Texting during a crisis has become a modern lifeline for millions, providing immediate support when it’s needed most, especially for young people. Crisis Text Line provides a free, confidential, and discreet service, offering assistance to anyone experiencing a mental health crisis. Whether through text, SMS, web chat or WhatsApp, trained counselors are on-hand 24/7, year-round, transforming mental health care support. Shairi R. Turner, MD, Chief Health Officer, Crisis Text Line, shares how the organization combines empathy with innovation to offer mental health support.
Guest:
Shairi R. Turner, MD, MPDH, Chief Health Officer, Crisis Text Line
Host/Producer: Carol Vassar
TRANSCRIPT
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Where do you turn when the world overwhelms you? When loneliness, anxiety, or depression take hold and friends and family aren’t available or aren’t willing to help? That’s a moment when you can look at your phone’s keypad, enter the numbers 741-741, type the word HELP or, in Spanish, AYUDA, and hit send. Doing so connects you to a trained volunteer mental health crisis counselor from Crisis Text Line who will provide you with a listening ear and direction on where to go next. Here to talk about the work of Crisis Text Line, its happenstance start, its intersection with the National Suicide and Crisis Lifeline, and how it provides information on mental health trends. In the U.S. is the organization’s Chief Health Officer Dr. Shairi Turner. Founded in 2013, Crisis Text Line was among the first text-only crisis platforms as Dr. Turner explains.
Shairi Turner MD, Crisis Text Line:
Crisis Text Line is a national nonprofit organization that provides free 24/7 confidential text-based mental health support and crisis intervention in English and in Spanish for anyone in the United States or Puerto Rico. So anyone can text HELP or AYUDA to 7-4-1-7-4-1 and receive support from a trained volunteer crisis counselor who’s supervised by a mental health professional. We only use texts, so SMS, web chat, and WhatsApp to give that on-demand access to mental health. We were founded in 2013 as one of the first text-only crisis support lines. No one was really doing text-based support at that point. Most were telephonic suicide hotlines, and we wanted to be about crisis. So we say a crisis to you is a crisis to us. So, the full continuum of crises, including suicide, and we wanted it to be accessible in the moment by text. Over the past 11 years, we’ve supported over 11 million conversations and our vision is an empathetic world where nobody feels alone, and our mission is at the intersection of empathy and innovation, we promote mental well-being for people wherever they are.
Carol Vassar, podcast host/producer:
How did this idea come about? In 2013, this was pretty unique, having somebody available to speak with when a person is in crisis and do it by text. Whose idea was this? How did this come about?
Shairi Turner MD, Crisis Text Line:
Yes, so our founder and CEO at the time was leading another organization that was working through text to mobilize young people to volunteer. So there was a lot of outgoing text messaging to young people to get them involved in volunteer opportunities, when there was an instance where somebody texted back asking for help and support, and it just sparked an idea for our founder that after a lot of research, she was able to determine a text-based support doesn’t exist like this across the country and just had this amazing idea and launched it and it took off from there.
Carol Vassar, podcast host/producer:
I think it’s important for us to say throughout the podcast that people can text 7-4-1-7-4-1, and that’s a particular… Just go right up from the bottom, the middle numbers right there, to get in touch with one of your volunteer crisis counselors. We’re going to talk about that in a moment, but I want to raise the issue of today’s youth mental health crisis, and it’s notable that 70% of the people who text Crisis Text Line are under the age of 25. How do you work with teens and young adults to point them toward the mental health services that they need and maybe get connected in their own community?
Shairi Turner MD, Crisis Text Line:
At Crisis Text Line, we know that young people are facing a mental health epidemic. We know especially young people of color are facing a mental health epidemic, and it affects all aspects of their lives: their education, their well-being, their safety, and their ability to thrive and develop and have relationships. And we developed Crisis Text Line as a unique platform for teens in particular because we know that 88% of teens in the U.S. have or have access to a mobile phone and 90% of teens communicate via text messages. So, at this point, they’re digital natives who feel very comfortable and confident reaching out for support through a text-based modality. Now, you or I would think, like, “I’ve got to talk to somebody on the phone when I’m in crisis, I’ve got to hear a voice.” And it’s actually the opposite for them. They’re so comfortable on text, they really don’t want to hear voices.
What we’ve done through our training is to teach our crisis counselors. We give them a 15-hour really robust training, and we teach them how to support people because Crisis Text Line is for anyone, 8 to 80, it doesn’t matter. But we teach our volunteers how to support people on a text just using text, right? So how do you explore the strengths, identify coping strategies in those moments of distress and de-escalate the situation and help them really to go from a hot moment to a cool calm? Part of that training and part of what the volunteer crisis counselors do is they provide resources and data from our database, and we have over 720 resources in English and in Spanish that help with whatever the topic may be.
Now, young people, our texters text in about depression, sadness, isolation, loneliness, anxiety, stress, relationships, substance abuse and more. And we have more than 470 national resources in English and 250 in Spanish. And our volunteers know that after they de-escalate the conversation, they offer the text or something else that they can have in their phone that’s relevant to that moment of crisis, whether it’s about bullying or eating disorders or any of the topics I listed, the texter will have a resource to pull back up if they are in need.
Carol Vassar, podcast host/producer:
Do you train the counselors on the tone? Because as you and I are talking, you can hear the tone of my voice, the way I’m going up at the end of a question. That can be lost in the text world. How do counselors go about interpreting that and doing it correctly in crisis?
Shairi Turner MD, Crisis Text Line:
Right. It’s a skill, right? The key tenets to the training are developing an ability to project and reflect and be empathetic, to actively listen, to collaboratively problem solve, and to safety plan, and all of that in the context of cultural competency because you don’t know who the texter is necessarily, right? We teach them words and ways to put together words and reflecting back to the texter what they’re hearing as a way of creating that human-to-human connection that’s so important and that demonstrates empathy. And it doesn’t replace tone, but like I said before, younger people aren’t looking for tone, I think in the way that we do. They’re, in fact, “Does this person hear me?” And when you take someone’s words and reflect them and magnify them and share them back and say, “I hear you, this is what I’m hearing you say,” that’s very powerful, and it can cross that digital divide in a way that’s effective.
Carol Vassar, podcast host/producer:
I’m curious about the counselors as well, all volunteers, as I understand it. How do you vet the counselors, make sure that those in crisis who text 741-741 are receiving the services that they ultimately might need? I know you did mention the training.
Shairi Turner MD, Crisis Text Line:
Yes. Anyone of any profession over the age of 18 who wants to help someone in crisis can fill out an application on our website, which is CrisisTextLine.org, and they will go through a background screening, and once they are accepted into the training cohort, they go through a robust 15-hour training that’s purely virtual, interactive, self-paced, in the privacy of their own home so that they can be free and accessible and learn at their own pace. And during this time, they’re assigned a volunteer experience success coach, and this is a person on our staff who is there to answer questions, help them with their training, and then after they complete the 15-hour training, they do a shift simulator, which is an opportunity where we use machine learning and AI to create something similar to what it would be like on the platform so they can practice.
Because we heard back from our texters way back at the start of the inception of Crisis Text Line that going from taking a training to actually supporting someone in crisis was frightening, as you might imagine. So this shift simulator allows them to try out the language and get a sense and kind of find theirself in this space. And then when they’re on the platform, our mental health professionals, our crisis supervision, our crisis supervisors are always there in the background reviewing their conversations, available for help and support. If it’s a unique situation or they get stuck and aren’t sure, they can flag, they can put up a little flag and ask the supervisor a question, and the supervisor’s there at all times. So they’re never alone when they’re supporting someone who’s in crisis.
Carol Vassar, podcast host/producer:
Which is great because that probably helps with their own mental well-being in terms of the volunteers because these can be intense and challenging conversations, can’t they?
Shairi Turner MD, Crisis Text Line:
Yes. So we have found, we actually did a study with our volunteers, and it was incredible because what they told us was just doing the training gave them the tools not just to support texters on the platform, but also to have these conversations and support their friends and their family members and enhance their relationships because we all can use tips and tricks on active listening and collaborative problem-solving. So they found that it both enhanced their relationships and helped with their own mental health, well-being, resilience, and ability to just cope. So it’s this benefit. We know that, just in general, helping others always has a rebound effect on the volunteer. But the skills that our volunteers gain from this training, it’s like a web that just penetrates out into communities because they’re able to support family and friends and themselves in difficult conversations and situations.
Carol Vassar, podcast host/producer:
Now, texting we’ve established is unique. It’s probably more used by adults, but as you said, 8 to 80, and I’m sure beyond, you do serve. How does the Crisis Text Line approach intervention compare to other intervention methods or models like phone hotlines or in-person services?
Shairi Turner MD, Crisis Text Line:
Our training was modeled off of the hotlines initially, but we have found, and there have been some studies done about Crisis Text Line as compared to telephonic models, and it’s been determined that we are equally as effective. We are able to provide the same level of service and care, and that our texters are equally as satisfied with the services that are provided by Crisis Text Line via text as those who used to utilize the telephonic hotlines.
Carol Vassar, podcast host/producer:
Many of us are familiar, and there was a big launch about two years ago of 9-8-8, which is the National Suicide and Crisis Lifeline. How do you intersect with them? Do you intersect with them? How is your service different?
Shairi Turner MD, Crisis Text Line:
So yes, in July 2022, the National 9-8-8 Suicide and Crisis Lifeline was launched for 24/7 suicide and mental health support. Now, we had been working with SAMHSA, so Substance Abuse and Mental Health Services Administration, federal government that had those funds, and with Vibrant Emotional Health that was the administrator because, as you recall, this used to be the National Suicide Prevention Lifeline, which was mainly phone, but it was a network of call centers across the country that made sense as we made this transition from the 1-800 number for National Suicide Prevention Lifeline to a 9-8-8 that you utilize that same network.
So, Crisis Text Line joined the National Network of Crisis Centers in order to support 988. We are what’s known as a National Backup Center for 9-8-8 for text and chat in both English and in Spanish. As you can imagine, not all states and centers were prepared to take text or chat. Everyone knew there was going to be a preponderance of text and chat. Crisis Text Line has been available and working closely as this backup center so that we can take a proportion of the texts so that people don’t have to wait as long. The texts get diverted to us, and Crisis Text Line, our staff are trained so that it doesn’t matter whether someone texts into a 988 center in their state or wind up with Crisis Text Line, the experience is identical or will be identical.
Carol Vassar, podcast host/producer:
So you have a very strong role in that national hotline?
Shairi Turner MD, Crisis Text Line:
Yes, absolutely.
Carol Vassar, podcast host/producer:
And the text and chat portion thereof.
Shairi Turner MD, Crisis Text Line:
And we maintain at the same time our 741-741 service. So they are two distinct services, and then we really see it as complementary. So our 741-741 service can provide a higher level of anonymity or for those who have used Crisis Text Line and have that established trust with us already. So just like the postal service, UPS, FedEx, there’s a lot of people in a space because there’s need. Unfortunately, there’s a high level of pain and crises. There’s enough to go around and we want to be part of that solution to support it, whether it’s as the backup to 988 or through our 741-741 service.
Carol Vassar, podcast host/producer:
Crisis Text Line also collects, I’m sure, gobs and gobs of data on the mental health crisis here in the U.S., whether it’s the youth mental health crisis or just, in general, the crisis of loneliness. That seems to also be a major issue in our nation. How do you leverage that data to inform public health responses and mental health initiatives to again alleviate some of that suffering?
Shairi Turner MD, Crisis Text Line:
So that’s a great question and that was part of the unique concept that the founder came up with from the beginning. So we have data and insight back from 2013 because we were able to collect it. Now, how do we collect it is a very important conversation because data, people’s personal information, is very private. So what we do after the texter has completed the conversation and been deescalated is receive a link for a voluntary post-conversation survey that’s completely anonymous and confidential, and about 21% of our texters completed it. It does give us a statistically significant amount of conversation data, since we have over 1.3 million conversations every year and we never collect personal information. And that texter survey really gives us the information about demographics. So race, age, the topic of conversation, that high-level information that’s so valuable, but is not personal to the texter themselves.
And then the volunteer will complete a post-conversation survey as well. Really just looking at what were the topics discussed and what were some of the resources provided. Now, with that information, we’re able to partner with leading researchers in the field of mental health to both validate the impact of our service. But we also have moved so far as creating reports. So, for our volunteer survey, we do a United and Empathy report every year, which is a state-by-state summary of the issues and the topics and the ages that people in our country and our texters in our country are facing.
We are overseen by an institutional review board, so very rigorous. We have a research and impact team that leads the research, that collaborates with other organizations because we want to provide this information to help our nation, to help people who are in crisis. We want to advance the policy and advocacy initiatives to improve access and the quality of mental health resources. So we want to be part of that solution-building through what we feel is really relevant and, in the moment, recent data. You don’t have to wait a year. We can tell you during any specific period of time what’s going on with texters in our nation, and we want to share that so that researchers, so that academicians, so that public health professionals, anyone who’s working to advance and help individuals who are in crisis can utilize that information.
Carol Vassar, podcast host/producer:
It sounds like you’ve got de-identification built in, but you’re still getting the aggregate data that’s going to give you trends and ways of looking at how people are calling in, why they’re calling in so that you can better serve and others can better serve those in need.
Shairi Turner MD, Crisis Text Line:
Yeah, we focus, Carol, on safety, privacy, confidentiality through encryption, access control, intrusion detection, and really making sure… And I say all that so that people feel confident that their data, their information is very private and it’s safe and secure because we prioritize that.
Carol Vassar, podcast host/producer:
So what are the trends? What are you hearing about nationwide that really concerns you?
Shairi Turner MD, Crisis Text Line:
I mentioned before our United in Empathy Report that we put out every year, and last year, we analyzed over 1.3 million conversations. The majority of those, as you stated, were under the age of 25, and what people were texting about categorically anxiety and stress. Those were the top issues that our texters reached out for, and that was closely followed by relationships, depression, sadness, suicide, isolation, loneliness. Sadly, we were seeing also, because we look at trends, self-harm started to reach a new high over the past three years. It was climbing along with a steady increase in bullying. So, post-pandemic bullying for the third consecutive year after schools reopened is a hot topic for young people.
Carol Vassar, podcast host/producer:
Something for those in the field who want to alleviate these issues to really look at and consider seriously. We have a few minutes left. I’m curious about the technological advancements. Have there been any in terms of AI or any innovations in digital mental health support that you’re excited about, that you’re looking into, that you’re considering?
Shairi Turner MD, Crisis Text Line:
We’re really excited. We have an engineering product and design team as part of our staff, and we are working on a new platform that will improve the volunteer experience, will improve the texter experience, will help us to provide faster and better access, really to enhance that human-to-human connection. So, at Crisis Text Line, we are committed to never using bots. We never want any texter to text in and think that they’re with a bot. They’re always with a volunteer, a live volunteer who’s supervised by a live, trained mental health professional. Because we know that we can scale up that human-to-human connection and keep it responsive, keep it in the moment without using anything automated or artificial intelligence. Now, in the background, we use machine learning so that our texters who text in and use certain words can be prioritized if our data has shown that that puts them at a higher risk of suicide. So we have innovations in the background that make for a better experience, that more human-to-human experience. We enhance that through the use of data and technology in the background.
Carol Vassar, podcast host/producer:
I find it interesting that you’re not doing chatbots in any way, shape, or form.
Shairi Turner MD, Crisis Text Line:
No.
Carol Vassar, podcast host/producer:
And I think that’s a great way to approach it. It’s that human-to-human contact that so many of us crave and maybe are reaching out for via text. Dr. Turner, where do you want to see Crisis Text Line in a year, five years, 10 years?
Shairi Turner MD, Crisis Text Line:
Again, just back to our mission and vision. We want to use empathy and innovation to continue to provide that support, that in-the-moment support for anyone reaching out for help. We provide our service in Spanish. We’re looking at areas where we can continue to provide that in-the-moment support to anyone who needs it. We know that we reach communities of color who would not otherwise have mental health support. So African-Americans, Asian-Americans, our Indigenous Americans.
We know that we’re reaching communities where stigma or insurance, or many other things are preventing individuals from getting the support they need. We’re going to continue to look for spaces where we can get Crisis Text Line out there and make it available to as many people as possible. What that means is we rely on our volunteers. One of the things I would add is that we talked about the fact that volunteering helps your own mental health that our training helps individuals with their own wellbeing and mental health support and relationships. So what I would encourage people to do is to join us in this mission in reaching out and trying to support others by going to our website, CrisisTextLine.org and become a volunteer. You can go to the website and very quickly fill out an application and help us to help others who are in need.
Carol Vassar, podcast host/producer:
Dr. Shairi Turner is the Chief Health Officer of Crisis Text Line. If you’re in need of a listening ear or find yourself in crisis, all you need to do is text the word HELP or AYUDA to 7-4-1-7-4-1, and a trained Crisis Text Line Volunteer will respond.
We’re happy to highlight the work of Crisis Text Line on the Nemours Well Beyond Medicine podcast. Thanks to Dr. Turner for sharing her time with us, and as always, thank you for listening.
Our podcast is your podcast, and we’d love to get your feedback on it, especially future podcast episode ideas. You can do that a couple of ways: visit NemoursWellBeyond.org and leave us a voicemail or send an email to [email protected]. You can find the podcast on that very same website, subscribe to it there and leave a review too. That’s NemoursWellBeyond.org.
All of our podcast episodes are also available in audio form on the Nemours YouTube channel, along with selected episodes with both video and audio, including this one. Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta, and Sebastian Riella. I’m Carol Vassar. Join us next time as we look into the pros and cons of using obesity control medications in the pediatric set. Until then, remember, we can change children’s health for good. Well Beyond Medicine.
