Helping Online Community Members Experiencing a Mental Health Crisis

[00:00:04] Announcer: You’re listening to Community Signal, the podcast for online community professionals. Sponsored by Vanilla, a one-stop-shop for online community. Tweet with @communitysignal as you listen. Here’s your host, Patrick O’Keefe.

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[00:00:25] Patrick O’Keefe: Hello and welcome to Community Signal. As a warning, on this episode, we’ll be discussing topics related to mental health crises, including self-harm and suicide. We’re joined by Becka Ross, chief program officer at Crisis Text Line, to talk about how you can help members in your community who may be experiencing a crisis, by thinking ahead, developing policies, and being empathetic.

Thank you to our Patreon supporters for finding value in our show. This group includes Jules Standen, Heather Champ, and Marjorie Anderson. If you’re interested in becoming a supporter, please visit communitysignal.com/innercircle.

Becka Ross is a licensed clinical social worker with over 15 years’ experience in mental health, working in both direct practice as a psychotherapist, managing a residential program for young men transitioning to adulthood, providing teletherapy in a medical setting, and currently, as the chief program officer at Crisis Text Line, which provides free 24/7 crisis support through a text-based service.

In her current role, Becka oversees the clinical team to ensure quality crisis intervention service through text. In her time with Crisis Text Line, she has been part of expanding Crisis Text Line service to three other countries using machine learning and technology to improve the speed and quality of crisis intervention through text. She is a passionate advocate for access to quality mental health and suicide prevention.

Crisis Text Line has trained over 39,000 volunteer crisis counselors, and in seven years, they’ve supported over 5.4 million conversations with an average of 4,000 people supported every day. Through machine learning, they’re able to triage conversations and respond to the highest risk texters within 24 seconds. Becka, welcome to the show.

[00:01:57] Becka Ross: Thank you so much for having me.

[00:03:22] Patrick O’Keefe: It’s my pleasure. As I mentioned to you before the show, it’s such an important topic, a lot of people care about it. A lot of people want to do the right thing. They care about their members, but they don’t know where to start. That’s really the impetus for doing this episode. It’s a pleasure to have someone like yourself on, with such a high level of expertise. Thanks for making time for us.

[00:02:17] Becka Ross: Yes, absolutely. I’m excited to be here.

[00:02:19] Patrick O’Keefe: I’ll start at the high end because the Crisis Text Line works with a lot of big platforms, names people know, a lot of organizations, also, plenty of nonprofits, charities, lots of organizations work with Crisis Text Line, but for those big companies, for the platforms, for the UGCs, user-generated content companies, it’s social media platforms, gaming companies, dating apps, so many different applications. Can you talk about how those partnerships work?

[00:02:42] Becka Ross: Yes, absolutely. There’s several ways that companies can work with Crisis Text Line. Currently, we’re working with over 130 partners in nonprofit, government, and education partners, through co-branded text lines. One way that people can work with us and we can support users is having a co-branded text line that an organization can use.

A great example of this is the State of Ohio’s mental health and addiction services. They have a keyword that they share with their residents of Ohio that comes directly to our crisis line, is linked with our trained crisis counselors, who support the residents in crisis. We provide the State of Ohio back with anonymized and aggregated trends about how their constituents are using our service, which, in turn, can help them to create better policies, more services, and support in specific areas.

That’s one formal way that we partner with organizations. We also work with some organizations who will use our number on their own forums or their own websites to promote any type of support that’s needed outside of the scope that they offer. Like you mentioned, dating apps, or even now we know mental health text-based or virtual services are very common, so being able to share our number for people who might be outside the scope or in higher need of mental health support, and they can share our information.

Then we also help with staff members who may be experiencing or have the potential to experience other people’s traumas like frontline workers. Obviously, during COVID, we’ve worked with a lot of organizations that work with frontline workers to ensure that they were supported as well and had a place to go and get support if they needed it.

[00:04:53] Patrick O’Keefe: These partnerships are important because the big ones, they provide financial support that helps Crisis Text Line operate because you’re not just a service that exists to serve these partners, you are available to anyone who happens to find themselves in need of help and stumbles across your website or your text number.

[00:05:09] Becka Ross: Exactly, yes. Open to everybody.

[00:05:11] Patrick O’Keefe: Online communities come in all shapes and sizes, and most of them are smaller. Most of them are a volunteer group or just one person who started this thing about their passion. They don’t think that a community about trains or gardening or any number of hobbies, or passions, or professions would necessarily become a place where someone might express something that suggests they’re in crisis, or they’re having thoughts of self-harm, or that they might harm themselves in some way.

That happens every day. A lot of these communities might have been started by a teenager. That was me once upon a time. I was the teenager starting online forums, from my mother’s basement, as the banned users would tell me, and hey, it was accurate. That’s where I lived back then. One thing I wanted to call out about Crisis Text Line is that you don’t have to be as big as Facebook, in order to refer a member of your community to Crisis Text Line. Any community can do this. Anyone who feels like they’re talking to someone in need of help can refer them to you.

[00:06:09] Becka Ross: Absolutely, yes. Thanks for bringing that clarification. Our service is nationwide, 24/7, free to everyone, mental health support. That is exactly how we want to show up for people is to be there in their time of crisis and to empower communities to keep their people that they care about safe. Generally, there’s probably more informal partners than formal partners that we have. Nobody has to enter an official agreement with us to share our number.

Our number is shared widely by whoever could potentially benefit from having somebody there to listen. It’s also an interesting point about, everyone has mental health. That’s something that everybody brings is part of who they are. Having a community where somebody feels supported and feels a sense of belonging, it’s actually pretty common that some of those most intimate parts of their experiences would be shared in those communities.

It makes sense that that would be a topic that might come up for people and then on the flip side, moderators having the ability to show empathy and direction to our number, 741741. Send people off our way to get support for their mental health crisis.

[00:07:38] Patrick O’Keefe: It’s so good. I want to talk about that, specifically. There are definitely people listening to this show, who manage an online community or a platform, who are smaller operators, and they want to do this, but what’s the right way to do it? What’s the right way for them, as a smaller community, to, I don’t know, identify a member? I know it’s a big topic with so many nuances to the human condition.

They don’t have a policy for this right now. They may have had it happen one time, or it’s something they’re realizing now they’re like, “It’s never happened.” I ran a community about the martial arts for 15 years. Then we had someone express something one day, and thankfully, we did have a policy in place, and that person is fine. They’re listening and now they want to put something together.

They want to be like, “How do I identify these people? How do I approach them? What do I do with me in my small volunteer team?” Where should they start? What’s the right way to approach that?

[00:08:29] Becka Ross: It’s a great idea to have a policy in place before you need it so that you can have something to fall back on. It can be alarming or even scary to hear somebody else say that they want to hurt themselves or somebody else. Having a policy that’s written before you’re in that situation can be helpful in ensuring that you can offer support in a meaningful way.

Sometimes, there’ll be some direct, very concrete signs that somebody is thinking about harming themselves, and that could be through self-disclosure. There could be a possibility that somebody is disclosing to the community that they’re having thoughts of harming themselves or struggling with depression or a variety of mental illnesses, or it could also be a change in behavior or interactions that maybe are outside the norm of what you would expect for the code of conduct that exists.

The real power is that anybody can be empathetic. When somebody is expressing or showing signs of mental illness, it’s not the expectation that somebody steps up into a role of a psychotherapist or a doctor or any other mental health professional, but all humans can be empathetic to one another. We often, based on our trainings, our volunteers, our crisis counselors attend about 34-hour training to learn these skills in empathy and active listening and require no specific background to be able to do this because we want to spread a world where there are more empathetic people.

That can look really just as simple as looking to see another’s perspective, even responding with things like, “Wow, that must be incredibly lonely to feel that way,” or to say, “You’re not alone. I care about you, and I’m here.” Then that connection and that awareness that that person is not alone, there’s support, there’s people who care out there can open the door to that person being able to get help.

Anybody can offer that empathy, just human-to-human connection. There’s also some really great evidence-based trainings that exist. For example, there is this training called Start, through LivingWorks. It’s a 90-minute online training that offers some really baseline information on things to look out for, so some warning signs and responses. Trainings like that can be really helpful for an individual or an organization in understanding of warning signs and then potential responses.

Responses and building a policy can be simply responding with empathy and sharing our Crisis Text Line’s text number, 741741, to allow for somebody to connect if they need to and even if somebody is at imminent risk of harming themselves, being empowered to call 911 or a local crisis center to offer support.

[00:11:49] Patrick O’Keefe: I pulled up that training while you were talking. It’s only $27.95, so very affordable training for anyone who really does want to understand this. I like that anybody can be empathetic. I think that’s a really good message.

[00:12:02] Patrick O’Keefe: I would like to take a moment to talk about our generous sponsor Vanilla.

Vanilla provides a one-stop-shop solution that gives community leaders all the tools they need to create a thriving community. Engagement tools like ideation and gamification promote vibrant discussion and powerful moderation tools allow admins to stay on top of conversations and keep things on track. All of these features are available out of the box, and come with best-in-class technical and community support from Vanilla’s Success Team. Vanilla is trusted by King, Acer, Qualtrics, and many more leading brands. Visit vanillaforums.com.

You mentioned that point at which someone might feel overwhelmed. I really appreciate that you point out that it’s not someone’s job, a volunteer, a moderator in the community to step up. Whether they think of themselves because “I can save the world,” or “I can take this on,” or “I can help,” or just because they’re there and they feel like there’s no other option, they don’t necessarily have to be the be-all-end-all to be helpful.

You said something else pre-show, something about encouraging people to ask because a lot of people, who may be feeling a certain way, you get a clue from them, you get a vibe, you read something in a forum post. If you feel a certain way, it doesn’t hurt to ask because a lot of the people who do take some sort of drastic action, it may not have been clear that they were going to do those things. If you feel something might be off, just go ahead and ask.

[00:13:19] Becka Ross: Yes, exactly. This can be pretty scary as well. It can also be one of the bravest things you could do as a human is to reach out to somebody who you feel like is struggling and just ask if they’re okay, also understanding that there are mounds of research that show that asking somebody if they’re thinking about ending their life will not plant the idea of suicide or plant the seed of suicide, it won’t induce suicidal behavior.

Quite the contrary, if using an expression of care, saying things like, “I really care about you, and I want to check if you’re thinking about ending your life” actually opens the door for somebody to talk about their feelings or their thoughts maybe for the first time ever. Also, asking that question to somebody does not then put you in a position where you’re responsible for their actions or behaviors.

Maybe more scary than asking the question is hearing the response and really understanding that, actually, even if somebody has thought about suicide, that does not mean that they’re at imminent risk of ending their life so really being able to be open to asking the question and giving resources as needed a Crisis Text Line number or even external intervention if needed.

[00:14:47] Patrick O’Keefe: Yes, and just not taking on the responsibility is an important thing because I think one thing that people get overwhelmed by is, obviously, with the internet. Going back to me as a teenager running forums, I didn’t know where these people were. I didn’t know what they looked like. I didn’t know what their age was beyond they said they were older than 13 because of COPPA.

I knew they were older than 13. It’s pseudonymous. It’s self-disclosure of everything from hair color, to gender, to location, to name, first name, last name and people are judging the community by their contribution to the community. This is fairly common in online spaces. One of the things that people get overwhelmed by is “I’m going to reach out to this person, but really, what can I do?

“If they tell me they are thinking about doing something, I don’t know enough. I can’t call someone. I can’t send someone to an address.” That responsibility kicks in because you’re like, “Well, if I start this conversation down this road, who else knows, who else can help? There’s a limit to what I can do,” and it stops you from reaching out at all.

[00:15:46] Becka Ross: Yes. I think that that’s pretty common, particularly in online communities, and our service is anonymous. We’re in the same situation that we do not know the details or demographics outside of self-disclosed information. Again, I will just go back to the importance of making that connection will probably mean more to that person than could never be known and not being responsible for the actions.

We talked a little bit about the policy creation or the helpful steps if somebody does say, “Yes, I do need more help. I do need something more. I’m not safe” and having those at hand, which do not require a significant amount of education or experience. Even as simple as sharing Crisis Text Line’s number or having a resource database so you can have a list of opportunities or further resources that can be easily accessible to the community.

[00:16:53] Patrick O’Keefe: Have you seen any good examples of those sorts of policies that are publicly available at all, where someone has a platform, any kind of app really, it’s all very related, where people show up online with each other and they have some sort of policy that they posted, maybe in public or even they just shared it in an industry conversation, that could be used to draw inspiration? Have you seen any examples out there that might be worth referring to?

[00:17:15] Becka Ross: Yes. We have this on our website I would offer. Interestingly, the way our organization works, we’re powered by volunteers. We’ve trained over 39,000 volunteers to respond to crisis conversations, and we engage them in a very high-touch way through an online community. On our website, we actually have some examples of code of conduct and resources available. That’s one. I could think about some others. I’m not sure, off the top of my head, who has a good policy.

[00:17:50] Patrick O’Keefe: You mentioned the volunteers you’ve trained. Crisis Text Line has trained over 39,000 folks who have stepped up to help people in this way. You mentioned an online community. Do you have a private space where they can get together, talk about the volunteer work, talk about the things they’re seeing, and exchange knowledge, ideas, and support?

[00:18:07] Becka Ross: Yes, exactly. We actually built our platform on top of Mighty Networks. We have a separate space for our volunteers, which is moderated by staff but then also by a handful of volunteers who’ve been with us for quite a while, have contributed a lot to the community, and wanted to step up in a way to help engage current volunteers. We really break up the rooms based on debriefing.

Obviously, in our line of work, there is some tough conversations that can come up. We offer a space where volunteers can talk to each other about struggles that they’ve had and conversations and then anything else that could build connection between people. We have groups on recipes and pets. Perhaps, those are probably the two most active, our community loves to talk about food and animals and then book clubs and all kinds of things. It’s also a way for us to be able to deliver continuing education, too.

[00:19:13] Patrick O’Keefe: Very cool. We’ve talked about volunteers, but I know you have three levels of care, as you describe them to me: technical level, the volunteers, and then staff who operate as supervisors. Do you want to talk about those three levels a little bit so people can understand how the service works when you actually hit that text message and send it to Crisis Text Line?

[00:19:29] Becka Ross: Yes, absolutely. We have a machine learning algorithm that triages our incoming conversations based on risk. We are able to respond to the highest-need texters the quickest. It’s a little bit more of an emergency room style of response than a queue response. Currently, our highest-risk texters, we, on average, get to those people within 24 seconds. That allows us to reach the highest-need people the quickest.

Then we have the volunteer-based, who is actually doing the conversation, listening with empathy, de-escalating, identifying coping skills, and really just building that connection and being there for the person in crisis. Then the third level are trained human staff. We have staff that are on our platform 24/7, observing all conversations with the benefit of our technology and being through text messaging, our mental health professionals are able to review all conversations and support as needed.

We operate off the philosophy that after going through our training, that can be applied to any issue, whether it’s anxiety or eating disorder. Because we’re not therapists, we’re not doing clinical long-term work, we’re short-term, helping somebody get to a calm state, and then offering resources. Our supervisors are there for that feedback and in-the-moment support if it’s needed. If things escalate like if we hear about abuse or any other high-risk situation, then our staff intervene on those and really support volunteers so they’re not alone.

[00:21:15] Patrick O’Keefe: Have you ever heard of anyone who does the work I do or community moderation, trust safety work, volunteering for Crisis Text Line? It strikes me that it might be a really interesting way to gain an education through the training that you offer for volunteers and then actually committing to a certain number of hours of volunteer work, talking to people directly that in some sense, it’s definitely emotionally taxing, but it’s not in the community you manage.

There’s a separation there where you can volunteer and help people separately and also gain a deeper understanding and some of these skills you’re talking about, like active listening and finally tuning your empathetic nature that probably is already there, I hope. have you ever heard of anyone volunteering as a way to build out those skills while also giving back, in a sense?

[00:21:55] Becka Ross: Yes, absolutely. The great thing about our volunteer community is we really come from all walks of life, all experiences. We do have people in our volunteer base that are mental health professionals or aspiring mental health professionals. The whole range of anybody is welcome to join our community after passing a background check and going through our training, obviously.

We have heard from people or volunteers, who are outside of the field of mental health, how helpful volunteering has actually been in deepening their understanding of supporting people in crisis and in different things. We have volunteers who are police officers, we have volunteers who are teachers or finance professionals and absolutely online community moderators as well, people in the tech industry overall.

[00:22:47] Patrick O’Keefe: Very cool. One thing about policy that I wanted to go back to is the type of thing where it’s, as we’ve discussed, it’s good to think about it before you need it. I was thinking about this around 12 years ago, and I reached out to the Jason Foundation for advice and for help crafting a policy. The policy that we came up with at that time was basically that if we identified someone who may be in crisis, we should try to take it off the public community and encourage them to make contact with someone they could talk to one-to-one, whether it be us or someone else.

That came out of this doesn’t necessarily happen as much in really small, close, well-managed online communities that are tight-knit. I’m sure you’ve heard so many more stories than I have about people who make some sort of disclosure on a public platform, where, first of all, you’ve got awful people who make it worst deliberately, but also, you have people, and this is something I’ve heard from talking to people that if you leave it in public, there is a risk that members in the community, even well-meaning members, may possibly do more harm than good in a group setting.

Even a well-meaning member could say something that may not be helpful in a particular moment. Do you think that’s true? Does that make sense as a thought? I’ve heard other people say it. I was just curious to hear your thoughts.

[00:23:55] Becka Ross: Yes. That’s such an interesting and very important point. In full transparency, I am not great at risk mitigation, that’s not generally my lens, so from a mental health perspective, I think being able to have public conversations or vulnerable conversations in public offers an opportunity to reduce the stigma around mental health and not something that is shuffled in the back.

If there’s policies that exist that can support somebody in being able to say, “Yes, I’m having a bad day, or I’ve been feeling really depressed lately” and that being an okay conversation, I think it’s important to have that in the open in terms of decreasing the negative stigma around mental health. There is something to be said, and I think it’s actually growing, particularly since the pandemic, peer-to-peer groups surfacing online.

In some of those forums for peer-to-peer mental health support, it is important. The line is, really, if somebody is looking for connection and to be heard, anybody can do that. If somebody is looking for advice on how to handle a symptom, that’s best left to a professional. It’s just knowing the scope and the role that the community can play. Again, anybody can be empathetic and listen and help somebody feel supported; not everybody is qualified to give advice.

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[00:25:32] Patrick O’Keefe: Now, that’s an interesting nuance. Even when I was writing that policy and talking about it in public because I do a lot of work in public, so to speak, I share a lot of what I’m doing at the time, there were people who were making the point that, in a well-run community, at least, there is a benefit to allowing people to have the conversation in public. You’ve mentioned, before, how they can text a moderator much like they would text a volunteer.

On my end, there is the need to moderate that thread very closely and carefully and for people to watch that thread and what people say in response, just to make sure that we are applying, I guess, empathetic moderation practices where if someone does crop up and say something that is either advice that they shouldn’t be giving because we don’t allow people to give medical advice in the forums, anyway.

You could post, “I have a broken leg?” Should I start digging into this myself?” We wouldn’t allow you to give that advice on the forum. If you can create that sort of space, it’s wonderful. I have a community that I’ve run for 20 years. On May 21st, I’ll have run it all 20 years from launch to today. Our listeners to this show are probably sick of hearing me talk about it, frankly.

There was a point last year because most people are just a small martial arts community, who cares? If you dig down below the surface a little bit, last year, at one point, at the same time, we were helping members who own businesses figure out what to do about COVID, martial arts schools. Martial arts are tough to do during a pandemic, in-person instruction, what they should do about their schools.

We were celebrating a member who was leaving us after 12 years on staff or however and then we were helping another member who was diagnosed with stage IV cancer, who was one of the most beloved members in the community. People were being just amazing, and I didn’t have to do anything moderation-wise. It’s just a beautiful moment when you lay the foundation for something like that.

To your point, I’ve seen it. Much like creating a really good volunteer community, to create that moment is so much work in preparation and just like your training and I’m sure everything that you’ve done that I don’t know about that happens behind the scenes. A good online community, people joke that the way to build it is you launch it, and then you work hard for 10 years, and then you’ve got a great community.

Because it’s like it’s everything that leads up to that moment, 18 years later, 19 years later, around policies, thoughtful application of policies, who you invite to the community, who you don’t want in the community, how you apply those guidelines, how you allow people to talk to one another, the example you set and the things that you allow would happen over and over again if you allow them.

It’s just a lot of work to create that environment. I don’t know if I have a question there, but there’s a framework you create of thoughtfulness and empathy that takes– It’s a real process. Even emotional things like empathy and things, how much we care about another human, that we can codify and build into our training and our processes, and how we apply our very basic technical roles. There’s a cold way to do things and then there’s an empathetic way to do things, and it makes a difference.

[00:28:36] Becka Ross: Exactly, yes. At least for us, the importance of really understanding what we value from our community and with our community upfront, so building an empathetic community, where people can feel a sense of belonging and show respect for each other and having those baseline shared values has also helped us be able to keep the community engaging, and it is a lot of work upfront and continuously, to continue to support that.

[00:29:06] Patrick O’Keefe: One other thing I wanted to call out for listeners, especially anyone who would like advice from someone who is really focused on helping people who may be at risk for any number of mental health concerns, is that yes, there are big national organizations like Crisis Text Line, but don’t forget that there are organizations more local to your region, your state, your province, your county, town, whatever, that would probably be very willing to offer you some advice on how best to responsibly approach these issues.

This isn’t something to just Google and go to the top result necessarily. Don’t overlook the people who are on the ground in your local communities right now working on these issues because they’re probably more than happy to chat with you as well. There’s, obviously, a lot of conversations around these types of topics. Crisis Text Line has a lot of things going on, they’re very busy, lots of things happening.

Don’t overlook your local organizations and the smaller orgs out there as well when you’re looking for advice, help, resources. Honestly, the website, for Crisis Text Line especially but also others, just the websites and reading through how they talk about, how you talk about issues is instructive when you’re thinking about how you as a community or you as a leader should talk about these issues.

Just reading through about pages, which might sound silly, just reading the about page, reading FAQs, reading how the services introduced to people who might be in need of help, and mirroring that, there’s a reason it’s worded that way, so just allow people who deal with these things all the time to guide how you speak and the words that you choose.

[00:30:34] Becka Ross: Yes. That’s such an important point, too. Especially mental health organizations that are government-funded often have an entire department focused on community education with the baseline or the understanding that the more that we can spread information about mental health and reduce stigma, the better off we’ll all be, so it would be fairly easy and expected to reach out to a local mental health organization and request from community education to inform policies.

[00:31:09] Patrick O’Keefe: Becka, this is a serious topic, and I wasn’t sure what this conversation would be like 100%, but I feel like we’ve had a really nice, thoughtful, empathetic, uplifting conversation. I think solutions and ideas are always helpful and help bring light to things that some people might even be dreading. Some people in this work might be dreading thinking about this or putting it off or like, “Oh my gosh. How do I deal with that?” but I think you’ve given folks some real actionable thoughts and ideas and steps today, so I really appreciate it. Thank you for spending time with us.

[00:31:36] Becka Ross: Thank you so much for having me.

[00:31:38] Patrick O’Keefe: We’ve been talking with Becka Ross, chief program officer at Crisis Text Line. To learn more about their service, visit crisistextline.org. If you have the means, I would personally suggest that you utilize them as a resource and be sure you give the money for doing so. If they’re taking on what a staff member might take on for you in the resources they provide, that’s how you should look at them.

For the transcript from this episode plus highlights and links that we mentioned, please visit communitysignal.com. Community Signal is produced by Karn Broad and Carol Benovic-Bradley is our editorial lead. Stay safe out there.

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