How a volunteer crisis line worked

The model in one paragraph

A room. A telephone that is answered every hour of every day of the year. A rota of trained volunteers, supported by a small paid staff. No charge, no appointment, no referral needed, no requirement to give a name, and no record kept that could identify the person calling. Whoever calls, for whatever reason, is talked with by someone who has been trained to listen, to ask directly about suicide when it is relevant, and to help the person get to whatever comes next. That is the whole design, and it has barely changed since the 1950s.

Where the model came from

The centre placed itself explicitly in an international lineage, and the placement is accurate. Organised suicide-prevention work in the United States and Europe dates from around the turn of the twentieth century. Telephone services for it began in the 1950s, with the Samaritans in London and the Los Angeles Suicide Prevention Center.

Those two set the template that Lawrence inherited in 1969 and that 988 still runs on today. Help is free. It is available around the clock. It can be used anonymously. It is available by telephone as well as in person. And — the innovation that made the rest possible — it is delivered largely by trained laypeople rather than clinicians, on the theory that the shortage which kills people is not a shortage of therapists but a shortage of someone to talk to at three in the morning.

The American wave the centre belonged to came a decade later and had a different flavour. Headquarters started as a drug centre run by students, out of a house, with an underground newspaper. Its founding proposal describes a service organisation run by qualified student volunteers. The formality came afterwards; the accreditation came seventeen years later.

What a shift consisted of

The published material describes a service that was free, confidential, anonymous, available twenty-four hours a day including holidays and university breaks, and available in person as well as by telephone. Over time it added chat and e-mail as the technology arrived, while keeping all counselling free of charge.

The counsellor on shift was doing several jobs that the public conception of a crisis line collapses into one. Some contacts were suicide-related and required direct risk conversation. Many more were people who were lonely, frightened, angry or confused and had nobody to say so to. A large share were information and referral — someone needing to know where to go for a specific practical problem, which is why the centre ran a community resource directory alongside the counselling line. Some were parents of children who were home alone after school. Some were people bereaved by suicide, calling months or years afterwards.

Volunteers also handled the connective work that makes a phone line useful: locating an advocate for someone reporting sexual assault, staying on the line while a person got themselves somewhere safer, or simply knowing which of the county's services was open at that hour. The centre also ran critical incident stress management, sending support to a workplace or group at their own location after a traumatic event — the crisis line going out rather than waiting to be called.

Anonymity and what it costs

The centre did not ask callers for demographic information. It said so plainly, and the consequence is stated in its own material: it could not say how many of its calls came from university students, even though the university was its founding constituency and a funder.

That is a real cost, and it is worth sitting with, because it is the central trade of the whole model. Anonymity is what makes the service usable by exactly the people least likely to walk into a clinic — and it is also what makes the service almost impossible to evaluate, hard to fund, and easy to dismiss. A service that knows nothing about its users cannot produce the demographic breakdowns that grantmakers ask for. It cannot follow anyone up. It cannot prove it prevented anything, because the counterfactual walks away and is never heard from again.

The centre's response to that problem was to measure what it could measure, at the moment it could measure it, before the caller hung up. That work is set out on measuring whether a crisis line works, and it is the most methodologically interesting thing the organisation published.

What the line was actually used for

The centre classified its contacts and published the totals, and the resulting picture is worth more than any description. In 2010, out of roughly twenty-two thousand recorded contacts, the largest single grouping was not suicide. It was what the centre called the emotional category — around 13,700 contacts covering people who were worried or scared, frustrated or angry, confused, lonely, or in no crisis at all but wanting to talk. Loneliness alone accounted for around 3,669.

Depression and suicide risk together accounted for around 4,492 contacts — over twelve a day — split between people experiencing depression or suicidal thoughts, people who had already acted, and people bereaved by or worried about someone else's suicide. Relationship and family concerns accounted for around 2,060. A violence category covering child abuse, sexual assault, physical abuse and military and veteran concerns accounted for around 564. A health and sexuality category covered medical worries, eating disorders, pregnancy, sexual orientation and gender identity.

Two things follow from that shape. First, the overwhelming majority of a suicide-prevention line's work is not suicide intervention; it is ordinary human distress being caught early by someone who answers the phone. Second, the twelve-a-day figure is the one that made the centre's case for funding, and it comes from the same counting exercise. Both facts are true at once, and the honest way to read a crisis line's statistics is to hold them together.

Where the practice went

The model did not end; it was nationalised. The area-code routing that connected Lawrence to national toll-free numbers in the 2000s became, in 2022, a three-digit number that anyone in the United States can dial. The centre that answered Kansas calls then still answers them now, under a different name. The practice described on this page is, in its essentials, the practice behind 988.

Read next: training volunteer counsellors, the part of the operation that consumed the most staff time and mattered the most; or from a national toll-free line to 988, for how a Lawrence phone line ended up inside a national system.