‘I validate your pain’: A new suicide prevention program on Cape Cod is rethinking mental health care

“A Caring Connection” is a new suicide prevention program on Cape Cod. Maya is a volunteer who is now involved in a long-term phone relationship in which she regularly calls individuals who may have been hospitalized for suicide attempts.Debee Tlumacki for the Boston Globe

FALMOUTH — On an “extremely lonely” night, when the pangs of depression threatened to overwhelm Julie, 41, she clung to a single hope: a calming voice on the other end of the phone line.

Several weeks had passed since Julie, a Cape Cod resident, tried to take her own life. She was worried about her parents’ ongoing illnesses.

But she knew that a specially trained volunteer from The Samaritans on Cape Cod and the Islands, whom she spoke with frequently on scheduled calls, could help her “settle down” and fight an impulsive urge.

The phone rang.

“I told her, ‘I think I’m feeling suicidal again. I think I might have to go to the hospital again,’ ” Julie recalled recently. “[The volunteer] said, ‘What can do I do to help you?’ ”

A sympathetic voice told Julie to take deep breaths and take her dog for a walk. That night, Julie managed to sleep in her apartment, not the emergency room.

As national suicide rates have swelled in recent years, these moments of human connection can improve successful approaches to mental health care.

In Massachusetts, suicide rates increased by 35 percent between 1999 and 2016, according to the Centers for Disease Control and Prevention. A recent Harvard Medical School study indicates that young people, particularly males ages 15 to 24, are an increasingly vulnerable population.

In 2017, the Cape Samaritans, the Falmouth-based branch of a global suicide-prevention network, was awarded a three-year grant to launch “A Caring Connection.” It is one of several ongoing efforts in Massachusetts — supported by the federal Substance Abuse and Mental Health Services Administration — to curb the suicide epidemic with integrated health models.

In May, after a six-month pilot run, A Caring Connection began trying to support a wider swath of health care agencies on Cape Cod, the region with the state’s highest suicide rate, said program director Greg Giardi. Agency employees recommend the program as an additional resource to patients, who then take the initiative in contacting Giardi.

Unlike a conventional hot line, in which people feeling suicidal pick up the phone, volunteers in the program initiate the calls with participants. They forge a stabilizing relationship — perhaps, even a transformative bond — with individuals who were recently hospitalized for suicide attempts or thoughts.

(To maintain the program’s confidentiality protocol, volunteers and participants are not fully identified in this article.)

The volunteers are not licensed mental health professionals, and they’re not meant to be a substitute for psychiatrists or social workers. They receive about 15 hours of rigorous in-person training for dealing with mental health disorders and crises.

“We’re listening, we’re supporting, we’re encouraging, we’re mentoring. We’re definitely befriending,” Giardi said.

The program’s focus, Giardi said, is to embrace the national “Zero Suicide” initiative once someone is released from a psychiatric facility, when risk levels remain elevated. Through the phone conversations, volunteers strive to ensure “their person” attends an initial therapy appointment and accesses long-term community care, Giardi said.

Cape Samaritans Executive Director Stephanie Kelly said that if patients return to the same toxic situation — with pressures previously deemed too painful to endure — volunteers could represent their sole bright spot.

“They’re feeling shame, guilt, anger, ostracized,” Kelly said.

Before the first conversation, the only information available to volunteers is a participant’s first name. Personal details of mental illness are slowly revealed over weeks or months.

Volunteers, who tend to live on the Cape but can be mobile, typically take handwritten notes or mark dates in their smartphone’s calendar during calls, creating a real-time relationship log. Asking about personal matters — such as a parent’s doctor appointment — or referencing a pet by name can propel the relationship forward, showing the volunteer genuinely cares.

Jill, a volunteer who started on Samaritans’ crisis phone and text lines, likened herself to a disembodied voice. Based on program rules, she and her caller will never meet in a physical setting.

“We’re just these people that sort of materialize out of the air,” said Jill, 57. “They don’t owe us anything. There’s no weight to it.”

This anonymity creates a sense of freedom for 21-year-old Hannah, a participant who was recently hospitalized. Whenever a private number calls, Hannah said, her “heart brightens and lightens up.”

Hannah can tell anything to this stranger, who she said feels more like a close friend.

“It’s easier to relax,” Hannah said. “It is intimidating when you’re right there with the person, and they can see you squirming around, or bouncing your leg, or sweating.”

In the absence of body-language cues, Jill said, volunteers become attuned to vocal characteristics. Monosyllabic responses, slowed speech, or lurching pauses can signal a tough day.

But sometimes sharing a moment of silence interspersed with bouts of pain can feel therapeutic, said Maya, another volunteer. She emphasized participants are courageous to simply answer the phone and disclose troubling emotions.

“I hear you, I see you, I validate your pain,” Maya said, describing her approach to mental illness.

An instinctive form of trust is required for volunteers to navigate calls fraught with heightened depressed or anxiety. In some instances, clinical consultants may be asked to provide advice and to intervene, Kelly said.

To judge the severity of a conversation, volunteers may use a tool called the “ladder of risk assessment,” Kelly said. It pinpoints if callers are suicidal, and if so, whether they have a detailed, time-specific plan.

In the first few weeks of their phone relationship, Maya’s person had never reached the top of the ladder, classified as “imminent risk.”

So the 23-year-old volunteer didn’t hesitate when making a call during a solo evening drive. That’s when Maya’s participant quickly climbed the ladder, from being upset to admitting she had a method to hurt herself.

Maya knew she needed to defuse the situation. Yet she also needed to hang up — just for a few precious minutes — to seek advice from Giardi, the program director, whom she called while keeping pace with traffic. By the time Maya reached her destination, the tension had eased.

The participant was emotionally drained but safe, Maya said.

“I was just really proud of her for finding that hope,” Maya said.

Their volunteer work is heavy, laden with the extraordinary responsibility to say the right the thing, at the right time. The conversations can be straining.

Maya prefers to lie in bed during calls, a posture that lets her decompress afterward. She’ll close her eyes for several minutes and listen to music before facing her own reality.

Volunteers don’t find their work burdensome, however. It is innately gratifying, they said, to ignite hope in others.

Hannah, the participant who is still in the early stages of talking with a volunteer, said she has learned coping skills to regulate her mood.

“When I’m feeling sad, I can change it,” Hannah said. “It’s that silver lining — the sun’s peeking out.”

Resources: If you or someone you know is thinking about suicide, call the National Suicide Prevention Lifeline, (800) 273-TALK (8255). Reach the Samaritans crisis line at [phone], or the group’s Falmouth office at [phone].