The girl was calling from her bedroom. Her parents were downstairs, unaware of the crisis unfolding above their heads.
Distraught over things going on at school, the 13-year-old had taken pills. But she also called 988.
Megan Cain, crisis counselor at Headrest in Lebanon, answered the call.
On July 16, the new 988 Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline) went live nationwide. People contemplating suicide or having a mental health crisis now have options at their fingertips 24/7: they can call, text or chat with a trained counselor, someone who cares about you.
Two agencies, Headrest and Beacon Health Options, have contracts with the state to answer 988 calls in New Hampshire.
Headrest’s Cain brings a powerful combination of professional expertise and genuine empathy to this critical work. She has a background in nursing, having previously worked in palliative care and in a children’s psychiatric hospital.
She also had her own struggles with loss and depression.
Cain listened to the girl’s anguish and convinced her to bring her parents into the conversation. They took their daughter to the ER and called back a few days later to let Cain know the daughter was seeing a therapist.
“It made me feel like she got the help she needed,” Cain said.
If someone is having a mental health crisis, they may not need – or want – a police officer or EMS to respond, which means 911 may not be the answer. Sometimes what they need is just a caring person on the other end of the line. This is where 988 comes in.
Jennifer O’Higgins, senior policy analyst for behavioral health at the Department of Health and Human Services, said the goal is to treat behavioral health crises like the emergencies they are.
“Mental health care is as important as physical health care, and it impacts our outcomes for our body and mind,” she said. “If I had a broken arm, would I sit alone or go for treatment?”
“If we have a crisis response for our physical health issues, why not for our mental health issues? ” she asked.
Last January, seven months before the 988 lifeline went live nationwide, DHHS created the Rapid Response Access Point (833-710-6477) lifeline, which provides immediate access, 24 24/7 mental health and/or addictions crisis support via phone, text and chat services.
This line is still available to New Hampshire residents. But now you can also call 988 for help.
“There’s no wrong number to call, and you’ll be helped by whoever answers it,” O’Higgins said.
Show the way
Headrest has operated a crisis line in the Upper Valley for more than 50 years, according to Al Carbonneau, the hotline manager. The job is still to help people through the crisis they find themselves in, but now Headrest is connected to a wider care system that includes mobile crisis teams, 211 operators and local health centers, it said. -he declares.
“It’s not our job on the hotline to fix someone,” Carbonneau said. “Our job is to get them to a point where they have options, and we point them in the right direction.”
Carbonneau, a nice guy with a penchant for Hawaiian shirts, has worked at Headrest for almost 20 years. “There’s nothing better than when you answer the phone and someone is crying and when the call is over, they’re laughing with you,” he said.
“There is no instant solution,” he said. “But there is help and there is hope. That’s what we try to do, is to instill hope in people.
In addition to counselors who answer calls, Headrest has two staff members working remotely who handle chats and text messages. Most of them come from young people: the average age is 11 to 15, Carbonneau said.
Beacon Health Options has 20 counselors working remotely who respond to New Hampshire calls to both 988 and the state’s rapid response line.
Eric Eason, Beacon’s representative for the state’s crisis program, came to New Hampshire in December from Georgia, where a 24/7 crisis lifeline was set up in response to Hurricane Katrina in 2005.
Eason said there was a distinct benefit to dialing 988: “It’s very difficult to remember a 10-digit number when you’re in a moment of crisis.”
The system is designed so that the “crisis” is defined by the caller, he said. “It basically means that if you call us and say you need help, we accept that you are and we will do everything we can to help you,” he said.
Doing this job involves a kind of “triage,” to first determine a person’s level of security, Eason said. “We do an assessment not only of their current state of mind and symptoms, we also do an assessment of their current level of coping ability,” he said.
Eason, who previously worked on a mobile response team, said he found most people in crisis needed “connection and understanding”.
Three-quarters of those who call a crisis line, Eason said, “feel their situation has been resolved and they feel essentially better at the end of the engagement with our staff.”
For the remaining 25%, he said, resources are available, such as mobile crisis teams, addiction treatment programs and emergency care.
Prevent the worst
Headrest’s Al Carbonneau said many callers were hesitant at first, insisting they weren’t suicidal. “It’s national suicide prevention lifeline,” Carbonneau told them. “If I can stop you from getting there, so much the better.”
The hotline is now called 988 Suicide & Crisis Lifeline to emphasize this point.
Carbonneau says he went there himself and shares it with those who call. “That’s how I know it can change,” he says. “That’s how I know it can get better.”
“It doesn’t happen overnight, and it’s difficult. It takes effort and energy, and as long as you are ready to do it, it will change for you,” he told his interlocutors.
Sometimes helping someone means calling first responders, Carbonneau said: “When the person, no matter what you say, still wants to die.
“They have access to every means, they have a plan, the intention is there, and nothing you say will change it,” he said.
Advisors speak fondly of the “regulars” who call. A woman, Carbonneau said, tells him she just needs to “let off steam.”
If a counselor tries to step in with advice, he said, “She’ll get mad at them and say, ‘I just need you to listen. “”
“We became part of their adaptive skills,” Carbonneau said. “We’ve become one of the things they can do when they feel like that.”
O’Higgins of DHHS said there is a link between suicide and loneliness.
“Connection is prevention,” O’Higgins said. “So if they call and they get Al and they talk to him every day, he can save their lives. It may not look like this active rescue and yet it can absolutely save their lives.
Cain said she knew what it was like to feel hopeless and alone.
“I tried to kill myself the night of my mother’s funeral,” she said.
She didn’t know about the suicide prevention hotline at the time, but she wished she had it.
“I felt very isolated,” she says. “That would probably have helped a lot. I could have been referred to therapy or a course on grief.
How strong does she feel now? She smiles and rolls up her sleeve to show off the tattoo on her left arm: “Unbreakable.”
“But it took a lot of work and a lot of time,” she said.
Listening to support
When the Federal Communications Commission established rules for the new 988 system, it decided not to require the type of geolocation that allows the 911 system to see a caller’s address. Some mental health advocates worried people wouldn’t call if their location was identified and they couldn’t remain anonymous, DHHS’ O’Higgins said.
The 988 system routes calls by area code to more than 200 local crisis call centers in a nationwide network. That’s why many calls to New Hampshire counselors come from out of state, from people who used to live here and still have 603 phone numbers. Counselors are trained to connect people to resources in their area.
Calls even come from abroad. In recent weeks, Headrest advisers have spoken with people in Germany, South Korea, France and Austria. Carbonneau thinks callers search for crisis centers online and find Headrest.
Cain recently received a call from a young Ukrainian refugee in another country. “She had all kinds of issues,” Cain said. “She called for help.
A woman who called from Germany was trapped in a marriage with domestic violence and alcoholism, Carbonneau said, but she resisted his efforts to connect her with services in her community. “She just wanted to talk, so that’s what I did,” he said. “I listened.”
At Headrest’s office, the phone rings and Cain recognizes the number. It’s one of his regulars, calling from Seattle.
The young man had called earlier, telling Cain that he had just taken heroin.
But this time, he tells her that he has an appointment with a therapist, that he has found accommodation and that he feels fine. “I’m going through a transformation,” he says.
Cain reminds her that he was talking about getting sober.
“I think it’s going to happen,” he said. “I haven’t been sober in so long, I know I’ll be a better me.”
She promises to check in with him the next day, and they hang up.
A few minutes later, he calls back. “I just want to say thank you. Thank you for being there,” he told her.
This is the fifth time he’s called today, and she ends the call early this time. “I’ll talk to you tomorrow,” she said, softly but firmly.
Cain looks thoughtful after hanging up. “I hope he gets a spot and gets sober,” she says.
DHHS’ O’Higgins has a message for those in trouble: “You are not alone.”
“A lot of people have dark thoughts and feelings,” she said. “People are getting better, so you don’t have to feel like this forever.”
His advice: “Call early; calls often. Call everyday if that’s what you need.
“But never worry alone.”
If you or someone you know is in trouble or in crisis, help is available. Call or text 988, or chat at: 988lifeline.org.
To reach a mobile crisis team or find inpatient treatment options through New Hampshire’s Rapid Response Access Point, call/text 833-710-6477 or visit: nh988.com.