Out of California Calls Protocols

Introduction

Calls from out of California impact our ability to provide quality care to our local callers. Our goal is to refer callers from outside of California to the National Suicide Prevention Lifeline or to their local crisis lines. We must still remember to assess appropriately and provide basic care to empower the caller to reach out for help. We want to make sure callers are safe, and to refer them to resources that are closer to them.

Establishing Good Contact

Establish good contact with the goal towards assessing for suicide. Let the caller know that that you care about their well-being. In one sentence, listen, empathize, and summarize the caller’s concern before moving on to the assessment.

Example Script: “I’m glad you are reaching out for help and I know how difficult it can be to take that step. I hear how stressful it is to be unemployed.”

Assessment

Our primary goal is to assess the caller’s imminent risk before directing the caller to the Lifeline. Proper assessment requires a reasonable attempt at establishing good contact with the caller. If you have any concerns about the caller’s safety, even after the initial assessment, stay on the line with the caller. After the counseling portion of the call, you will have another opportunity redirect the caller to their local resources.

Protocols for callers who are not at imminent risk

Once you are confident that the caller is not at imminent risk of suicide then you can ask directly for the city of the caller. If the caller is outside of California, you should redirect the caller to the Lifeline or to their local crisis line. If time & resources allow, we recommend you complete a warm transfer to the local crisis line. Otherwise, provide the appropriate crisis line number and encourage the caller to reach out for help.

Example script, “I’m glad you are reaching out for help and I know how difficult it can be to take that step. We are a crisis line located in Oakland, California intended to serve our local area. I’d like to connect you to your local resources. I want to offer you the National Lifeline number, 1-800-273-TALK. Calling that number will connect you to local resources.”

Protocols for callers who are at imminent risk

If the caller response or affect gives you reason to believe they are at imminent risk stay on the line with them until their safety is established or emergency procedures are completed.

Protocols for regular callers from outside California

Look in the CSS Call Database in the Themes Box to see if the caller is continuing services with CSS

Frequently Asked Questions

The caller says their local crisis line is unreliable or not helpful.

Unfortunately, there will be times when callers will have experiences with their own local crisis lines, which will make it more difficult to redirect them back to these other resources. Empathize with their bad experiences and their need to reach out for themselves, but also explain that we still cannot take out of area callers due to our own limited resources. Also introduce the possibility for the callers to have better experiences with their area’s crisis lines the next time they call.

Example: “I’m sorry to hear that your past calls with other lines have not been helpful for you, I know that you are just trying to reach out for yourself in your time of need. I’m glad that you are trying to find new options to help you connect with the right counselor. As much as I would like to take your call, our crisis line does not have the capacity to offer our services to callers that reside outside of California, due to our own limited resources. There are various counselors that work at each crisis line, and next time you call your local line there may be a counselor much more suitable to your needs.”

What if the caller is a young person (under 18 years old)?

When an out-of-area caller is under eighteen years of age, we still need to redirect them to the Lifeline or their other local resources. However, because the experience of reaching out to a stranger for help while in crisis may be a more intense experience for children, we want to create a comforting atmosphere for them during the call. Take some time to assess for their safety and give them a couple of minutes to build some rapport with you. If they are out-of-area and are not in crisis, emphasize that they are making the right decision in reaching out. We still have to redirect them to the Lifeline or another local crisis line, but we want to make sure that they feel encouraged to call a crisis line again, especially if they are calling for the first time. Give them the national text line as a resource, and conduct a warm transfer to another crisis line that is within their area.

Will people who live out of the area, but have a cell phone with a 510 area code still be routed to us?

Yes, this is why crisis counselors must gather city data in every call.  There is always the possibility that a caller’s cell phone could have an area code from a different state, and could still be calling from California. Callers that have a California area code also might be calling from a different state, so always ask for where they are calling from during the beginning of the call (after assessing for crisis).

The caller says that someone else on our hotline has taken their call before.

With so many people calling our crisis line on a daily basis, we recognize that it might be difficult for all counselors to remember the protocols for out-of-area callers. Sometimes a counselor will give someone a full counseling call and not redirect the caller to a closer line, giving the caller the impression that we can take their calls in the future. When taking a call from an out-of-area caller who is not in crisis and has talked to one of our counselors before, explain that you are glad that they were able to have a good connection with one of our counselors. However, also explain that we still cannot take out-of-area calls because we only have enough capacity as one crisis line to service callers within our own state, and proceed with redirecting them to the Lifeline or a local crisis line.

Example: “I can hear that your last call with us was helpful for you, and I am glad that you were able to have a good call with one of our counselors. We made a mistake by not telling you this earlier, but we can only offer our services to those who are calling from California.  As much as I would like to give you another good call, we have very limited resources as a local crisis line. However, I would be happy to give you a warm transfer to your own local line, or you can call the Lifeline.”

What if an out-of-area caller has suicidal feelings and a plan, but has no intent for hurting themselves in the next 24 hours?

It is difficult to turn away a caller who is experiencing suicidal thoughts. We understand that having to redirect such a caller will be difficult for our volunteers. However, it would still be in the caller’s best interests to talk to a local hotline, because they will be able to serve him or her better than we can. They may know of local mental health resources that we don’t, and a rescue of the caller should be conducted by a local line that can contact the authorities or send a mobile crisis team. If the caller is feeling immediately suicidal, we will keep them on the line while we explore other options for rescue or conducting a warm transfer. Make sure to contact your supervisor immediately.

I am feeling guilty because I gave someone out-of-area a call, and did not redirect them to a local line.

Don’t worry! We understand that the nature of the work at the crisis line is going to bring up many dilemmas when having to redirect callers that are in need. As part of your responsibility as a crisis counselor, your main focus is to be empathetic towards our callers, which makes it difficult to turn some away.

However, there are various reasons that we must continue to practice our protocols for callers outside of California. As a local crisis line with so many of our own callers needing our services in Alameda County, including more calls from out of state would greatly increase the work load on our volunteers. This in turn can affect the ability of our volunteers to give satisfactory counseling to our local clients when experiencing more pressure from a higher work load, and our local callers may experience a lower quality of counseling calls from us if we try to stretch out our limited resources too much. By taking outside callers, we might have to triage local callers more often depending on who is currently in crisis, and the last thing we want to do is turn away our own county’s clients from a place they continuously seek support.

The out-of-area callers can also benefit more from contacting their local lines if they are immediately suicidal, because their local lines will be better for conducting a rescue or finding other local resources in their state that we do not know about. These protocols are also in place to protect our own counselors from experiencing burnout, as we want your own experiences on the line to remain fulfilling, rather than constantly stressful. Please keep this information in mind when on your next out-of-area call, and remember to practice the protocol during your next out-of-area call. If you have any questions about the protocol, please talk to your supervisor.

What does establishing good contact look like?

After answering the phone, give the caller a minute to explain why they are calling before assessing for suicide. Use active listening and give the caller a safe space to not feel judgment, and use empathetic statements and open-ended questions to show that you have been listening and understand their need to talk about their situation. Try to get their first name, and be sure to offer yours. Be sure to reiterate that you are glad that they called, that you are talking to them now, and that calling to get themselves help was the right choice for them. Some calls will take longer that others to establish good contact and then redirect them to an appropriate local crisis line, but this part of the process should take about one to three minutes.

What if the person starts abusing me, or gets angry at me?

If a caller starts to abuse you during a call, you are not obligated to stay on the phone with them. Abuse can take form of various behaviors, including but not limited to name calling, threatening your safety, or masturbating during the call.  You may simply tell the caller that this is an inappropriate use of the line, and that they may call back when they are ready to have a more suitable discussion for the lines. Be sure to end these calls as soon as the caller is no longer willing to practice appropriate behavior during the call, in order to not reinforce these negative behaviors. Make sure to alert your supervisors after or during the call.

What if I have a highly intense call and the caller is in immediate need of a counselor?

With callers that are out-of-area and are exhibiting intense emotions during the call, we recognize that immediately redirecting them to another line will not be a sound approach. With callers that are constantly crying or hyperventilating, give them a couple of minutes to give them some space and establish good contact. After assessing for suicide and lowering the intensity of the call, practice your compassionate limit-setting skills. Transferring highly intense calls will take more time, but keep in mind that the caller needs to contact their local resources for their own good. Crisis lines in the same area of the caller will be more effective for referring them to local resources and conducting rescues if they are needed in the future, make sure to mention that you can do a warm transfer.

Example: “I can really hear that you are in a lot of pain, I am glad that you are reaching out for yourself tonight. I’m glad that I am getting the chance to talk to you now, and I really care about your safety. I want to make sure you receive the best care, and I believe that your local crisis line would be better for giving you services today. We have limited resources here for taking callers from outside of California, but I want to make sure you get a safe space to talk about your experiences with a counselor today. I can give you a warm transfer to your local crisis line.”

What if they just got redirected from another line?

If the line a caller was using before was out of area, and that line redirected an out-of-area caller to us, that line has given the caller an inappropriate referral. This happens occasionally when other lines are over capacity, and their counselors do not realize that we are not a national line, or are located in California. If the caller has an immediate urge to harm themselves, you may give them a call. However, it is best to try and redirect callers to their own local resources for their own safety, since it would be difficult for us to organize a rescue from a different state.