What We've Learned From The Data On Crisis Counseling Via Text Message
AUDIE CORNISH, HOST:
And I'm Audie Cornish with All Tech Considered. Teens send tons of text messages to their friends, to their parents and, if they need to, to a crisis counselor. Since launching in 2013, Crisis Text Line has processed 129 million text messages, most of them from teens. Founder and CEO Nancy Lublin was running another nonprofit that uses text messages to engage teens in community service when they got this distressing text, a cry for help.
NANCY LUBLIN: Within about two weeks of getting that message, I just thought we - clearly, there needs to be a hotline. Like, we need to do something. There needs to be a hotline by text if young people feel more comfortable sharing this stuff by text.
CORNISH: So when someone text 741-741 and asks for help, who is on the other side of the line?
LUBLIN: So you're actually cared for by three different levels of help. First, there's an algorithm that stack ranks and puts you in the queue based on severity.
CORNISH: So this is an AI-driven front desk.
LUBLIN: Yep. Exactly. Exactly. Second, there's a crisis counselor, who is someone who has applied, gone through a background check 'cause they're over 18 and about a 30-hour training and passed. And third, supervisors, who are paid full-time staff with a master's degree in a relevant field. They are watching every conversation 24/7.
CORNISH: Talk about what the conversation looks like, so to speak. I mean, you're talking about how you're essentially monitoring it in real time. What are the kinds of things these counselors are saying? And are there red flags that can alter the nature of their support?
LUBLIN: So one of the things that we've discovered is that you don't need to be specially trained in eating disorders. You don't need to be specially trained in how to talk to someone who's LGBTQ. You don't need to be specially trained for any of these particular issues. You need to be really awesome at empathy and capable of mirroring and validating without actively problem-solving for them, without telling them what to do.
CORNISH: It's funny because these are actions I think of being more effective with eye contact.
LUBLIN: Yeah, sure - in person or hearing our voice. And you don't get any of that by text. And so you know what you don't get? Bias. And so almost 19% of our texters identify as Hispanic, 12% black and 5% Native American. I mean, we get really, really diverse. We skew young, poor, rural and diverse. And also, LGBTQ - 44% of our texters identify as LGBTQ+.
CORNISH: What do you think it is about texting that leads to that kind of demographic?
LUBLIN: There's no judgment. Humans have bias. And when you don't hear their voice, they're a blank canvas. The thing I'm most proud of with Crisis Text Line is, if you think about it, 100% of our customers, 100% of the people texting us are miserable. They're unhappy. They're at the end, and so they're turning to a hotline for help - 100% unhappy. And yet somehow right now we have an 87% satisfaction rating from those unhappy people.
CORNISH: What lessons have you learned from the data that have changed the way your counselors do their work?
LUBLIN: One of my favorite things that we've learned is a policy we call always ask, which is - we looked at the data and saw that it is not harmful or suggestive to ask someone if they're thinking about killing themself.
CORNISH: So when you were first starting out and doing the trainings, this was not something you suggested people do, for the concerns you just mentioned.
LUBLIN: That's right. That's right. And so now we ask every single - our goal is to ask, in 100% of our conversations, if they're thinking about killing themself. Now, the keys that we learned in the data were to ask early in the conversation, which is a surprise to us. Somewhere between message 8 and 20 is the sweet spot of when to ask. Two, we learned the best way to ask is to start with an expression of care. And then, thirdly, to, after that, have a very direct question that doesn't use the word suicide, but instead uses either the phrase, are you thinking about killing yourself, or the phrase, are you thinking about death or dying?
And so we shipped this policy early in 2019. And early in 2019, we had an 85% satisfaction rating from our user base. And we ended 2019 with an 87% satisfaction rate from our texters. I think you can actually attribute some of it to this always ask policy. People like when you ask. They feel seen. They feel more comfortable sharing because you asked.
CORNISH: Nancy Lublin is CEO of Crisis Text Line. Their data is at crisistrends.org.
Thank you for your time.
LUBLIN: Thank you.
CORNISH: And that Text Line number is 741-741.
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