hollombe@ttidcc.UUCP (Jerry Hollombe) (01/29/85)
A week or so ago I posted the following question. I'm here posting the
answers I received with some comments of my own interspersed.
The question:
When I used to work for the L.A.S.P.C. one of our major problems was with
repeat callers. A statistical analysis showed that 60% of our calls were
from 20% of the callers. Most of these were lonely people who wanted
someone to talk to (having burnt out all their friends, if any). Some of
them were actually classified as high suicide risks but were getting no
apparent benefit from our service. We tried all kinds of schemes and
strategies for dealing with these people (at least one Master's Thesis got
written about it), but never came up with a really satisfactory solution.
So, who else has suffered with this problem and what have you tried? Any
reasonably elegant solutions?
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The responses:
Your statistic is still approximately valid for suburban Toronto. However,
few of the repeaters display suicidal behavior. They are more likely to
be ex-mental patients or alcoholics. Of the few that are suicidal, some are
put on "Person-to-person", a program where a team of usually three volunteers
telephone the person (a schedule is worked out to ensure that one call is
made every day). I worked on one of these teams once - it almost seemed as
though looking forward to the call was enough to keep the person going
through each day.
Russ Herman
{allegra,ihnp4,linus,decvax}!utzoo!aesat!rwh
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From ttidca!ttidcc!hollombe Mon Jan 21 10:06:49 1985
To: ttidca!ttidcc!hollombe ttidca!vortex!allegra!utzoo!aesat!rwh
Subject: Re: State of the Art question (not a joke).
Thanks for the information. In L.A. we routinely classified alcoholics,
especially older male alcoholics, as high suicide risks. The former
mental patients were evaluated on an individual basis. We tried a
similar program once but limited the calls to one a week. The most
difficult part was getting those hotline volunteers not directly
involved with the program to cooperate and refer the repeat callers
back to their special program. Otherwise, it seemed to help considerably.
Each caller had one counselor who would call them at a specified time
each week. Each counselor would carry a "case load" of three
callers. (This was originally set up as a Master's Thesis experiment,
so a number of controlled factors were taken into account when setting
up counselor/client relationships.) Unfortunately, the program was
cancelled before complete statistics could be gathered (internal politics
raised its ugly head once again). Some things never change, it seems.
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I have some grim news for you. There is nothing that you can do if
someone *really* and *sincerely* wishes to commit suicide. What you
are dealing with is not people who actually want to commit suicide,
but with people who want more attention.
Now, unless you happen to be professionally interested in this problem,
there is *nothing* *you* *can* *do* -- except to suggest to these
people except that they find someone who will give them the attention
they want. If they are picky, and *want attention from MOTHER*, say,
you can do nothing until they are willing to settle for attention
from someone else.
There are several categories of professional ``someone else's'' which
I am sure you are aware of...religions and psychiatry sspring to mind,
though organisations like the SCA and many dance organisations can do
the same sort of thing. But you can never sell these organisations to
any one -- they have to sell it to themselves. And this you cannot
do for them.
It is possible that you could end up as a ``special friend'' to a very
small fraction of the repeat callers, but you cannot keep on doing this
for everybody: you will only wear yourself out.
So stay calm, and remember what proportion of the people who *do* call
in really *don't* commit suicide just because there was someone there...
Laura Creighton [also manned suicide prevention lines]
utzoo!laura
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Well, I've been dealing with non-suicidal people (but stuck in a
rut) on an amateur (I don't get paid, but I am in psych) basis for
the last few years, and some of the more effective ways of getting
people not to mope (or stuck in a rut) have been:
1. The 'get them furious with you' route. I may not recommend this
with suicidal patients, but ones who have exausted the 'yes, but'
route... well... I just start telling them that they might be total
losers, and if they think so, why are they wasting my time and
theirs with their whinings (whine is an important word here). When
my sarcasm reaches its peak they usually get good and frosted and go
off an do whatever they felt they could, just to show me.
2. The 'get them furious with whomever dumped them' route. This
works really well for the mildly depressed after a break-up. The
person usually is talking half-heartedly about either killing
themselves, or running away to a nunnery, or something along the
line of 'I'll be gone, and then they'll see'. Well, I just point
out that if the ex-SO is such a schmuck, he/she would probably get a
bit of a kick out of it. Then I counter with 'do you really want to
give them the satisfaction of knowing that they have the power (key
word is power) to do that to you?'. This usually has the effect of
getting the person mad at the SO (which they probably need to be,
since they have usually been blaming the whole mess on themselves),
and gets them off to show how they really can 'survive by
themselves'.
BTW, a variant on the first method (changed to 'If you want to
do something, you have to go out and do it, dammit!') was working
quite well with Jeff S until the christian minister (not the latest
one, he seems to almost be decent) he was going to started the 'pray
to God, and he'll decide for you' line...
Laurie Sefton
{harpo,ihnp4,allegra,decvax}!pur-ee!pucc-h!afo
===================
Comment:
A variation of the above I've used with some success is to agree with the
caller. Something to the effect of "I guess you're right. There's nothing
I can do to help you. I've offered everything I have and you've shot it
down. I guess I'll be going. 'Bye." [Subtext: You win. Now what?] This
type of line has been known to jolt people out of yes-but mode though it's
not always effective.
===================
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That's interesting about LASPC "automatically" classifying a group as
suicidal. We tend towards conservativism in that area: unless the caller
has attempted in the past, or shows clear evidence of suicideal ideation,
we would not classify them as at risk. While it's well established that
alcohol is a factor, I wonder if it's as large a factor in the subgroup
of pre-suicides that call distress centres.
=====================
Comment:
Our statistics showed that adult male alcoholics were among the highest
risks for suicide, even without prior attempts. Prior history and
increasing age contributed significantly as well. Note that we had two
risk classes: emergency and long-term. Adult male alcoholics were always
classified as high long-term risks but not always high emergency risks.
====================
The problem up here with person-to-person is assembling a team willing and
able to work with the caller, who can indicate preferences. Usually by the
time the program is set up, there has been enough contact with the centre
so that the caller is well known, and has probably established some
preferences among the volunteers (even though the official policy is that
volunteers are interchangeable - we will not tell a caller when a particular
one is coming on shift).
================
Comment:
Same here, though the repeaters got to know who was on what shift pretty
well after a while. Some could recognize voices (and we theirs).
================
I wouldn't anticipate that weekly calls would have much of an effect. Some
of these people are already seeing therapists; most are also calling other
centres (there are 5 additional centres that are in Toronto's local
calling area). With daily calls, the callers can be told "Wait for your
call" if they call in without imposing too much of a hardship. What I
would like to see is some sort of inter-centre co-ordination of these callers,
but there are widespread political differences amongst the five.
Russ Herman
{allegra,ihnp4,linus,decvax}!utzoo!aesat!rwh
=======================
Comment:
Our experience was that the once a week calls did help, at least in terms
of getting the repeaters off the crisis lines. An over-all policy at the
SPC was to refer anyone who was seeing a therapist back to that therapist
and otherwise refuse to speak to them unless it was clearly a high
emergency risk situation. The reasoning was that our talking to them
interfered with their therapy because they were telling us things they
should have been discussing with their shrink.
======================
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I haven't had any further response for most of a week so I guess that's it.
Thanks, all, for your contributions. I hope everyone else finds them as
interesting.
--
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The Polymath (Jerry Hollombe)
Citicorp TTI If thy CRT offend thee, pluck
3100 Ocean Park Blvd. it out and cast it from thee.
Santa Monica, California 90405
(213) 450-9111, ext. 2483
{vortex,philabs}!ttidca!ttidcc!hollombe