When You Call the Crisis Hotline

It's a crisis call, and a real one this time, not someone asking about the open hours of the local drugstore.Each crisis clinician handles calls differently. There are standards for what we do, such as making sure a person is safe before getting into details, but after that people have their own styles, and I am going to tell you how I do crisis calls.

Usually when it's a crisis call the person on the other end will just launch into a description of their problems without waiting for me to ask questions. So how do I determine if they are safe and how do I get the information I need?

I wait for the person to take a breath or pause, and then I ask their name. I make sure to get the pronunciation right. As Dale Carnegie said, “...a man's name is to him the sweetest and most important sound in any language.” I reintroduce myself and after that try to use the person's name at least a few times. This creates for them a sense of connection with me. Next I draw on the information they're giving me to ask questions about safety. For example if a person says they are depressed I will mention that sometimes depressed people think about hurting themselves and has the person ever thought about that? Its important to get this information early in the call in case the person has attempted or is attempting suicide. If that were the case I would need to call for help.

By this time in the call I would at least have found out the town where the person lives, if not their address. If I needed to call for help, I might ask the person if I could call an ambulance for them. If so, I would try to stay on the line with them until help arrived. If they objected, I could use the caller ID or I could have a co-worker trace the call and send an ambulance while I tried to keep the person on the phone. I would terminate the call after talking with the professionals who arrived on the scene.

But let's say the person is safe, and not thinking about harming him or herself. Then I would do some problem solving with them, to help them find and take advantage of whatever support was available to them. It could be referrals to counseling or therapy, or to a support group. It could be reminding the person of friends and family who were willing to help out. It could be just listening to them and reminding them that the crisis service is there 24/7 to support them.

If the crisis were severe or the person requested it, I would set up a face to face interview. I would get all the needed information and then present the case to the supervisor, who would assign a clinician to the case. That person would then take over working with the client; I would confirm a time for the client to come in and turn over all my notes to the clinician for the case. In some cases, such as for a wheelchair bound client with no transportation, it would be more appropriate for a mobile evaluation to take place. It would be up to the supervisor to approve this type of evaluation.

I should note that if we send an ambulance for a client we usually end up doing an evaluation with them after they are medically cleared in the emergency room; either we send out a clinician or have them based in the emergency room.

Later I will show you exactly what happens by publishing a mock phone call with a fictional client. But for now, if you have questions, please ask!