PHOENIX, Ariz.—For those feeling trapped and alone in the middle of a behavioral health crisis, suicide can seem like a solution.
There are times when call takers at Solari Crisis and Human Services in Tempe, Arizona, will have people on the phone literally on the precipice.
“We do get callers with guns to their heads,” said Eric Lee, Solari’s director of contact center operations and clinical services.
Suicide calls and threats of self-harm go with the territory, Lee said, and account for roughly 20 percent of Solari’s growing monthly caller volume.
He said it takes a skilled crisis worker to talk a desperate individual away from the abyss; though not every case will have a happy ending.
“Sadly, some [suicidal] people will call, and we are their notice that they will do it. It’s sad for many reasons. The [call taker] knows it could happen to go into that phone call.”
“What’s easy for me might be difficult for you. Usually, dealing with child sexual abuse will be the hardest [of calls]. It can be very stressful, depending on the situation,” Lee told The Epoch Times.
Since COVID-19, calls to the 24/7 statewide crisis center have continued to increase.
Lee said this can be a good thing in one respect. It means people are becoming more aware of the national crisis line and that help is only a 988-phone call away.
On the flip side, it means a growing need for crisis intervention services as life’s stressors become more severe and complex in difficult economic times.
As of April 22, Solari handled 38,601 crisis calls since the start of the month, with an 88 percent case stabilization rate.
Talking People Off the Ledge
Suicide is the 12th leading cause of death in the United States, according to the American Foundation for Suicide Prevention. In 2020, 45,979 Americans committed suicide.
The U.S. Centers for Disease Control and Prevention reported more than 12 million adults seriously thought about suicide in 2021. Of those, 3.5 million planned to take their lives and 1.7 million attempted suicide.
The suicide rate among adult males in 2021 was around 80 percent—four times higher than females, the CDC added.
Solari Chief Operating Officer Andrew Erwin said that while suicide is a primary reason for 988 calls, “social concerns”—the economy, joblessness, financial stress, and homelessness—also rank high among callers.
“Before COVID, suicide was the number one reason for people calling. Now, we see social concerns higher than self-harm and suicide,” Erwin said. “A part of that is pressure from unemployment, homelessness, and other things.
“The situation around housing has turned particularly difficult. We have callers who don’t have options on what to do next. Those calls can turn into crisis calls. They don’t know what to do,” Erwin said.
Erwin said Solari Crisis and Human Service’s monthly call volume had increased by 40 percent since July 2022, when the 10-digit “National Suicide Prevention Lifeline” switched to a three-digit 988 “Suicide and Crisis Lifeline.”
Federal funding to the program had also dramatically increased, and through it, a general awareness of the lifeline, he said.
“I believe it is around the marketing of the number and accessibility. People recognize this is a resource and are making the outreach,” Erwin said.
While the same factors driving call volume existed before the pandemic, “What people are saying is they can get help here now. That’s a big shift,” he said.
Solari Crisis and Human Services has been in operation since 2007, working in tandem with first responders and social service providers in municipalities throughout Arizona.
The company is a strategic partner with the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services established by Congress in 1992.
Nationwide Network
SAMHSA coordinates with about 12 other 988 crisis call centers nationwide.“Arizona has always had a well-funded system because of our partnership with Medicaid administrator access,” Erwin told The Epoch Times. “They’ve created a robust crisis system.”
Solari Crisis and Human Services employs about 120 crisis call takers in a modern facility with advanced computer and telephony systems.
Many call takers choose to work in the company’s main call center in Phoenix or from home. Each call taker is a behavioral health technician by requirement, with a bachelor’s degree in a related field or a high school diploma with relevant experience.
Lee said training crisis call takers start with clinical orientation and an overview of crisis work, domestic violence, and mental illness. New hires also receive training in the use of company technology. They also learn to take phone calls with live feedback from floor trainers.
“It’s a total of about four weeks [of training]. They put all the pieces together usually in the third week,” Lee said.
Lee said many call takers come from a family or personal background marred by suicide or substance or domestic abuse.
In many ways, Lee said, these are the best people to handle crisis calls, having been through similar life circumstances.
“A lot of that is just listening and validating and supporting them. One of our greatest things here is letting people know they’re never alone. That’s so often where people are when they call us,” he said.
A Thankless Job
Though it seems counterintuitive, Erwin said social isolation was one reason people did not use the system more often during the pandemic.“They weren’t getting that same intervention from community members. They weren’t getting the feedback,” he said. “There was a big factor in isolation in that people weren’t utilizing the services like we would have seen in other times.”
Historically, the former 10-digit national number was a suicide hotline. Now, 988 is a behavioral crisis line with an easy-to-remember three-digit number.
“We do get calls where people have panic attacks, anxiety, and depression that isn’t a behavioral health emergency with the same acuity as a suicidal caller. But it’s opened the door wider—and it’s a good thing,” Erwin said.
Erwin said self-harm and suicidal thoughts remain the number one reasons why people call 988.
“There are a lot of calls where people are asking to get connected to services. It’s having someone to talk them through [a crisis] and acknowledge that things will improve. They have to get through that moment.”
Robbie, who asked not to use his last name, had worked in several mental health and behavior crisis positions before becoming a call taker at Solari in May 2022.
“It’s been informative and strengthened my ability to work with people,” Robbie said. “When I’m on a call, I'll try to be as empathic and understanding the perspective of what I’m hearing, where the client is coming from. Active rescues are always very hard. I recently had an active rescue where the person had a seizure so that they couldn’t communicate on the phone.”
Fortunately, Solari Crisis and Human Services’ team approach and networking capacity made sure an ambulance was at the scene quickly.
Saving Lives One Call At a Time
“It’s life-saving. Even more than the life-saving aspect of it, there are so many people that I talk to and see emails [from saying] ‘Not only did you save a life, [but] how things got better and continued to get better.’”Too often, however, being a crisis call taker can be a thankless job. Burnout is common.
It’s easy to say a crisis call taker needs thick skin to do the job, Lee said.
The reality is everyone has their stress limit.
“It’s a balance between being sensitive and being able to compartmentalize and leave work at work. The nature of the call is stressful. Just the volume can be difficult,” he said.
“We say this can be a thankless job. You may help hundreds of people and not hear back from any one of them. That positive feedback a lot of times is what helps keep people going.”
For this reason, Solari Crisis and Human Services provides multiple opportunities for “self-care,” including “compassion rooms,” where employees can step away and decompress, said Thomas Bond, Solari’s senior director of communications, marketing, and education.
“If they were living in this world 24/7, it would be overwhelming,” Bond said.
“We’re comfortable with where we are now but know that if things arise, we’re constantly looking for crisis specialists. We’re looking to hire to prepare for volume increases.”
Cassie Villegas, contact center operations and clinical services senior director at Solari, said 988 crisis calls generally take more time to resolve, given their more sensitive nature.
“I think it’s just to have a safe space that’s a resource for people to call for any reason,” Villegas told The Epoch Times.
A Multifaceted Problem
“We always say the crisis is self-defined,” Villegas added. “It can be anybody having suicidal thoughts to folks afraid of going to the store—something we might think is a normal activity that’s very stressful for them and can put them into that panic.”“People can call us if it’s 8 a.m., 8 p.m., or 2 a.m. They need someone to talk to. There is always somebody there that can provide that support.”
Erwin said calls involving social concerns have only increased since the pandemic, rivaling suicide and self-harm as reasons for calling 988.
“Now, we see social concerns higher than self-harm and suicide,” Erwin said. “A part of that is pressure from unemployment, homelessness, and other things. Housing, in particular, is a significant issue in the Phoenix Metro area.
“We see more pressure around the economy and the factors that echo from the pandemic. I just hope we continue to put resources into them.”
The 211 hotline is for callers who require guidance for accessing available health and human services. Approximately 3,000 monthly calls are 911 emergency diversion contacts.
“What this program has done is shift the option of having two buttons to push—police and fire—to now police, fire, and behavioral health response,” Erwin said. “When somebody is looking for behavior health assistance, the sooner we have a conversation with them about what’s happening, the sooner we'll have an opportunity to have a conservation to prevent that from escalating into something direr, more acute.”
He said the 988 rebranding with three-digit dialing, and the increasing the number of people calling the crisis line, are all “good signs that people understand we’re here and that there’s hope out there.”
