5 Disturbing Things I Learned Working At A Suicide Hotline

5 Suicide Hotlines Get The Worst Prank Calls

"The gunshot prank call I can remember best," PM says. "I answer the phone. A person cries, 'I'm calling because I'm going to kill myself!' I start to ask, 'OK, what's going on that you want to kill yourself?' But before I can get all the words out, I hear a loud gunshot. My gut drops, and tears come to my eyes. Live suicides have happened on the line before, but I never thought it would happen to me. Then another voice screams melodramatically, 'Mommy! Oooooh nooooo!' Bang! Another gunshot. But then, a muffled giggle. Another voice in a falsetto says, 'Well, they're dead, I guess...' Bang! And another muffled giggle."

Here's the point where you'd normally invent some new swears and discover the bottle of a bottle of a cheap bourbon. But PM is ever the professional, "because after all, today's pranker could be tomorrow's actual caller," she says.

Believe it or not, these calls come in with some regularity.

"Pranks like this would go in spurts," PM says. "Trolls from a popular website I'll refrain from naming would go on occasional expeditions against the hotline and we'd have a few hours where we'd get blasted. Usually they were mere nuisances, but then we'd get the gunshots, or people talking about obviously provocative topics -- like detailing graphically how when he was away at war, he raped a little girl, that he liked it, that he still thinks about it."

You know, things terrible people mistake for fun.

The suicide hotline also gets sex calls, because the world is always a worse place than you imagine.

"One of our frequent flyers used to be a sex addict, and he'd occasionally call us out of breath, asking us to talk slower," PM says. "Another frequent flyer would always try to get us to say a particular woman's name, and if we did (this was before we caught on), he'd start moaning and ask us to say it again."

Sometimes the calls would start out completely normal, slowly seguing into pornography. PM says:

"Here's one that stands out from one of our repeat sex callers:

Caller: 'Can I talk to you?'

Me: 'Yes, you can talk here.'

'What's your name?'

'Penny. Can I ask your name?'

'Call me John.'

'OK, John. What's going on that you called us?'

(long breath) 'It's really embarrassing... (another long, trembling breath)

So I live with my mom, OK?'

'OK.'

'And while she was out of the house... I put on her panties...'

(starting to see where this is probably going) 'OK...'

'And... (panting) when she got home she was mad... And she started to spank me. (more panting)'

(silently hating my life)

'And I liked it...' (heavy breathing)

'John. We're here for when you're in crisis. If you are in crisis, please call back.'

PM very patiently explains that "if we know for a fact someone is spanking it, we just have to explain why we're hanging up, and then do it." Oddly enough, the official explanation is not "you're a demented pervert and everything hates you."

4 Even If You Don't Want Help, You're Getting It

Suicide hotlines are anonymous, so you can pour your heart out to someone who won't get all judgmental and start refusing to deliver pizza to your house anymore. But remember the troll up there talking about raping a little girl? If the hotline suspects something like that really is happening, they can -- and will -- report you.

"Some can trace your call regardless of what you do to block your number," PM says, and if "you report child abuse to me, I'm legally required to report it."

Of course, sometimes people accidentally report themselves.

"That example I gave of the sex caller who tried to get us to say a woman's name? Well, one night he was calling us repeatedly, panting into the phone and the obvious sound of fapping heard. That's bad -- but then I got him, and I heard a young child not too far from the phone. The child was crying, hard. At best, this guy is trying to masturbate in front of a child. At worst? Well, I took the incident details and, after reviewing the situation with a supervisor, we called the child-abuse hotline with the scant information we had (a name which may or may not be correct, a phone number, the estimated age of the caller/child). We later learned that the CPS worker who investigated discovered the reports of abuse were founded. We were not told what that meant, but I was grateful we called with even that small amount of information."

More often, though, the hotline worker is assessing whether someone is an immediate danger to themselves, which is a little less satisfying.

"If you have already done something to harm yourself (say, you mixed a bunch of sleeping pills with alcohol), I'm going to be advocating for 911," PM says. "In a perfect world, I'm going to sell the idea to you, begging you to agree to the help -- which I may have already sent anyway."

That's right, like a Bizarro Liam Neeson, they will find you, and they will live you.

PM doesn't like doing this without permission, and notes that "some hotlines have a protocol that they will not send any active rescue (911) unless they have the caller's permission," but as far as she's concerned, "if your life is in danger, all bets are off."

After all, if you've tried to kill yourself and then called the suicide hotline, you're probably not super confident about your decision.

In Emily's position, she often has to determine whether a patient needs to be placed under observation. (That means a psychiatric hold, which generally lasts from 48 to 72 hours, depending on the state. After that, forcing someone to continue treatment is considered involuntary commitment and requires a court hearing.) The good news: She needs a really compelling reason to do that. The bad news: The client doesn't always see it that way. She told us about being called to the ER to assess a 17-year-old girl who'd been sexually exploited in a prostitution ring.

"The kids themselves didn't think they were being exploited because they were getting paid," she says. " felt she was making a really smart business decision being part of this. It was more money than she'd ever had the opportunity to make, and she didn't feel she was being exploited. That was really hard for me to sit with."

Fortunately, she didn't have to for long.

"My main concern was making sure she was safe, and what that meant in that situation is, for that client's own safety, I couldn't allow her to return home because of the risk she was going to be victimized again," she says. "So it was very tricky. I had to keep the kid against her will, even though she wanted to go home and make more money."

3 There's No System For Talking People Down From Suicide

Crisis counseling can be a counterintuitive process. For example, Emily sometimes tells them they have a point. That approach essentially saved her own life.

"I got into this field because when I was a teenager, I was also trying to kill myself on a monthly basis, or cutting myself, or ending up in the ER," she says. "I finally met a therapist who said, 'Well of course you want to kill yourself. Your life is terrible.' And the moment she said this, I thought, 'OK, now I can fix my life.' Because before I had been so busy trying to prove to people that my life was bad, and once someone believed me, I could go do something about that."

That's why, according to PM, traditionally trained clinicians are not always the best crisis counselors -- they first have to unlearn a lot of what they were taught.

"Most counselors and social workers are profoundly uneducated about suicide prevention techniques," she says. "This can lead to a lot of frustration or even panic."

On the other hand, "at one of my hotline jobs I worked with a guy who, on paper, looked like a terrible candidate," she continues. "His last job was manufacturing, and before that he'd been a bouncer at a couple of different strip clubs. But ... he was the most sensitive person ever, and he knew how to approach a call. 'It sounds like you're thinking of suicide.' Totally non-judgmental, but puts the topic out in the open so we can talk about it more freely. When he'd hear a person talk about why they wanted to die, he'd be compassionate. 'Given all that, I understand why you'd think about killing yourself.' That may sound like a really bad idea, but it's actually been proven to be really effective: You're actually hearing them, which makes them feel more open to talking. Then you can circle back to reasons to live."

How many times have you heard a loved one say: "But they seemed to be doing so much better"?

That's actually a red flag, because that newfound sense of peace might just mean they've made their final decision. It can also mean they're about to face an epic reality check.

"If somebody was terribly suicidal yesterday, and today they're saying that everything is OK, and they're going to go home and talk to their wife and talk to their boss and they're going to make everything OK, that is actually the most dangerous point of somebody's life," Emily says. "What's going to happen is they're going to come home with all that energy, and they're going to talk to their wife and their wife is gonna go, 'Excuse me, yesterday I had to call 911 for you and now you say everything is OK?' And it's like hitting a brick wall at 70 miles an hour."

She remembers "a 30-year-old man with a history of cutting. And this man had quit drinking, he had quit meth. I knew from his statements and from his drug test that he really had been sober. And so I sat with him, I talked with him, I said, 'Look, I'm sick of seeing you here.' We shook hands on the safety plan, I patted myself on the back when I left there. When he was in the waiting room waiting for his cab home, he grabbed a pen and tried to kill himself."

2 Suicide Hotlines Might Be The Only Psych Treatment People Can Afford

A "frequent flier" is a repeat caller.

"A lot of our frequent flyers were folks who had long-term mental illness, some of them poorly connected to services," PM says. " were often people who we call SPMI (severely, persistently, mentally ill), the people who have had severe mental illness their whole lives. These are the sort of people who will probably never get better, no matter how much treatment they get."

That means part of the job is doing your best to help someone even when you know you can't, like Sisyphus pushing a particularly sad boulder.

"But then there were folks who didn't have linkage to services," PM says. "These were folks who were usually so ill that they couldn't maintain that sort of commitment. One example was 'James.' As far as we could tell, he was homeless and would call us from pay phones. We weren't entirely sure because he was so delusional he rarely made any sense."

In these cases, the hotline is their only source of care. That's a really bad plan for a number of reasons, and the workers will be the first to say so.

"With folks like these, we would try to direct them to agencies that could provide more long-term support, but we didn't often meet with success," PM says. "We were good for that crisis situation where you need help NOW, but counselors/social workers have the luxury to get to know someone better and come up with long term solutions."

It's also really hard to get psych drugs from a strip club bouncer over the phone. Trust us, we've tried.

Sometimes, though, drugs are the revolving door.

"I have one client who has been in the ER probably twice a month, if not more, for about a year," Emily says. "And he comes into the ER with a very specific complaint, and his very specific complaint would be lethal if it was left untreated." That complaint? A gnarly suicide attempt that requires a minor surgical procedure, with a heaping side of the rather addictive painkiller Dilaudid.

"So in order to feed this addiction, he makes a suicide attempt twice a month, so that he can go into the ER, report his suicide attempt, receive the surgical procedure, and get high," Emily continues. "I always recommend inpatient. I can see how people think it's annoying, but I believe that if you're trying to kill yourself every other Tuesday, then something is terribly wrong and you need to go to the hospital."

A controversial stance if we've ever heard one.

1 Sometimes The System Just Lets People Do It

According to Emily, "If somebody says, 'Oh, I just really want to kill my classmates,' and I'm like, 'Which ones? Do you want to kill all of them?' And they say, 'No, just one.' 'When?' 'Oh, sometime' -- I can't hold that person, because it's not an imminent danger."

That's the answer to the most pressing question in the wake of every mass shooting: They were clearly planning something, why couldn't anyone stop them? Because even if they say "I'm going to kill everybody I see," unless they amend that statement with "right now," you don't have probable cause. The alternative is a bevy of civil liberties violations -- potentially innocent people having their homes ransacked and their bodies medically kidnapped. Which is preferable? It can be really hard to say sometimes.

"I had a girl, she was 16, she was in the ER because she had threatened to kill her father," Emily remembers. "When I talked to her, she was like, 'My bad! I just talk a lot of shit! I'm 16! Don't pay any mind!' And I was like, yeah, I probably said I wanted to kill my mom every day when I was 16 and it didn't happen. Then I talked to her dad, and he said, 'Don't , she's dangerous. She has a friend who's over 18. You have to make sure that she doesn't go home with her friend' over and over. I wrote up the report and I recommended that she stay in the hospital, for danger to others."

But "the thing is, no hospital has to take you," she says. "If we have 10 hospitals on our list that take juveniles, all 10 of them can say it's their individual policy not to take homicidal individuals, and they don't have to. End of story. So that's what happened with this girl."

The doctor dropped the hold, her friend showed up and signed her out -- and the two of them did a drive-by on the family later that same day. Fortunately, there were no deaths, but when Emily showed up to work the next night at the ER, she saw some of the carnage.

At least she knew she made the right call. Even if nobody could do a damn thing about it.

PM Singer has a book with more about life on the job available here.

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