While You Are Sleeping

Not long ago I was asked to write a blog post for the National Suicide Prevention Lifeline staff and volunteers. I was happy to do it.  Later, I wondered…, if you asked 100 Americans in the street what NSPL stood for, how many could translate the acronym?

My guess?


They would get NSA, FAA, FBI, CDC, and hundreds more, but no one would get NSPL.

And yet, the NSPL is America’s default 24/7 mental health crisis service telephone system.  On a national basis, there is no other.  Many crisis centers answer the 1-800-SUICIDE number, but how the two systems are different and the same is a long story.

So, if you are down in your cups, depressed, just broke up with your lover, lost your job, and start to stumble into a downward spiral toward suicidal thinking, who is there for you after the bar closes at two in the morning?

Your primary care doctor?  Very doubtful.

Your therapist? Doubtful.

Your minister? Maybe.

The National Suicide Prevention Lifeline and its affiliate members? Always.

For 25 years I directed a 24/7 crisis line. Hired the staff.  Help train the volunteers. Tried to minister to the volunteers and staff impacted when someone we had tried to help killed themselves.

With almost perfect memory I can see the eyes of a young woman volunteer who was trying to help a suicidal man with a gun.  She, and the team, were doing all they could.  The call was being traced and the police were rolling.

Then she heard the shot.

Later, the officers on scene confirmed the man had died of gunshot wound to head.

What Winston Churchill once said of the fighter pilots who defended England during the Blitz in WWII also applies to these staff and volunteers, “Never was so much owed by so many to so few.”

During the Blitz, 40,000 English citizens were killed, or roughly the same number of Americans who will die this year by suicide.  While many work to prevent suicide, these few crisis line volunteers are the last line of defense, the last heart extended to those losing heart.

Because they will not be able to save them all, here is the post I wrote to those serving on the NSPL.

Research shows that the most feared clinical outcome for mental health professionals is the death of a patient by suicide. According to the National Violent Death Reporting System, roughly 35% of all suicidal people die while in the active care of a treatment professional.

As clinicians across the country go home for the day, many of them switch their calls over to you. Others see your number in any of a million places, and in those worst hours of suicidal pain, you get the call.

Courage is defined as overcoming fear, and crisis workers who help suicidal callers are nothing if not brave. While many professionals step out of their clients crisis after hours, you step in.

Lets be frank.  If client death by suicide is a professionals number one fear, experiencing a caller suicide is, by definition, a major stress event. Death has come to your door and pounded on it. In the aftermath of learning a caller died by suicide youd have to be a robot not to feel powerless, helpless, and a kind of overwhelming psychological paralysis.

While different people experience traumatic events differently, the loss of a caller to suicide is a 10 on a 10-point scale, and no one emerges from such an event unchanged.

Psychological trauma triggers changes in the brain, some temporary, some lasting. If severe enough, symptoms include hyper-reactivity (startle response), numbing, feeling not quite of one piece (dissociative state), disturbances in memory, and perhaps avoidant behavior – in this case difficulty getting back on the phones. These symptoms are the bodys way of saying, “Get down, you fool!  Theyre shooting at us with live ammo!”

Following a callers death by suicide support by supervisors and peers is often enough to weather the ensuing emotional storm. And it is a storm.  But like all storms, it will eventually pass, and calm waters will return.

But just to be safe, be wise.

Consider that acute stress symptoms last for a few days to up a month. Max.  If these symptoms persist beyond a month, the event may have had a more significant impact than first imagined, and professional help may be warranted. 

It is good to remember that no matter how hard we try sometimes our very best is not enough and a suicidal caller dies. While we are all waiting for better research, better training, and better assessment, treatment, and management tools, if the worst happens, here are some keys to taking care of yourself:

  • All your feelings are normal, so just accept them.
  • Eat something. Yep, food is a comfort. Go for the mac-and-cheese or roast turkey sandwich. You can diet later.
  • Take a hug, give a hug.
  • You cant fix what has happened, so dont try.
  • Lower your demands on yourself. Remember, start your own oxygen before trying to help others.
  • Dont judge the motives of the deceased; you cant have known his or her life fully, and you will not feel better if you blame the victim for being weak, stupid, or selfish.
  • Avoid alcohol. Sure, one drink may remove an edge, but three or four or more may tip you into a dark place.
  • Sleep in.
  • Accept that you will feel 110% responsible for this persons death. Call it the helpers curse it is just the way empathic people are wired.
  • Remember, the person called you, not the other way around.
  • In the end, the choice was theirs, not yours.
  • Expect to feel some guilt; youd be a robot if you did not.
  • Tears help, never hurt.
  • You may even have thoughts of suicide yourself. This, too, is normal. Like a storm, these too shall pass.
  • Find something to laugh about. Since they release natural feel-good chemicals into your brain, funny movies and stand up are therapy.

Heres something to think about. Research shows that 1 in 4 Americans will experience an episode of mental illness in any given year. If your three best friends seem normal to you, then maybe it is your turn ☺ 

While clinical professionals are stepping out of their offices when their day ends and going home to dinner, you are stepping in. So it is good to remember that the purpose of crisis work is not to live well, but to care enough so that others might live at all.

Finally, the young woman who suffered the trauma of hearing a man shoot himself to death carried on.  We supported her, counseled her, and wrapped our arms around her.  She went on to complete her tour as a volunteer and then a degree in social work.  She is helping people today.

Dr. Paul

I wish to thank my dear friend Iris Bolton, author of My Son! My Son!, for originating this list of how to survive a suicide loss.

11 thoughts on “While You Are Sleeping”

  1. Hi Paul,
    Thank you for this post. I sent it on to the supervisor of our 24 hour Suicide/Crisis Line. It was much appreciated.
    One question for you – what is the meaning of “down in your cups”?
    This is an expression I have never heard before.
    Looking forward to maybe seeing you and Brian at the AAS conference in Atlanta in April.
    Take care and have a good day.
    Jean K.
    Jean A. Kaelin, MPA
    Suicide Prevention Associate
    Santa Clara Valley Health & Hospital
    871 Enborg Court
    San Jose, CA 95128

      1. “In your cups” is an old Irish term meaning drinking or drunk. Thank you for this touching article. I lost a very beloved brother to suicide a few years ago. The guilt is sometimes overpowering. God bless all those who try to make a difference.

  2. We have a team of youths who are working to prevent suicide and depression in Bhutanese American community (the community which has the highest suicide rate in America). Your blogposts and your courses are our backbone. I can relate to the example that you have shared above. Few months ago, I was very frustrated and depressed. I knew I was working to prevent the same thing, but I, myself, was in that situation. I had to take some strong steps to step out of that zone and focus on the prevention. Thank you Dr. Quinnett for the great service you are doing to people.

    1. Hi Robin, we were aware of problem you reference and the QPR Institute has developed training materials just for Bhutanese communities — they are available to our certified instructors. Thanks for all you do.

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