Colorado’s Mental Health Crisis Hotline Prepares For A Busier, Higher-Tech Future

Jul 5, 2018

A chorus of voices fills a Denver call center, coming from the rows of soldier-like operators in cubicles.

“Colorado support line. This is Caroline,” a female operator says. “Who am I speaking with?”

The caller’s words are muffled, inaudible to anyone but the operator. In the next cubicle, a male operator is finishing his conversation.

“Is there anything else that I can do to try and assist you tonight?” he asks.

Silently, he nods along, taking diligent notes.  

They’re answering calls on the Colorado Crisis Line from people around the state, all of them experiencing suicidal thoughts, suffering from anxiety or depression or worrying about a loved one or friend’s mental illness.

In times of crisis, the operators are often the only ones around to help them.

The hum of conversations and clatter of keyboards encapsulates what everyone on staff has lived with for some time now: growing demand and limited staff. For the Colorado Crisis Line, slow days are a thing of the past.

In the four years since it went online activity volume has quintupled. The influx has forced Rocky Mountain Crisis Partners (RMCP), the Denver non-profit contracted by the state, to keep up by constantly evolving.

A few things must never change. Caller satisfaction must remain positive. Wait times must stay short. If they don’t, a lot is at stake.

The state’s Department of Human Services, which oversees the line, is set to decide whether it will renew its contract with the non-profit – along with its $3 million a year budget – sometime in the next year.

The decision comes as the state’s suicide rate continues to rise, presenting RMCP and DHS with a complicated question: Is what they’re doing enough?

When the male operator hangs up, a ping comes through his headset. Another call is waiting. With the click of a mouse, operator and caller are connected.

“Colorado crisis line,” he says. “Who am I speaking with?”

The process, without pause, begins anew.

Keeping up

Camped out in an empty conference room, the supervisor is watching.

On a laptop screen, a color-coded grid updates in real time. Jessica Stohlmann-Rainey uses it to monitor active calls on the crisis line floor. There are about a dozen in progress on this particular afternoon.  

“It is busy out there,” she says. “You can see there’s two peer calls waiting right now and we don’t have people available.”

The hotline has two options for those who dial in: the crisis line and peer support line. The two offer different services for those in need. The latter is more about relating one-on-one, the former for finding immediate care.

On the peer line, she says, callers can leave a voicemail, and someone will follow up the next day.

On the crisis line, where problems must be addressed immediately, callers must wait. The average time before an operator picks up these days is about 48 seconds, according to RMCP’s records. That’s not bad given the growing volume, according to Stohlmann.

The 24/7 mental health hotline was created in 2014 in response to the Aurora theatre shooting two years prior. It’s part of legislation passed by lawmakers that also includes walk-in clinics and a mobile crisis team.

In June 2014, the earliest records available, the hotline logged 3,703 interactions, defined as the number of conversations over phone, text or instant message.

In May of this year, the most recent monthly data available, the service recorded 19,956 such contacts. Staff say they expect June to be even higher.

These days, RMCP’s staff numbers 75 people.

The peer support line employs 14 individuals and the crisis line, 22 people. There are 28 licensed clinicians who step in to handle more serious calls that operators aren’t qualified to address, such as a person at risk of carrying out a suicide in the near future.

The rest are administrative staff.

In the week following the deaths of fashion designer Kate Spade and celebrity chef Anthony Bourdain, the number of calls to the crisis line surged 15 percent, according to RMCP. Calls to the National Suicide Prevention Lifeline made from within Colorado, which also get funneled through RMCP, surged 67 percent.

The wave put a lot of strain on the staff. Stohlmann-Rainey says she worked through that weekend.

“Sometimes, it’s an all hands on deck situation,” she says. “It’s not just the people who are normally on the floor. But all the supervisors and everybody has to chip in in that sort of situation.”

She has several theories as to why the hotline’s overall demand has grown. It’s been around for a while, so word has gotten out. And there’s our ever-growing obsession with social media, which can bring people together. But it can also isolate.

“(People are developing) these surface relationships that allow people to say ‘I’m fine,’ and not be fine,” she says. “And no one to know.” ­­­­

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‘Sufficient capacity’

Over the last year, a lot has been happening with the crisis line.

Colorado lawmakers voted to increase its budget by $700,000 during the 2017 legislative session, according to Camille Harding, who oversees the hotline’s strategic planning as a director in the Office of Behavioral Health, which sits within the Department of Human Services.

“(That all goes to) supporting the core business functions of supporting the state crisis hotline,” Harding said. “It's making sure that we have sufficient capacity to manage that fluctuation in volume.”

DHS couldn’t provide an exact number of hotline positions the extra funding from the state is supporting.  

In a review (PDF) of Colorado’s behavioral health crisis system released by DHS last month, suggestions for several other improvements to the service were also made, namely investing in new technology.

One suggestion from the group involved creating a GPS-enabled crisis app so callers don’t have to remember the phone number.

“We know that technology has a lot of opportunity to improve a variety of things from response time or being able to instant message and provide feedback about the support you received,” she said.

The report also suggests exploring the possibility of changing the state’s three-digit food and housing hotline — 2-1-1 — to direct to the hotline.

Other suggestions include rolling out a statewide-integrated data system to better keep track of calls and upping the line’s marketing efforts to underserved populations.   

A sign advertising the crisis line is posted outside the call center's break room, where employees take a break before the late shift. The hotline is staffed 24/7, so the working hours of an operator don't line up with that of a typical business day.
Credit Matt Bloom/KUNC

In May of 2017, the state received a $7.8 million federal grant form the Substance Abuse and Mental Health Services Administration, or SAMHSA, to combat opioid addiction. A portion of that went to adding two opiate specialist positions to the hotline’s staff this spring: a peer support line operator and a clinician.

Heidi L. took on the role of the line’s first opiate specialist in March 2018. KUNC is withholding her last name for caller-operator privacy concerns.

She says the new position is a vital one considering the amount of calls she gets specifically about addiction-related crises.

“Sometimes when people are calling they just want detox,” she said. “Some people don’t know what they’re doing and have no idea of what to do or where to go. It’s a really complex problem.”

Her first contact with the crisis line was as a user. She dialed in during a panic attack on her way to a work training in 2013 and again before a suicide attempt in 2014.

She says it was an invaluable part of her recovery.

“Even if I didn’t have anybody else, there was somebody who gave a damn that I picked up the phone,” she said.

The call center's tranquility room offers an escape for operators, who often answer dozens of calls a day from those experiencing a mental health crisis.
Credit Matt Bloom/KUNC

Taking care of their own

Even the people answering the phones need a break at some point. That’s why the center has what staff call the “tranquility room.”

Stohlmann-Rainey sorts the assortment of stress-relieving tools in the small room, away from the chorus of calm voices emanating from the office’s rows of cubicles. There’s a yoga mat, a salt lamp and a massage chair. A door shuts, keeping it quiet. 

Stohlmann-Rainey used to do jiu-jitsu. She brought in a rebreakable board.

“So people can get some energy out,” she says, laughing.

A sense of humor is also important, she adds. The work of an operator can be grueling.  

“We ask them to do something really big, which is to meet people who are in their darkest moments,” she says. “And that’s a really vulnerable place to ask people to be.” 

Without supporting the call center’s staff, she says, they can’t support the growing number of callers.