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Crisis Text Line Helps People Cope

Shairi Turner

Seeing the troubling increase in depression and anxiety among adolescents, Shairi Turner, MD (MED '96), recently jumped at the chance to become the first chief medical officer of a free, 24/7 support service called the Crisis Text Line. More than 65 million messages have been exchanged since the line's launch in 2013—and from every area code in the country. Turner, who also has a master's degree in public health, previously was the first chief medical director of the Florida Department of Juvenile Justice, and served as deputy secretary for health and director of the office of minority health for the Florida Department of Health.

I bring clinical expertise to the executive level. We have thousands of volunteer crisis counselors. They are overseen by crisis supervisors, who are primarily master's-level mental health clinicians. I lead the supervisors. My responsibilities also include the development of quality measures for conversations and ensuring that we are providing effective and appropriate crisis interventions.

When I take conversations with a texter, I focus on what's best for this individual who's experiencing a crisis, however they define it. Texter issues can range from actively trying to kill themselves while they are texting with us to discussing the stress of midterm tests. We've seen situations where texters are ingesting pills while they are texting us. So, compassion fatigue, which is what you're describing, is very real. We limit the amount of time a counselor can spend texting with people in crisis. We encourage self-care. I have to engage in self-care as well.

The purpose is to take a texter from a hot moment of crisis to a cool calm. The volunteers are not mental-health professionals but undergo an extensive application and rigorous training. We do not diagnose; we do not treat. We focus on exploring the crisis, identifying a texter's internal strengths and helping the texter brainstorm coping strategies so the texter can feel empowered and leave the experience feeling better. We also perform "active rescues," where, if we determine that a person has thoughts of suicide—they have a plan, means to undertake it and a time frame that's within 24 hours—we contact local law enforcement. About 15 to 20 times per day across the country, we send law enforcement because we feel someone is at imminent risk of dying by suicide.

Mission critical! Our volunteer counselors log what issues were discussed. We also ask the texter to fill out a survey if they wish so we can collect demographic data. We can then say at a given time for a given area what the hot issue is. For towns, cities, states that are low on funding for mental health—which most states are—we can say, for example, "the people from your state are texting about dealing with financial stress or bullying" so people can target resources with much more accuracy.

You can be in crisis and seek help, and no one has to know. And the fact that you're not speaking with someone or seeing someone—the anonymity—lends itself to people being far more open more quickly.

It was a pioneer and ahead of its time. I loved how quickly we were able to have clinical interactions as medical students. In the first two years, I worked with an OB-GYN and a pediatrician, and we were the first point of contact for a pregnant mother. All of the faculty were so knowledgeable, but so approachable.

—Bill Lubinger

Crisis Text Line (text 741741 from anywhere in the United States). For more information, visit crisistextline.org.