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Content warning: This article contains discussion of depression, self-harm, and suicide.

The first time I texted into a crisis hotline in the middle of the night, I didn’t want to hurt myself. I just wanted to feel like someone, somewhere in the world, was on my side. I can’t recall exactly what I was going through—I was in my early 20s, so probably a mélange of general loneliness, a petty argument with my roommate, and mounting anxiety about something minor I’d messed up at work—but what I do remember is that I didn’t want to hurt myself. I just worried that I would.

At the time, every viable person in my support system was presumably asleep, and whatever I was going through didn’t feel big enough to warrant a random, 2 a.m. phone call. But I felt triggered, terrified of accidentally slipping back into harmful coping mechanisms I’d used as a teenager, and desperate for someone to help me stop my spiraling thoughts and get to sleep. So I sought out a hotline, and five minutes later, I was connected with a volunteer crisis counselor who introduced themself, asked about what was on my mind, and talked to me for nearly an hour about every small, horrible thing that had happened that day, why it all felt so overwhelming, and what I could do to take care of myself until I fell asleep.

My experience becoming a trained crisis counselor myself started the exact same way: during a really bad night. It was early on in the COVID-19 pandemic, I was unemployed and disconnected from my friends, and I just wanted to feel like someone was there. I texted into a hotline, and received a message that there was a slightly longer-than-usual wait time—thanks to the pandemic, more people than ever were texting into the hotline.

While I waited—panicked, restless, and lost—I went to the hotline’s website and clicked “Volunteer.” What I needed was a sense of connection, and maybe I could find that from the other side of a conversation too. The thought of it helped me calm down and step outside of my own mental spiral, and I was able to fall asleep before I was connected to a counselor.

The very next day, I officially started the application process; a few weeks later, my application was approved. I underwent 30 hours of training and was assigned an awesome coach who would serve as a mentor and support system. I was terrified before my first shift: Despite all that time and all that training, I still had no professional background in psychology or crisis intervention, and I worried I wouldn’t know the right thing to say to someone. Frankly, I was also concerned that my own mental health—which still felt precarious—would preclude me from effectively helping anyone else. If I was still learning to navigate my own lowest nights, was I really qualified to walk anyone else through theirs?

But as I started my first conversation, I remembered what propelled me to text in and apply to volunteer in the first place: that sense of loneliness and hopelessness, that desire for connection. I knew that if my texter was anything like me, they didn’t even want a long-term solution or mental health advice. What they really wanted was someone who would listen.

Although mental health hotlines saw a surge during the pandemic, they’ve been around for roughly 70 years.

Suicide and crisis hotlines first gained worldwide traction in the 1950s as more and more households started owning telephones, reports the World Health Organization. And while the practice and psychology of crisis intervention also had its origins in the 1940s and ’50s—psychiatrist Erich Lindemann is often credited with first popularizing “crisis theory” in the wake of a deadly Boston fire in 1942—these strategies weren’t initially employed by hotlines. (More on these strategies soon, though.) Rather, the first hotline in the U.S. was based on a simple tenet: empathy.

Bernard Mayes, who worked as a BBC correspondent and priest, founded America’s first suicide prevention hotline in 1962 in San Francisco. He put advertisements in local city buses and ran the hotline on just one phone out of his basement. People started calling, and they never stopped. “What was really needed was a compassionate ear, someone to talk to,” Mayes told The San Francisco Chronicle in 2012, two years before he passed away. “We had to have some kind of service which would offer unconditional listening, and I would be this anonymous ear.”

Soon after, many local and specialized hotlines started operating nationwide. Samaritans, a suicide prevention organization that now has branches around the world, opened its first U.S. branch, in Boston, in 1973. Thanks to funding from the city of San Francisco, Mayes’s hotline expanded in the ’70s and ’80s to a Drug and Alcohol Line, an HIV/AIDS Nightline, and a hotline specifically for young people. And in 1998, filmmaker Peggy Rajski joined forces with actors Randy Stone and Celeste Lecesne, and mental health professionals, to launch the Trevor Lifeline, a groundbreaking resource for LGBTQ+ youth around the world.

As these hotlines gained traction, another turning point came in 2004, when the U.S. Congress approved federal funding that led to the launch of the National Suicide Prevention Lifeline, a network of crisis centers and lines from all over the country. With the 2005 advent of the Lifeline, more and more people were able to find and reach local hotlines simply by calling 1-800-SUICIDE. In its first year, the network received 46,000 calls; by 2007, they’d taken nearly 430,000.

Over the past decade, advances in technology, funding, and support have helped these organizations reach even more people. In 2013, the Crisis Text Line became the first text-based nationwide hotline. In 2014, the Trans Lifeline launched, with the goal of connecting trans and nonbinary callers with trans and nonbinary crisis counselors; the same year, organizer Vanessa Green founded BlackLine, an anonymous hotline for BIPOC callers to both receive crisis counseling and report and talk through negative experiences with police and self-proclaimed vigilantes.

Even more recently, in 2022, the National Suicide Prevention Lifeline rebranded to the 988 Lifeline, with the goal of creating an easy-to-remember, three-digit number that people can text or call. When the new number debuted, there was a 45 percent increase in calls, notes Laura Erickson-Schroth, MD, a psychiatrist and crisis intervention specialist who works as chief medical officer at the The Jed Foundation (JED), a mental health nonprofit geared towards protecting emotional health and preventing suicide among teens and young adults.

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As mental health hotlines became more widespread, so did concerns about their practices.

After the (initially, mostly positively-received) launch of the 988 Lifeline prompted an unprecedented influx of calls, many people on social media started to warn that calling the number can lead to an “active rescue” or “wellness check.” This equates to police intervention or hospitalization—fates that can often be harmful or even deadly, especially for callers who are trans and/or people of color.

Today, less than two percent of calls to 988 involve emergency services, and representatives from the network say that over half of those happen with consent from the caller or texter.

However, this two percent statistic hasn’t really changed in the past five years, meaning that while it sounds like a small number of callers are getting the emergency services, once you factor in the recent surge in calls, it now equates to a much larger number than you might realize, noted reporter Rob Wipond in Mad in America, an online publication that aims to rethink psychiatric care.

The 988 Lifeline received over 4 million contacts during the ten-month period between July 2022 and April 2023, which means 81,000 people were connected with emergency services and potentially faced unwanted intervention.

At the Crisis Text Line, active rescues make up around just one percent of conversations, and are conducted in collaboration with texters. In these cases, crisis counselors loop in a crisis supervisor—that is, a staffed mental health professional—who helps de-escalate the texter’s conversation and comes up with a safety plan. If the staffed professional deems it necessary to conduct a wellness check, they talk with the texter to make that happen, says Shairi Turner, MD, MPH, the Crisis Text Line’s chief health officer.

With all this in mind, there are still reasonable fears about using these hotlines, especially from communities that are disproportionately impacted by police violence. Many people who call BlackLine mention that they’re scared of police intervention, says Green. “We never call the police, ever,” she explains. “A lot of people call us because they don’t trust the other [hotlines] that they know.”

Having this alternative is invaluable. Green also notes that many of BlackLine’s callers and texters are directed to the line by volunteers from 988’s counseling centers, specifically when they express concerns about the chance of emergency intervention. But it’s also important to note that, across hotlines, hospitalization or intervention is never the end goal—in fact, the goal isn’t even to find a solution to the texter’s crisis. It’s about listening.

“People in a state of severe emotional distress will develop tunnel vision. Talking with someone can really help them shift their way of thinking.”

“It’s not about having all the answers. It’s about connecting to [someone’s] humanity,” says Nova Bright, head of internal volunteer training at The Trevor Project. “That component of feeling with a real, live person and connecting with someone…that piece is more powerful than any sort of safety plan or road map at addressing in-the-moment crisis. Because more often than not, [that crisis] is loneliness.”

Connection can be life-saving, research shows.

Like me, Luisa Garbowit, 25, started her crisis counseling journey as a texter. She used The Trevor Project’s lifeline “two or three times” as a teenager, when she was going through a rough time. “Just having someone who listens to you, who is dedicating their time to you, who’s engaged in what you’re saying, who wants to help you—it’s so huge,” she says. “And I think when you’re younger, that doesn’t happen all the time.”

For LGBTQ+ people, having an option, like The Trevor Project, for immediate connection—even via an anonymous phone call—is particularly important. Bright points to the disproportionate number of queer youth in the U.S. with unstable housing. “LGBTQ youth are much more likely to be rejected, to lose homes, to lose relationships, to lose support systems, to lose jobs,” Bright says. “And when LGBTQ youth experience that type of rejection, they are desperately seeking connection to remedy it.”

But the mental health benefits from talking through crises can help anyone. From a biological standpoint, relying on others for support is “hardwired” into humans, says George S. Everly, PhD, a professor in the department of international health at Johns Hopkins University and author of The Johns Hopkins Guide to Psychological First Aid.

“Communities that cooperate and depend on one another and foster interdependence are the ones that invariably do better than those who do not,” Everly says. “People who are truly lonely have more health concerns, physical health conditions, and sometimes, even shorter lives.”

“My initial drive to start volunteering as a crisis counselor was to help other people, but I had not expected that it would help me equally.”

Basically, connection can be life-saving. And during a mental health crisis—which Turner defines as an emotional response that limits one’s ability to cope emotionally, cognitively, or behaviorally—communicating with another human being can stop someone from spiraling and panicking.

“Often, people in a state of severe emotional distress will develop tunnel vision. They’ll have a hard time seeing outside of their own immediate feelings,” explains Erickson-Schroth. “Talking with someone else can really help them not only feel more calm, but also shift their way of thinking and escape from that tunnel vision.”

There’s also research dating back to the 1960s showing that talking about your worries and problems can lower stress levels. Everly adds: “It’s not just a feeling. It’s a physical release.”

There are surprising benefits to being on the other side of a hotline call or text.

Angie Anaeme, 23, went through her own challenges before applying to volunteer with the Crisis Text Line. At 18 years old, she was diagnosed with alopecia areata, an autoimmune disease that causes hair loss; eventually, it progressed into the harsher form of alopecia universalis, which is characterized by complete hair loss. “That journey was really difficult for me—not only physically, but also mentally,” Anaeme says.

She started volunteering as a crisis counselor in 2020, inspired to help people who were suffering with loneliness and mental health crises amid the COVID-19 pandemic. But learning how to support texters also helped her as she continued to come to terms with her diagnosis. Going through both of these things at once “really emphasized how important it is to put equal importance on physical health and mental health,” says Anaeme. “My initial drive to start volunteering as a crisis counselor was to help other people, but I had not expected that it would help me equally.”

“The Crisis Text Line teaches you how to make people feel heard. That’s an everyday goal of mine, in almost any conversation. On the other side of the coin, too, I’m like, ‘Do I feel heard?’”

For me, it was uniquely gratifying when I was randomly paired with younger texters whose fears, problems, and anxieties mirrored challenges I’d also faced. I felt proud of my texters when they vowed to make it through just one night without hurting themselves; I was impressed by the high schoolers who were able to identify and verbalize their feelings, even if they didn’t know what to do about them. By treating their struggles and wins with the gravity and empathy they deserved, I slowly found myself gaining a new respect for what I’d overcome too.

How To Reach These Crisis Hotlines

Crisis Text Line: Text HOME to 741-741
The Trevor Project: Call 1-866-488-7386 or text 678-678
BlackLine: 1-800-604-5841
The Trans Lifeline: 877-565-8860
The 988 Lifeline: Call or text 988

These are common sentiments among volunteers, says Turner. “Reaching out, stepping outside of yourself, and helping someone else solve their problems can create an endorphin rush,” she says. The Crisis Text Line recently conducted a volunteer impact survey and found that nearly 90 percent of volunteers reported using techniques on themselves, within their relationships, and in their careers as teachers, leaders, and psychologists.

“The Crisis Text Line teaches you how to make people feel like they’re heard,” says Julia, 23, who volunteered as a crisis counselor in 2021 and 2022. “That’s pretty much an everyday goal of mine, in almost any conversation. Does this person feel heard? On the other side of the coin, too, I’m like, ‘Do I feel heard?’”

Garbowit was also able to implement crisis counseling strategies into her own relationships. “How do you validate someone? How do you ask the right questions to help them process their experiences, to help them feel like they’re not alone? It really is this amazing lesson in supporting people—not just in a volunteering sense, but also with people you love,” she says.

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How To Use Active Listening To Help a Friend

While the first crisis hotlines were centered on listening and empathy (and that’s still a key tenet of their strategy), many crisis counselors now follow specific, research-backed crisis intervention steps to guide a caller or texter from a low state into a calmer mindset. Here’s how these steps work, and how to use them to help a loved one or stranger in crisis.

Whether you’re helping someone over the phone, over text, or in person, the most important and first step is to create a safe space. A friend or family member might already feel safe around you, but with a stranger, this means building “trust and connection,” says Turner. Introduce yourself, express your interest in listening, and ask what’s on their mind.

If you’re physically with a person in crisis, make sure your cell phones and any other distractions are put away, advises Erickson-Schroth. If you’re helping someone from a distance, it might be a little harder to create a safe space—but you can gently check to ensure “that their biological needs are being met,” adds Bright. Ask if they’re able to go to a safe place and drink some water, and maybe even offer to start with a breathing exercise to regulate their emotions.

Whether you’re with a loved one or a stranger, don’t rush this step. “Black women are really struggling in this country, and a lot of times, Black women call [BlackLine] and just cry for ten minutes at the beginning,” Green says. “And so I’ve taught my [volunteers] to just sit with the discomfort of somebody crying.”

Crying, in and of itself, has many mental health and stress relief benefitsResearch has shown that shedding tears soothes intense emotional states and prevents that energy from turning into mental health problems. It can even cause your body to release hormones like oxytocin and endogenous opioids, which are naturally designed to ease pain. Giving someone the space and sense of safety to cry in front of you is imperative.

During my time as a texter, then a crisis counselor—and finally, today, speaking with other people who have used these platforms—I’ve always been really curious about the different ways in which volunteers end conversations. Some offer well wishes or thank the caller for their time and trust. Anaeme likes to ask her texters what they’ll do to take care of themselves after the conversation ends.

Every time I ended a successful conversation, I’d find myself thinking back to that first time I texted for help: how it felt to be alone at 2 a.m., with some anonymous person devoting their time and energy to making sure I felt heard and stayed safe.

With that in mind, I always closed my conversations the same way: “Somewhere out there, I’ll be rooting for you.” I knew that all those texters might not remember my name or anything I said; they might not even remember the specifics of what they were going through during their lowest points. Mostly, I just hope they remember that last sentiment—that someone, somewhere in the world, is in their corner.

An Active-Listening Script: Exactly What To Say To Someone In Crisis

Wondering what these crisis intervention steps might look and sound like IRL? Here’s an example of snippets of a texting conversation between two friends. Friend 1 is struggling with their mental health and Friend 2 is responding, using the steps outlined above to support them (with language approved by expert Becka Ross, LCSW, chief program officer at the Crisis Text Line), just like you can with your friends, family—or even a stranger—in the future.

Step 1: Opening the conversation and creating a safe space

Friend 1: Hi, I know it’s late but do you have some time to talk? I’m just totally spiraling.
Friend 2:
Hey, of course! I’m really glad you reached out to me. Are you in a safe place right now?
Friend 1:
I guess, I’m just in bed. My roommate’s in the other room, maybe I should shut the door.
Friend 2:
For sure, take the time you need—I’m here for you. It sounds like you have a lot on your mind. Was there a specific incident that made all of this come to a head?

Step 2: Actively listening

Friend 2:
From what I’m hearing, you’ve just had to deal with so much loss this past month: the breakup you mentioned, the loss of your family dog, even the friends you mentioned you haven’t seen at all the past few weeks. I think it makes total sense that you’ve been feeling so isolated.
Friend 1:
It’s just so much at once. I’ve been really lonely, I guess.
Friend 2:
Well, you’ve got me on your side, okay? But I understand why you’ve been feeling alone.

Step 3: Assessing risk

(Ex: Your friend isn’t at a high risk of self-harm)

Friend 2:
I know you’re going through a lot right now, and it’s been such a hard week. You mentioned earlier that everything feels pointless these days—I care about your safety, have you had any thoughts of suicide?
Friend 1:
Honestly, it’s crossed my mind a bit—I just feel so hopeless and alone. But I don’t have a plan.
Friend 2:
Thank you for telling me <3 I care about you so much, and I’m hoping I can help you stay safe tonight.

(Ex: Your friend is at a higher risk of self-harm)

Friend 1:
I feel really, really tempted to hurt myself. I don’t want to, but I just feel out of control.
Friend 2:
Thank you so much for sharing that with me—really. I know this might be scary to talk about, and it means a lot that you’re trusting me. You mentioned you were in your bedroom; do you have the tools in there that you would use to hurt yourself?
Friend 1:
Friend 2:
Would you be willing to put those in another room, just for right now? I want to help you stay safe as we text.

Step 4: Exploring solutions

(Ex: Your friend isn’t at a high risk of self-harm)

Friend 1:
Thanks so much for listening to everything :( I’m feeling a lot better, if you need to get to sleep soon.
Friend 2:
<3 We can talk as long as you need, but I’m glad you’re feeling better. Is there something you can do to relax and take care of yourself after we stop talking?

(Ex: Your friend is at a higher risk of self-harm)

Friend 2:
Also, I’m here to talk as long as you want, but I want to make sure you have a plan for after we’re done, too, since you mentioned you were worried about possibly hurting yourself. Is there anything you can do to make sure you don’t relapse?
Friend 1:
Talking to you has helped a lot, but I honestly don’t know.
Friend 2:
You mentioned that self-harm helps you feel a sense of relief. Maybe there’s something else that makes you feel that way? We can try to brainstorm some ideas together too.

Step 5: Ending the conversation with a warm close

Friend 2:
I feel really honored that you opened up to me about all of this <3 You mentioned trying some meditation—maybe you can text me again if you’re still feeling overwhelmed after that?
Friend 1:
That sounds good. Thank you so much :’)
Friend 2:
Always <3 You’ve got this. You can always reach out to me, I’m here for you.

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Lydia Wang
Love & Life Editor

Lydia Wang is the love & life editor at Women’s Health, where she writes and edits articles about sex, relationships, identity, and pop culture. She lives in New York and spends way too much of her free time reading romance novels in coffee shops and tweeting about her favorite dating shows.