Sexually abusive calls burden 988 mental health crisis line counselors. They want more protection

Daisy started working as a crisis counselor for the 988 Suicide & Crisis Lifeline because she was personally affected by the loss of loved ones who’d taken their own lives, and wanted to help people avoid that outcome.

She and other crisis counselors talk to people facing a mental health emergency, and in some cases, in the process of dying by suicide. It is a difficult role, but Daisy said she felt the training at PATH Crisis Center in Bloomington, Ill. prepared her for it.

Then, she started getting what she described as “bogus sex calls.”

A man telling the story of his incestuous relationship with his sister, talking about her hopscotching, and asking Daisy if her chest bounced when she hopscotches. Then, asking her and other female crisis counselors to count to 69 or 100 — so he could time how long his climaxes would take.

“Everyone knows that there's repeat callers to a crisis line, and there were repeat callers who were not using it for its intended purpose,” she said. “They were using it as a way to pleasure themselves.”

Sexually inappropriate calls, texts and chats are infrequent, but not uncommon on the 988 line, as are other types of abuse, including pranks, insults and personal attacks on the crisis counselors.

National totals aren’t tracked, but data from one crisis center shows abusive contacts account for around 1% of the nearly 5,000 total calls the center receives per month. While the volume may be small, the impact these calls have on crisis counselors can be long-lasting, and multiple current and former counselors expressed there aren’t enough measures to protect them from these behaviors.
 

‘They were masturbating on the phone’

Side Effects agreed not to use Daisy’s real name because she said she is in a position to be retraumatized. Daisy was her alias as a counselor.

She said these abusive contacts were the reason she left her position at PATH, in July 2023, after around just 12 months in the role.

Lily Lantz, another former crisis counselor at PATH, said she endured similar abuse.

“They would sometimes say things like ‘Your voice sounds so good right now, you’re making me feel so good right now,’” Lantz said.

PATH advised counselors to set boundaries, telling the caller inappropriate comments — like discussing body movements — are out of line and threatening to disconnect if they continued. The nonprofit also trains counselors to differentiate between aggressive callers, and abusive callers, who direct their aggression toward the caller, but it’s a line blurry enough that counselors can get stuck.

Meanwhile, abusers got more clever.

Daisy and Lantz said sometimes the caller claimed they were suicidal, often leaving counselors with no choice but to stay on the line and endure the abuse.

“Whether that was true or not, I can't really say, but they were masturbating on the phone,” Lantz said.

[If you have worked at the 988 Lifeline, Side Effects Public Media wants to hear from you. You can fill out this Google Form to share your input]
 

A universal issue burdening the Lifeline

These types of abusive behaviors have burdened the 988 Lifeline — and similar crisis hotlines — for decades, and other current and former counselors reported facing similar interactions.

988 became the national 3-digit Suicide & Crisis Lifeline in 2022, with over 200 crisis centers opening nationwide. Last year, it received around 10 million calls and texts from people in crisis. Before that, when it was the 10-digit National Suicide Prevention Lifeline (NSPL) with less public awareness, people who worked for the line said abusive behavior persisted.

“It's certainly not anything new,” said Greg Borders, chief clinical officer at Lines for Life, which operates one of two 988 crisis centers in Oregon and answered for the NSPL prior. “I've been at Lines for Life for 12 years, and it existed long before I got there, and it continues to exist.”

Stopping abusive behavior is nearly impossible since 988 must be accessible. Crisis centers are forbidden from blocking numbers because, at any point, someone might try to call or text from the same number with a mental health crisis — even someone who’s previously abused the line.

“It's a delicate ecosystem where the work is just as dependent on the crisis counselors’ well-being as it is on…trying to assist the well-being of the person who's calling in,” said Shye Louis, assistant vice president of the clinical standards, training and practices department at Vibrant Emotional Health, a nonprofit organization and administrator of the 988 services nationally.

Vibrant oversees the 200-plus crisis centers across all 50 states. While it has policies for responding to abusive contacts or angry expressions and dealing with familiar contacts, these documents are not meant to be all-encompassing.

Louis said Vibrant is constantly updating policies as general guidance allows, but call centers have to take the initiative. Each has a unique location and some may have special accreditations or state standards they must adhere to, she said.

“Part of learning to be a good crisis counselor has to be experiential, and we can't provide those things at a national level,” she said. “So, those things have to happen at the local crisis center to meet all of those individualized, geographical and population-based needs.”

The onus to protect crisis counselors is on the call centers

Vibrant has some backstops. It contacts a crisis center when it notices a number reaching out repeatedly to them, but those numbers aren’t always abusive. PATH’s call center Director Sara Carter-Mills said Vibrant can also step in to handle abusive contacts, but that requires crisis centers to submit prohibitively extensive evidence of the issue.

All crisis centers — per Vibrant's policy — are supposed to allow counselors to hang up calls when the person is deemed safe, and the call is found unproductive. Lines for Life and PATH follow this guidance and give counselors time to debrief with coworkers or supervisors following tough mental health crisis calls or abusive interactions. They also inform people of abusive contacts during training, and at PATH, during the interview. They also inform people of abusive contacts during training, and at PATH, during the interview.

Lines for Life has an added policy through which abusive calls can get transferred to supervisors.
 

PATH started using a voicemail policy in May 2023. When people continue to call after being warned of their inappropriate behavior, the counselor can assess for safety and forward the person to a voicemail, Carter-Mills said.

“It's one of the only ways right now that I think our crisis counselors feel completely supported,” Carter-Mills said.

Counselors at other crisis centers say they have less supports.

At Colorado’s former 988 crisis center, counselors reported ineffective policies for dealing with abusive contacts. Six former crisis specialists are suing the nonprofit Rocky Mountain Crisis Partners (RMCP) in federal court over the matter. RMCP ran the state’s call center until August.

Plaintiff Myriah Montoya-Gallegos, said she was never given permission to hang up, even when calls became abusive — and that was the only clear guidance she recalls getting.

In an email to Side Effects, RMCP denied that it didn’t have policies in place, citing that it “maintained protocols that empower our team members to set a limit when such a call is suspected and to terminate the call.” They did not specify policies further.

Montoya-Gallegos said RMCP’s guidance did not include these measures. Instead, she was told to “redirect.”

“I would ask, ‘What do you mean by redirect? I feel like that's what I'm doing. Tell me if I'm wrong,’“ she said. “Their explanation would be, ‘Focus on a solution,’ or ‘Use verbiage or language that will redirect him to the emotions that he's feeling, or how this experience is making him feel, versus the details of what's happening.’”

If the approach continued to fail, she said supervisors doubled down rather than giving additional strategies. In one call, Montoya-Gallegos said a man would not stop talking about how his girlfriend allegedly abused him during sex. Then, he started masturbating.

“When he finished, he laughed about it, and he thanked me, and then he hung up,” she said. She alleges her manager who listened in on the call did nothing.

Iris Halpern, one of the lawyers representing Montoya-Gallegos and the other plaintiffs , called the nonprofit’s policies “problematic” and “fundamentally lacking in, kind of, any understanding about the impacts of this type of harassment” for employees. Montoya-Gallegos said she still has nightmares about them.

‘Systemic issues’ and potential solutions

Crisis centers have an incentive to find a solution to the problem.

PATH’s CEO Adam Carter with PATH pointed out that abusive behavior harms individuals, as well as a call center’s ability to perform 988 services. Every abusive call a crisis counselor takes saps resources and lengthens the wait time for calls from people in need.

“It's much larger systemic issues on how are we going to hold individuals who are knowingly misusing this and keeping these resources from folks [accountable],” Carter said.
 

The emergency number 911 — another local program, with national guidance but municipal and state oversight — has been dealing with the same issue of abusive behavior for decades.

“It's not as frequent, because we can determine right where the caller is calling from or who's calling us, and they're not going to call if they know that,” said Rhonda Flegel, director for McLean County 911 Communication Center Metcom, which is located in the same city as PATH.

Flegel said Metcom uses multiple services to pinpoint precise call locations. State and municipal laws also tend to deter misuse of the line because of legal repercussions.

988 doesn’t have the same protections, but that’s what crisis counselors want.

In 2023, Dan Fichter, who created CrisisCrowd and serves on 988-related research advisory committees, conducted a survey of 47 crisis counselors from various call centers in the U.S. He said his survey didn’t include any questions about abusive contacts, but many brought up the issue organically.

One of the survey respondents said: “We have received all the PDFs about how to manage abusive or frequent callers, but the reality is, it doesn’t matter how many times a counselor sets those boundaries if there are no actual consequences set by [988].”

Laws against abuse of 988 would likely need to come from the municipal and state levels since both 988 and 911 are local programs.

A measure that could be taken at the municipal, state, or federal level — and that Carter with PATH would like to see — is upgrading the classification of 988 crisis counselors from clerical workers to first responders. This would give the professionals support such as for mental health treatment and therapy.

At this point, 911 dispatchers in only 19 states benefit from that designation, according to the National Emergency Number Association.

Daisy said it makes sense to put the decision in states’ hands, since 988 is funded through state and federal grants.

“There are people misusing the line, and there are excuses being made for why we can't have ramifications for that action,” she said. “And so I feel like the state has a responsibility to protect crisis counselors.”

Lantz said solutions are needed so the Lifeline doesn’t continue “losing good people because of the emotional toll.” But she added that abusive contacts shouldn’t outshine the work 988 does.

“I don't regret working there at all. It was nice knowing that I made a difference, and I still want to help people,” she said. “It's just right now, the crisis counselors are not getting support that they need to do the job well.”

If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

Melissa Ellin covers mental health as a Report for America corps member. Report for America places journalists in local newsrooms across the nation to cover underreported topics.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.