Study Report: The 2023 CrisisCrowd Crisis Counselor Survey

Executive Summary

January 24, 2024 | Dan Fichter

Close to 50 counselors participated in a first-ever national study of crisis hotline counselors, representing their experiences serving at nearly 10% of America’s suicide hotline centers, including many of the largest. Their narratives paint a detailed picture of the 988 system that served people in crisis 4.4 million times through phone, text, and chat conversations in 2023.

The study principally addressed:

a. Disparities in training for crisis counselors. Because crisis counselors may be hired without educational prerequisites, their training on the job is often their entire initiation into how suicide prevention works, and some find it inadequate in particular respects. While some 988 centers expose new trainees to dozens of real 988 calls or chats and extensive role-play practice, and many counselors feel well prepared to take their first 988 calls after initial training, other counselors are trained in only two weeks or less, without any exposure to what either end of a real crisis call sounds like. Counselors may feel their training touches too lightly on vital topics including anxiety, depression, child abuse, eating disorders, and how to handle abusive calls and chats.

b. Disparities in ongoing learning and support. Many counselors feel strongly that ongoing learning and coaching can help them serve the public better. While some receive support during difficult calls or chats whenever they need it, and benefit from immediate feedback after listen-ins, monthly one-on-one coaching, and weekly or monthly continuing education sessions, others struggle to get timely support while on challenging calls, are rarely or very summarily evaluated, and may go months or longer without continuing education.

c. Uneven standards of care for callers and texters in crisis. Some counselors are routinely asked to limit certain calls and chats to only 15 minutes, a time cap many feel is far too short, and may feel unable to make meaningful referrals, including to non-police mobile crisis teams. And while unconsented police interventions are reported to occur on average under 1% of the time on 988, counselors at some 988 centers feel they happen too readily. Some counselors are trained in how to tell a caller when they have to intervene without consent, to remove the element of surprise when first responders arrive, but others report being trained never to say anything to callers about 911 calls in progress, even when they wish they could.

Recommendation #1 Include listen-ins and group discussions of real crisis calls and chats in initial training and in monthly ongoing learning for counselors. This learning format is the one counselors are most interested in and say they benefit from the most. In particular, many want to hear how experienced counselors handle calls and chats involving abuse toward the counselor (including calls where it is appropriate for the counselor to end the call), high risk of suicide, and thoughts of harming others.

Recommendation #2 Give all crisis counselors a voice in selecting topics for monthly learning sessions, and share some of the high-quality learning material that is developed in-house with other crisis centers.

Recommendation #3 Ensure that all counselors feel they can ask shift supervisors urgent questions while on challenging or risky calls and chats and can get timely advice and support. Supervisor availability appears to be very strongly correlated with how well a counselor feels the crisis center helps them manage the strain of doing their work overall.

Recommendation #4 Ask each counselor what types of crisis interactions they are finding most challenging and would like coaching on through live, regular coaching sessions (rather than relying exclusively on random listen-ins for quality control).

Recommendation #5 Solve for the shortage of supervisors, coaches, and reviewers by inviting experienced counselors to serve in these capacities part time. Creating hybrid roles like these could ease burnout from being on shift full time, and might supercharge the circulation of knowledge within crisis centers.

Recommendation #6 Standardize call and chat time limit expectations nationally so that users of 988 consistently feel cared for, have time to discuss safety planning and referral resources, and come away confident that 988 will be helpful to them in the future. Include crisis counselors in policy discussions around time caps, and consider the relationship between multitasking and time guidelines for text and chat conversations (which may proceed more slowly when a counselor is engaged in two crisis conversations at once).

Recommendation #7 Pool and share lists of localized resources across crisis centers, including lists of clinics, shelters, and mobile crisis teams, so that every 988 counselor in the country has the same referral resources at their fingertips.

Recommendation #8 Standardize 911 intervention practices nationally so that the public can be educated about exactly what to expect when calling or texting 988 in an acute crisis. Clearer public messaging about these practices, once they are consistent nationwide, may help people in many communities feel safer using 988 in the first place.

Recommendation #9 Crisis centers without expertise in disclosing involuntary interventions to callers and texters should draw on the experience of other centers in the network that have been training counselors in safe disclosure practice for decades. They should also consult the Veterans Crisis Line regarding its own intervention disclosure practices, training, and experience.

Recommendation #10 Crisis center leaders should be aware that human resources teams can become overwhelmed, and that counselors may feel left out in the cold if HR does not have bandwidth to answer their questions or approve their time-off requests. Counselors should be encouraged to speak with leadership if they do not hear back from HR staff, or if they do not feel they are getting adequate time to recover psychologically after difficult crisis calls and chats.

Recommendation #11 National, state, and tribal 988 authorities should track crisis counselor compensation to identify situations where current funding levels may not support a living wage for crisis counselors. They should also make efforts to fund employment benefits for crisis counselors.

Recommendation #12 National, state, and tribal bodies supporting 988 should continually speak with front-line crisis counselors and shift supervisors about their experiences serving the public and their ideas for improving the system, just as public health authorities in other contexts have direct relationships with care providers. Counselors should be invited to conferences, asked to sit on advisory committees for policy and research, and encouraged to speak and write within 988 circles about their experiences and insights.


47 crisis counselors with experience serving at 20 U.S.-based suicide prevention crisis centers responded to an online survey between June and August 2023 seeking insights from their experience. Counselors were recruited through social media postings announcing the survey and through individual outreach, the latter done primarily by means of searching for job titles such as Crisis Counselor, Crisis Specialist, Crisis Responder, and 988 Counselor on LinkedIn and messaging with or emailing counselors who agreed to connect. A full archived copy of the survey is available here.

Because we estimate the population of U.S. suicide prevention counselors to be many times larger than the 47 respondents this survey drew, it is important not to draw inferences from this study about the overall percentage of crisis counselors in the U.S. who are paid staff versus volunteers, work full time versus part time, answer phone calls versus texts and chats, have a particular amount of crisis counseling experience, or have a particular demographic background. Likewise, we cannot project from this study to know what percentage of crisis counselors in the U.S. overall feel satisfied in any of the areas discussed below.

But this study does gesture vividly at the range of differences in experience counselors are having serving on different crisis lines within the system. This report heavily features counselors’ own narratives describing the realities behind those differences, including major differences in approach between individual 988 centers. In most areas discussed below where at least one in five respondents felt “not at all satisfied”, at least another one in five reported feeling “extremely satisfied”. This reflects the wide range of practices in place across crisis centers, and counselors’ in-depth explanation of those differences presents an opportunity for crisis centers and their front-line staff to learn from one another, borrow and adopt best practices and training resources, and collaborate on research into practices of crisis care that best serve the extremely diverse public that relies on crisis lines and 988.

The survey was conducted as an independent, unaffiliated initiative by Greta Opzt and Dan Fichter, and this report was written by Dan Fichter, with special help from Greta Opzt.


We received 58 responses to the survey, representing experiences at 24 different hotlines. Among those responses, 47 responses reflected crisis counselors’ current or past experience at 20 different U.S.-based suicide prevention crisis centers. This report will focus on the responses from those 47 U.S.-based crisis counselors.1

Among the 47 U.S-based suicide prevention crisis counselors, 35 reported having answered 988 calls, chats, or texts at 17 crisis centers participating in 988. Geographically, the crisis centers represented in the survey are spread across every region of the continental U.S., and several participate in the 988 national backup network, answering specialized or spillover calls, chats, and texts from across the country. Among respondents regarding whom demographic background information was available, 67% were white and not Hispanic, 16% were Black or African American, 7% were Hispanic, 5% were Middle Eastern, and 5% were Asian.

The majority of counselors (83%) served in paid (non-volunteer) capacities, with only eight of the 47 having served exclusively as volunteers. 55% of respondents served exclusively or mostly as phone counselors, 32% served exclusively or mostly as chat or text counselors, and the remainder reported doing a roughly even mix of phone, chat, and text counseling.

Among paid (non-volunteer) counselors who took the survey, 62% reported being scheduled on shift for at least 30 hours per week, 13% were scheduled for between 20 and 30 hours per week, and the remainder were on shift for under 20 hours per week.

Among paid counselors answering the survey, 89% had served for at least one year.

Crisis counseling experience among paid counselors answering the survey.

When asked to rate their feelings about “how effective you feel you were able to be, overall, at giving callers/texters the care they needed,” 54% of counselors surveyed said they felt extremely satisfied, with 41% feeling moderately satisfied, and the remainder feeling not at all satisfied.

Among the 12 focus areas presented on the survey (which can be found along with a description of each area on the second page of the archived survey here), counselors were asked to flag the one area where they would most like to see improvement at their crisis center. Compensation was selected the most times, followed by Career Progression. Tied in third place were Training, Shift Flexibility, Psychological Support, and Benefits. Counselors’ levels of satisfaction in each of the 12 areas on the survey2 are reported in the table below.

Area Not At All
Counseling Efficacy 44254
Training 113851
Vetted Resources 155035
Shift Flexibility 184141
Feedback Helpful 235126
Psych. Support 234334
Active Intervention 253342
Benefits 265519
Compensation 265420
Continuing Ed. 263638
Career Progression 283636
Feedback Freq. 283438
Compensation and Working Conditions

Background: Compensation was the #1 area on the survey where counselors said they would most like to see change. Career progression (defined as “how well the organization supported you in growing professionally and progressing in the way you wanted”) was the #2 area.

  1. Among paid (non-volunteer) counselors, 36% reported earning $20 per hour or less. Only 16% of paid counselors reported earning $25 or more per hour.
  2. Counselors described heavy burnout among their peers, reporting that few stay in their roles for longer than two or three years. Work days may be up to 12 hours long, with as little as 15 minutes total per day of time to spend recovering from especially difficult crisis calls. One counselor had worked over 120 hours in a single week.
  3. Some counselors said their human resources teams simply never replied to some of their emails, or said their time-off requests were denied or left pending until the day before they hoped to take time off.
  4. Others wanted full-time roles, with benefits, but said their centers were hiring additional part-time staff instead of offering them full-time hours and benefits.
  5. Among ten counselors who answered a follow-up question about remote versus in-office work, nine work exclusively from home, and one described a hybrid role. Most were happy with their setup, but some said they would like the option of spending time in person (or in an online break room) with fellow counselors, especially during difficult shifts.

Hourly (or hourly pro rata) compensation, as reported by paid counselors (volunteers are excluded here).
  • Organizations need to provide employment pathways outside of crisis work, look at part-time or alternate duty positions (for example, having someone work in a different department for half their time, to recover from stress and burnout).
  • Most of the coworkers I started with left well before I did, and a number of crisis counselors I worked with experienced PTSD or severe burnout. Organizations often seem to view their paid counselors as a disposable resource — they expect people to burn out and quit after a year. But people who stay in this role long-term develop skills and experience that can be a major asset to an organization.
  • The field has been largely ignored and relegated to the realms of newbies or short-term workers. People don’t last more than 2 to 3 years due to burnout and lack of support. While there are some agencies that have exceeded in really quality care and taking care of their staff and providing benefits and resources, many of them have not, and as a whole we don’t really respect crisis workers or train them well enough or give them what they need to do their jobs effectively.
  • It’s difficult to help others who need financial help when the counselor may need financial help as well.
  • It can be draining and hard when time is not properly compensated and [counselors] have to look for additional employment.
  • Living below the poverty line while dealing with the ever-present struggles of compassion fatigue, vicarious trauma, and burnout. Crisis counselors (and the helping professions in general) deserve to have their most basic needs met.
  • Not feeling truly valued for my significant contributions in the role. The fact that it is viewed as entry-level.
  • Working 60-80 (most I hit was [over 120 hours] in one week) is very hard to manage.
  • The pay was really poor and still is. We unionized several years ago but the union still does not have a contract, and I think that management was being really dishonest and frankly engaging in possible union-busting behavior. No one other than our executive director has gotten a raise this year, and the executives have refused to take a pay cut, and are not communicating clearly with the union.
  • [Our] policies are for a workday under 12 hours; we are entitled to two 15-minute breaks, one 1-hour meal (unpaid), and a total of 15-minute self-care breaks that must be broken down in five-minute increments and cannot be used consecutively. I’ve had really distressing calls that required more than five minutes to regroup and compose myself for the next call. Having a more flexible protocol about how we can utilize these self-care times will be much more helpful, especially if we are working longer hours.
  • Having more admin time would be helpful. The amount of time on [shift] they want is contributing directly to burnout.
  • I’m also very frustrated with the way that time off and time off requests are handled. I may know I need time off months in advance, and the agency will not grant or deny that request until a week or two in advance (or in one case, a day in advance).
  • [My ask:] not having paid time off denied when requested, and not having to provide a reason why we want to use PTO.
  • [Human resources] often just doesn’t reply to staff emails or calls, and that is not acceptable. I would change the agency so that management prioritized higher staff pay and better benefits and so HR actually listened to and responded to staff consistently.
  • They’ve hired a bunch of people to work not many hours a week, when many of us have expressed wishing we could work more hours a week, and were consistently working more hours than our regularly scheduled ones before the latest wave of new hires came on. We’re definitely a victim to the general gigification of the economy, where no one is hired full time (we’re explicitly not allowed to work more than 38 hours a week), so they don’t have to give us health insurance (I’m assuming).
  • I am fully remote at home, and this is most ideal for me.
  • I take chats at home and prefer that it stays that way, with the option to go to the office.
  • I’m happy with 100% remote, though I wish there were opportunities to gather in-person or online in a sort of break room setting, which we miss out on.
  • It can be quite strange when you have a difficult [crisis] conversation, close your laptop, and just walk away. [We have] a group chat where you theoretically could check in with others about the conversation, but in my experience, that’s kind of flimsy, and really just continues the feeling of physical disassociation that comes with working on the line.

Background: Crisis counselors are often not required to have academic degrees or work experience in a mental health field before starting in their roles. The training in suicide prevention that they receive on the job can therefore be essential to their efficacy and self-confidence as counselors. The survey found that the depth and perceived quality of this training varies significantly between crisis centers, including between 988 centers.

  1. Most counselors in the survey — including all who were dissatisfied with their on-the-job training — received that training in four weeks or less. Others reported receiving several months of training, but did not specify whether the training was delivered full-time over that period.
  2. Many (including some 988 counselors) were trained in just two weeks or less. And some non-988 counselors received four days or less of training.
  3. While some counselors were able to listen to real crisis calls (either live or recorded) or read transcripts of real crisis chats as part of their training — as many as eight full-length examples, for one trainee — others reported having finished their training without ever getting the opportunity to hear a trained counselor handle a call or to see how a trained chat counselor approached a real chat conversation.
  4. While some counselors were given the opportunity to role-play simulated crisis calls and chats as part of their training — as many as four full-length role-plays, for one trainee — others were never engaged in full-conversation role-plays in their training, and first experienced what it was like to conduct a crisis conversation when they went on shift for the first time, to help real people in real crisis.
  5. When asked a follow-up question about what kinds of ongoing education they would find most helpful, active listening skills and cultural competency were among the subject matter areas most frequently cited, perhaps reflecting that some counselors feel undertrained in certain core fundamentals of crisis counseling even after having finished their training, and even after having completed months or years of service.
  6. Many counselors said their training touched very lightly, or not at all, on challenging types of calls they handle regularly, including prank calls, sexually-motivated calls, callers who are not open to collaborating on a safety plan, and higher-acuity suicidal intent.

All of the respondents who reported feeling “not at all satisfied” with their training received that training in 20 working days or fewer. Among the 15 respondents whose training lasted longer than 20 days, none felt “not at all satisfied”.

Five respondents reported having received four days or less (i.e., 30 hours or less) of training.

Fourteen respondents — eight of whom serve on 988 — reported having received one to two weeks (i.e., 40 to 80 hours) of training.

  • I felt least prepared for dealing with people who were non-collaborative. There was no training on how to deal with prank calls or sex calls, which we get on a nightly basis; sometimes multiple times a night. I was not prepared to deal with imminent risk or high risk situations.
  • [I felt least equipped for] callers who made sexually inappropriate and/or bigoted comments. I don’t even remember this being touched on in the training, even though it happened on a regular basis. I think they eventually did address this in newer trainings after years of feedback that people didn’t feel prepared to handle these situations.
  • I feel least prepared for mandated [abuse] reporting.
  • Would’ve benefited from listening to a couple recordings of real calls made on the line. I understand that even with about 120 hours of training, we can’t get through all the nuances that boost confidence.
  • We heard about how important it is to psychoeducate. But what exactly should we educate about? At this point, I do this for substance use withdrawals, effects of sleep deprivation on mental health, etc. However, having an actual list of things we can all be on the same page on and talk about can give all counselors consistent information to share with the callers.
  • [My crisis center’s] theory was that you didn’t need to know “about” a particular struggle, such as an eating disorder, child abuse, depression, anxiety. Instead, if you used active listening techniques, it would generically apply. Which was true to a very limited point. This was mitigated by having a supervisor, and a running chat available in the dashboard where a person could ask questions and get answers in real time, from other volunteers or staff on shift. [But] I was personally very uncomfortable with my limited knowledge, not having worked or studied in any of it, so I did self-study as much as I could.
  • I think maybe overall I just wasn’t prepared for the variety of conversations. [My crisis line] accepts anything, so the issue, the intensity of the conversation, and the character of the texter vary widely in each conversation. There could have been more emphasis on how different each convo would be.
  • We did not get to listen to full-length calls. The manager at the time said [they] didn’t want us to. They said it wasn’t useful to training and it would be a violation of privacy. Although I do believe our line tells people the calls are recorded. They said listening to calls wouldn’t make any difference in training.
  • Training did not provide us with full-length real crisis calls, which made it difficult to understand what a “normal” interaction would look like. We had a simulated training activity, but this wasn’t very helpful since this was an online activity.
  • Crisis counselors are often recruited straight out of school or as volunteers and provided inadequate training to deal with life or death using zero physical cues… Throwing them to the sharks in crisis is unfair, not trauma-informed and downright dangerous… Agencies don’t know how to train or even what to teach people coming in, coming straight out of school or with no experience at all coming in as volunteers. And being asked to deal with things that are life and death and sometimes require some superhuman inner abilities most people don’t come equipped with those. The training is pathetic.
  • I have read more conversations as a working counselor [than I did in training]... you can see all the old convos someone has had. But I honestly wouldn’t say I’ve learned what to do from those; I’ve more learned what not to do. The error that most counselors make is following [training] instructions too closely, and texters will say things like “You’re just repeating yourself” or “You sound like a bot”. And reading those conversations, they are not wrong. I understand how it happens — it’s a fine line between following your training and inserting enough personality/style to not sound robotic.
  • As a former [volunteer counselor], I think I got to skip role-plays. I charted for a few days, listening to pre-recorded calls, and shadowed for about a week. After I had my first couple of supervised calls I felt completely ready and was let loose! Other counselors were in training for longer.
  • I did not do full length role-plays of calls. I did listen to many full length calls, though. Maybe four or five for my initial training, and then an additional three or four live, for my shadowing, before I started to take calls myself.
  • We did several role-plays in the ASIST (Applied Suicide Intervention Skills Training) training and three role-plays in our orientation training, and I listened in on a few real staff and volunteer calls.
Continuing Education

Background: Because crisis counselors may receive as little as four days of initial on-the-job training, and often come to the work without previous experience or training in mental health work, ongoing education can be critical to setting them up to do their best work and to feel self-confident on shift.

  1. After completing their initial training, the degree to which counselors are offered ongoing learning varies widely between crisis centers, including between centers that participate in 988.
  2. Many counselors (including 988 counselors) are not offered any form of continuing education over their months or years of service. Even counselors who had one week or less of initial training, or did not have the opportunity to listen in on calls or role-play calls as part of that initial training, may receive no continuing education. Others, in contrast, receive ongoing learning every week. Many reported experiences falling somewhere in between.
  3. Counselors would like to receive more continuing education on the core fundamentals of crisis counseling, including active listening skills, cultural competency, safety planning, redirection, and trauma-informed care.
  4. Others asked for more training on particular types of challenging interactions, including abusive conversations and sexually-motivated/prank conversations, cases involving violent or homicidal intent toward others, third-party contacts, and repeat/frequent users of the hotline.
  5. The ongoing learning format most requested by counselors who answered a follow-up question about their preferences was the opportunity to listen to recorded crisis calls or read example chat transcripts in order to learn from techniques used by experienced counselors. Several said moderated group discussions would also be helpful, and one asked for more opportunities to role-play as part of ongoing learning.

“How frequently does your hotline run case conferences or other continuing education sessions for counselors?”
  • I was there for three years and not once was [an ongoing learning session] held.
  • [My center offers sessions] rarely, and if they do, we have to request to be able to attend because they’re always during the day only (during my shift) and can be denied. They’re also held once, always during the day, even though we operate 24/7, so most of the staff can’t attend.
  • Topics would [ideally] be: the techniques of active listening and carrying on the conversation effectively under any number of situations — “normal conversation”, abusive texter, third party, homicidal thoughts, circling, repeat texters, etc.
  • Watching videos or reading articles feel a bit removed from the specific lessons we have to learn.
  • Any type of ongoing learning would be useful beyond “here is a document.”
  • I think example transcripts are really helpful.
  • Listening to calls would be wonderful, if only to learn from the different styles and approaches of different counselors.
  • Group discussions and listening to examples would be most helpful.
  • We do have 988 group supervision maybe every two months now at my agency, and last time we listened to a long call with a particularly high-risk (to self and others) caller who had become known to us. That was incredibly helpful as it was with a counselor with many years of experience who handled a very difficult call VERY well. I wish we did more ongoing listening to exemplary calls in general, not just for that one special case, as I think we could learn more continuously from each other that way. In an ideal world… supervisors at the agencies across the country would nominate calls to Vibrant who would pick, say, five each month for agencies to choose one or two to listen to and discuss together.
Case-Specific Feedback

Background: Providing case-specific feedback after listening to counselors’ calls or reviewing their chat and text transcripts is essential to helping counselors grow and develop professionally, as well as to maintaining quality assurance on a crisis line.

  1. How frequently counselors are offered case-specific feedback varies widely between crisis centers, including between centers that participate in 988.
  2. Many counselors (including some full-time 988 counselors) received no case-specific feedback in their most recent six months of service. One 988 counselor had not received feedback in nearly a year. Others received case-specific feedback with more frequency, up through on average at least once per month.3
  3. Counselors described a wide range of ways they receive case-specific feedback, including live voice or in-person conversations, direct-messaging (DM) conversations, email, and rubric-style call rating forms. Counselors who expressed preferences for the timing and format of feedback generally preferred feedback within a few days of the case and preferred two-way, live voice conversations over one-way modes of communication or DMs.
  4. Counselors rated the helpfulness of feedback they have received relatively low, potentially reflecting that feedback was delivered after their memory of the case in question had faded, was terse or generic, or was provided in a one-way or non-interactive mode.
Among all counselors Among counselors who have answered 988 calls, texts, or chats

“How many times in the most recent six months of your service did you have listen-ins/case-specific reviews and receive feedback on your counseling skills?”

Across all focus areas where counselors were asked about their level of satisfaction, Feedback Frequency received the highest percentage (28%) of “not at all satisfied” ratings (tied only with Career Progression).

Defined on the survey as “how helpful the feedback on your performance as a counselor was”, Feedback Helpfulness received close to the lowest percentage (26%) of “extremely satisfied” ratings, surpassed only by how infrequently “extremely satisfied” was selected for Compensation (20%) and Benefits (19%).

  • I’ve literally never been reviewed in 15 months.
  • I think that a culture where in-the-moment feedback is normalized is most helpful. It’s tricky because [direct] messages are often the [easiest] way to give in the moment feedback, but there is also a high chance of misinterpreting [it]. I think that talking about giving and receiving feedback in the initial training is really important, and I think feedback should be very matter-of-fact and also acknowledge that this work is difficult and that there are many different kinds of approaches. I also think that regular supervision where specific calls are discussed is important. I have mixed feelings about call rating forms, but I think that they are necessary to communicate and document feedback, especially if there are ongoing concerns. I think it’s generally better to discuss the feedback in person or by phone prior to emailing the form if possible.
  • I understand that our agency uses a metric grid for consistency of ‘scoring’ counselor calls. I wish it were more of a general conversation. I also wish that there was some real support and honoring of what we did right that felt less perfunctory than a ‘compliment sandwich.’
  • The QI department for [my crisis center] listens to random calls and grades us to monitor how we support our callers. There have been instances where this department doesn’t review the call notes (which indicate if this is a complete call or not) before doing an assessment, resulting in the counselor receiving a poor grade. This can be quite discouraging and not helpful to how we can improve ourselves on the lines.
  • I find my supervisors relatively prompt with helpful feedback. Feedback for me about more concrete stuff like not identifying a repeat caller or missing a potentially helpful referral is within a few days of the relevant call and via email. More substantive or general feedback if it’s needed happens in individual supervision, held every other month. With difficult calls, I sometimes have an immediate debrief with the on-call person as well, at my request.
Time Limits

Background: Many centers ask counselors to put time limits on crisis conversations, meaning the counselor is supposed to guide the conversation to a conclusion within a particular time frame. That time frame may depend on the suicidal acuity of the caller or texter, whether or not that person is using the hotline frequently, and whether the medium is a phone call (where time limits are often shorter) versus chat or text (where time limits are often longer).

One crisis center represented in the survey applies especially short time limits to callers who are not from the primary demographic the center is set up to serve.

  1. Reflecting striking inconsistency across 988 crisis centers, some 988 counselors were expected to limit crisis conversations with first-time callers and texters who did not have immediate plans for suicide to just 15 minutes. For others, that limit was 20 minutes, while for others, it was 30, or 45, or 60 minutes.
  2. Across 988 centers, there was also a range of experiences as to whether counselors were expected to adhere strictly to these time limits or had discretion to treat time guidance as flexible.
  3. Many counselors who operated under shorter and stricter time limit expectations felt these time limits prevented them from providing good care. For chat and text conversations, time limits up to 55 minutes were sometimes experienced as being too short.

Because counselors’ experiences of time limits varied so dramatically between crisis centers, as different centers have such different time limits in place, their comments are presented here in several blocks: first, quotes from counselors describing shorter or stricter time limits, followed by descriptions of longer or laxer time limits, the benefits of time limits, and complicating factors.

On shorter and stricter time limits:

  • My previous job allowed around 15 minutes.
  • Callers that are not having thoughts of suicide are supposed to be under 15 minutes. Typically they check in on you around 40 minutes if you’re still on a call.
  • The length of the call is always 20 minutes unless someone is in crisis or feeling suicidal.
  • When someone was calling frequently, we would put in 20-minute call limits if there were no imminent safety issues. I had mixed feelings about these limits. I see why we need to put in limits on frequent callers and leave the lines open, but 20 minutes was kind of an arbitrary, one-size-fits-all limit.
  • For callers who are not suicidal [to] medium risk, [the limit] is 30 minutes. High or imminent risk has no official time limit. I don’t like [the limits]. You can’t wrap everything up in a neat little bow in half an hour. And that we give people over 24 only 15 minutes is egregious.
  • [I] think giving less time to folks who are 25+ is not the best choice and assumes things.
  • Callers in certain demographics/circumstances had a 15 minute time limit expectation, which I was almost never able to meet.
  • I didn’t like their guideline of 45 minutes. I generally needed an hour. I’m a little slower, methodical. I found 45 messages to be a good guideline. They need to be careful about this, it’s not a factory line. Get more volunteers if the wait is too long, is my philosophy.
  • The limit is about 40 min for non-crisis conversations and an hour for crisis conversations. It makes sense and is better than the 10-min limit on phone hotlines, but doesn’t leave room for deeper exploration with the texter.
  • It feels very rushed and not very supportive to the contact in need. [The limit] for non-suicidal chats [is] 55 minutes; cases that present at low risk of suicide: 65; medium: 80.
  • The expectations are ridiculous. Time expectations lead to lack of connection, anxiety, quality issues, and turning the job that takes very human responses into a data-driven, robotic, reactive position.
  • Time limit expectations are helpful for frequent utilizers with little to no presenting crisis — the “just want to talk” folks. Otherwise, they greatly impact the quality of the interaction.
  • Trying to follow the timeline of the call model can escalate contacts.
  • Limits are harmful because they are not used with the [counselor’s] ability and experience in mind, putting more pressure on time than safety on most calls. The last line I worked on, a caller took their life after being told they had reached their time limit and would need to call back tomorrow despite not being safe.

On longer and laxer time limits:

  • No time limits… not even suggested guidelines. Again, this is one of my favorite things about how [my organization] runs their program.
  • I think our ‘goal’ is to try to be around 30-45 mins, the reasonable expectation is just under an hour, but we don’t have a set time limit and calls can take as long as they need, which is how I feel it should be.
  • My organization’s expectations feel reasonable to me. They understand not all interactions will fall into the expectations for one reason or another, but the averages always seem to work out for me.
  • There was not necessarily a clear written rule around [length], but generally we were not supposed to let a call go over an hour if there were no imminent risks. Some calls were easy to keep to 20-30 minutes, which was considered the general standard.
  • There’s no expected time limit, but they would check in to see if you have been on an interaction past a certain amount (i.e., a call past [90 minutes]).
  • Typically they check-in on you [at] around 40 minutes if you’re still on a call.
  • What happens if a counselor is on beyond 40 or 45 minutes is that a shift-lead will generally ask if you need any support.
  • It’s important that the organization sets time limit expectations, but some [supervisors] enforce this more strictly than others. Because of that, it appears that some supervisors/managers are more keen on good adherence numbers instead of making way for some instances where the caller requires longer-type of support.
  • My current organization (paid) does not set time limits on calls. My previous one (volunteer) did, and it drove me crazy. I am quite glad to now be trusted as a counselor to feel out how long a call is most beneficial to a caller, and to have adequate staffing that long calls are not a strain on the organization.
  • There is not a hard time-limit for either, but there is a general guideline of how a call is supposed to go. I think something like 35 min for non-suicide was suggested as ‘it is not generally productive after this length.’ What happens if a counselor is on beyond 40 or 45 minutes is that a shift-lead will generally ask if you need any support. I usually feel pretty supported if I say ‘hey this will be a long call’ if it’s [suicidal ideation] or complicated in some way.

On the benefits of time limits:

  • I think it’s okay to have a general timeframe because sometimes calls do get a bit lengthy, and there are countless other people who need our services.
  • When I first started taking chats that limit felt very difficult to maintain and I was often going over by quite a lot. But now that I have been working there for over a year, sticking to the limit the majority of the time is much easier, makes me more efficient, and helps prevent burnout in a conversation. I understand my role a little better.
  • I think that for low-risk, you’re not really supposed to go over 20 minutes. At first, I really bristled at that, but as I’ve gotten more experienced, I actually agree more. I’ve been working on the line for about three and half years now, and after those time limits for those situations, you end up repeating yourself, and most importantly, the texter doesn’t seem to get much more out of it past that point (except in very rare cases).
  • We [used] to be told to keep it at an hour; now we are suggested to stay on as long as need be, which can be exhausting for a counselor when chats go on for three or more hours.

On complicating factors involving time limits:

  • [Some] calls were much harder to keep even under an hour, even if there were not concerns about [suicide], due to other factors such as a caller being intoxicated, concerns about domestic violence and/or child/elder abuse, callers who were very distraught, and callers for whom English was not their first language and we had to get an interpreter.
  • For a lot of chats, the time limits are reasonable. However, there are chats that involve additional steps that don’t get any additional time. For example, if child abuse is mentioned, we disclose our obligation to report and ask what the contact wants to talk about, but don’t get any additional time after changing topics and potentially asking questions about what may happen if we do report.
  • Personally, I tend to spend more time supporting a first-time caller. I have also noticed that my support or crisis calls range somewhere from 50-70 minutes, depending on the need for constant redirection of a tangential client, or having to go through safety planning and finding resources. If the client just wants support and isn’t tangential, these calls are easier to keep around 40-50 minutes.
  • [Time limits] are not the same across [centers], and it causes a lot of confusion for callers when one line will give them 15 mins and another will give 20-30.

Background: For chat and text counselors, there is sometimes an expectation to chat with more than one person in crisis simultaneously.

Conversations may play out more slowly when a counselor is multitasking as compared with when they are able to provide undivided attention, which might imply that longer time limits are warranted when a counselor is handling multiple crisis conversations at once.

  1. Among chat and text counselors, 84% serve more than one person in crisis simultaneously at least some of the time.
  2. This practice is most common among paid counselors. Volunteer (unpaid) counselors chatted with multiple people in crisis simultaneously at only one crisis center.

“How frequently were you in more than one chat/text crisis conversation at the same time?”
Active Intervention

Background: an active intervention is when a crisis center, concerned about someone’s imminent plan for suicide, or a suicide attempt in progress, attempts to send first responders to assist that person. Historically, some crisis centers have referred to active interventions as ‘rescues’, although most avoid that term today.

A self-intervention is when a person in crisis decides to contact first responders or seek immediate in-person care on their own after a 988 call or chat. A voluntary intervention is when a crisis center gets the caller’s permission to transfer them to 911 or contact first responders on their behalf. An involuntary intervention (sometimes also called a non-consensual intervention) is when a crisis center contacts first responders without the permission of the person in crisis,4 and in some cases also without that person’s knowledge.

Involuntary intervention is generally meant to be a last resort to help someone stay alive after less-intrusive efforts have not helped, or are no longer possible. The intended policy at most suicide prevention crisis centers in the U.S., before resorting to involuntary intervention,5 is to exhaust efforts to help the person in crisis feel de-escalated and reconsider their plan for suicide, choose self-intervention, or agree to voluntary intervention. Involuntary intervention may also be done if the person in crisis, while still having an immediate plan for suicide or having initiated a suicide attempt that is believed to remain in progress, goes quiet, stops responding to the counselor’s messages, or otherwise becomes disconnected from the crisis conversation.6

While a few crisis centers are integrated with broader systems of care and can dispatch mobile crisis units7 directly, most are not, and perform active interventions by calling a 911 PSAP (public safety answering/access point).8 Typically, the crisis counselor stays on the line with the caller while another member of staff calls the PSAP.

  1. Counselors were polarized in how they felt about their crisis center’s approach to intervention, with some feeling grateful about the restraint their center exercises around involuntary intervention, while others felt their center intervenes without consent too readily.
  2. This divide spanned across crisis centers participating in 988, suggesting that not all 988 centers are approaching involuntary intervention in the same way.
  3. Counselors who were aware of mobile crisis teams generally felt very positively about them as alternatives to police. Some counselors working at national crisis centers were under the impression that very few cities have mobile crisis teams, and in one case said they were not permitted to give callers information about any local resource (such as a mobile crisis team) because no local resources have been pre-vetted and approved by their crisis center. Others said they were unsure exactly what a mobile crisis team does, and might not be able to tell callers who are open to self-intervention or voluntary intervention exactly what to expect from a mobile crisis team.
  4. At one suicide prevention hotline that does not participate in 988, three counselors reported that their organization’s policy is never to dispatch first responders without consent from the person in crisis.
  • Active rescue/intervention in the form of police intervention without caller consent happens more often than I believe policy justifies. Call takers and supervisors seem to often dispatch police more for their own comfort than [as] justified by assessment. I’ve found myself countless times defending the least restrictive intervention with my supervisors and colleagues.
  • Active rescue policies are challenging for me. I despise our policy and system [toward] active rescue, and I feel I’ve been forced to dispatch EMS on callers on many occasions where I felt it would cause more harm than good.
  • Honestly I really struggle with whether I think we should call police at all in these situations. I’m not sure if calling police is ever helpful in these situations, and I’ve heard of police making these situations much worse. I definitely think we should err on the side of only contacting police if there is clearly an imminent danger. There are a lot of gray areas in these situations, but given how unhelpful police often are, and given what a heavy use of resources this is, I think calling police should be avoided if at all possible.
  • I wish across 988 we could just tell [callers] flat out, “if we cannot agree to a safety plan, by using this service, you are agreeing that one will be made for you.”
  • Making decisions about interventions (calling 911) that callers may not want is a heavy responsibility and one I’ve had to work through my own feelings about, to make sure I know when I feel like I can ethically violate someone’s autonomy in that way.
  • I did appreciate that my employer was cautious about calling police and treated it as a last resort. I also appreciated that they stopped using the term “rescue” for calling police and started using the more neutral “dispatch”.
  • Active rescues were incredibly uncommon when I was working.
  • We don’t do active rescue without consent. No one should.

Several counselors answered a follow-up question about their crisis center’s relationship with local mobile crisis teams or mobile crisis teams nationally.

  • We always [encourage] self-intervention first and foremost. Mobile crisis is amazing, and I will always vote for them prior to deferring to police in a mental health crisis.
  • [Mobile] crisis teams are not available everywhere [but] tend to lead to more voluntary or self directed interventions. Calling police is always traumatic.
  • It’s really helpful to have [mobile crisis units]; they are a great option for people who don’t want to call the police but would benefit from a free, in-person visit to their home either for themselves or a loved one. I don’t know much about what happens after an MCU team connects with people, so I’m not sure how helpful people eventually find them to be, but for us, when we explain and offer their services, callers frequently haven’t heard of them before and are enthusiastic about connecting with them.
  • [Mobile crisis teams are] generally available, but difficult to come by.
  • I’ve seen counselors ask [supervisors] if they can look up local resources [such as mobile crisis teams] for people. Technically, I’m pretty sure we’re not supposed to do that. We’re supposed just to use the vetted resources on [our] site, none of which are regionally specific. It does seem like a shame in those cases.
  • I support these programs in theory, but I don’t feel like we have much of a relationship with local crisis programs. When I have contacted [one in particular] I usually found them pretty unhelpful and door-closing. [They have] so many limits (i.e., the person can’t be suicidal, can’t be in a private residence) that I am not sure how helpful they can be. I know that mobile crisis programs can be helpful, but my experience with our local services has not always been super helpful. I also don’t agree with the requirement in most places that police have to go out with a mobile crisis team even if there is no concern of physical violence. I know that [our local mobile crisis team] is meant to get around this requirement, but again, they have so many other limits. I think police should only have to go out with mobile crisis if there is a clear threat of violence.
Transparency about Involuntary Intervention

Background: counselors’ overall feelings about active intervention policy and practices are described above. This section focuses on the impact of disclosing, or not disclosing, an involuntary intervention in progress to the person first responders are being sent to. Crisis centers (including 988 centers) appear to be divided on whether they expect counselors to tell a person in crisis when they are sending first responders without that person’s consent.

One counselor shared that Vibrant Emotional Health, the nonprofit organization that administers 988 nationwide through a contract with the federal government, recently introduced a supplemental counselor training providing clarity on when and how counselors should be transparent about involuntary interventions. But other counselors reported that they had not seen this new training, leaving unclear whether its release will resolve the divide among crisis centers on how to approach transparency.

  1. When asked “does your organization always tell callers/texters if they have decided to send first responders to their location?” counselors at three 988 crisis centers replied “no”, while counselors at seven other 988 centers said they do inform the person in crisis about an involuntary intervention in all or many cases.
  2. Counselors’ overall feelings of satisfaction about active intervention practices are correlated with transparency expectations. Counselors who are trained to be transparent tend to be happier overall with active intervention practices at their crisis center.
  3. Some counselors who are trained not to be transparent said not being allowed to disclose interventions to callers was the most challenging part of their job. One described a tragic experience where a caller who had not been informed that first responders were on their way completed suicide when responders arrived.
Level of overall satisfaction with active intervention policies among the 17 counselors who were expected to be transparent about interventions without consent. The same, among the 15 counselors who were expected not to be transparent.

At two 988 crisis centers, counselors working at the same center answered “does your organization always tell callers/texters if they have decided to send first responders to their location?” in a way that reflected opposite understandings from one another:

No. Many 911/EMS situations are uncollaborative. This is when the client disengages or disconnects during safety planning (which means they’re already at least actively suicidal/homicidal) or is highly erratic during the conversation but is at imminent risk and declines to get themselves to safety. Yes, we are trained to let the callers/texter know when first responders are headed to their location.
Center A,
Counselor 1 (phone and text/chat counselor)
Center A,
Counselor 2 (phone and text/chat counselor)
No, we rarely ever do [provide transparency]. In fact, I don’t think I have ever told a texter/caller that emergency services is going to their location. Yes, we do value disclosure. The cases where clients may not be aware [of the intervention] is when they end the call/chat still expressing intent.
Center B,
Counselor 1 (text/chat counselor)
Center B,
Counselor 2 (phone counselor)

Among counselors who are expected to practice transparency, some reported no exceptions to the expectation of transparency. Others described certain cases where a judgment call to refrain from transparency might be made, including where “there was reason to believe that it would escalate the caller further,” “it would likely endanger the person’s safety or cause them to disconnect, leaving them endangered,” “someone threatened to complete suicide if we did call for help,” “we need to keep the client on the line to ensure safety,” “they end the call/chat still expressing intent,” and “we couldn’t tell them because they disconnected and didn’t answer when we tried to call them back.”

Counselors who had experience disclosing an involuntary intervention in progress described a range of responses from the person in crisis.

  • Fortunately this was a fairly small percentage of calls, since most callers were willing and able to engage in safety planning. However, if a caller wasn’t able to safety-plan, they often got very upset if we told them that police would be dispatched. This was especially true if the caller had a marginalized identity, especially if they were disabled and/or a person of color, and if they had had a previous traumatic experience with police or knew someone who had.
  • There is no typical reaction. The few times I’ve had to do this, reaction ranged from disconnecting to being anxious and scared. Once or twice, angry. I make sure they have information and stay on with them until help arrives unless they disconnect.

Several counselors operating under expectations not to disclose involuntary interventions described how uncomfortable that was, with one counselor attributing a caller’s death to the policy.

  • I have an issue with how sometimes interventions are called without the knowledge or approval of the caller. Transparency is important to establish and maintain trust.
  • I’m opposed to transferring a 988 call to 911 without explicit consent from the person texting in… I would have favored being honest with the person and telling them exactly what would be done if they did a, b, or c, once it got near that point. So yes, full transparency, to me, would be necessary in order to respect the person.
  • [The] most difficult [aspect of serving as a crisis counselor] is initiating involuntary interventions and not letting contacts know EMS will be arriving to them.
  • The policy was to not tell them, which was a moral and ethical betrayal of trust, and it backfired more than once. I needed to walk away from everything after it happened a few times with people I was trying to help, and I still feel a lot of guilt and personal responsibility. Even though, “oh no, it’s not your fault, you did what you were supposed to.” F- that… [The] most difficult [aspect of serving as a crisis counselor] was not being able to tell the caller that intervention was dispatched, and them committing suicide when intervention arrived because [of] not being able to tell them. A nightmare I wish on no one.

And one counselor discussed the new training from Vibrant that addresses transparency.

  • I can’t remember if we were trained specifically to avoid telling callers that first responders were on their way if those callers hadn’t consented to their arrival; however, in practice, we’re told to try to keep callers on the phone until those responders do arrive. The few calls I’ve had… when I’ve asked my supervisors to call 911 without the callers’ consent, I didn’t make them aware of that decision, as I felt doing so would result in them ending the call. My supervisors have never asked me to do anything differently in this regard. However, I just last week did a new imminent-risk training from Vibrant that asked us to, in general, let callers know that 911 had been called to help them prepare for the arrival of law enforcement, unless we thought that doing so would elevate risk for high-lethality callers (i.e., they would kill themselves before cops/EMS could show up). So it still seems like a little bit of a gray area, which unfortunately I think might be necessary, given the competing aims — respecting callers by being honest with them, and keeping them alive — and is just a difficult part of the job, and why it’s helpful to have supervisors involved with those kinds of high-risk calls. Overall, I’m okay with [our] approach to intervention (we’ve always approached it as a last resort), but I wish it had been more coordinated with Vibrant’s overall 988 policy from the beginning of the job. If callers ask us directly about the policy on calling the cops, we are supposed to tell them the truth — that we will call if a caller has already taken action to end their life, or is adamant that they are about to, and we try to make that a last resort.
Psychological and Practical Support

Background: Many counselors described experiences of burnout and asked for more psychological support. The improvements they asked for included better or clearer policies around handling abusive calls and chats, more training in those practices, more real-time support on shift from supervisors, and better compensation.

  1. How available supervisors were to chat with and help counselors during crisis conversations was strongly correlated with how psychologically supported counselors felt overall, with only 41% of counselors always finding it easy to reach a supervisor when they needed one.
  2. Many counselors saw shift supervisors as their strongest allies and expressed a high degree of satisfaction with how supervisors supported them (both on shift and off). One counselor said their supervisors gave them helpful resources for callers, as the crisis center’s formally vetted resources were never useful.
  3. Many counselors described the difficulty they have with abusive calls, prank calls, callers seeking sexual gratification (including callers who masturbate while speaking with the counselor), obscene or aggressive calls, and callers who tell them about a desire to harm someone else. Some reported that there were no clear, consistent, or workable policies for how to handle these kinds of challenging interactions.
  4. Several counselors answered a follow-up question about how they would like their crisis center to address abusive calls and texts or frequent users of their hotlines. They said they wished their crisis center would set up an internal system for sharing observations about particular abusive callers, give counselors permission to end abusive calls, and better support counselors in setting boundaries with callers. One said they wished 988 would allow crisis centers to block calls from phone numbers responsible for repeated abuse of the line.

“How easy was it for you to talk or message with a shift supervisor when you needed them?”
Level of satisfaction with “how well the organization helped you manage the strain of doing your work” among the 19 counselors who said it was always easy to get a shift supervisor’s support when they needed it. The same, among the 10 counselors who only sometimes, seldom, or never had an easy time reaching a shift supervisor.
  • Official policy was that people would be available to support us. The reality was that [supervisors] are mostly unavailable.
  • Burnout and PTSD is a huge problem. I spent two years taking crisis conversations, and while I myself wasn’t severely burned out, it was getting difficult to continue, and I cried about work a lot.
  • [I have] never-ending dread/anxiety before I go to work every day, and every second between calls.
  • Having to keep in mind all the metrics/points you have to hit while trying to build rapport and potentially save a life [is my greatest challenge].
  • My supervisors really had my back in times they were needed. I was able to be a high-performing counselor because of their level of care. We almost never use the vetted resources provided by the org. When resources are needed, the supervisors are so quick to hop in and find what’s most helpful to the contact. The supervision team for my department is beyond immaculate, and I’m so grateful for them.
  • My supervisors are overall quite good and things have been by the book, transparent, and consistent.
  • [Supervisors] clearly do read our call write-ups thoroughly and check in if anything we wrote caught their attention.
  • I saw something I did not feel was right. I contacted my supervisor and [their] supervisor about it. Not only were my concerns taken very seriously, but I was asked to help create a training/ongoing learning presentation for the agency.
  • Frequently being exposed to people calling for sexual gratification [is my greatest challenge].
  • Having to form boundaries with those who misuse the lines and having those boundaries negated because they don’t receive any consequences when they are abusive or inappropriate to the counselors [is my greatest challenge]. This can easily deplete our empathy levels, and also takes away resources from others who are at imminent risk and/or more receptive to receiving support.
  • I often felt like it wasn’t clear what the policies actually were or how to find them, and we would often get contradictory answers from supervisors and leadership.
  • Counselors often feel like our ideas fall on deaf ears. For example, many of my peers feel that the organization should have better policies to handle abusive or inappropriate callers. Even though this is something that supervisors may agree with, it is still up to the higher-ups to enact change. However, they may be so far removed from the situation that it doesn’t become as pressing as it should be. Counselors need stricter boundaries set by the organization to handle such calls. Any boundaries set by the counselor themselves are negated when abusive callers face no consequences.
  • The most challenging aspect has been the supervisors not all being aligned in what they expect of crisis counselors and each has their own variation for how they want you to interact with them.
  • Various departments in the company are not on the same page when it comes to certain policies — whether it’s something about how we approach calls, or if it’s internal understanding of company policies such as pay/benefits, etc.
  • There was little enforcement of official policy and procedures.
  • I often felt like it wasn’t clear what the policies actually were or how to find them, and we would often get contradictory answers from supervisors and leadership. One example was duty to warn issues where a caller made violent threats. Although there could be some room for clinical judgment, it felt like there was a real lack of clarity and consistency around this important issue.
  • For years we did not have a policy in place for setting limits with inappropriate callers (to my knowledge), but they eventually created a written policy in 2020… in addition to contracting with 988, we contracted with other agencies to provide phone coverage. In theory, the other agencies’ policies were written in the account procedures, but they were often ambiguous and out of date, and it was often unclear who to contact when there were questions about these policies. On several occasions, the main point person around these procedures left the agency without an announcement to the staff, so we didn’t even know that the point person wasn’t working there anymore. Also, the agency seemed really unclear on their policy around “Duty to Warn” issues. We had a lot of gray-area situations where callers would make vague or ambiguous threats to harm others, and supervisors seemed to have vastly different ideas about when we should or shouldn’t call police in these situations, and there didn’t seem to be a clear written policy on how to handle threats of harm to others.
  • I think there should be a place where [counselors] can share and report about who is doing this [abuse], so we can look up who the main perpetrators are and learn to recognize them. It’s so important to share information about these harmful people and at least have current info available for [counselors] who want to avoid them.
  • They should allow counselors to be able to initiate hang-up. Frequent callers need more limits and more clear expectations.
  • We do need to support people who are distressed but shouldn’t have to tolerate verbally abusive or sexually inappropriate behavior. I think the agency got better in more recent years about giving ideas and tips for redirection and having a written policy in place for handling this behavior. However, I continued to hear multiple staff, especially POC staff, say that they did not feel consistently supported around setting these limits.
  • There needs to be better protocol to manage frequent callers. It is a disservice to enable dependence of low-risk callers on the line. [988] does not block or have suspension or blocking policies for callers who are abusive or sexual. We have received all the PDFs about how to manage abusive or frequent callers, but the reality is, it doesn’t matter how many times a counselor sets those boundaries if there are no actual consequences set by [988]... Most of the calls that are draining are the abusive/sexual calls or those that misuse the lines. On Tuesday, I had a caller say all the “right” things to keep me on the phone until a point where I found out he was masturbating while talking to me. That was disturbing, very bothersome, and definitely needed more than five minutes for me to regroup.
Highlights and Feeling Heard

The survey asked: “What has stood out as a hotline’s best ways of making your voice as a counselor heard on matters of practice and policy? What has a hotline done to include you on important evolving questions about how things should work?”

Numerous counselors simply replied: “nothing.” Others shared similar sentiments.

  • Crisis workers and their shift supervisors have no voice about policies and procedures.
  • They do not ask our opinion or include us on any changes, and they typically don’t respond to questions at all when they’re asked, even in meetings.
  • Feedback from crisis counselors is not requested.
  • We usually get updates, don’t have much say though.
  • This is an area of disappointment for me. Any voice that deviates from the general consensus is typically in the out-group and not allowed career advancement. It can feel like there is a ‘popular’ portion of staff and those of us who are viewed as rabble-rousers or ‘negative’ when we express concern.
  • We have monthly team meetings but [it] still feels like not everyone is heard.
  • I have never participated in [feedback] sessions because they are often outside of my work time. We have feedback forms, but I am unsure if they are really ever seen.
  • I couldn’t tell you whether or not my observations and/or suggestions are actually implemented.
  • As far as voicing my experience/issues and the like, there are weekly (I think) group meetings for that but they aren’t led or attended by leadership to my knowledge. This survey was the best I’ve gotten in a while, and it’s for you, not them.
  • I have never felt heard before now.

In contrast, others shared that their shift supervisors make them feel heard and valued.

  • My supervisors usually respect my opinion… I feel safe, comfortable, and encouraged to share my thoughts and opinions. My organization values feedback in all areas, and I believe they practice what they preach.
  • Supervisors listen and actively engage with counselors; they also take immediate action. We are definitely heard.
  • The agency did have the agency supervisors check in individually regularly and this was often the best way to have a voice.
  • We do weekly polls, and our supervisors try to incorporate new ideas from the polls.
  • We are very supported here and have weekly staff huddles to talk about what we are experiencing and ways we deal with stress.

Other counselors described helpful engagement with managers and leaders at their crisis center.

  • There’s a pretty open dialogue between the counselors and the supervisors and directors so we can bring up our concerns. We also have monthly meetings one-on-one with a shift lead to talk about our developments and if we have any issues we might want to bring up. That being said, I don’t know that I feel we necessarily have a say in the larger [evolution] of the field and its guidelines.
  • Having an open-door policy with our higher-ups as well as having sessions where we can talk about things.
  • Speaking with the CEO of the organization and providing other departments a chance to enter into our work environment. This may include listening to real calls and talking to another crisis counselor about their experiences regarding calls, texts, and chats.
  • Providing proposed changes to the counselors who need to implement them for feedback first is really helpful. Frequently, counselors can identify potential problems or important questions that managers with no direct crisis experience don’t think of.

Finally, when asked about the most rewarding aspect of serving as a crisis counselor, most counselors described the satisfaction of being there for someone in an hour of need.

  • Having someone feel supported and know they’re not alone is the most rewarding.
  • Helping people see that they do have hope.
  • I get to make real, human connections with people who are struggling and be a buffer between them and suicide; I get to witness the power of the human will to overcome feelings of loneliness, hopelessness, suicidality, and powerlessness.
  • Learning how to convey empathy, active listening, and developing skills that help me communicate my feelings in my personal life.
  • Most calls were regenerative for both the caller and me.
  • The people who tell me the difference I made for them before they hang up.
  • I find it a true honor to be on the other end of the line when someone is allowing themselves to feel the pain they’re in and to be vulnerable.
  • I had an opportunity to say ‘I’m proud of you’ towards the end of conversing with a 12-year-old, and [they] said, ‘thank you, no one ever tells me that.’
Further Notes

While no individual crisis centers are named above, it can be challenging to borrow best practices without knowing exactly where to turn. Accordingly, leaders at several centers told me they would be happy for their practices to be discussed here and their names shared. The information in this section comes exclusively from my conversations with those leaders, and not from the survey.

Cassie Villegas, who served as a front-line quality specialist at Solari before moving into leadership, and Andrew Erwin described new counselor training at Solari to me as follows: following one week of core-skills training, during which trainees listen to 20+ real calls and participate in six full-conversation role-plays, trainees enter a minimum of a three-week mentorship cycle where they shadow an experienced training specialist, in a small group setting, listening to both the training specialist’s calls as well as calls handled by other new staff where they discuss, process, and provide feedback about what they hear on both ends of the line.

The length of this shadowing phase ensures each trainee hears their mentor and peers take numerous calls involving imminent risk of suicide, prank calls, disclosures of the caller’s intent to harm others, and other challenging types of cases. The shadowing phase continues for each trainee until they have observed and documented a prescribed number of calls of certain types (including calls where a mobile crisis team is dispatched, high-acuity suicidal calls, and calls involving domestic violence).

When a trainee finally begins taking calls of their own, supervisors listen in on all of their calls for an additional three weeks or longer, and are able to assist or take over on especially difficult calls. Staff who take chats and texts receive specialized chat and text training and transcript review once they are confident answering calls.

Counselor self-reflection and self-rating are a major ingredient in Solari’s quality assurance program, as Villegas describes it, in recognition that counselors often know what aspects of the work they are finding most difficult and may want to discuss, recognizing that random listen-ins may not identify those issues as clearly as a counselor can articulate them.

Villegas says Solari staff complete continuing education throughout the year for a total of 40 hours of ongoing in-house training, in addition to required continuous 988 training. Weekly supervision often centers around reviews of call recordings and group discussions about challenging callers, other crisis-related topics, and counselor self-care. Lunch-and-learns are often designed around trends identified by counselors, with new example calls recorded by team leads as discussion material.

Joyel Bennett and Deb Turner at Goodwill of the Finger Lakes told me that new counselors at their center are led through 20 to 30 days of initial training, listening to 10+ real calls (or reading 20+ real chat transcripts) and completing at least five full-conversation role-plays varying in difficulty and scenarios. Turner, who served as a full-time counselor at the center before moving into a leadership role there, believes in the importance of exposing trainees to how different counselors sound on different kinds of crisis calls. Recordings of some of her own calls are among those new trainees listen to, critique, and learn from. New counselors also get paired with experienced peers for mentoring. These mentorship pairings are rotated every few days during training, to widen each counselor’s exposure to different ways of thinking about counseling, and to foster more bonds among staff.

In addition to monthly in-service continuing education for counselors, which recently has focused on topics like local behavioral health drop-in centers, other community programs, and using person-centered language, Turner says the center’s quality assurance team coaches each counselor in live conversations each month, helping each person recognize their strengths, reflect on growth areas, and strategize around trying new techniques on the calls and chats they have found hardest.

1 We are grateful for all the responses we received, including those from folks who have served in roles other than crisis counselor, who have served outside the U.S., who have served on sexual assault, domestic violence, and other mental health-related lines, or who declined to provide information about the kind of line where they have served.
2 The 12 focus areas presented on the survey (found on the second page of the archived survey here) are as follow:
Shift Flexibility: getting shifts at the times and of the lengths that worked well for you
Training: the quality of the training in crisis counseling that the organization provided before your first solo shift
Continuous Learning: availability of ongoing training, continuing education, and opportunities to refine your counseling skills
Feedback Frequency: how frequently you were given feedback on your performance as a counselor
Feedback Helpfulness: how helpful the feedback on your performance as a counselor was
Psychological Support: how well the organization helped you manage the strain of doing your work
Vetted Resources: the breadth and quality of local and online resources curated for you to pass along to callers/texters in crisis conversations
Active Intervention/“Rescue”: your feelings about how the hotline handled instances where a caller/texter may have needed immediate in-person care
Efficacy in Crisis Counseling: how effective you feel you were able to be, overall, at giving callers/texters the care they needed
Career Progression: how well the organization supported you in growing professionally and progressing in the way you wanted
Compensation: how well you were paid for your work
Benefits: the quality of your employer’s benefits
3 Among counselors who received feedback more than six times in the most recent six months, many shared that they had started in their role at the crisis center within the last six months, which suggests that some of the feedback they received may have been part of their initial training. But nearly all counselors who reported receiving feedback 4-6 times in the most recent six months had been serving at their crisis center for well over six months at the time of responding, which suggests that the relatively frequent feedback they receive is part of an ongoing quality improvement and/or counselor development program.
4 In an involuntary intervention, the crisis center will tell first responders or dispatchers where they believe the person in crisis is, if they have some idea of it. But when they are intervening without the person’s consent, they will likely not have asked the person exactly where they are, and therefore may not be sure about the person’s location. Details the person has disclosed may be helpful in tentatively locating them. The crisis center generally passes this information along to dispatchers, along with the phone number (in the case of calls and texts) or IP address (in the case of chat conversations) of the person in crisis. The dispatcher may be able to contact a phone carrier or internet service provider with this information to get a better idea of the person’s location.
5 988’s own policy on intervention, which crisis centers that participate in 988 are expected to follow, can be found here.
6 A person in crisis may lose their connection or stop responding to the counselor for a range of reasons, including accidentally ending the call, losing consciousness due to a suicide attempt, running out of battery on their phone or device, moving out of cell range, accidentally closing the chat window in their browser (and potentially getting connected to a different crisis center if they open a new chat window), focusing on someone else who is helping them, attending to something else that requires their attention, falling asleep, or simply not wanting to keep talking. Before resorting to involuntary intervention, some crisis centers may attempt to re-establish contact with the person if they have their phone number (which is generally the case for calls and texts but not for chat conversations).
7 An increasing number of communities in the U.S. have mobile crisis units (sometimes called ‘mobile crisis teams’ or ‘community responder teams’) composed of social workers, peer responders, or other specially trained staff available to visit and assist people in crisis. Some of these are ‘co-responder’ teams that include a police officer, while others do not include police. Most include someone with EMT or paramedic training. Some of these teams can be contacted directly, while others are dispatched exclusively by 911 PSAPs. Further suggested reading:
8 If a mobile crisis team is not available, the 911 PSAP will typically dispatch police along with paramedics or EMTs. Some police have received Crisis Intervention Team (CIT) training.