Veterans Crisis Line averting suicide via text
April 24, 2012
Vet: Hello i have a question
BruceL: Thank you for using Veterans Text. My name is Bruce. I will answer the best I can.
Vet: I honestly dont want to be here anymore, but i feel like i dont have a choice but to be here, but the longer im alive, i just become more withdrawn
Bruce Long's job is to save lives, 160 characters at a time.
The Veterans Crisis Line responder calmly taps out a reply to the distraught veteran, repeating his words. "So you've been feeling trapped," he writes. "You do not want to be alive and yet feel like you have no choice."
He pauses before hitting send. Unlike the caller texting on a mobile phone, Long has the advantage of working with a full keyboard and computer monitor. He has to make sure he's not moving too quickly and overwhelming the caller.
The response comes back almost two minutes later.
"Basically, i don't have a reason to stay, im just here because im hoping I can find a reason."
That's a good reply, staffers say. It shows the man wants to talk. It shows he wants help.
Long and other staffers at the crisis line have been working with text services for only five months. It's the latest outreach in the Veterans Affairs Department's suicide prevention efforts, and Long said it has been a significant change from the traditional phone hotline services he has been involved with for years.
"You don't have tone of voice," he said. "The pacing is different. Documentation is different."
But the work, staffers quickly point out, is the same. Suicidal veterans are reaching out for someone willing to talk - or text - with them, and looking for a reason to live.
BruceL: can you tell me more about what it's been like for you? It sounds very empty.
Vet: It has been, i dont trust anyone, i cant i dont know why, i feel like people will make me happy and rip it away from me
BruceL: Thank you for reaching out today. It sounds very difficult.
Vet: I seriously thought about driving off a bridge this morning on my way to school
The crisis line workers get fewer than 10 texts a day. That's not a surprise, since they only started advertising the service in February.
They expect it to pick up dramatically in coming months. When the office launched its online chat services in 2009, they saw roughly the same small number of daily users for the first few months.
Today, they conduct up to 200 chats a day, and need five people each shift to handle the workload.
"In a year, I think we'll need a whole room for just text," said responder Janice Adams. "I hope we will. It'll mean that we're reaching people."
Jan Kemp, the department's national director for suicide prevention, said the text message services are the next logical step for their outreach efforts. Many younger veterans have grown up using their phone more for texting than for live conversations.
"The idea behind it all is to give veterans another door into the VA, a way to get around some of the red tape and bureaucracy," Kemp said. "If people call the crisis line, they get care first. We can get them enrolled or whatever after that. But it's a shortcut to services."
BruceL: Have you ever tried to kill yourself before?
Vet: Ive never been hospitalized for it, no one even really knows either which is pretty sad, considering i never tried to hide it
BruceL: you haven't tried to hide it and no one seems to notice what you are going through or that you tried to kill yourself?
Vet: I poisoned my self, several time, that never worked it just made me really sick. I even sent myself to a warzone and still came back.
Vet: i cant win for losing lol. I am destined to fail, even in my own death.
The terminals used to handle the text lines in the crisis center sit beside the chat computers in a crowded room down the hall from the fully renovated hotline offices.
Even though no one is talking on a phone, it's full of noise - a doorbell chimes whenever someone visits the center's website; an intercom sounds off if they enter the chatroom.
When someone texts the suicide hotline, it rings an old office phone. Responder Jason Goldwasser has to pick up the receiver and hang it back up to start the process.
He said the conversations often start out choppy, like any exchange on a mobile phone with tiny keys. Misspellings and abbreviations are common. Goldwasser said he is careful not to write more than a few sentences in any response, because of the difficulty in reading the words on a small cell screen.
But this veteran isn't holding his words back. He's sending long sentences stretching over four or five texts, detailing fantasies of killing everyone in his college class, then killing himself.
"I was drilled not to show weakness," the messages state bluntly.
"Ive gone downhill since I left the Army.
"I've thought about hurting a lot of people, and myself.
"Now you can respond."
After an hour, Goldwasser is still working with the same upset man. The text exchanges take longer than any other calls, staffers say. Blame for that also falls on those tiny keyboards.
Vet: I dont want to be like this anymore, i dont know if i have a choice, im sure ill either get denied or run away, that what I do best, fail.
BruceL: It sounds like you are feeling stuck, you are alive and feel live you have no choice but to live and reaching for help and afraid to fail.
BruceL: If you are interested, I can have someone from our Crisis Line call you at this numer and they can do a Consult to the VA for you to get some help.
would you be willing to give that a try?
Vet: Maybe its too late for that
Staffers say the text message exchanges have some distinct advantages. Pauses in the conversations are expected because of the medium, which gives the responders time to reconsider the weight of their words. Those same pauses on the phone calls can heighten the tension on both sides.
The text operators (and chatroom workers, too) can also handle more than one caller at once. They won't do more than two, fearing that might be too distracting. Most are comfortable they can manage a pair of suicidal texters simultaneously without jeopardizing anyone's safety.
There are disadvantages.
The lack of a voice loses some of the personal touch of the calls, the responders say. The anxiousness in veterans' voices, the pace of their breathing, their choked-back sobs - none of that really translates into a convenient emoticon.
They also can't hear if there are children or pets in the background. The trained operators use those kinds of details to steer emotional callers away from thoughts of suicide.
Texters also seem to be more suicidal than their peers on the voice lines, although center officials said they don't really have enough data to back that up. Sometimes typing out words makes the veterans less inhibited , and more emotional, in their pleas for help.
Vet: yes, I feel trapped
BruceL: so you want to live out your days in total isolation and suffering until you die
and yet, part of you wants change and feels like you can't.
Vet: Because i dont have that option. But think about it, if i have to live, then isolation would keep me from hurting anyone with my problems
BruceL: You don't have the option to change you mean?
Vet: No, i dont have the option of isolation, nor do i have the option of change
Caitlin Thompson, clinical care coordinator at the Crisis Line, said responders aren't instructed to get veterans using the chat or text lines to call into the traditional suicide hotline. Many times they do end up transferring people over.
Often it comes down to the resources available through the voice line. Operators there can see where the call is coming from, directly connect veterans to local mental health officials, and even dispatch local emergency response teams if the situation deteriorates.
On the text line, the responders get a phone number and little idea if the area code matches the caller's physical location. They could be texting from their back porch, or a nearby parking lot, or the side of a bridge.
Long said he'll offer a "live" conversation to texters after he feels they've reached a comfort level with the process and might be ready to engage even more.
More often than not, the texters simply stop once they feel like it. Goldwasser said it can leave the responders with unanswered questions, but an open-ended exchange doesn't mean failure.
"It's not abnormal for people to think [about suicide]. It's actually pretty damn normal," he said.
"Ultimately, it's the lack of control people feel. If we have everything taken away from us, what's the one thing we can control? Our own life and death. That's why people self-harm or obsess about suicide. It gives them control. It gives them that branch they can hold on to.
"Once you get that message to them, they see they're not just lost in space, completely alone. And we work from there."
Vet: I guess i can talk to someone
BruceL: ok would you be willing to have someone contact you from our Crisis Line in the next few minutes?
BruceL: ok I hear you are on the phone with one of our Responders. I will end the text dialogue for now. We are here if you need us. Take care.
Reported from Canandaigua, N.Y. Source: The text conversation shown here is from an actual exchange from the Veterans Crisis Line. The transcript has been edited for space.