey, tell me more". Obviously, again, within your own capacity.

However, to be there to listen to people, being there with someone, that itself and having that space can be really beautiful. But also bridges that connection, right? And kind of gives them that permission to say, "Oh, someone's willing to listen to what I've been going through". Yeah, so, I wanted to kind of add that in where it's you're doing a lot just by listening. Even if it doesn't feel like you're doing a lot, you're doing a lot.

Alex: I think that's really helpful. I can relate to that too. I'm a person who likes to get in the weeds and try to fix problems. So, I've had that experience in my own life too where I've been super unhelpful, I'm sure because I'll just go in and say, "Oh no, you got to try this... do this, do that... let's solve this thing" when really I just need to kind of zip it and listen to loved ones too.

Dr. Crawford: It comes from a good place. I mean, as both, not just a psychiatrist, but an oldest sibling. That's really... I think we've all been there with our advice. There is, on 988.ca, how to have those conversations and also how to think about language, so some people find that very helpful.

Megan: Yeah, I think from talking with Aaron, it's clear that from your experience, that just the act of having that conversation with someone...

Aaron: Yes.

Megan: who's called and texted in is super helpful.

Aaron: Yeah.

Megan: So, Dr Crawford, maybe you could tell us at the end of a conversation by phone or by text on 9-8-8 what happens next?

Dr. Crawford: Right, so, I mean, it depends on the call and what that person needs, so we really value collaborating with the person who's calling or texting and letting them kind of take ownership over what they need and what they want to do. So, that's figured out on the call. We always tell everyone, you can always call again, so it's not a service you can only use once. It's not even a service you can only use once in one day. Sometimes we will encourage people to call back, or anyone can call back.

The other thing is, if as part of that dialogue, the person wants resources, we will work with them to figure out the appropriate resource. A very common one that we use is 2-1-1 because it's accessible in most communities in Canada, and they have a lot of detailed information. And then in some cases, if the responder does have ongoing safety concerns, and if the caller or texter consents to it, we will do a follow-up phone call just to check in. The one thing to say that the service is not, it's not a mental health navigation service. So, it's not the place that you would call if you want a referral to a service or if you want to speak to a psychiatrist or psychologist. But, you know, you can talk about that on the line.

Alex: And get some tips on where to find those services.

Dr. Crawford: Yeah, absolutely.

Megan: So, maybe we could close with some advice for someone who might want to call or text in, but they're a little bit hesitant...

[Laughter]

Megan: Aaron let's start with you because I can feel your energy.

Aaron: Yeah, I think the goal is definitely to support everyone, but I am also aware that some people will never choose to reach out, and I understand that, and I accept that, right? Where I think what I could say to the person who's hesitating and who's kind of ambivalent, right now, about whether they want to reach out or talk to someone, I think what I could say is to know that 9-8-8 exists. You may use it, you may not use it, you may continue to consider using 9-8-8. However, what I would say is that for 9-8-8 to exist, it means that there is someone there that can be there and ready and is willing to support you and to know that you're not alone.

I am aware of how hard it can be to think about these things and to figure out what you want to do. And as kind of what Alex mentioned, is where there's a big jump and a big leap between thinking about it and actually taking the action to call. It is not lost on me how hard it can be to pick up the phone to dial numbers and to stay on the line and to talk with someone or to text with someone. That is not lost on me. I am aware that you could end the text, you could end the call at any point.

But for me, in terms of the people I've interacted with, they choose to stay on the line with me because they are wanting help. We don't know what that help looks like, and that's kind of where we work together to figure that out, but what I can say is that for you to reach out that is a sign of strength. I know a lot of people can think of that as a sign of weakness and kind of the idea of this phrase, "How could you have let it get to this point?", but that's where for 9-8-8, we don't judge.

We know that people have lived a lot of experiences in their life, and I don't know specifically the people's experiences before they call or text, but I am very aware that things have happened in the past. In terms of experiences with just other people and just the invalidation that... I hope you decide to call and or text, whichever you're comfortable with, and to know that there will be someone with you in your corner helping you out and being there with you. We may not fix everything. We may not solve everything in that phone call or text, but again, just to have that conversation to let you know that you're not alone, I hope that is enough for you to consider reaching out to us.

Megan: Thanks Aaron. I feel like you would be a good person to have in someone's corner.

Alex: Yeah, definitely.

Megan: And Dr. Crawford, what would you say to someone who's not sure about whether they want to make the call or the text?

Dr. Crawford: Everything Aaron just said...

[Laughter]

Dr. Crawford: But I think, you know, there is a very well-known suicide prevention campaign that said, "Things get better", and I think that's... I always think about that and that doesn't necessarily mean things get better in the future, in 5 years, or 10 years, although certainly, we hope that's the case.

Things can get better in 15 minutes, and sometimes that is what makes the difference between somebody thinking about ending their life and deciding to end their life. And so, call. Just know things get better. Just the course of that conversation can help things even just get a bit better and to be accompanied through that really difficult time. So, number one, just call or text. We really want to connect with you.

Megan: Beautifully said thank you. Thank you, Aaron. Thank you, Dr. Crawford. Thank you for joining us in this conversation today. I think people are going to take away a lot of practical information but also, we got to know a little bit about Aaron and what it's like and how supportive it is to call in so, thanks so much for your time today.

Dr. Crawford: Yeah, thanks for having us.

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Learn more

• Get Help | 9-8-8: Suicide Crisis Helpline
• Get Help Here: Mental health support
• The Centre for Addiction and Mental Health | CAMH
• Hope for Wellness Helpline
• Get support with these mental health resources - Kids Help Phone

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