Saving Lives Via Text Message

Nov 26, 2017
Originally published on November 26, 2017 8:42 pm

This is the first story in an NPR series, "Take a Number," that will explore problems around the world and the people who are trying to solve them.

Elisheva Adler was 20 years old, sitting in pajamas in her childhood bedroom in Long Island, the first time she saved someone's life via text message.

Adler had just started volunteering as a counselor for Crisis Text Line. The 4-year-old nonprofit provides free crisis intervention through a medium that is increasingly favored by young people: texts. Using the code 741741, counselors have exchanged more than 50 million messages with people who are facing issues from stress at school to self-harm. Out of those exchanges have come thousands of "active rescues" where first responders are called to a scene.

Adler heard about Crisis Text Line when she watched a TED talk by founder Nancy Lublin. Lublin had been running a text-based volunteer organization for teens, called DoSomething. One day, Lublin tells NPR, the platform got a text that read, "'he won't stop raping me. It's my dad. He told me not to tell anyone. r u there?' "

"It was so terrible and desperate that it stopped us in our tracks," Lublin says. "And a couple of weeks later I just thought, wow. If they're going to share stuff like this with us, if they're that alone, if they trust text that much, there should be a hotline by text. And so I set out to build it."

Adler, for her part, had been looking for a way to help people ever since she lost a friend to suicide when they were both teenagers.

"I sort of knew depression existed, but it existed somewhere out there," she says. "And when I lost my friend I remember just first being so confused and then just being frustrated. Like, what did I not see?"

To volunteer, Adler completed over 30 hours of training. Then, she began logging into Crisis Text Line's platform late at night and on weekends, when volume is typically highest. And one night she found herself chatting with someone who told her he was a veteran having problems with his marriage. "At some point he said, I just want to disappear."

Thanks to Adler's training, these words set off alarm bells. She asked whether he was thinking of suicide, and whether he had a method in mind. "He said, 'yes, I'm sitting on the edge of a bridge.' "

It may sound strange, or too explicit, but Adler's training taught her to ask these questions to identify an imminent danger. That's because having a concrete plan is a key risk factor for suicide.

Crisis Text Line employs data scientists who constantly analyze the texts coming in. One goal is to make sure the most serious texts get answered first. This has yielded unexpected insights.

For example, they have found that the word "ibuprofen" is a very powerful indicator that someone will make an attempt in the next 24 hours. It's 16 times more telling, their research shows, than the word "suicide" itself. The name of this common over-the-counter drug indicates that someone has the means to harm themselves, and a plan in mind.

Earlier this year, the Centers for Disease Control and Prevention reported that suicide rates for teen girls, specifically, in the U.S. are at a 40-year high. Crisis Text Line is especially well targeted to this group. Seven out of 10 texters are women, and 75 percent are under age 25. They also skew rural, LGBT and low-income. Lublin says people often hear about them through viral posts on social media. If you search the hashtag #741741 you will see posts on Instagram, Twitter, and Facebook spreading the word.

Crisis Text Line is not set up to provide ongoing therapy. But Lublin says the service aims to be more than just a Band-Aid. Their philosophy is that intervening at the right time, with referrals to a network of organizations on dozens of different issues, can make a lasting difference in someone's life.

People often tell the counselors something they have never told anyone else. "Many of these things, it's a hot moment where you can be tipped to a healthy decision or an unhealthy decision," Lublin explains. Her goal going forward is for the organization to take more of the burden off local 911 dispatchers and first responders.

Clearly, she says, there is a need. Fifty million texts were exchanged in the first four years, and they expect another 50 million just within the next year.

The wealth of data those texts provide makes counselors more effective. It also helps researchers identify trends in public health.

For example, although National Suicide Prevention Awareness Month is in September, Crisis Text Line's roughest times are in the spring, when school stress peaks.

This time of year, around Thanksgiving, also sees a spike, Lublin says, because of what she calls: "Breakupmageddon" or "the turkey dump." That is, many people end relationships around Thanksgiving, whether college students returning home or young adults considering bringing a partner home for the holidays.

On that night, when the man texted Elisheva Adler that he was on the bridge, Adler contacted her supervisor. Trained professionals are always available on Crisis Text Line's web site to support the volunteers.

Her next job was to get the man to give her his location, so first-responders could be called. And she kept the conversation going, asking about his child, until he texted her, "I hear them coming. I think I'm going to be okay."

Crisis Text Line currently has about 20 active rescues a day across the country. Adler, who is now 21, had seven in her first year as a volunteer. She has recruited many friends to volunteer as well. And she is applying for Ph.D. programs in clinical psychology.

Working with Crisis Text Line, she says, has "really restored my faith in humanity."

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

MICHEL MARTIN, HOST:

We're going to start this next story with a number - 5.1, 5.1 in 100,000 - that's the suicide rate for girls ages 15 to 19 in this country according to the Centers for Disease Control. We're focusing on this number as part of a new NPR series looking at problems around the world and the people who are solving them through the lens of a single number. The Crisis Text Line is a nonprofit trying to bring down that 5.1 suicide rate. It provides free crisis intervention through text messages. NPR's Anya Kamenetz reports.

ELISHEVA ADLER: I'm hopping to another conversation now.

ANYA KAMENETZ, BYLINE: Elisheva Adler is a 21-year-old applying to Ph.D. programs in psychology and a volunteer counselor for Crisis Text Line. Late at night on weekends, when the need is greatest, she sits at her computer in her parents' house in Long Island responding to people in pain.

ADLER: So right now, there are 81 conversations happening simultaneously. And we have 57 crisis counselors logged on and two supervisors.

KAMENETZ: All over the country, people in trouble are picking up their cellphones and tapping out messages to a number they might have seen on Instagram or Snapchat - 741741.

ADLER: Right now, there are 21 flagged conversations, which is way higher than usual. So usually, a conversation will be flagged if you think that there's a situation where someone's feeling suicidal or homicidal.

KAMENETZ: Traditional phone hotlines are often devoted to just one issue. Crisis Text Line takes them all, but suicide and self-harm are some of the most common problems. They automatically analyze the texts coming in to try to push these more serious ones to the front of the line.

Tell me about your first rescue.

ADLER: So I was actually here at this desk.

KAMENETZ: And this is your bedroom, like your childhood bedroom?

ADLER: Yeah. This is the bedroom that I've slept in more or less every night since I was one. So I was here. My dog was with me. And it was Saturday night at - Must have been like 2 a.m. I took this new conversation, and it was a man.

KAMENETZ: What did he say at first?

ADLER: I think he was actually in the military, and he was just having a hard time with his marriage. And then at some point, he said, I just want to disappear.

KAMENETZ: With those words, an alarm bell went off in the back of Adler's head, and she typed...

ADLER: Something along the lines of - sometimes when someone feels that way, they consider suicide. Is that something that you're thinking about tonight? And he said, yes. Right away, I said, thank you so much for sharing that with me. And I said something along the lines of - it's really brave of you to share that with me. It took a lot of courage for me to reach out tonight. Do you have a plan for how you would do it?

KAMENETZ: It may sound strange or too explicit, but Adler had learnt that having a concrete plan is a key risk factor for suicide. For example, Crisis Text Line's data scientists have found that the word Ibuprofen is a very powerful indicator that someone will make an attempt in the next 24 hours. In fact, it's 16 times more telling than the words suicide itself. The name of that common over-the-counter drug is a red flag that someone has the means to harm themselves. But on that night, Adler's texter told her he had a different method in mind.

ADLER: He said, yes, I'm sitting on the edge of a bridge. And so that had escalated pretty quickly.

KAMENETZ: You've been talking to him for how long at this point or texting with him?

ADLER: If I had to guess probably, around half an hour.

KAMENETZ: And how did you feel in that moment?

ADLER: I thought - beforehand, I had sort of anticipated that moment and sort of thought that I'd be like sort of freaking out, but I just got very calm. And I'm like, OK. That's fine. I've been trained. I know how to do this. I know what I'm doing.

KAMENETZ: And you're a 20-year-old at the time?

ADLER: At the time, I was - I had just turned 20, yeah.

KAMENETZ: And you're sitting in your bedroom.

ADLER: In pajamas.

KAMENETZ: While texting, Adler contacted her supervisor. Professionals are always available on Crisis Text Line's website to help the volunteers when things get serious. Her next job was to get the man to give her his location so first responders could be called, and then, to keep the conversation going.

ADLER: The thing is you can't just be like, OK, great speaking to you. Bye.

KAMENETZ: She kept texting.

ADLER: And then he sent me a text message. And he said something along the lines of like - I hear them. They're coming. I think I'm going to be OK.

KAMENETZ: Crisis Text Line currently has about 20 active rescues a day across the country. Adler had seven in her first year as a volunteer. Nancy Lublin founded Crisis Text Line. She says they're more than just a Band-Aid. Intervening at the right time with the right referrals can make a lasting difference in someone's life.

NANCY LUBLIN: Many of these things, it's a hot moment where you can be tipped to a healthy decision or an unhealthy decision.

KAMENETZ: Fifty million messages were exchanged in the first four years. They expect another 50 million within the next year. There are lots of insights buried in these conversations. For example, 7 of 10 texters are women, and 75 percent are young - under age 25. They also skew rural and low income, and nearly half are LGBT. Crisis Text Line's roughest times are in the spring, when school stress peaks. This time of year, Thanksgiving, also sees a spike because of what Lublin calls...

LUBLIN: Breakupmageddon (ph). A lot of people go through break-ups around Thanksgiving, especially people who've gone off to college.

KAMENETZ: Lublin says her ultimate goal is to take more of the burden off local 911 systems nationwide. To do that, they need more volunteers, what she calls...

LUBLIN: It's a love army.

KAMENETZ: Elisheva Adler's motivation for volunteering is partly personal.

ADLER: When I was around 16 or 17, I lost a close friend of mine to suicide. And that was a point in my life where I sort of knew depression had existed, but I knew it existed somewhere out there. And when I lost my friend, I remember just first being so confused and then just being frustrated, like, what did I not see? What did I not say?

KAMENETZ: She lets us listen in as she takes up a new conversation. This time, it's a woman.

ADLER: I usually introduce myself as Ellie (ph) and say, hey, my name's Ellie. Thanks so much for reaching out. And sometimes I ask if they'd feel comfortable sharing their name with me. They don't have to. But - so the texter just responded with their name. So the texter just texted in and expressed feeling suicidal.

(SOUNDBITE OF TEXT NOTIFICATION)

KAMENETZ: Adler keeps listening to make sure the anonymous texter will be OK, at least for tonight. Anya Kamenetz, NPR News. Transcript provided by NPR, Copyright NPR.