By Molly Bohannon/Special for Cronkite News
PHOENIX – The small office building, nestled just off the road near a medical office and appliance store, looks more like a house where a quiet family might live. The only signs of activity are the cars in the small parking lot out front.
Most passersby likely have no idea what goes on behind the dark purple door; an intercom doorbell ensures that only those who belong are allowed in. There are no signs outside, only inside, such as “You Matter” and “Happy Thoughts.”
Bulletin boards are brightened by slips of neon-colored paper with phone numbers to Planned Parenthood and shelters for homeless youth. There are nearly 10 work spaces, each with a computer, a landline and a chair.
On a Friday night early last spring, Madison Marks, 20, sits in one of the chairs waiting for the phone to ring. The part-time Starbucks barista, who’s dressed in black and rocks blonde streaks through her short brown hair, picks up when a 15-year-old calls to share the troubles that led her to seek help from a stranger.
Marks stops her at one point and asks the requisite question: “On a scale of one to 10, one being you’re OK and 10 being you’d kill yourself right now, how are you feeling?”
A 2018 study from the U.S. Centers for Disease Control and Prevention ranked suicide as the second-leading cause of death for teenagers nationwide. Experts and studies can’t point to one main reason for the high numbers, although many U.S. teenagers are feeling alone despite seeming more connected than ever, thanks to social media and the internet.
Arizona has been hit particularly hard in recent years, with its teen suicide rate surpassing those in more than half the other states. A 2019 United Health Foundation report showed that from 2017 to 2019, the suicide rate for ages 15 to 19 rose 17% – to 13 deaths per 100,000 teens from 11.1 deaths – well above the national rate of 10.5 deaths per 100,000.
Kelli Donnley Williams, a suicide prevention specialist in Arizona, said the state’s increase in teen suicides mirrors national trends, especially in states west of Mississippi River, where “the thread that seems to weave through everyone’s suicide story is one of isolation and lonlieness.”
Marks, the barista, is part of a one-of-its-kind team working to reverse the trend.
She is among about 100 volunteers for Teen Lifeline, a teen-run suicide prevention hotline that opened in 1986 – the year after “Surviving,” a controversial Molly Ringwald film portraying teen suicide, aired on prime time television.
If the film opened the doors to public conversations about teen suicide, Teen Lifeline made teenagers part of the solution.
In 2003, Teen Lifeline became the first teen-run hotline nationwide accredited by the nonprofit American Association of Suicidology. Teen Lifeline has been growing since then, helping other hotlines receive accreditation while expanding and improving its own services, including a text-based hotline launched in 2016.
It remains Arizona’s only crisis hotline operated by teens.
The trained volunteers work shifts from 3 to 9 p.m., answering calls and texts. Some come to the hotline in sweatpants, their smartphones loaded with Netflix, YouTube and other apps so they can watch movies between calls. Others are still dressed in school uniforms and use free moments to finish assignments in notebooks and on laptops.
They work under the supervision of clinicians, who train volunteers and sit with them during calls, offering words of assurance and writing notes to help the teen operator when needed.
The teens aren’t there to give advice. They try to calm the callers and, mostly, just listen.
Marks tries not to let her mind wander during calls. Occasionally, something a caller says reminds Marks of her own struggles and takes her back to her own dark times. These are the moments that remind her of how much having someone to talk to can improve a situation.
“You can hear a difference in the caller’s voice, when they’re like, ‘Thank you, you helped me so much,’” Marks said. “And, really, all we did was listen when they felt like they had no hope at all.”
Although no research has been done on the effectiveness of peer-to-peer hotlines with regard to teen suicide, Madelyn Gould, a researcher specializing in suicide prevention lines at Columbia University Medical Center, said there’s promise in the format because teenagers are more likely to turn to peers during mental health struggles. A main reason, she said, is that teenagers often believe they’ll be better understood by someone who might have had the same experiences.
“It’s not the only thing (to combat youth suicide), it’s not going to be the main thing,” Gould said. “But it has the potential to be a way to get kids into help that ordinarily wouldn’t have that would be missed with all through the cracks and have a safety net.”
The success of peer hotlines, she said, is largely dependent on the preparation of its volunteers. She suggested hotlines follow Teen Lifeline’s example and train volunteers on active listening, collaborative problem solving and the ability to connect with callers.
It takes two months to two years to train a volunteer to work at Teen Lifeline. The rigorous, three-phase training includes two weekend seminars, speakers from organizations the hotline refers callers to and thorough role playing and practice calls. Although the process is lengthy, volunteers say every step is necessary for the job they’re preparing to do.
The second phase is the longest – six to 52 weeks – and focuses on six areas: suicide, pregnancy, relationship violence, runaways, abuse and sexuality, which are the issues that come up most frequently on the hotline and drive many of the callers to consider suicide.
Clinicians rotate through the call room supervising volunteers and teaching trainees intervention tactics for each problem area. Modules on the six focus areas end with a role-playing exercise in which trainees are tested on their ability to have a conversation that meets Teen Lifeline’s strict standards.
“They don’t have to be counselors,” said Nikki Kontz, clinical director of Teen Lifeline. “They just have to learn how to be themselves and use good communication skills.”
Kontz said her group’s volunteers are taught skills that behavioral health experts typically learn in graduate school programs. They practice how to actively listen, solve problems, show empathy and build relationships with callers to guide the caller to what a good next step would look like.
They learn the techniques during the second phase of training, by practicing phone calls, discussing with the clinician team what might happen during calls and watching situational videos of what callers may be experiencing.
Learning to apply these skills to callers isn’t too hard for the volunteers because so many of them have friends who are going through similar problems, or they’ve been through the issues themselves. For callers, it should feel as though they’re talking to a friend.
“We are not an advice hotline,” Kontz said. “So we’re not there to give them advice, but instead to help the caller to figure out what is the best course of action for them and the strengths they have in their own life.”
Even after the three phases are complete, volunteers can remain in training until they’re confident enough to take calls. It typically takes 80 to 100 hours of training for teens to be cleared to work the hotline, Kontz said.
Marks trained for 10 months.
“I went in thinking, ‘Oh, I know this already’ and then being totally blindsided,” she recalled. “I didn’t know any of it.”
Marks came to Teen Lifeline in 2017, to make sure psychology was the right field of study for her. At least that’s what she told herself.
Deep inside, though, Marks knew there was more to it. Since seventh grade, she had struggled through dark times of her own. She harmed herself to release the pain, which she didn’t want to burden others with, and once thought of suicide.
She never knew the hotline even existed.
Looking back, Marks said her own mental health struggles “100%” played a role in leading her to be a peer counselor and, in many ways, made her more qualified for the job.
“I wouldn’t really want to change (my) experience just because I feel it has made me a better person, a more empathetic person,” she said.
Marks is a typical 20-year-old. She’s working toward a degree in psychology from Arizona State University, works part-time at Starbucks and volunteers for Teen Lifeline. You can’t see her internal battles, and for a while, she tried hard to hide them. But then she realized that she could use her battles to help others. And when things began to get dark for her again in recent months, reviving the urge to cut herself – or worse – Marks had something she didn’t have before.
“I knew that if I was going to start self-harming again, or if I was going to try to kill myself
again, then I would just be such a hypocrite telling these people that they shouldn’t do that,” she said.
“I feel like if it wasn’t for Teen Lifeline, that I may not be here today.”
Kontz said it was a strategic move to blend Teen Lifeline’s building with the neighborhood, and the space has a homey feel to it. In the lounge – which Kontz calls the most important part of the building – a big green couch and a foosball table take up most of the space. A flat screen television hangs on the wall, allowing volunteers to entertain themselves with Xbox, Wii and Nintendo 64 on slow days. In one corner is a vending machine filled with Hot Cheetos and Three Musketeers, as requested by the volunteers.
“It’s meant to be in a family environment,” Kontz said. “We want this to be a place that they want to come, a place that they find their voice, they find their passion.”
The lounge is a place the teenagers entertain themselves while passing the time and comfortably file reports and decompress after taking calls.
In April, Arizona’s stay-at-home orders to slow the spread of COVID-19 put the volunteers in an odd spot: Many were sent home from school, but their hotline job was considered an essential service. And the need was apparent. Kontz said calls and texts increased as the outbreak began and continued to rise in the following months. Although the subjects of calls were mostly the same, she said, callers felt added stresses from the pandemic.
“We’re also dealing with the reality of what’s being affected immediately: graduation is nonexistent, (and) when you’ve worked so hard for something and to have that taken away, it’s heartbreaking,” Kontz said.
Those added stresses, including the loss of prom and other typical school activities, made it clear to Kontz that the volunteers needed the hotline as much as it needed them.
“They don’t have the outlet of school,” she said. “This is the time where the reason we exist is very evident: we exist for them as well as them to be there for callers.”
As schools closed, the hotline opened its doors to volunteers to come in earlier and later than its normal 3 to 9 p.m. hours. A strict cleaning regiment was implemented, and if people felt sick they were advised to stay home. But with many former volunteers home from college and coming in to volunteer, Kontz said, the hotline is more alive than ever.
“When I first started volunteering here, when I heard about it,” Marks said, “I thought it’d be like cubicles. And that’s what everybody says they expect it to be.
“It’s definitely not the environment you think it would be, but it’s an environment you’d want it to be.”
A wall of individually decorated shoe boxes, one for each volunteer, accents the dim room that connects the lounge to the kitchen. In these mini-storage lockers, volunteers keep slippers, snacks and even toothbrushes.
One box has the word “Greg” in capital letters and underlined seven times. Its only adornment is the logo for Raising Cane’s chicken fingers.
Marks’ box, decorated with a floral background and an image of the cat from “Sailor Moon,” is usually empty. She prefers to bring ramen from home and get a 50-cent Dr Pepper from the vending machine, and she doesn’t stash candy there.
The television recently has been screening “The Office” or “Love Is Blind,” but occasionally, after a few minutes of the teenagers telling Kontz to “just switch the input,” it switches to playing a late-1990s informational VHS about dating violence.
When they’re not answering calls or texts from teenagers in crisis, some volunteers alternate between napping on the bean bag chair and answering Snapchats on their phones. Some do schoolwork and browse the internet. Others talk – with each other and the supervisors – going quickly from hotline-related topics to debating who rules the foosball table.
The volunteers are discreet about their work, making it hard to tell whether one is writing an essay or answering a hotline text until they ask for a second opinion on a message or need help crafting a response.
Gregory, a senior at Brophy College Preparatory, became a peer counselor in 2018 after seeing Teen Lifeline’s information on the back of his school ID, which is one of the organization’s initiatives to expand its community presence.
Eva, a sophomore at Scottsdale Prep, began training in November 2019, after realizing she was the “friend group problem solver.” She has considered being a counselor when she grows up.
“I’ve always enjoyed helping people, or knowing that they’re happier feeling better about something. So I really like being able to know that (callers are), in a better and safer place,” she said.
All the volunteers at Teen Lifeline have the desire to help their peers, but the similarities end there in a lot of cases, Kontz said.
“The kids that are attracted here, really the thing that unites them is that they want to help, but they look very different from each other,” she said.
“(They) probably would never talk to each other at school. But here they get to know each other on a different level; they get to be a more genuine part of who they are, versus who they have to be at school or on social media.”
On the other side of the door in the hotline room, Marks stares at a blank computer screen, fidgeting with a ballpoint pen.
Softly and confidently, she paraphrases a caller’s words – “OK, the last time you had suicidal thoughts was after that breakup?” As she reassures the caller that she hears what they’re saying, Marks continues to collect more information.
“Can you tell me about what happened right before that?” Marks asks, nodding along with the caller, voicing comforting acknowledgements while scribbling notes to update the clinician beside her.
Marks “is an asset to us,” Kontz said.
During shifts, while other volunteers are taking a break, Marks almost always is on a Teen Lifeline computer answering texts. She laughs with the others but also provides a calming presence when debates over movies or politics creep into the lounge. If Kontz hasn’t been feeling well, Marks will bring a medicine ball drink from Starbucks – hot tea steeped in lemonade – even though it’s “a pain to make.”
During the call, Marks is fidgety, but focused. She takes on and off her clear-rimmed glasses, fumbles with the pen as she jots down notes and glances around the room, smiling at her supervisor.
Marks’ posture changes as the caller says they have to go. Her voice remains gentle. After confirming the caller is lower on the suicide scale than when the call began, Marks encourages them to call back whenever they feel like it. She or someone else will always be there.
When the call ends, Marks sighs, and walks back to the lounge.
“I’m so tired,” she says.
She pulls out her phone and giggles at a text from her boyfriend. Then, she slouches back into her chair at the table to wait for the next call.
This story was produced in partnership with the Arizona Community Foundation.
If you or someone you know is in need of help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text 741-741 to connect with a trained crisis counselor right away. Or, contact Teen Lifeline directly at 602-248-8336 (TEEN).