Today's guest post is part 1 of a series that looks at the gaps in our current mental health care system and provides information on how to fill those gaps on an individual basis. This piece is really the epitome of the category, "What Can I Do?" It gives us the tools we need to face problems far larger than we can control on our own.
CN: in depth discussion of suicide and suicide ideation, mental health crises, abuse; brief mentions of disordered eating, addition, and police intervention.
I tend to get frustrated with mental health “awareness” campaigns. Look, I mean, I know they’re well-intentioned. And I know people want to help the people they love, and that’s awesome. Beyond that, awareness campaigns encourage people to reach out and ask for help, which is also important! So, in and of themselves, awareness campaigns wouldn’t bother me. Getting accurate information out there is good, and encouraging people to ask for help is fine.
But, still, they do bother me. Mainly, I suspect, I get bothered because the campaigns miss the clear, key issue that’s escalating the mental health crisis in America, which is pretty straightforward: the need for comprehensive mental health care and treatment far outpaces the resources we have available, in over half of American counties.
People who are struggling with mental illness are asking for help-- sometimes over and over again! But, for too many of us, the main result of asking for help seems to be getting put on wait lists, stuck with an over-worked therapist who can only see us once a month, or incredibly urgent in-patient hospitalized care, with difficulty accessing follow-up treatment upon discharge.
The United States Department of Health and Human Services estimates that almost 111 million Americans currently live in areas with a “severe mental health professional shortage,” (source).
Some patients wind up putting themselves at financial risk in order to afford copays, or even entire out-of-pocket costs, for private practitioners. And, as mental health issues intersect with poverty-- since mental illness can often make it difficult to hold down a job or achieve higher levels of education-- private practitioners are off the table for a lot of the people who live here.
We’re in the middle of a mental health crisis, and poster campaigns telling people to ask for help aren’t working. What does work?
Using a Crisis Hotline
Currently, I’m a certified volunteer at the Crisis Center in my county. Here, the crisis center runs a lot of community programs, but the main place I work in is the phone room. If someone from this or a nearby county, calls one of the national hotlines we’re affiliated with, that caller gets rerouted to us. We get calls through the National Suicide Hotline, RAINN, addiction hotlines, and others, in addition to answering calls to help navigate serious-but-not-immediately-urgent local situations, usually things like housing insecurity or connecting with free legal aid services.
Like most of the employees and volunteers here, I was once on the other side of the phone. Back in 2012, during my Sophomore year of college, I became overwhelmed. Stress from dealing with a chronic illness, challenging classes, living with roommates in a dorm when I’m a private person, and the slow dawning realization that I might actually flunk out of undergrad began to wreck my mind. I began fantasizing about suicide.
Instead of acting on my impulse, I found a flyer for the local crisis line number and called it.
If you’re able to find the number for your local crisis line, it will almost always be easier than calling in via the national number; national line callers are often put on hold up to forty-five minutes, whereas people calling their local number directly generally have their call picked up right away.
The decision to call in wasn’t easy; like many people, I was afraid I’d be judged-- that my thoughts were too extreme, my issues weren’t serious enough, or that I’d put myself in a vulnerable position only to have an outsider confirm that my problems are genuinely unresolvable. But, I felt I had to tell someone, and laying everything out in front of a stranger seemed easier than telling anyone I knew in real life.
It helped. A lot. The crisis center counselor helped me process and unwind the intense fear and despair that seemed to be tightening around me, a process that took more than an hour, until I felt, if not exactly calm, then at least farther from the brink. At that point, we were able to start brainstorming an action plan, one where I took the lead in coming up with people I trusted and solutions that worked in my life in other circumstances. Ultimately, I made a short-term plan to draw and listen to music until I fell asleep, and a longer-term plan to schedule an appointment with my primary care doctor, tell her how I was feeling and possibly get a referral.
The crisis counselor asked if I wanted her to call me the next day to follow up and make sure I made it through the night okay. I said yes, which wound up being a good suggestion. There was a degree of positive motivation, then; If I got through the night, I could hear from her, and I could let myself feel-- however slightly-- proud of myself. And, she’d be proud of me too. That little extra motivational boost helped me stick with the drawing-music-sleeping plan until the next day. When she did call back the next day, everything seemed clearer; if the day wasn’t exactly bright, it was, at least, only metaphorically overcast compared to the previous night’s hurricane.
By September of 2017, I had improved significantly, mental-health-wise. I had successfully gotten treatment for my illness, and I had graduated from college--a year-and-a-half late, but still! I was diagnosed with obsessive-compulsive disorder, and while I wasn’t able to get in to see a psychiatrist, I was able to work out a solution where I met with a CBT therapist and had my primary care physician prescribe my medication.
The crisis line and the follow-up literally saved my life; a pain that seemed inescapable, actually had, in retrospect, more than one way out. I’m grateful that I found someone who could lead me to that door.
Working as an Emotional Paramedic
2017 was the year I enrolled in the 100-hour class to train and get certified as a crisis counselor in my own right. While I was in training, I discovered that every single volunteer and paid staff counselor had a position similar to mine: at some point in their lives, they struggled with a mental health crisis, they were trapped in an abusive situation, or they were overwhelmed by stress and had turned to harmful coping mechanisms like addiction or disordered eating. And, for each of them, working with a crisis counselor was a turning point that helped them figure out and stick with a plan, connect to local resources, get out of their crisis situation and move into a more peaceful life.
While we do have repeat callers, the average caller only needs to call 1-to-3 times to get out of a crisis situation.
Contrary to a frequent fear, we do not call the police or paramedics, even if someone says they’re suicidal unless it is immediately necessary-- for example if someone says they have already poisoned themselves in a suicide attempt.
If a person is just thinking about suicide, even if they’re serious, we won’t call 911 unless they want us to. The only time police would be involved is if someone directly threatens homicide, which, unfortunately, does sometimes happen. But, this is rare.
If a person concludes for themselves that they need inpatient treatment, we offer means to connect them to hospitals with psychiatric services nearby, or we help them come up with a plan to get a friend or loved one to drive them. The vast majority of the time, the crisis can be eased or resolved without coordinating with 911 or a hospital at all.
Generally, once a person is able to process their emotions and feels truly heard and validated, they are able to work with us to prioritize their problems and come up with concrete steps to solve them. This may involve connecting to local government or non-profit assistance programs, or it may be as simple, though not easy, as identifying people they trust in their lives whom they can ask for specific help from.
Crisis counselors don’t exist to replace long-term mental health care, just like paramedics and emergency rooms aren’t meant to replace primary care doctors and specialists. The existence of crisis counselors shouldn’t be considered “good enough,” from a political standpoint. Shortages on mental health care professional and problems that make access a challenge for many of the people who need care the most necessarily require solid, long-term resolutions from all angles.
How to Be Part of the Solution
If you’re interested in training to become a crisis counselor in your own county, Google “crisis centers in [your county],” and see if yours has a website with information about enrollment. The National Suicide Prevention Lifeline has a page where you can look up all 150 affiliated crisis centers across the country; RAINN also has a list of partnered crisis centers that you could potentially contact to enroll in volunteer training.
Not everyone has the time to enroll in a class and commit to a set number of volunteer hours, and that’s okay! Everybody has their own life stuff going on, and it’s important for volunteers to be able to make good on their time commitments so that the phone rooms don’t end up inadvertently understaffed. In the remaining parts of this series, I’m going to write about how to use the strategies crisis counselors use to help your own friends and community members informally, no official training required.
In Part 2, I’ll cover how to:
Master the three C's: Calm, Competent and Compassionate
Check for signs of immediate danger or abuse
Maintain your own safety and boundaries during the conversation
Learning the methods crisis counselors use to help others interpersonally can be a great way for people who have tight limits on their time to help meet mental health needs in our communities. But, I do want to throw a caveat out there: it is okay to not do this.
Helping a friend or loved one through a crisis is serious emotional labor. It involves, more than anything, remaining calm and open, even when someone is spiraling and saying hurtful things. If you tend to “absorb” the emotions of those around you; for example, if they’re scared, you start feeling scared or nervous as well, or if helping a specific person in a crisis will be too challenging for you because of your history with that specific person, or because of your own current emotional state-- you’re not under any moral or ethical obligation to do this. You are neither a trained, committed volunteer nor a professional.
If you don’t want to help someone through a crisis personally, but you do want to have something on-hand to give people when they are spiraling, panicking, or suicidal, here are a few options:
Pleaselive.org has the current numbers for many national hotlines. Despite the categories dedicated to Christianity*, the abortion lines and LGBT lines are legitimate, pro-choice and pro-LGBT support numbers.
*I suspect that for demographics in many rural parts of the country-- the same places that have fewer accessible mental-health resources, having Christian-centered phone lines are helpful. After all, people are more likely to call someone they trust, and it makes sense that a person who centers Christianity in their life is more likely to trust someone on a Christian line than on a secular helpline since they know they have their religious and cultural mindset in common.
If you want to be equipped and ready to help someone before a crisis starts, it can help to have a list of numbers printed out and keep the paper on hand, perhaps folded up in your wallet or purse. Adding the local crisis line number and lines for numbers for, say, local emergency homeless shelters, food assistance, or legal aid, can improve the helpfulness of your list.
It can be empowering to be able to say something like, “I feel for you, but I can’t be the one to help you right now. But, try calling some of the numbers here; the counselors there are professionals, and they’re more likely to really get you the help you need.”
That way, you’re able to draw a boundary and acknowledge that you’re not the best person to help your friend, but you are able to give them something, so they still have an opportunity to try to get the help they need. The act of believing that a person in crisis has the inner strength to call a crisis line themselves can be remarkably encouraging to a person. It is a good choice.
Whoever chose to put up the flyer with my own local line’s number helped me a great deal, and choosing to give the same tool to others can genuinely help them too.
If you want to go further and learn how to use crisis counseling strategies yourself, please check out:
About the guest blogger: Lucy Merriman is a poet and artist living with her friends in Ohio. Her poetry has been printed in Pif Magazine, and her personal blog, Welcome to Tree City, is a fun place where she interviews artists, posts contemporary art criticism, and is generally trying to figure the big stuff out. You can also find her on Instagram on @merriman_lucy. She likes people! She probably thinks you're pretty neat.