CANANDAIGUA, N.Y. -- Hi, this is Tricia. Thank you for calling the Veterans Crisis Line. What’s going on tonight?
Tricia, a crisis line operator, is talking with someone we'll call Steven. Her long black hair frames her face as she bends over her desk, eyes closed, listening and then replying softly.
Steven, will you take a few deep breaths for me, it’s really important that I understand what you are experiencing.
In a few cramped rooms inside a dark red brick veterans mental institution built here in the 1930s, Tricia Lucchesi, along with some two dozen mental health professionals and veterans, fields the calls that come in every minute through the Veterans Crisis Line.
Tricia is 52 and has years of experience in teaching and mental health care; her son is an enlisted airman in the Air Force. Her headset is decorated with blue sparkles. She listens, oblivious to the bustle and ringing phones around her. When she responds she speaks slowly, pouring warmth down the phone line.
What is it Steven, that is making you so desperate that the only way you can think of is to kill yourself?
Seventeen thousand times a month, at all hours of the day and night, the operators answer the callers, listening intently, absorbing the anger and despair, gently shifting them back toward life.
Okay, Steven, I hear that you want to kill yourself tonight and I want to be able to help you not feel that way.
The conversations reflect the private pain of men and women, once proud and productive in military service, who now struggle with unemployment and homelessness, with drug and alcohol addiction, with the ravages of combat stress, with the grief of losing loved ones -- and who call as their last hope before taking their own lives.
Steven, can you take a deep breath [sounds of sobbing] ... Ohhhh, that is horrible ... All right ... It’s a horrible experience to go through, Steven, it’s always so hard when we lose ... Steven? Steven? It’s okay ... Sure ... Can you go get a drink of water? Can you do that for me?
The free and confidential Veterans Crisis Line, operated by the Department of Veterans Affairs (VA), is intended to bridge the gap between the vast number of veterans who need help, and the broad array of veterans services offered by the VA.
In the four years of its existence, the Veterans Crisis Line operators, or “responders,” as they are called, have initiated 18,600 “saves” of veterans who vowed to kill themselves. It is common, the responders say, to hear this abrupt demand: You got 10 minutes to convince me not to pull the trigger.
The need is greater than the Crisis Line can handle. While every call is answered, as many as 50 a day spill over to a back-up call center, where the responders are not VA trained but can direct the caller to the proper resources.
Anticipating a further surge in demand, the VA is adding more lines and call stations here at this upstate New York facility near Rochester. In the years ahead, thousands of war-weary men and women are expected to leave military service and face the stresses of civilian life, strained family relationships and a sagging economy.
Already, the desperate veterans who don't call the Crisis Line outnumber those who are saved. Tragically, the number of suicides each year by military men and women and veterans surpasses the combat deaths of a decade of war in Iraq and Afghanistan. According to the VA, 18 veterans take their own lives every day -- 6,750 per year -- while the total number of deaths in Iraq and Afghanistan is 6,3620.
Hundreds of active-duty, reserve and National Guard personnel also choose suicide. In the past two years, 583 killed themselves, according to a new U.S. Army study, which said part of the reason is an "epidemic'' of post-traumatic stress disorder. Of the more than two million service members who served in Iraq or Afghanistan, the military believes that about 472,000 active-duty, National Guard and reserve troops have or will develop symptoms of PTSD.
Since 2008, the military rate of suicide has surpassed a rising rate among the civilian population. According to the most recent Pentagon data, the rate for a civilian population similar to the military in age, gender and race is 17.7 suicides per 100,000, while the military rate is 19.6 per 100,000 active-duty personnel and 43 per 100,000 among active-duty males.
Steven, I hear you want to die because you are in a lot of pain ... And you don't feel people have treated you well ... Steven? Steven? Take a sip of water so I can understand you ... Okay ... I'm glad you could take care of yourself that way ... You know, there are a lot of ways we can help you if you will allow us, Steven. And I will be with you the entire time ...
"It's a vulnerable population and we put them in the most difficult situations, and we bring them home and expect them to carry on," said Jan Kemp, the VA's mental health director for suicide prevention, who founded and oversees the crisis line.
During their military service, whether in Vietnam or Afghanistan, "these are young men in the last stages of their moral and ethical development, a time when lots of them are experimenting with independent living and making decisions on their own for the first time," Kemp said in an interview with The Huffington Post. "There's a lot of risk-taking behavior, which is a normal part of growing up in America -- but then we throw them into these life or death situations."
The VA has made huge strides in providing services to the new and Vietnam-era veterans who are demanding medical and mental health help in record numbers. But its facilities, and especially mental health therapists and consultants, are often overwhelmed by the demand.
"Many of the veterans feel very frustrated when the system doesn't work for them,'' said a crisis line responder. "Our VA system is strained, a lot of times there's not enough staffing. It's a big job, and often there aren't enough people to do it.''
Steven, do you have someone you can- ... Okay, AA [Alcoholics Anonymous]? Oh, good, you have people in AA. How long have you been sober? Seven years! Good for you! And with everything that's been going on with you, you haven't picked up a drink for seven years? ... You have a bottle of wine? ... Was that today? ... Have you been drinking today? ... Okay, okay ... All right, so you stayed sober for seven years and today you were in so much pain you felt you had to pick up a drink ... Okay .... Sure ... Sure ... I hear you're in a lot of pain and you want to die right now ... We have ways to help you and make your life easier, but you need to work with me on this ...
Calls to the crisis line can last three hours or longer. The practice, more of an ethic than a rule, is to stay on the phone with a caller as long as he or she can be helped.
Across the dimly lit room from Tricia is Katie Geller, who is almost nine months pregnant. Once on the night shift -- 11:30 p.m. to 7:30 a.m. -- she had a call that ran to six hours. During that time she had to go to the bathroom three times -- taking the phone with her. The caller was a veteran who had been sexually abused while on active duty; he described the abuse in graphic detail, and claimed he had weapons and a bomb.
In that instance, and in other cases in which violence seems imminent, the crisis line staff often asks if they can send someone to the house to help -- and in extreme cases will track down the caller's location from the phone number and dispatch police. Geller did dispatch cops, who surrounded the house, and another veteran talked the caller into surrendering.
The brutal images of sexual abuse stayed with her.
If callers to the Veterans Crisis Line really meant to kill themselves, wouldn't they just go ahead and do it instead of calling? Not necessarily, said Leslie, a crisis line responder. "Some people don't want to die alone," she said, declining to give her last name. "And a lot of them don't really want to die, but they are in pain and have no one else to talk to."
If the callers are unsure of their intent, the mission of the crisis line is clear: to prevent suicides, to save lives.
Garrett Fenton, a 40-year-old Navy vet and a crisis line responder, once took a call from a veteran who had lost his job, his wife and his home and felt he had nothing to live for. Sensing he was serious about killing himself, Fenton and another staffer worked with the cellphone provider and police in California and Florida to track down the caller, who had refused to identify himself. Police finally arrived at his house, 30 minutes too late: He had already taken his life.
"Sometimes these calls do not have a happy ending,'' said Fenton, who sports a bushy black beard. He and others stress that a suicide decision is not in their hands; it is a decision only the veteran can make. But still, every suicide stings.
"The truth is,'' Fenton said, "we fell short and death won out."
The preferred outcome is to listen hard to the caller, and gradually edge the conversation around to positives and solutions. Crisis line responders draw callers out of their immediate emergency and make sure they are safe, then guide them to the wide range of services now offered at their nearest VA center to help with substance abuse, family problems, grief, employment, housing and other issues.
The first stop for many who call the crisis line is the local suicide prevention coordinator or a crisis coordinator. During office hours, the crisis line responder will get the local coordinator on the phone with the caller to ensure the connection is made.
While Tricia is on the phone with Steven, she is scrolling through a list of VA crisis coordinators, looking for one in Steven's area. Bluish light from her computer screen bathes her face as she squints and furrows her brow.
I hear you, Steven ... I would like to connect you with someone who can help get you your medicine and look into where your check is, and ... Yes ... And help make your life a little easier, is it okay if I do that for you, Steven? Now, what are you going to do to keep yourself safe tonight? ... Well, Steven, that's not okay just to say you will try not to ... You still have wine in the house? It's gone? Okay ... So your plan is to get something to eat and try to sleep, that's good ... You know Steven, I'm really glad you called here tonight, I am really glad I am sitting on this side of the phone and you reached out to talk to somebody, all right?
The crisis line responders say that in the course of even a short call, an emotional bond emerges on both ends of the line. Callers seem to be more willing to divulge intimate and often embarrassing details about their life on the phone than they would be in a face-to-face conversation with a therapist. Their openness seems to evoke a similar intimate response on the part of the crisis line staff.
"You are given the opportunity to be at your best when others are at their worst,'' explained Joe McMahon, a former police officer who served for 20 years as a crisis intervention specialist.
Or as Fenton put it: "Sometimes you spend hours on the phone with a guy who says at the end, 'I love you,' and without hesitation I say it right back, 'I love you.'''
But the responders aren't pushovers. "I had one guy who had seen and done some pretty unsavory things and he wanted to confess before he ended his life," McMahon said. "Well, I'm not willing to play that role. I told him, 'I don't want to clear that way for you [to die]. My job is to keep you safe.''' And he did. McMahon directed the police to the caller's home and he was saved.
Okay, Steven, I heard you say you agree that you will not hurt yourself tonight, thank you for giving me your word on that, and you agreed that you will let me call a crisis coordinator, and, Steven? Is it okay if I call you back in a couple of weeks to see how you're doing, is that something you would allow me to do? Okay, I will do that. And if you need us tonight, just pick up the phone and call us, okay? ... You are welcome so much, I am glad you called, thank you.
When Steven hangs up, Tricia is motionless for a moment, then arches back in her chair and lets off an explosive PHEW! She laughs in relief. "Oh, boy!" she says with a sigh of relief. "Oh, boy!"
There is little time for celebration that a life has been saved. The phones are ringing.
The Veterans Crisis Line can be reached at 1-800-273-TALK (8255) or via text to 838255. The Crisis Line website can be found here.
CORRECTION: An earlier version of this story incorrectly reported the outcome of McMahon's interaction with a caller who said he wanted to confess before ending his life.