“I have to save myself,” said the caller, and I knew there was still hope for him. We had been talking for almost an hour on the phone since he told me that he had deliberately overdosed on antidepressants.
I’m a senior supervisor at the Beijing Suicide Research and Prevention Center, the first organization in China to set up a hotline for people contemplating suicide. After undertaking research into schizophrenia and, later, the causes and effects of suicide, I transferred to the center in 2002.
At first, the center didn’t have a hotline for those with mental health issues, but people still called us nonetheless, asking us for advice on how to cure their low mood or negative feelings. Eventually, we arranged for office staff to answer these calls. In 2003, the then-Ministry of Health pressed us to offer a hotline that could help people suffering anxiety, panic attacks, or other psychological disorders during the nationwide SARS epidemic.
When our center was set up, China had no official guidelines on suicide prevention or how medical professionals should respond to people disclosing that they were considering killing themselves. We had to figure out many of the regulations and details along the way, like defining high-risk suicide cases or handling a case following a call.
The conversation above took place in the autumn of 2006. I was on the night shift when a colleague answered a high-crisis call from a 20-something man living in a village somewhere in the Chinese countryside. He said he had depression and had swallowed a large number of antidepressants. This set off the alarm bells: Excessive doses of many antidepressants can occasionally cause potentially fatal symptoms like cardiac arrest, low blood pressure, or seizures.
About 15 minutes later, the call suddenly cut off.
For privacy reasons, hotline operators are discouraged from phoning back when the caller hangs up. But if we think a caller is a high risk to their own safety, we sometimes break that rule.
At the time, my colleague was new to the job, so I took over. The phone rang for so long that I worried he may have fallen into a coma. I was so relieved when, after the dial tone sounded for what seemed like forever, the man answered.
His voice sounded weak. He told me that he was lying on the ground outside, not at home, but he refused to tell us where so we could call an ambulance. “My body is going numb,” he murmured. “Everything looks pitch black.” I encouraged him to drink water and make himself throw up, but he was unable to. He also refused to share his family’s contact information with me, so all I could do was keep talking to him and taking note of his responses.
Suicide intervention is a delicate job. Even though you want to do all you can to talk the person out of it, you must be wary of talking too much and overwhelming them. So I didn’t say much; when he fell silent, I did, too. Now and then, I would quietly ask how he felt. I remember saying, “I’m still here for you,” over and over again.
Fortunately, he decided not to go through with it. “Let’s get you home,” I said, but he couldn’t stand up. I told him: “If you can’t stand up, you can crawl. I’ll stay with you.”
I could hear a noise on the line and understood that he was dragging himself back toward the house. Finally he said, “I’m home.” There was a knock on the door, the sound of a dog barking. And then, the sound of hurried footsteps.
“Who is that?” I asked.
“Then put your dad on the line.” Once he did, I told his father what I knew about the drugs his son had taken. Then I instructed him to take both his son and the medication to the hospital immediately.
With high-risk cases, we always try to inform the caller about steps they can take to mitigate the causes of suicidal thoughts, usually by suggesting ways to distract them from their thoughts or advising them to find someone to keep them company. But we always say that when things become overwhelming, they can call us any time.
Fortunately, the young man made a full recovery from his overdose. During our follow-up calls, we explained to him that suicidal thoughts were symptoms of depression, just like sneezing and runny noses are symptoms of a cold.
Once he accepted this, we were able to teach him to respond effectively to these symptoms. We encouraged him to hand over his medication to a family member when his thoughts turned to killing himself, thereby avoiding another overdose. We also taught his parents, who had previously struggled to recognize the symptoms of depression and appreciate its seriousness, to look out for the telltale signs that their son was relapsing.
I am pleased to say that this man recovered control over his depression and, as far as I know, is today enjoying a much higher quality of life. He called us back two or three years after the incident, just to say that he was doing much better. On particularly low days, he said, “I go and pick vegetables in the fields with Grandma.”
On average, three or four staff at the center handle each case. Working the hotline requires us to stay calm and collected, but obviously a job like this takes a toll on your mental state. We have to be able to adjust emotionally at any given time, so it’s important to have the support and company of our colleagues.
We teach intervention personnel that, to some callers, suicide is a way to resolve situations they perceive as utterly hopeless. Some call us deeply heartbroken; others are mired in debt that they cannot pay back. And some, of course, are depressed without really knowing why. Often, people around them simply don’t realize that their friend or relative is at their lowest point, and unwittingly sweep the problem under the rug with a brief “hang in there” or “focus on the positives.” Unfortunately, these comments can make seriously depressed people feel even more misunderstood and isolated.
Lots of people think that being a crisis hotline operator is about saving people. But it’s actually about helping them save themselves. Sadly, there have been people whom we haven’t been able to help in time. But the emotional support of our hotline operators has also helped dispel the helplessness of countless callers, many of whom manage to conquer their mental health problems and recognize their own strength. Their experiences help to remind us hotline operators that the work we do can and does make a difference.
The World Health Organization estimates that China has a suicide rate of around 1 in 10,000 people. But many suicides likely go unreported, due to longstanding taboos about death and the traditional view that suicide is shameful. The quality of psychiatric treatment also varies from place to place: While increasing numbers of urbanites are realizing that depression and other mental health issues are clinical diseases, more traditionally minded folks — many of them in the countryside — tend to write off depression as a sign that the person in question lacks resilience.
In China, the Beijing Suicide Research and Prevention Center can be reached for free at 800-810-1117 or 010-82951332. In the United States, the National Suicide Prevention Lifeline can be reached for free at 1-800-273-8255. A fuller list of prevention services by country can be found here.
As told to Sixth Tone’s Wang Yiting.
Translator: Katherine Tse; editors: Yang Xiaozhou and Matthew Walsh.