It takes a teenager to help a teenager in crisis

Harrison, who is now 23, later joined the staff at YouthLine, a service that Lines for Life offers for those aged 11 to 21. He said he dreams of discovering what that caller went on to accomplish.

Youth suicide is climbing faster than suicide by any other age group, perhaps because of social media, which can cause rising anxiety and depression among teenagers. While peer support has proved effective for adults with mental health challenges, scientific evaluations of teenagers helping one another are difficult to find — even though some limited studies show that teenagers experiencing the stress of adolescence cope better emotionally when they are with their friends than with their parents. YouthLine is one of six youth lines across the country that have demonstrated how teenagers can relate to their peers over the internet or the phone in a way that adults are sometimes unable to do.

These peer-run crisis lines are coming together to bring more young voices to crisis intervention. But to spread this service nationwide, they will have to convince the sceptics that teenagers can do this work.

‘Anything in possible’

YouthLine volunteers work from an office building a few blocks from the Willamette River in South Portland. On one wall a huge banner reads, ‘ANYTHING IS POSSIBLE’. The volunteers created a poster with 100 ways to stay safe, including “high five everything,” “go jump in puddles” and “fake laugh until you start laughing for real.”

No one would confuse this for a typical crisis line staffed by adults: A recent debate among volunteers working the evening shift was over whether it would be better to fight with a sword one 20-foot rat or 20 one-foot rats.

In other words, they are teenagers being teenagers. Then the phone rings or a message pops up on the screen, and they switch gears.

YouthLine trains volunteers who are between 15 and 20 years old. They answer calls from teenagers who reach out to their help line by phone, text, chat or email.

Since young people in distress are more likely to turn to peers than adults, training is critical to equip YouthLine volunteers to do what they do safely — both for themselves and the callers, said Emily Moser, YouthLine’s programming manager.

“Our aim is to get kids to reach out earlier. If we can help kids build better help-seeking skills, we won’t get that call from them down the road.”

- Dwight Holton, chief executive of Lines for Life

YouthLine volunteers go through a three-hour orientation and 55 hours of training where they listen as their peers take calls. SafeTALK (Suicide Alertness for Everyone) training helps them recognise thoughts of suicide. And more experienced volunteers go through Applied Suicide Intervention Skills Training, or ASIST, which prepares them to intervene during a moment of crisis.

YouthLine asks teenagers to commit to one three-and-a-half-hour shift per week for at least a year. Many of these volunteers sign up for extra shifts, and stay for several years.

“I started volunteering at YouthLine because I felt like a lot of my friends were coming to me with these really intense issues and I felt powerless to help them,” said Katarina Grealish, 17. She said she has built the confidence she was looking for to help others, and can relate to the young people who call in, without downplaying what they are going through.

“Teenagers have a lot of black and white thinking,” Grealish said. “And so it can be really hard to have an adult, who has more of the grey area thinking, point out the grey area.”

Everyday challenges

Volunteers know what it means to be a teenager in 2019 and they are trained to meet callers where they are. When callers say, for example, that they failed a test and now they will never go to college, volunteers can listen, let the callers express their feelings and relate — instead of immediately responding that everything will be OK.

There is always a clinician with a master’s degree in the room, supervising activity from a standing desk. To coach the volunteers, these experts listen to calls and review texts, chats and emails using an internal messaging service. They remind the volunteers of best practices that are part of their training and share ideas for how to move the conversation along. Volunteers learn to suggest that callers talk to an adult whom they trust, like a parent, counsellor or neighbour. The YouthLine has to report to child protective services or emergency services if they speak with anyone who is being abused or in danger, but Moser said they rarely have to do so.

While Lines for Life does get calls from teenagers who are suicidal, most conversations are about the everyday challenges they face, from break-ups and bad grades to bullies, said Dwight Holton, chief executive of Lines for Life.

Lines for Life is focused on substance abuse and suicide prevention, and it serves people of all ages, from Oregon and across the country. In addition to YouthLine, Lines for Life has an alcohol and drug helpline, and a military help line for service members and veterans. It recently introduced a senior loneliness line. Crisis intervention specialists take calls 24/7. YouthLine volunteers work from 4pm to 10pm.

Out of the five other youth lines across the country, Holton said YouthLine has the most in common with Teen Line in Los Angeles.

Risk of vicarious trauma

Both programmes have young volunteers who work the lines, serve as role models and mentors in their communities, and raise awareness about mental health in schools.

The six youth lines, which together speak to more than 50,000 people each year, have monthly conference calls to share best practices. In April, they presented their work at the American Association of Suicidology conference in Denver. Volunteers from Teen Line and YouthLine took the stage to address how the experience of working the crisis lines affects teenagers.

At the event, Holton encouraged members of the audience to speak with Moser and Michelle Carlson, the executive director of Teen Line, to learn how adults working crisis lines can better connect with teenagers — and discuss ways to start similar programmes in their communities.

Last year, about 25 per cent of calls and texts to YouthLine were from Oregon and about 75 per cent were from the rest of the United States, with a small percentage from outside the country. Lines for Life and Teen Line talk regularly about ways to employ this model nationally. Holton said he envisions a service that is similar to the National Suicide Prevention Lifeline — 1-800-273-8255 (TALK) — but specifically geared toward the young. He hopes to initiate it in the next 12 to 24 months.

But not everyone thinks teenagers can or should take calls from people in crisis.

Crisis Text Line, a non-profit that provides crisis intervention by text, decided to steer clear of volunteers under the age of 18 for a few reasons, according to Dr. Shairi Turner, who was the first chief medical officer at the organisation. She said she is concerned that conversations with people in crisis “run the risk of vicarious trauma” for teenage volunteers.

Wendy Farmer, the chief executive of Behavioural Health Link in Atlanta, also had reservations about the model, until she visited Lines for Life last August. “The clinician in me said, ‘Wow, it’s a great idea, but I don’t know if we want to expose young people to what happens on a crisis line,’” she said.

Initially, Farmer travelled to Portland to learn how the adults who run her lines could better relate to teenagers or preteens. But she said she was “really blown away” by the young people she met.

Farmer went through the YouthLine orientation, spent a night on shift and conducted a focus group with some of the volunteers. She said she was struck by how smart the students were — indeed, she said, the 15-year-old she was paired with for an exercise in reflective listening did a better job than she did.

What surprised Farmer was not only how effective these teenagers were in helping their peers through challenges, but also the way that work helped them build their own resilience.

Whereas Crisis Text Line volunteers work remotely, the teenagers at YouthLine work side-by-side, so they can support one another. Behavioural Health Link now seeks to replicate that model. The programme is in close touch with YouthLine, and Farmer said her hope is to have teenagers helping others by next year.

Despite the promise of peer-run youth lines, stigma remains a hurdle for young people reaching out for help, Holton said. “I can’t tell you how many parents have told me that stigma killed their child,” he said.

Reach out earlier

Nobody who breaks an arm would be embarrassed to go to an emergency room, Holton explained, but there is a stigma associated with reaching out about mental health and addiction.

That is why YouthLine offers services that are confidential and free of judgement, explaining on the website: “No problem is too big or too small for the YouthLine!”

And it can be easier for a teenager to reach out to a peer first, even if the next step is to speak with a trusted adult. Holton said that if he were to tell one of his son’s teenage buddies that he should talk to his mother about something, he would get an eye roll. But if his son were to say the same thing to his friend, that suggestion would land in a totally different way.

“Our aim is to get kids to reach out earlier,” Holton said. “If we can help kids build better help-seeking skills, we won’t get that call from them down the road.”

At the suicidology conference in Denver, Holton introduced Farmer from Behavioural Health Link. She moderated the panel featuring volunteers from YouthLine and Teen Line, sharing how her time in Portland changed her opinion on whether teenagers can or should volunteer on crisis lines.

“I don’t know why we haven’t embraced the idea that young people can help young people,” she said.

— Catherine Cheney is a correspondent for Devex, a media platform for the global development community, and works on staff for the Solutions Journalism Network.