A Call for Help
211 Hotline offers a lifeline for those overwhelmed by life’s challenges.
This is not your typical telephone answer center.
The small, unassuming space is, by design, quiet and Zen-inspired. There are no raucous bells or cheers to celebrate success; gentle chimes signify an incoming call. The energy of the space is purposely intended to be calm, amid the storm. Using measured and reassuring voices, the highly trained call specialists of the Mental Health Association of Frederick County Call Center provide a lifeline to those who are struggling with a range of mental health issues.
This 24/7/365 call center provides information, referrals, support and crisis intervention to residents from northernmost Montgomery County all the way west to Garrett County, although the majority of calls originate in Frederick and Washington counties. Some of the calls are from people simply in need of reassurance or information. Others come from those in the throes of a suicidal crisis. In between, the Call Center supports the MHA’s Telephone Reassurance Program that provides outreach to isolated seniors, some of whom may have outlived their children or welcome the opportunity to say things to the specialists that they can’t say to anyone else.
The MHA Call Center began in 1990 as a part-time service for children home alone after school. Nearly 30 years later, that service has now expanded into a multi-pronged regional intake center for mental health calls that are routed from several different sources, including the National Suicide Prevention Lifeline, Maryland Crisis Hotline and Maryland 2-1-1, which provides connections to local mobile crisis teams.
Twenty years ago, the Call Center averaged less than 10,000 calls a year, according to Suzi Borg, director of MHA’s Community Support Services division. In 2017, it answered more than 46,000. Staffed by two paid specialists and, on occasion, a volunteer or two, every call is carefully documented, both to ensure funders that the center is fulfilling its stated mission and also to track where the greatest needs are so that future resources can be allocated to address them.
Thanks to a combination of public and private support, all of these services are offered free of charge to callers. MHA has contracts with some of the organizations for which they take calls, but those barely cover the cost of the Call Center’s utility bills. “The National Suicide Prevention Lifeline pays us $2,500 a year,” Borg says. “That is why we rely so much on multiple sources of funding.”
Those sources include state agencies such as the Maryland Department of Health’s Crisis Hotline as well as local government grants, including Frederick County’s Community Partnership Grants. But Borg says the MHA Call Center also relies on the strong support it gets from private foundations, businesses and individuals. “There is a whole lot of generosity in Frederick County,” Borg says.
Answering the Call
When people hear the term “mental health hotline,” they often assume it’s only for suicide prevention. But the MHA Call Center serves anyone in need of support and reassurance. At one end of the spectrum, that may be someone who simply needs an empathetic sounding board or a referral to resources that will help reduce stress in their lives. On the other end is the person who may be contemplating suicide.
“We have three main categories of calls,” says Julia Webb, MHA resource manager. “Supportive listening calls are those where we provide people with a chance to talk about what is going on in their life and to express empathy.” She says calls often come from people who struggle with chronic mental illness. Whether it’s helping them through a panic attack or providing a reality check, “They may call episodically or multiple times a day,” she says. “Sometimes just verbalizing what is on their mind helps them ‘off-load’ and get clarity.”
The second type of calls falls under the category of information and referrals. Using an extensive database of regional providers, call specialists can refer callers to community resources that can help them address the challenges that are affecting their mental health. These include problems such as potential eviction, transportation, health care, energy assistance, etc.
“One of the key messages we try to communicate is that people can call anytime, even when they are not in crisis,” says Linda Myers, the MHA’s Telephone Reassurance and Call Center Training Program coordinator. To help spread the word about MHA’s services, Myers regularly reaches out to numerous community groups who are dedicated to addressing the needs of the elderly, veterans, the homeless and others. She says Frederick County is fortunate to have a robust network of nonprofits that work well together to serve those in need.
The third category is the most challenging: the crisis and suicide calls. Borg says the MHA Call Center takes one of these calls every four to five hours. They range from callers who are contemplating suicide to those who are actively engaged in trying to kill themselves.
Although all calls to the Call Center require careful listening, crisis calls present special challenges. “Some callers will say outright that they are thinking of killing themselves, but we are also trained to listen for cues, such as if they say, ‘I’m so tired’ or ‘I just want this to all be over,’” Webb says. By asking open-ended questions to assess other risk factors such as substance use, poverty, physical or sexual abuse and the like, the call specialists are trained to evaluate the caller’s intentions. “We are very comfortable with saying the word ‘suicide,’” Webb says. “We don’t dance around it by saying things like, ‘Are you thinking of hurting yourself?’ We leave no room for interpretation.”
If a caller is having suicidal thoughts, the call specialists will help them develop a safety plan. “Part of preventing suicide is helping them realize their own risk,” she says. So the call specialists will ask a series of questions designed to help the caller identify opportunities to get help nearby and/or separate themselves from the means of suicide.
“Simply talking to someone is intervention,” Webb says. That is why, if the caller agrees, an MHA call specialist will follow up with them the next day to see how they are doing.
Ask the Second Question
It goes without saying that it takes a special person to provide calm counsel to those struggling with life’s challenges. But there are two basic skills that are non-negotiable: listening and empathy.
Webb and Myers say, first and foremost, call specialists must be exceptional listeners. “There is no script for our calls,” Myers says. “This is an endlessly variable experience. But it starts with listening to hear what they need, because you don’t want to give someone a rake when they need a pillow. They have to know how to listen and then ask the second question.”
By using open-ended questions and reflective statements, such as, “It sounds like that is really important to you” or “I just want to clarify,” call specialists strive to build a rapport with their callers. By communicating back to the caller what they are feeling, the call specialists convey a sense of empathy that many callers hunger for. “You want to communicate that you get what they are feeling,” Myers says.
Several call specialists started with MHA as volunteers while they were pursuing undergraduate or graduate degrees, often in fields such as psychology or social work. “If you are in a program in either of those fields, it is hard to find good hands-on experience that teaches the skills you will need in the profession,” Borg says. “Working in the call center provides a level of exposure that is unlike most anything else.”
But successful call specialists are not limited to those with a formal education in social or health sciences. Sometimes people with a personal connection to mental health, such as those who have a family member with a history of mental illness, want to get involved. And Webb says that, stereotypes aside, “Bartenders are good at listening, multi-tasking and de-escalating. Those are all skills good call specialists have.”
Whether volunteer or paid staff, call specialists undergo more than 50 hours of training. In addition, they must complete training established through the State of Maryland on how to handle calls related to substance use and abuse, including what it looks like and how to respond. This has become especially crucial since Borg estimates that the Call Center now answers a substance use-related call every 9.5 hours. These are not just calls from the substance user, but also from family members who need support.
Caring for the Caregivers
Given the toll their work can take on their own well-being, call specialists are always supported by a shift supervisor who helps them debrief and process difficult calls or even actively assist by calling 911 or poison control while on the line.
In addition, Myers says that assessing a candidate’s ability to engage in self-care is a big part of the interview process. “Whether they run, do yoga, meditate or journal, we want to make sure they have a way to channel their emotions,” she says.
With the average call lasting about 10 minutes, the Call Center offers several on-site “de-stressing” tools that help the call specialists regroup and relax, including coloring books, puzzles and playful nerf ball toys.
Call specialist Jane, who is not using her real name, started volunteering for MHA’s Call Center several months after she lost a friend to suicide. She holds a bachelor’s degree in psychology, has worked as a supervisor at a residential facility and is now a full-time employee for MHA. “A lot of my friends say that they couldn’t imagine doing this job, but I actually think that one of the reasons so many of our call specialists have been here for so long is because we are in it together—for the callers and each other,” she says.
One of Jane’s co-workers, Mary, also not her real name, has been a specialist for 15 years. She, too, began as a volunteer. She now trains and coaches other specialists. Over the years, she has taken her fair share of difficult calls, yet she says the more challenging the call, the more satisfying her work is to her. “So many people have problems and there aren’t people who can meet their need,” she says. “But I’ve always been good with dealing with crises.”
Unfortunately, however, not every situation ends happily. For Mary, the only thing worse than sad outcomes are unknown outcomes. “When you are trying to save someone who was going to kill themselves, the hard part is when you don’t know how it was resolved,” she says. “It leaves you wondering, did they carry through with it?”
Despite the challenges of their work, the call center specialists see some bright spots, among them the growing trend to remove the stigma around mental health. “Younger people seem more comfortable with reaching out,” Jane says. In 2017, more than half of the Call Center clients were under the age 50. “Some of it might have to do with social media posts that normalize the need for mental health care. But whatever it is, when they do reach out, they are often surprised at the number of resources available to help them.”