How Lived Experience is Changing the Face of Crisis Centers
By Courtney Brown
--
At San Francisco Suicide Prevention we start every new volunteer training class with a story about the importance of lived experience. When our founder, Bernard Mayes, was first searching for office space in 1962 there were no volunteer-based suicide prevention services in the United States. No landlord in downtown San Francisco was willing to house an experimental service that would be accommodating contact with the suicidal, even if it was only ever over the phone.
Bernard visited dozens of office spaces, but the mere mention of suicide eliminated any possibility of a lease. After weeks of searching, he noticed a ‘For Rent’ sign in the window of a basement apartment beneath a tattoo parlor. The stocky, guarded man who answered our founder’s ring was at first skeptical about Bernard’s interest in the dark and cramped space. But once the word suicide was uttered his tone changed entirely.
“Like this?” the man asked, revealing the long scars along his wrists. As an attempt survivor he not only understood and believed in our mission, but also offered the lease at half price.
Lived experience of suicide is the reason why suicide hotlines are able to operate. Our volunteers are working professionals, parents, caregivers, and students with a variety of other responsibilities, but still they dutifully attend their weekly four-hour shifts. When asked why they pursued this work and why they so reliably continue, they don’t speak of selflessness but of need. To have once felt the impact of suicide is to need to connect to those still suffering.
When I started as administrative staff at San Francisco Suicide Prevention in the summer of 2012, one of my first duties was to clean and digitize decades of former volunteer information. As I shredded past applications, I noticed a pattern. The volunteers who disclosed past suicidal thoughts during their interviews were also the ones who remained as volunteers the longest.
“Lived experience of suicide is the reason why suicide hotlines are able to operate.”
This realization contradicted accepted wisdom within volunteer recruitment. I’d heard from some sources that accepting volunteers with potentially traumatic memories of suicide was dangerous. The combined burdens of lived experience and supporting those currently at risk were thought to be too much for anyone to handle. Such volunteers were said to be frequently triggered, struggle on calls, and be unreliable.
Anecdotally, I noticed the opposite to be true. Those with close exposure to suicide, if anything, seemed empowered by the work. Even with our strict non-disclosure policies during calls, the formerly suicidal volunteers intuitively knew how to develop profound rapport with at-risk callers. The words paraphrased, emotions reflected, and insights offered were uniquely accurate. Most of all, there was a demonstrated respect for those at-risk. Their support wasn’t paternalistic, but gracious. Volunteers with lived experience expressed a sincere reverence for their callers, and were more likely to note appreciation for the at-risk’s wisdom. Callers could feel this respect, and it encouraged them to better respect themselves.
With this in mind, I began crunching data. I wanted to know if my conclusions were biased, or if it was true that volunteers with lived experience had increased resilience for the work. I cleaned and coded lived experience and call data from the applications of 381 past and present volunteers. The results were illuminating.
The easiest metric to evaluate was retention. We ask that all volunteers sign on to a minimum 200-hour commitment, in order to justify our long and involved training process. While the baseline completion rate among the 381 volunteers evaluated was 62%, attempt survivors completed the commitment 72% of the time. Those who said they had helped a loved one through a suicidal episode completed the commitment 73% of the time. Based on this data, it seemed as if those who were previously exposed to suicide found exposure more sustainable than those who hadn’t.
Next, I compared lived experience to a more subjective qualitative metric. As part of our training process we set up all new recruits with our most skilled veterans as mentors. Volunteers qualify to become trainers based on high marks on in-person evaluations, reflecting good contact practices. Only 28% of volunteers are asked to become mentors. I found that over 50% of our attempt survivors were mentors, along with 40% of those who had helped a suicidal friend or family member. On closer inspection, those with lived experience were also more willing to assess for suicide, and were less focused on problem solving.
All of the data suggested that those with lived experience were particularly tenacious and competent, but I felt none of this mattered if it harmed them in the process. Next I surveyed current volunteers, trying to find out how working at the hotline had affected their mental health. I expected ambivalence, that at best our volunteers would say the work was difficult but worthwhile. At the time of my survey we had over 120 volunteers, and the 67 who answered all had lived experience, whether they had personally felt suicidal, helped someone with suicide or lost someone to suicide. Instead of the responses reflecting increased burden on mental health, the volunteers described improved mood and well being.
It turned out that the coping techniques taught in classes were as beneficial to volunteers as they were to callers. In the survey one volunteer noted,
“Working on the hotline has become one of my self care tools. After every shift, I feel like I’ve kept true to my life’s purpose of helping those in crisis. Whenever I have negative thoughts toward myself, I like to counsel myself as if I were counseling a caller.”
A common theme of survey responses was that kindness towards callers inevitably yielded kindness towards one’s own self. One volunteer explained,
“Taking calls doesn’t always make me feel better, or put me in a positive mood, but it does help me get back in touch with my core values when I’m preoccupied by life stressors. It nudges me to use empathy and listen, it reminds me that life is made of a series of choices, and it gives me some perspective that often brings gratitude.”
Lived experience isn’t beneficial to a hotline unless it’s also de-stigmatized. If a suicide hotline doesn’t nurture a community culture of disclosure, then volunteers at risk will not be willing to tell staff. In our training classes, we note that if you become suicidal while volunteering, the supervisory staff is a willing and dedicated support system.
In our training classes, willing staff will share their own struggles with suicide, and create space for volunteers to do the same. Once normalized in the classroom, disclosure continues into our call room. One volunteer shared,
“My own suicidal ideation, suicide attempt and mental illness have allowed me to share and teach my fellow volunteers. I honestly think that this has improved the quality of their work because they can understand emotional and psych difficulties from someone they trust, someone who is so much like them. My presence has “normalised” our callers for many of our volunteers.”
Having volunteers with lived experience in the call room provides suicidal callers an internal advocate for best practices.
This only works if suicidal ideation will not be penalized. At San Francisco Suicide Prevention, if a volunteer is suicidal they are given the option of taking a break, but it’s not mandatory. For many, continuing to help is a necessary part of healing, and being unable to answer calls will only increase feelings of powerlessness. Instead, supervisory staff will perform regular check-ins, assessing for triggers and adequate self-care.
Since instituting this policy, many volunteers have come to me talking about their own suicidal thoughts. Based on our conversations, some have decided on hospitalization or outpatient treatment. Those who have continued volunteering following treatment cite the experience here as part of the reason they had hope enough to continue living.
An attempt survivor who has contributed to San Francisco Suicide Prevention in many capacities shared,
“The work of helping others has profoundly improved my own mental health because I’ve had the opportunity to help other people. I remember back to a time where I felt worthless, and never in my wildest dreams thought that I could actually help anyone. My self-esteem has risen dramatically in the 7 years since I took my first call on the crisis line.”
Those with lived experience have a tremendous amount of resilience. By supporting their work on hotlines, we’re not only facilitating the recovery of our callers, but of willing caregivers.
Courtney Brown started in suicide prevention work as a volunteer at San Francisco Suicide Prevention in 2011, and has since held many staff positions including Volunteer Coordinator and Hotline Coordinator. As the Hotline Director she uses her background in psychology research to evaluate and implement optimal recruitment, training and crisis support techniques.
If you’re involved with a crisis center and interested in joining the Lifeline, a network of over 160 crisis centers around the country, please email lifelineinfo@mhaofnyc.org.
If you or someone you know is struggling with depression or thoughts of suicide, reach out. The Lifeline is available 24/7 at 1–800–273-TALK (8255).
