More people in crisis doesn’t mean more calls to suicide hotlines. Why the disconnect?

This story is from The Pulse, a weekly health and science podcast. Subscribe on Apple…

This story is from The Pulse, a weekly health and science podcast.

Subscribe on Apple Podcasts, Stitcher or wherever you get your podcasts.


It was a tall order for a teenager barely out of high school: Save a desperate stranger’s life, over the phone.

“She was with her children, with her young children, at the time, and she was feeling suicidal and had gotten to a point where she didn’t think she could do it anymore,” said Kelly Kautz, speaking about her time at a suicide call center. “She didn’t think she could stop herself from actually committing suicide, and she was worried about herself and her kids.”

Kautz is a web designer now, but this call with a mother stuck with her.

“She didn’t want to put [her] kids through that, and that was maybe the only call that I ever had to forward to crisis intervention,” Kautz said.  “I think, I hope I made a difference for her.”

Making a difference is the whole reason Kautz wanted to volunteer for the suicide hotline.

“I was young, I was in my late teens, and I had spent a lot of my teenage years struggling with depression and anxiety,” Kautz said. “So I wanted a way to give back.”

Over more than 100 hours of training, Kautz had learned two really big things. The first was how to decide when to make the intervention call to an ambulance or police when it seemed like someone was really on the edge.

The second was how to listen really well and reflect back what she was hearing from callers.

“We did a lot of repeating back and forth, we spent a lot of time in those mock interviews saying, ‘You’re feeling really scared right now, you’re feeling really frustrated,’” Kautz said.

It sounds simple, but there’s real science behind this method — it’s designed to put a brake on the brain’s fight-or-flight stress response and get what one expert called “the thinking brain” back online. That’s critical for someone in crisis.

But on the job, Kautz learned a third lesson: that truly at-risk callers, like that mother with her kids, were rare. She would get another type of call much more often.

“They would tell us about how they were not sure they could go on anymore, and my adrenaline would be going,” said Kautz. “I would be constantly thinking, ‘Is this a life-threatening scenario? Am I going to have to connect them with crisis intervention? Can I do it fast enough?’”

They were “This is what I trained for” moments, until they weren’t.

“And then the more they talk, the more my intuition is saying, ‘Something’s not right here,’” said Kautz. “And then in a couple scenarios, when they would stop talking, I would hear a porn playing in the background, or I would hear other things that made me realize this is just somebody who’s calling to get off on the sound of another person’s voice.”

It was not exactly the type of thing Kautz expected when she signed up to answer phones.

The hotline number comes up any time you type the word “suicide” into Google. It’s at the end of every newscast or TV show that deals with suicide. For many, it represents the first line of defense against suicide in the United States, where rates have climbed year after year for decades.

But almost all the callers Kautz spoke with during her year on the phones weren’t actually suicidal. She thinks she got a good chunk of the weird sex stuff because she’s a woman and she worked Friday nights. But most of the calls weren’t that either.

“If I had to break it down into percentages, I would say probably 85 to 90% of the callers were lonely and they were looking for connection, and they just wanted somebody to talk to,” she said.

A lot of them were quite old, some disabled. They weren’t in tears or afraid, no real crises, Kautz said, they were isolated and bored. Some of these callers even became regulars, calling several times a day, tying up the lines.

“Sometimes, we had to set up rules with specific callers where they created a formal agreement with our director that said, ‘I will call for up to 30 minutes at a time, twice a day, once in the morning and once at night,’ and we agreed to this to stop them abusing the line,” she said.

And while people who were not suicidal kept calling, a great many people who actually were never did.

Connecting, but not in the expected ways

John Draper heads up the National Suicide Prevention Lifeline, the big umbrella organization that coordinates local efforts.

“You know, frankly, there’s about over 13 million people who think seriously about suicide every year,” he said.

But only some 2 million people call the hotline, Draper noted. “We’re only reaching a fraction of the number of people who are suicidal.”

The lifeline works a bit like a switchboard. Anyone, anywhere, anytime can call the same 1-800 number and will be routed to a crisis center. It could be in the next town over or across the country.

You might think the number of calls to the hotline would be a barometer of sorts for how the country is doing, a mental health reading at the population level. You might think that, with the COVID-19 pandemic, the phones would be ringing off the hook. More people thinking of suicide, more calls. But it turns out that’s not really the case.

“I don’t know if it tracks directly so much with suicidality and an increase in suicidality as it does with market penetration and awareness,” Draper said. “More people become increasingly aware of what we do, and if they become aware, they call.”

A prolonged national trauma like, say, a crushing once-in-a-century pandemic doesn’t increase calls. Ad-buying does — commercials. It’s as if a fire department got calls based on how many YouTube ads it placed at any one time, as opposed to how many fires were actually burning.

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