Crisis Text Line 741741
Shoot Me a Text: Why Millennials Prefer Text Over Talk
Techs Biggest Names Are Giving Millions to Crisis Text Line
We are now living in a chat-based society and traditional crisis hotlines are struggling to adapt.
The volume of text messages has surpassed voice calls in the United States since 2008. Which means, with every passing year and new messaging app, the telephone becomes more irrelevant. According to Experian, U.S. smartphone owners between the ages of 18 and 24 send an average of 2,022 texts per month on averagethe equivalent of 67 texts a day. Meanwhile, telephone conversation is in the midst of a serious decline. People (especially Millennials) just dont call each other like they used to, and this has serious implications for the institutions designed to help them through crises. The telephone hotline has dominated crisis support for over 40 years, and now the tide is slowly turning.
As a volunteer for the Rape Abuse Incest National Network, or RAINN, I know first hand about the organizations efforts to adapt. I went through 60 hours of training and supervision to become an online volunteer on RAINNs National Sexual Assault Hotline, where I talk to victims of rape and sexual assault through an anonymous, Instant Messenger-style chat service. I let visitors know that the chat is anonymous and they do not have to share anything with me they do not want to. I ask if they are safe and if they have any privacy or safety concerns. Then I ask what brought them to the hotline. Sometimes, visitors share what is on their mind right away, while others take longer to open up. The chats usually last at least an hour.
RAINN was one of the first victim-support organizations to launch an online hotline back in 2007. Since then, it has served almost 250,000 visitors and demand for the service grows every year. Two hundred volunteers and 45 paid staff members work around the clock24 hours a day, every day of the yearto provide continuous support for the online hotline. Earlier this year, RAINN added a Spanish-language service, and between the two, RAINN conducts an average of 113 sessions a day.
RAINN also operates the Department of Defense Safe Helpline services through a contract with the agencys Sexual Assault Prevention and Response Office (SAPRO) and has partnered with the Peace Corps to provide chat-based support to its volunteers.
RAINN offers these chat services in addition to its telephone hotline: 1-800-656-HOPE (4673). Operating the online hotline requires a substantial amount of financial and human resources, and money for initiatives like this is in short supply. However, as with businesses across all sectors, nonprofits are not impervious to shifts in the way people communicate. In order to stay relevant, they have to modernize.
The interface of the chat system looks ambiguous, so it can be used in public spaces without screaming crisis hotline.
We get people who are talking about what happened to them for the first time, and if it wasn't for an online service like this, they wouldn't have reached out in another way, said Jennifer Marsh, RAINNs vice president of victims services. We are catching young survivors and people who say they could never talk about this out loud. Online communication gives them the space to control the conversation and put down their own narrative about what happened.
Marsh said that a vast majority of the online hotline visitors are between 13 and 24 years old. More than half are talking about abuse or assault that took place five or more years ago. RAINN has also found that the chat system appeals to people who have been through particularly violent trauma or experienced a type of assault or abuse with a higher stigma, such as incest40 percent discuss an attack that was perpetrated by a family member. (The RAINN chats that I have had reflect these findings as well.)
The interface of the chat system is stripped of branding and looks ambiguous, so it can be used in public spaces like school libraries, home computers, and mobile devices on a bus without screaming crisis hotline. RAINN does not ask for any personally identifiable information or track IP addresses. It records no transcripts of the session and all data are encrypted. There is nothing that could be subject to subpoena. From a volunteers perspective, all I see is that anonymous is typing.
According to Marsh, and in my own experience, most visitors dont come with quick questions. They want to discuss layers of complex issues and the online chats are generally longer than the phone chats. I was raped when I was 15. I was very young and scared, and worried that no one would believe me, said Toby Wagner Klein, a member of RAINNs Speakers Bureau who agreed to talk with me about her experience with the online hotline. The idea of taking up a phone and speaking to a complete stranger about things I wasnt even entirely sure of myself seemed daunting. The online chat helped me express what I wasnt able to vocalize with my therapist or family and friends. I probably would not have gone to RAINN if it did not have an online chat.
In addition to appealing to a younger demographic, online hotlines also enable conversations that cant be overheard, which is critical when immediate safety is at risk. Brian Pinero is the Chief Programs Officer at the National Domestic Violence Hotline, which launched an online chat service called The Hotline in 2013. The Hotline now sees 1,000 to 1,500 chats a month, half of which come from mobile devices. Pinero said the ability to communicate silently is key, since visitors often cannot discuss sexual coercion and assault on the phone when their husband or kids are in the house, or in public.
It is hard to have a discussion about how your husband makes you have sex in ways you dont want to, he said. On chat, people reveal way more than they do on the phone, and that is a huge opportunity for us to start exploring topics surrounding assault and coercion without making the visitor feel completely vulnerable.
Conversely, the greater anonymity of the chat system makes it more difficult to gather information that can help provide the best support. Volunteers have far fewer contextual clues about the visitors gender, age, or current state of mind, and you cannot make assumptions. With so little personal and contextual information, saying the right thing or recommending relevant resources can be a challenge. You have to focus completely on and respond to what the visitor has felt comfortable sharing.
Our entire approach was phone-based and we had to change our advocacy style, because in chats you dont have the ability to hear environmental things, Pinero said. On the phone, I can hear if children are crying. With chats, you need to follow up, clarify you understand what is going on, and check in. You can't hear the inflection in someones voice that this is a difficult moment. Conveying empathy is much more difficult.
Chat-based conversations require more time to build trust and rapport. While it might seem that online chats would be more scalable than phone hotlines, this is not the case, at least not yet. Longer sessions demand more volunteers, and volunteers take a long time to find and train. A shortage of volunteers means longer wait times. On RAINN, peak wait times can be up to an hour, and Ive had sessions where 10 people are in the waiting room at a time. Its sad, but demand significantly outstrips supply.
The National Suicide Prevention Lifeline just made its chat service available 24/7 in January across a network of 28 (out of 165) centers, but the wait times are still significantly longer than on the phone. As a result of limited capacity, John Draper, the project director, said that the chat remains a secondary service. However, he hopes to continue expanding it into a robust and fully-integrated option.
You cant schedule a crisis, and our goal is to open as many doors and windows as possible to get people help in the moment when they are in crisis, he said. 97 percent of calls to the phone hotline are answered within 90 seconds, while only about half of chats can be responded to at all. But we do know from early data that an overwhelming majority of people who access the service feel better after the chat. Typically, they are feeling less sad and more hopeful.
"Our goal is to open as many doors and windows as possible to get people help in the moment when they are in crisis."
Draper said that the Lifeline Crisis Chat service is overwhelmingly visited by young women. The phone hotline is around a 50-50 split between the genders, whereas 78 to 80 percent of the chat visitors are women, and 70 percent are women under 25. Draper said this is not just an American phenomenon, and that similar international services have found the same.
Like the National Suicide Prevention Lifeline, RAINN and the National Domestic Violence Hotline also aspire to scale up their chat services and acknowledge that they are the way of the future. However, scaling up requires funding, and funding requires evidence.
In May 2013, the Department of Justices Office for Victims of Crime published a report titled Vision 21: Transforming Victim Services that represented the first comprehensive assessment of the victim assistance field in nearly 15 years. This initiative received $12.5 million in the congressional Consolidated Appropriations Act, 2014, to address the recommendations in the report by providing grants to organizations that are working to address gaps in capacity and infrastructure, including making victim services more accessible through technology. While any funding amount helpsRAINNs Spanish language online hotline was made possible through a Vision 21 grant$12.5 million is a drop in the bucket.
The funding infrastructure to support chat hotlines is just not there yet, Draper said. Wed like to expand, but we can only stick our toes in because we dont have the funding to jump all the way in. Once we have scientifically-based data that says, X number of people want chats, this is how effective they are, and this is how much they cost, then we will see crisis chats become increasingly ubiquitous, but it could take 15 to 20 years.
Thats a long time, especially when you consider that hotlines can dramatically expand the reach of crisis organizations, not just in terms of numbers, but also in terms of the populations they reach and when.
When you look at short and long term effects of sexual violencewhether substance abuse, depression, self harm, unhealthy relationships, or intimacy problemsthe fact is that we are getting to people earlier with chats, Marsh said. There are public-health ramifications to getting people plugged into support systems earlier, by allowing them to avoid or lessen long term effects. This is really powerful. I think it is one of the greatest things about the online service.
Victim services organizations
arent the only ones faced with the need to update
their infrastructure, and with the challenges inherent in
doing so. Just 5 percent of the 6,500 emergency dispatch
centers across the U.S. accept 911 text messages, but last
year, the FCC voted to require all cell service providers to
universally support 911 texts by the years end,
including those from third-party messaging apps. Progress,
albeit slow progress, is being made. In the meantime, it
seems the best way to get immediate help remains to call.
Otherwise, there may be a wait.
In August 2011, teen-focused social change organization DoSomething.org received this startling text message. It wasn't rare for the nonprofit to receive replies unrelated to the social causes it highlighted through its mobile platform teens often looked to talk about issues such as bullying, questioning sexuality and substance abuse. But this text's raw honesty was particularly jarring.
After one of DoSomething's digital engagement managers hesitated to answer, another message came through from the same number about an hour later: "R U there?"
The manager then texted back, asking the texter who was assaulting her. She responded the following day: "It's my dad."
It's been almost five years since that text, and former DoSomething.org CEO Nancy Lublin still hasn't heard from the girl, though she's tried several times to contact her. But the message created a sense of urgency in Lublin, calling her to act.
"We realized with that message that it was time to create counseling based around texting," Lublin said. "So we built it."
That text was the catalyst for Crisis Text Line, a mental health-based text messaging support line geared toward teens in the U.S., founded in August 2013. Over the past three years, users of the text line have exchanged nearly 7.5 million text messages with volunteer Crisis Text Line counselors.
Now independent from DoSomething (though Lublin calls the two organizations the "best of friends") the line has started a mental health movement based around a medium of communication teens can get comfortable with text.
"We get a lot of people in the heat of the moment, when they are about to get really angry, or they're about to have a panic attack, or they're about to have a bulimic episode," Lublin says.
A Crisis Text Line counselor's goal is to move a texter from that "hot moment" to a "cool moment." And every day the stakes are high. Lublin says the line performs an estimated eight "live rescues" per day, in which counselors call EMTs or police to intervene in a potentially life-threatening situation, such as suicide ideation.
It's these intimate conversations and demanding moments that make for a different type of volunteering experience for counselors.
"This is not like painting the side of a school. This is contact with another person who is in pain," Lublin says.
When a texter messages Crisis Text Line, they're greeted with a simple prompt from an automated algorithmic system: "We're here for you. Tell me more about what's going on..."
"We want to try to get the texter to tell us what's happening so the algorithm can read the severity," Lublin says. "If a texter says something like, 'I want to die' or 'I want to kill myself,' we make them No. 1 in the queue."
The algorithm makes the line operate like a hospital: The most critical patients are seen first by a crisis counselor. Crisis Text Line volunteers "text" via an encrypted, secure site on their personal computers so secure, in fact, that counselors don't even see the mobile numbers of those they're helping.
And there are even more intensive privacy measures in place for texters concerned about their anonymity.
"Anyone can be scrubbed from our system just by texting in the word 'loofah' and then we scrub you," Lublin says. She admits "loofah" can be a difficult words for teens to spell correctly, so variations like "lufah" work, too.
But "loofah"-ing yourself is more of a technicality than a necessity when using Crisis Text Line. Even with phone numbers saved in the depths of the Crisis Text Line system, there's no other identifying information connected to those numbers or made available to counselors.
This is not like painting the side of a school. This is contact with another person who is in pain.
We have a special relationship with all the major mobile carriers, where you aren't charged a fee, we aren't charged a fee and it doesn't even show up on your bill," Lublin said. "It's like you never even texted us."
Lublin says texting is the perfect medium for anonymity, despite popular opinion that tech can never afford true privacy. The main reason? It's a way of communication that doesn't require speech. You can confess your deepest secrets while sitting in a room full of people and they'd have no clue.
"We tend to get a lot of texts every day around lunchtime," Lublin says. "People are sitting in a cafeteria or a Starbucks and you think they are texting their mom. But they are actually texting us."
The history of on-demand crisis counseling is tied to the evolution of tech. First, it was solely telephone-based hotlines, through which those in crisis could call in for help. With the popularization of instant messaging, mental health organizations started adding chat features to their websites with live support.
The next logical step for a connected generation of teens is text. Nearly 75% of U.S. teens own or have access to a smartphone, with only 12% of 13- to 17-year-old teens reporting they don't have access to a phone of any type. Of those teens who are connected, about 90% text.
Finally decided to check out @CrisisTextLine , it's honestly very helpful and the counselors are amazing.
Even with Crisis Text Line's success by capitalizing on texting, Lublin says older models aren't losing their staying power.
"I don't think [hotlines or instant messaging support] are ever going away and they shouldn't," she says. "When it's possible to do crisis intervention by Tupac hologram or crisis intervention by Oculus Rift, it should all be made available. People are very divergent in their needs, and there should be a plethora of options to get help."
But, for Lublin, there's something special about texting. It's familiar, she says people know they have limited space and already expect a delay in response.
"People are sitting in a cafeteria or a Starbucks and you think they are texting their mom. But they are actually texting us."
"What's really great about this is that, unlike phones, we dont get the word 'um,'" she says. "We don't get repetition. We don't get hyperventilating or crying. There are no interruptions. It's incredibly effective for counseling because what we do get is facts."
And those facts help to create a "juicy corpus," Lublin adds. Anonymous data collected through text conversations is available to the public through a sister effort called Crisis Trends, which tracks mental health trends that help inform the public, policy leaders and the nonprofit itself.
"We use the data in two ways: to make us faster and more accurate, and to, hopefully, make the country better," Lublin says.
Because of this data, Crisis Text Line knows that text counseling appeals to teens and young adults. About 65% of Crisis Text Line texters mention "school" as their location. While thats not entirely surprising, an unexpected 35% of texters are estimated to be older than the line's target teen audience. In fact, 10% of Crisis Text Line texters are middle-aged men.
"That's really exciting, because [middle-aged men] are most at risk for depression and suicide, Lublin says. "But they are least likely to seek out help."
Although mental health is the main focus, Lublin hesitates to make it the sole aspect of Crisis Text Line's story. First and foremost, she says, Crisis Text Line is about innovation with data and startup roots taking center stage.
"We think of ourselves as a tech startup first and a mental health organization second," she says. "When it comes to volunteers, we love people who think of themselves as tech innovators first and volunteers second."
Right now, the line has 1,500 volunteer counselors across the country. Crisis counselors complete 35 hours of intensive mental health training created and facilitated by Crisis Text Line trainers including online modules, quizzes and role plays. Lublin says about 39% of those who apply to be a counselor are accepted and complete the training.
"If you're introverted, this is a really great way to volunteer," she says. "This doesn't require your voice. You can do it at home in your jammies. And you're going to save lives."
Allen Wang, a 19-year-old counselor who just completed his sophomore year at Iowa State University, has been a volunteer with Crisis Text Line since August 2015. As a student, Wang isn't pursuing mental health as a career path. His studies, to Lublin's point, are more tech-based aerospace engineering and economics.
"That's how I know I'm doing this because it matters to me, not because I want to push forward a career or whatever," Wang tells Mashable.
Not only is Wang a counselor, but he also knows what it's like to be on the other end of the conversation. His first interaction with Crisis Text Line was when he was in crisis himself. In May 2015, he was fighting through a period of depression; after finding Crisis Text Line's number on Reddit, he decided to reach out.
"There was this girl I was really into, but it wasnt going to happen," he says. "I was feeling really bummed out after a really hard semester. It was just me sharing what was going on. It felt good to be able to do that."
If you're introverted, this is a really great way to volunteer ... And you're going to save lives.
Now as a counselor, Wang has about five or six conversations with texters in crisis per every four-hour shift, each one lasting about 45 minutes to an hour. Most days, he's talking to texters who are being bullied or having difficulty with self-image. But, once in a while, he does talk to an actively suicidal texter.
Out of 160 conversations in his time with Crisis Text Line, he estimates three or four have ended in police involvement due to suicidal ideation.
A few months ago, Wang was connected to a girl who was actively cutting herself while texting the line. She told Wang she didnt want any help. What she wanted, she said, was to die.
Wang told his supervisor, who ended up contacting the police. Using the signal from her cellphone, the authorities were able to pinpoint her location.
"When they got there, she texted me back saying, 'What the...?!'" Wang says, trailing off. "She cursed me out, asking why the police were there, and just shot me texts of quite a few obscenities."
He sighs heavily, his voice quiet. "I knew we did the right thing, but that one really sticks with me," he says.
The emotional weight of being a counselor is one of the biggest obstacles of the job. Burnout from high stress and pressure is something Wang has struggled with, along with the obligation to stop communicating with a person in crisis after a single, intense conversation.
"In some cases, you are the only person they have ever told these things to. It was really hard when I first started to just walk away from that."
"You heard from the very depths of these individuals," he says. "Their deepest, darkest secrets hopes, dreams, fears, terrible things that have happened to them. In some cases, you are the only person they have ever told these things to. It was really hard when I first started to just walk away from that to just let go and move on.
But being a crisis counselor has given him a "crash course in letting go." If he couldnt, he says, it would be too much of a burden.
"It's a really good skill to have in life to just move on from something, he says.
Lublin, however, cant move on from the text that started it all.
The girl who texted DoSomething about her sexually abusive father is still on Lublins mind and she has been for five years.
Lublin talks about her a lot in speeches, interviews, daily life hoping that even if she never speaks directly to her, the girl will find out what her bravery and honesty helped to create.
"I want her to know that her courage inspired this whole thing. Thanks to her, we are saving a lot of other people," Lublin says.
"She started all of this."
To learn more about Crisis Text Line or to apply to be a crisis counselor, visit here.
If you want to talk to someone or are
experiencing suicidal thoughts, text the Crisis Text Line at
741-741 or call the National Suicide Prevention Lifeline at
1-800-273-8255. For international resources, this list is a
good place to start.
text-message hotline can predict your risk of depression or
Crisis Text Line, a non-profit text-messagebased counseling service, operates a hotline for people who find it safer or easier to text about their problems than make a phone call or send an instant message. Over 1,500 volunteers are on hand 24/7 to lend support about problems including bullying, isolation, suicidal thoughts, bereavement, self-harm, or even just stress.
But in addition to providing a new outlet for those who prefer to communicate by text, the service is gathering a wellspring of anonymized data.
"We look for patterns in historical conversations that end up being higher risk for self harm and suicide attempts," Liz Eddy, a Crisis Text Line spokesperson, tells Tech Insider. "By grounding in historical data, we can predict the risk of new texters coming in."crisis-text-line-sms
According to Fortune, the organization is using machine learning to prioritize higher-risk individuals for quicker and more effective responses. But Crisis Text Line is also wielding the data it gathers in other ways the company has published a page of trends that tells the public which hours or days people are more likely to be affected by certain issues, as well as which US states are most affected by specific crises or psychological states.
According to the data, residents of Alaska reach out to the Text Line for LGBTQ issues more than those in other states, and Maine is one of the most stressed out states. Physical abuse is most commonly reported in North Dakota and Wyoming, while depression is more prevalent in texters from Kentucky and West Virginia.
The research comes at an especially critical time. According to studies from the National Center for Health Statistics, US suicide rates have surged to a 30-year high. The study noted a rise in suicide rates for all demographics except black men over the age of 75. Alarmingly, the suicide rate among 10- to 14-year-old girls has tripled since 1999.
Crisis Text Line's goal to use data in order to tackle these challenges made headlines in 2014, and the attention brought a wave of investment. Shripriya Mahesh, a partner at the philanthropic investment firm Omidyar Network (which was started by eBay founder Pierre Omidyar), says the firm has given the service two grants. Last week, Crisis Text Line received $23.8 million in grants from a squadron of Silicon Valley investors, including Melinda Gates, Steve Ballmer of Microsoft fame, and many more. This round brings its total up to $35 million in funding.
Mahesh says the Line has been raising money the same way a startup does, and this current wave of grants can be thought of as a "Series B" a secondary funding round in which investors are confident the company is going in the right direction.
"[Crisis Text Line] not only does good but it's really efficiently and is conscious of how effective they are," she said.
To further that effectiveness, Crisis Text Line is partnering with other services to move beyond text messages. The company now provides counseling to users of Kik, Facebook Messenger, and After School, a safe discussion space for students. And Liz Eddy says company is still expanding.
"We're working with social media apps, search engines, messaging apps and other tech companies to help them provide support and resources to their users who are in crisis," Eddy says.
She declined to name any specific apps
the service plans to partner with going forward, but it
wouldn't be a stretch to imagine contacting the Crisis Text
Line through Twitter, WhatsApp or Gmail in the near
Biggest Names Are Giving Millions to Crisis Text
On stage at the WIRED Business Conference in New York, founder and CEO Nancy Lublin said the company raised nearly $24 million. LinkedIn founder Reid Hoffman led the funding, with additional participation from tech philanthropists Melinda Gates and Pierre Omidyar, as well as former Microsoft CEO Steve Ballmer. Altogether Crisis Text Line has raised $35 million.
Of course, these investors arent looking for an exit in the conventional sense. (There is no equity; no possibility of a liquidity moment, Lublin said.) But the venture-style approach makes sense in the context of the Crisis Text Lines startup sensibility.
We have the bones and minds of a tech startup, Lublin said. We solve problems with products.
Eighty percent of Crisis Text Lines texters are under 25, Lublin said. For people that age, messaging likely feels much more natural than making a phone call to a crisis hotline. Crisis Text Line also makes use of algorithms and machine learning to prioritize the most urgent queriesfor instance, if someone texts that theyre considering suicide.
Since launching in August 2013, Crisis
Text Line has processed nearly 19 million messages. Right
now more than 1,500 volunteer crisis counselors man the
lines for Crisis Text Line; over the next couple of years,
its seeking to expand to more than 4,000. Its
also in the process of moving beyond texting alone as it
integrates with popular messaging apps like Facebook
Messenger and Kik, as well as Facebook itself via its Safety
Check Point feature, Lublin said today.
Some crisis intervention resources saw an uptick in users following the election.
Many people felt a deep need to reach out for mental health help following Tuesday nights election results.
Crisis Text Line, a mental health service that allows people to chat with a counselor via messaging, experienced twice the average volume in the last 24 hours, according to the organization.
In an analysis of the messages Crisis Text Line received, data researchers at the organization found the words election and scared were the top two phrases being mentioned by texters. The most common association with the word scared in texts was the phrase LGBTQ.
The National Suicide Prevention Lifeline, a 24-hour hotline for people who are at risk for self harm, also saw a rise following the results. The number of calls between the hours of 1 a.m. and 2 a.m. Eastern Time increased by 140 percent, according to John Draper, the project director for the Lifeline.
While we may not know if this particular election that caused psychological distress (its possible call volumes increase after any election), its also no secret that this divisive and negative race has taken a toll on citizens mental health. A survey conducted by the American Psychological Association last month found that the majority of Americans felt significant stress over the election.
Election stress becomes exacerbated by arguments, stories, images and video on social media that can heighten concern and frustration, particularly with thousands of comments that can range from factual to hostile or even inflammatory, Lynn Bufka, APAs associate executive director for practice research and policy, said in a statement following the survey.
That, according to Draper, is what the Lifeline saw firsthand. While the calls into the hotline peaked in the few hours following the results, the stress started to take hold long before. The Lifeline saw a 30 percent rise in calls starting this pas Monday, the day before the election, compared with their average Monday traffic.
We know during times of great change and uncertainty there are fears, anxieties and, for some, even a large sense of loss, Draper said. Thats why the Lifeline is there.
Exercising self-care can work
The Crisis Text Line analysis found that 88 percent of people who used the service felt connecting with the counselors was useful, which was an increase from their normal rate. Bottom line: These resources do help.
Immediately, its important to exercise self care during contentious periods where your mental well-being may be threatened. Experts stress that finding techniques that work for you is crucial.
Think of three things that make you feel strong: A person, an activity and an online resource, Nancy Lublin, chief executive officer and founder of Crisis Text Line told HuffPost. Prioritize these things.
And, most importantly, both Lublin and Draper hope anyone struggling with a mental health issue ? no matter if its election-related or not ? knows that theyre not alone in their experience. Below are a few other ways you can take care of your mental health following the election:
Spend time with loved ones.
Theres power in human connection and social support. Research shows hanging out with close friends can beat stress.
Keep up a routine.
Going about your day can help during difficult times, Draper said. That may include going to work, heading to the gym or even just making your weekly grocery store trip. Its nice to do things that are familiar because it reminds yourself that youre not out of control, he stressed.
Write down your emotions.
Put pen to paper to sort out whats going on with your psychological wellness. Then it might be worth chucking it: Studies have found that writing down negative feelings and physically throwing them away can help clear your mind.
Allow yourself to feel sad...
We experience a spectrum of emotions, including negative ones. Once you fully accept that you are affected by this loss then you can begin to move forward and eventually heal, grief therapist Claire Bidwell Smith wrote in HuffPost.
...but seek help if it becomes overwhelming.
Theres nothing wrong with talking to someone. Reach out to crisis hotlines or a mental health professional if your sadness ? for any reason ? is interfering with your every day life.
If youre in crisis, you can text SOS to 741741 for free, 24-hour support from the Crisis Text Line.
If you or someone you know needs help,
call 1-800-273-8255 for the National Suicide Prevention
Lifeline. Outside of the U.S., please visit the
International Association for Suicide Prevention for a
database of resources
Pride in Mental
Health: An Interview With The Trevor Project And Crisis Text
This week I had the privilege of speaking with experts, activists, and advocates about the various mental health needs we have in the LGBTQ communities, at an event hosted by Crisis Text Line. We all agreed that a supportive and continuous, therapeutic relationship is key, for everyone really. But for those of us who face constant discrimination it can be a matter of life and death. The trouble is that psychotherapy is stigmatized; not enough clinicians are competent, curious, or empathetic enough to make a connection with LGBTQ clients; and too many people simply cant afford therapy, or their insurance wont cover it (if they even have insurance). The experts I spoke to all fight tirelessly against these obstacles, in order to connect people to the safe, loving, and supportive relationships they need and deserve.
For this segment of my Pride in Mental Health Series, I talk with David Bond, Vice President of Programs at The Trevor Project, (the leading national organization providing crisis intervention and suicide prevention services to LGBTQ+ youth), and Shoko Morikawa, Crisis Counselor Supervisor at Crisis Text Line (which provides 24/7 text support to those in crisis, text SOS to 741741 for free).
What are the mental health needs of the LGBTQ people who contact your crisis counselors?
David Bond: This is a huge huge question. They are so wide and varied. On one spectrum, we need to stop pretending that sexual minorities and gender minorities are the same population. We come together for advocacy and support and allyship of each other, but for research purposes and intervention purposes those things are really distinct because the stressors are very, very different, and the trauma can be very, very different. So, education and advocacy are immensely important [in identifying the specific mental health needs of the people who contact The Trevor Lifeline, Trevor Chat, or Trevor Text]. If you look at the National Institute for Mental Health, and all the funding they provide for research, less than one half of 1 percent of all NIH funding goes to LGBT issues and 80 percent of that goes to HIV/ AIDS, theres a tiny sliver of funding that goes toward research of any LGBT healthcare issue whatsoever, and almost none of that goes to minors. So theres this population of people who are completely not understood. Closeted youth never get studied because...no closeted youth is going to sign up for a research study, since theyd need to have parental consent. So we need to have a better understanding of the funding sources and avenues to research these communities to really understand their resiliency, what theyre going through, and how to intervene in the most effective kinds of ways.
Shoko Morikawa: I know that at Crisis Text Line, roughly half of the people who text in [44 percent] are LGBTQ+. Its great that we can reach that many people from those communities. They mostly talk about family, depression, suicide. Compared to people who text in who do not identify as LGBTQ+, they are more likely to talk about bullying, [4.7 times the rate of CTLs general population], school [4.3 times the rate], and emotional abuse [3.6 times the rate]. Those who identify this way also tend to be a lot younger, under the age of 25. And the majority of these texters tend to talk about issues that are more generally about bullying, or family rejection, and less about being LGBT or Q, directly. They dont tend to text about issues like coming out or gender identity. [Its more to do with not fitting in and/or being abused, emotionally and/or physically, at home and/or at school]
In addition to the crisis counseling your organizations provide for those who text and call into your hotlines, what types of long term services do you connect them to?
Shoko Morikawa: Were a short term service: conversations will last about an hour. Which is generally enough time for our trained crisis counselors to listen and validate whatever that person texting in is going through. And then helping them calm down, identifying their strengths, and helping them brainstorm next steps, and more ways to cope with whats going on. Our goal is to bring them from a hot moment to a cool calm [i.e., use techniques in empathetic listening to build rapport and trust, and explore the texters issues and goal, so that they can collaboratively problem-solve to develop a plan to stay safe.]
Since we are a national organization, we dont always have specific referrals [for therapists and other mental health professionals] though we are growing those lists, state by state. But we do refer people to organizations like The Trevor Project, The Trans Lifeline, GLSEN.
David Bond: Crisis services are meant to be episodic. Even if someone calls six times, theyre not necessarily seen as our client at the organization. Its framed as, that person had six episodes of a moment of care. Although we will follow people over time. But whats complicated for many people is to identify where those local resources are, depending on where they are in the country, they may have to travel two states away to find an LGBT center. So we do work very hard to try to find mental health resources, and if we cant identify them, we work with people especially young people to think about all the people in their lives and who is the most supportive, who cares about them the most. Really try and help them to realize that there might be alternative ways of thinking about the people who are in their life. Because some of them may be much more supportive than you would assume.
David, you brought up a crucial point earlier, which is that a great deal of LGBT youth are not out. So how do we prepare teachers, guidance counselors, parents, and other adults, to at least provide a safe environment for those who are closeted and too afraid to seek help?
David Bond: The Trevor Project has these resource posters that are meant for classrooms and healthcare organizations, as part of the crisis intervention and peer support resources that we provide for free. Theres this little tiny rainbow sliver that goes through the middle of it. And I say to educators all the time,If you have something like this in your classroom, it sends a tacit communication to the person in your classroom who might be struggling, that you might be a safe person to have a conversation with about all these things. I used to tell, teasingly would tell other mental health practitioners, In your office you need a great big book that says LGBT on it, or Gay or Trans. And you dont even have to read the book. You just need to have it on the shelf, so that a client could come in and see your office might be a safe place to talk about it. Because doing a safety assessment of, I mean doing a coming out safety assessment is incredibly important. You hear these messages all the time that, Everyone just needs to come out. But the truth is if youve done a strong safety assessment, then its not necessarily a protective factor at all.
The youth who reach out to the Trevor Project, only about 50 percent are out to at least one parent. But 90 percent of them are out online. So its also important to create safe online spaces that are non-sexualized, that provide opportunity for young people to meet each other and build systems of support. If you think about that Trans girl of color in rural Arkansas, who doesnt feel that theres any one around her who understands. And she needs to find an online space, for example, that will give her access to other people like her so she doesnt feel so isolated.
How do you get the word out about your service?
Shoko Morikawa: We use a lot of press at the schools all across the nation. With high schools, grade schools, and colleges as well. We also have partnerships with various city-based organizations, such as The Golden Gate Bridge and the CalTrain System in San Francisco. They help us get the word out by having billboards, especially at places like train stations, where we know that suicide attempts take place.
At the schools we have our Crisis Text Line posters, or our cards with our number on it, that school counselors can hand out to kids. We also have a lot of social media and national press coverage.
What would help to make mental health services more available, accessible, and appealing for people in need?
Shoko Morikawa: More discussions about mental health for sure. With our text line we have exchange 40 million messages the past 3 ½ years. So were also reaching a lot of people. And
the great thing about being a texting service is that its private and for that reason it is a great way to increase conversations about mental health awareness. We always fight [for the texter] during lunch times, because many young people who may seem to their peers like theyre texting their friends or something like that at the lunch table, are actually texting about an eating disorder, or about a family conflict. And especially for LGBTQ+ texters, its a great way for them to get help if theyre not out. They dont want to be overheard. And by text its safe, silent, private, and accessible. And were 24/7 so you can text during your lunch break. When you get up in the morning. At 2am when you get up and go back to sleep. Were always there. I think were making steps toward having those conversations more and having [mental health] become more accessible.
David Bond: Suicide is the second leading cause of death for all young people, between the ages of 10 and 24. And I always get the question, Whats number 1? Its motor vehicle accidents. So since the year 2000, weve been able to decrease motor vehicle fatalities in this country between 35- 40 percent. And thats because of policy change. We have bicycle helmet laws and seat belt laws and zero tolerance for drinking and driving, and texting and driving and we have enhanced crosswalks, and we have car seat laws for infants. Fatalities have been reduced by 35-40 percent, in just 17 years. Yet were not engaging in massive large scale public education about suicide prevention. Even though its number 2. And the big problem around this is the stigma. Because if someone has an accident or if someone has a physical health disease, people can blame the disease. But when people have mental health struggles. Or people are struggling with depression or thoughts of suicide, its not a disease model of blame. People are blaming the people who are feeling that way, who are suffering, saying, Why dont you snap out of it? And, we need to have a real shift in the public health conversation in this country about mental health issues so you respect them in the same way that health care issues are respected.
You also have to identify the problem. So the other major problem that the LGBT community is suffering from is that were not being counted. So theres a national violent death recording system that records all violent death in most states throughout the country. So theyll know how somebody died. If they dont collect the information about sexual orientation or gender identity, death investigators. Death certificates dont say...they will say veteran status. So we know how veterans die. Theyll say male or female. So we get, Well men die from some of these things, women die from some of these things. But the whole country has absolutely no concept of how LGBT people die. So when we talk about research that we need to protect ourselves, to protect the community from death by suicide and mental health issues, we have to be counted. So its census. Its death investigators. Its a number of other ways.
At Trevor we do quite a bit of
advocacy around this. We work on trying to change that
scenario for the science. We work on bans for conversion
therapy on a state by state basis. Successful in five states
that ban conversion therapy for minors, as well as other
municipalities. We also work on having states implement
legislation that requires all of their schools to have
suicide prevention policies. And those are LGBT inclusive,
as well as other vulnerable populations. So we need policy
interaction, but we also need more research. I mentioned
earlier the NIH funding? Leukemia 30 years ago had a 90
percent mortality rate. It now has a 90 percent survival
rate. The change was every leukemia patient participated in
research and their doctors submitted it. Research led to
treatment which led to cures, which created a huge shift in
life. Because of research and advocacy.
For Teens in
Crisis, the Next Text Could Be a Lifesaver
Crisis Text Line counselors have already exchanged more than eight million messages (42 million as of July 8, 2017) with individuals in distress.
For the past year, he has been able to draw upon his experiences to assist this woman and others by volunteering with the Crisis Text Line a free, confidential 24-hour service accessible via the number 741741. The text line currently has more than 600 volunteer counselors around the country. To date, Amrich has assisted more than 400 people. His text conversations indicate that he consistently helps them get through crisis moments. In the process, he has also helped himself. Its one of the best things that ever happened to me, said Amrich. Its made me a lot happier than all the therapy I was doing with the Veterans Administration.
To qualify as a counselor, Amrich had to undergo six weeks of training, pass tests, and commit to offer at least four hours of volunteer service per week for a year. As he had been instructed, Amrich listened openly and nonjudgmentally to the young woman. He didnt offer advice; he didnt try to help her solve her problems. Mostly, he said, his messages mirrored back what he heard from her, occasionally emphasizing a strength that he noticed like the fact that shed taken this step to help herself even in the midst of her depression.
A lot of people have an overwhelming loneliness, he told me. They feel unworthy and they dont talk to people they care about because they dont want to be a burden. Sometimes it takes a stranger to say, Hey, youve been through hell and I want to emphasize that youve done a lot. Youve been helping yourself without any training. Good job. If you can do that on your own, you can do more. Many people reply: Ive never thought about it that way before.
The opportunity to share her feelings with an empathetic person appeared to help this woman. She said she couldnt remember the last time anyone had told her they believed in her, he recalled. She ended the conversation the way people often do, by texting: Thanks for listening, Amrich said. (The Crisis Text Line follows up after conversations with an automatic message asking texters if they feel better a data point that is closely tracked.)
The Crisis Text Line has been in operation for two years. Although it has received little publicity, its counselors have already exchanged more than eight million messages with individuals in distress. The service is filling a critical need and is likely to grow considerably in the coming years. Across the country, there is widespread concern about the social, academic and economic pressures that young people are facing and the alarming prevalence of anxiety, loneliness and suicidal ideation among teenagers and young adults. (Note: Sept. 10 is World Suicide Prevention Day, an initiative of the International Association for Suicide Prevention.)
We may not be able to change the things that make teenagers depressed and anxious, but we can make it easier for them to get help.
While the environments that produce these pressures are tough to change in the short run, its possible to make it easier for young people to get help. When young people are in distress, the single most beneficial step they can take is to confide in and seek help from a trusted and capable adult. But only 15 percent of high school students who seriously consider suicide do so. Only about half speak with friends. And only 2 percent use telephone crisis hotlines.
Thats why researchers are excited about the Crisis Text Line. Young people have been reluctant to use crisis services, observes Anthony Pisani, a suicide prevention researcher at the University of Rochester. The top two barriers are the sense of shame and self reliance. I think the Crisis Text Line has cracked the code on both of them. It offers a layer of protection from the shame of expressing your vulnerabilities. And it lowers the barrier of entry for the proud and self reliant because its so easy to experiment with a conversation.
The Crisis Text Line emerged from the work of DoSomething.org, a youth social change organization with over four million registered members that uses text messaging to communicate with them.
Today, the Crisis Text Lines counselors exchange 20,000 messages a day with people seeking help. Nancy Lublin, who spent 12 years as the chief executive of DoSomething.org and is now heading the Crisis Text Line, which she founded, hopes to have 2,000 counselors in place by the end of the year, more than tripling its current reach.
Everything hinges on the quality of counseling. The training program was designed by mental health experts. Only a quarter of applicants complete it. We try to instill in trainees that when you start a conversation, all of your suppositions have to be put aside, explains Kaley Leshem, who trains counselors. Its not about giving advice. You have to be completely nonjudgmental. Its essential to establish trust. One of the most effective messages is simply: Im hearing that youre feeling X because of Y. It gives the texter the opportunity to correct you and to clarify, Leshem says. And by being very specific, it shows that youre paying attention and that you care.
If a young woman says that she is cutting herself, the counselor might ask: How does it feel when you self-harm? After rapport is established, she might follow up with: Its understandable that you would like to feel relief from the stress youre under, but can we think of other ways to do that?
The goal of a crisis line, explains Lublin, is narrow. Its not therapy; its meant to bring people from a moment of hot to a moment of cool, so counselors can suggest ways the texter can move to a place of increased safety.
The counselors are scattered far and wide, but the conversations are monitored on a central platform by supervisors who are trained mental health professionals. Counselors can ask for assistance in real time. If a texter says that he or she is thinking about suicide, the conversation is prioritized and a supervisor is brought on to oversee it. Together, they will assess if the texter has a plan, the means, and a time frame the key indicators of serious risk. If so, the supervisor will lead an active rescue, asking the user their location and contacting 911. In rare cases, when the texter does not provide an address, they work with mobile carriers to determine the location and send help through 911.
The millions of messages that the Crisis Text Line has amassed have become a treasure trove for researchers. Beyond the C.D.C. and the N.I.H., its the largest database on real-time crisis in the country, says Lublin.
For now, the data is primarily used to prioritize conversations and improve training for counselors. When counselors express sympathy, as opposed to empathy, texters give lower ratings to the conversations, says Bob Filbin, the services chief data scientist. Counselors who focus on problem solving, as opposed to listening, also get lower ratings. Research indicates that the optimum conversation contains 40 to 60 messages and lasts an average of 45 minutes. Lublin says that veterans, young gay women, and people who are deaf or hard of hearing, have proved to be excellent counselors.
Moving forward, the Crisis Text Line is making its anonymized data broadly available. Researchers and government agencies are interested in using it to better design and target prevention services. (See its Crisis Trends website.) The information can be mined to identify broad patterns. For instance, depression or suicide are currently mentioned in 35 percent of conversations, anxiety comes up in 16 percent, family issues in 14 percent, and self-harm in 9 percent.
Or it can be used for deeper explorations. Messages for eating disorders currently peak on Sunday night; for sexual abuse this summer they spiked between 6 a.m. and 9 a.m.; for substance abuse they peak at 5 a.m. If you run an intake facility, knowing that is super important, says Lublin.
You can look at the data from so many angles, she adds. What happens on Christmas Day? What are the triggers for eating disorders? How many times do people mention social media as a source of depression or anxiety?
John MacPhee, the executive director of the Jed Foundation, a leading organization working to promote emotional health and prevent suicide among college and university students, says: Being a teenager and transitioning into adulthood can be a difficult period and its not unusual for a young person to find themselves feeling uncertain, concerned and in distress. Having a 24/7 service there for someone who is afraid to speak up to have an exchange on a safe, anonymous basis in a medium theyre comfortable with is a tremendous advance. Every older adult should give every younger adult that number and make sure its in their phones.
The big problem adults have in trying to help young people is getting them to open up. Many programs seek to make adults aware of signs that teenagers are in distress and increase their willingness to talk with youth, said Anthony Pisani. But research has shown that unless they have established trusted connections the youth arent going to talk with them. Kids worry that adults might overreact and not understand their challenges.
Can we increase the willingness among youth to seek help from adults? Yes. The program Sources of Strength, for example, has demonstrated success in training peer leaders. Pisani hopes that the text line will also help with this challenge. Kids who text to Crisis Text Line are likely to be those who dont perceive themselves as having trusted adults in their own natural support system, he says. If a positive interaction with the text line can begin to shift their attitudes about the role that adults could play in providing guidance and support, we have the potential to strengthen a key protective factor against suicidal behavior.
If kids tell stories about successful experiences with adults who are capable and available, it could shape social norms, he adds. If thats the case, they may be on to something even bigger than they know. These are the kinds of stories that youth-oriented groups like To Write Love On Her Arms are well suited to share.
For Aaron Amrich, the stories he has heard have touched a deep chord. Talking through problems with other people has given me an outside perspective on things Ive been through but didnt know how to process or deal with, he said. And working with the other crisis counselors has given me a sense of belonging that I havent had for a long time.
Were all people, and people can help, he added. You dont need to have a Ph.D. to help people feel that they can be pushing forward in their lives. I think thats a beautiful thing.
Join Fixes on Facebook and follow
updates on twitter.com/nytimesfixes. To receive e-mail
alerts for Fixes columns, sign up here.
Shoot Me a
Text: Why Millennials Prefer Text Over Talk
More recently, weve passed a point of regression. Millennials are actually shying away from making phone calls. Why is that and whats replacing them? Hint: You dont have to go as far as you may think.
Millennials Want to Text
Though voice calls arent at risk of going extinct anytime soon, millennials who make up an overwhelmingly vast percentage of the mobile phone market prefer not to have to speak on the phone. To be more exact, they would rather text.
According to a recent survey we conducted here at OpenMarket, when given the choice between being able only to text versus call on their mobile phone, a whopping 75 percent of millennials chose texting over talking.
In fact, millennials overwhelmingly prefer to receive text messages from businesses, as well, instead of phone calls, which they regard as intrusive. According to Nielsen data from a few years back, the average monthly voice minutes used by millennials fell from roughly 1,200 per month in 2008 to 900 minutes a month in 2010.
During this same period of time, texting among 18 to 24-year-olds more than doubled, climbing from just 600 per month to around 1,400 texts per month. Now, the Nielsen data isnt exactly brand-new, but it does illustrate that this isnt a new trend or phase that is likely to fizzle out.
For the past eight-plus years (at least), millennials have increasingly shunned voice and gravitated towards text messaging. If you run a business that may be largely dominated by Baby Boomer thinking, an affinity for SMS may seem strange. After all, phone calls are quick and easy.
But you have to remove yourself from your own biases and think about this from the perspective of your customers. Millennials are unique and clear about what they want and what they want is to text. So moving forward, its in your best interest to move in that direction.
Four Reasons Millennials Love SMS
Before delving into some of the ways you could adapt your marketing strategies to respond to the general popularity of texting, take a look at some of the reasons millennials have fallen in love with SMS.
Youll want to understand the logic behind this preference so youll be better able to target the right individuals with the most effective marketing strategies.
Convenience and Ease of Use
Millennials are all about simplicity and ease of use. This generation has grown up with more technology than all the previous ones combined. Theyre conditioned to think in terms of which technology affords the most conveniences, and the simple answer is SMS.
Its not so much that millennials feel an intense antipathy toward talking on the phone. They still spend time talking, but theyd prefer to do it with parents and close friends.
Its not a mode of communication they positively associate with brand interaction. Instead, they view unsolicited business calls to be nothing more than pestering from telemarketers.
Easy to Remember
Phone conversations can be difficult for millennials to recall. What time did they say we were supposed to meet? How much did she tell me the tickets cost? Was the address 113 or 131?
Hours after a phone conversation, details like these tend to slip away. But with SMS, everyone has a readily retrievable transcript of the conversation. An individual can go back and see that the meeting was set for 5:30, the tickets cost $25, or the address is 113. Theres less pressure on the recipient to remember everything.
Text messages are less stressful than phone calls. The latter may require the person to come up with answers on the spot or remember specific questions he or she wanted to ask.
By contrast, a text message gives the recipient time to think and respond on his or her own time. Its a more organized experience that involves less overall pressure.
Trumps Voice Mail
Because millennials prefer not to answer phone calls from numbers they dont recognize, most calls from businesses go unanswered. As a result, companies sometimes leave a voice mail. And millennials hate voice mail.
Voice mails take too long to retrieve and understand; theyre impersonal, intrusive, and sometimes confusing. Worse, if theres information the recipient needs in the voicemail such as an address, callback number, etc. the person has to write the information down on a piece of paper.
With a text message, the crucial data is already written out for the recipient to see and use. So thats why SMS trumps voice mail for most millennials.
How Businesses Can Respond
This raises the question, as a business how are you to respond appropriately to millennials and their preference for testing? The only reasonable answer is to satisfy their desire by adopting marketing strategies that place an emphasis on text over talk.
According to our research, 75 percent
of millennials think receiving texts for things like
appointment reminders, payments, deliveries, promotions, and
surveys is helpful. Nearly two out of three millennial
customers like to receive product offers and coupons. More
than half believe its helpful to receive texts that
address account activity, order alerts, and other general
Crisis Text Line:
Saving Lives Through Data
Crisis Text Line is a non-profit organization that offers free support 24/7 via text message to people facing a crisis. Founded in 2013, the organization was birthed out of DoSomething.org, a text-based non-profit organization that connects teens with volunteer opportunities. The catalyst for the organizations creation was that some teens were responding to calls for volunteers with messages crying out for help. In particular, a respondent asserted that she was being regularly raped by a family member and didnt know what to do. DoSomething.org staff felt like they had to truly do something.
The victim could have called one of many crisis hotlines; however, there wasnt a way to text one. Teens, in particular, significantly favor texting over calling as a means of communication and texting provides a different level of privacy than calling. Additionally, people are more likely to disclose sensitive information via text message than in voice interviews.  Accordingly, it was then obvious that there was a real opportunity to address mental health issues facing teens in a new fashion.
Since Crisis Text Line was established, over 34 million text messages have been exchanged, and it only took four months for the line to receive text messages from all 295 area codes in America.[3, 4] Consequently, the organization has amassed a huge amount of real-time, mid-crisis data an unparalleled data set in the mental health field. In contrast, other data are typically captured post-crisis, when memories can be biased or tarnished. The text based nature of the service is also advantageous as it allows for easy data capture (e.g. time, geography, language). The data is completely anonymized upon collection and counselors dont have access to the texters contact information. Neither party is billed for the correspondence (as a result of an agreement with national cellphone carriers like Verizon and AT&T), and the conversation isnt even noted on the texters phone bills.
Harnessing and analyzing the data has been a key focus for the organization from its inception: the second hire was a Chief Data Scientist. Data helps to modify and optimize crisis-counseling practices and enables the organization to more efficiently and effectively help those in crisis. For instance, Crisis Text Line has found that first-person responses are more effective in helping people cool down from a hot moment. Also, based on a texts language, Crisis Text Lines algorithm can help predict the crisis severity level and place that person in the number one slot in the queue, similar to how triage works in hospitals. Lastly, because theres only one number to text (versus crisis-specific hotlines), people in crisis dont have to overthink which number to text. The organization and algorithm also benefit by being able to centrally aggregate and, in turn leverage, a variety of data.
Crisis Trends is Crisis Text Lines sister effort, which helps to educate the public about mental health trends. Researchers, who want to delve deeper into more granular data, can gain access to it by affiliating with a university or research organization and having proper IRB (Institutional Review Board) approval. There are three types of data available: conversation level, actor level, and message level. The aim is that this data set will help the public and policy leaders better address mental health challenges and improve peoples lives. Learn More Here.
Although Crisis Text Line and Crisis Trends dont capture value in a traditional manner (i.e. monetization), the data helps to drive the organizations operational efforts. For instance, knowing that depression peaks at 8 p.m., anxiety at 11 p.m., self-harm at 4 a.m., and substance abuse at 5 a.m. can help the organization appropriately staff employees and volunteers, which in turns helps to streamline costs. Since data can help control costs, the burden of fundraising is lessened. Lastly, value is captured via social impact (i.e. lives saved and bettered as a result of the service). Crisis Text Line serves hundreds of folks daily and, on average, has eight live rescues a day. The service also is more accessible to the hearing impaired and deaf, relative to other crisis services available.
Looking to the future, the organization hopes to generate greater awareness, onboard more highly trained volunteers, and grow to international markets.