What do you do when you feel like there’s no one left to talk to? How do you ask for help? What happens when the problem is too daunting for you to fix by yourself? For many in the Ithaca community and nationwide, the answer is a crisis hotline.

Crisis hotlines are still a relatively new concept. In 1958, the first ever hotline sprung up as the Los Angeles Suicide Prevention Center. This was the first place in the country to provide 24-hour crisis prevention services. Now, there are crisis lines across the country, ranging in specificity to cater to particular audiences like the helpline for the National Eating Disorders Association or the Grief Support Hotline.

It’s undeniable that these crisis lines have saved lives. In a discussion with Lee-Ellen Marvin, the head of Ithaca’s Suicide Prevention and Crisis Service (SPCS), she discusses the need for these services in rural communities.

“We’re here for those people who might be too afraid to seek traditional therapy. For the people who don’t want to be seen walking into a counselor’s office.”

SPCS exists as more than just a crisis line however, offering post-trauma services and community education as well. “We like that our office is in this old house because it makes it more inviting: like they’re just walking up to someone’s front door.”

Crisis hotlines were created out of necessity. In 2015 an average of one person every 12 minutes took their own life. Suicide is a public health crisis in American and throughout the world. Suicide is the tenth ranking cause of death in the United States — and the second highest for youth. Suicide ranks higher than homicide as a potential cause of death in the United States and on average, there is one suicide attempt every 29 seconds. This translates to twenty-five attempts for every death by suicide.

But what exactly is considered to be a suicide attempt? A misguided gunshot wound, or just a fall down a long flight of stairs? The leading cause of death in many age groups is actually classified as “Accidental Deaths.” This could be anything from drowning to motor vehicle accidents to fire poisoning. In truth, it’s almost impossible to determine a death as a suicide if it’s not done in a traditional

For example, no mortician will identify alcohol poisoning as someone dying by suicide without other indications, even if the reality of the situation was that the person was intentionally drinking themselves to death. Accidental drug overdose will not be classified as suicide without other indicators. Motor vehicle accidents, drowning, suffocation, falling, suicide by cop, and even fires can come about as someone intentionally dying by suicide and wind up as falsely reported accidental deaths. So the numbers we have for suicide rates are inaccurate, not because they were misreported, but because there are simply so many more that slip by with other causes to overshadow them.

At SPCS conversations about mental health are not only welcome, but also vital. An extensive amount of training is required to work for any crisis hotline, as Tufts University freshman Alex Strong found out. At nineteen, Strong has already spent three years working for the only teen to teen crisis hotline in the country, Teen Line.

“Teen Line takes calls encompassing literally every and any problem a young adult could have in their life,” said Strong. “This wide range is helpful for callers, but as listeners, I think we naturally excel even more on certain calls. In my case, I found that I was particularly good on suicide calls, which in itself is unfortunate because no one should have to be good at those. No one should have to get to a point in their life where they feel like they want to die, but it’s a reality we have to deal with at Teen Line.”

Strong discussed the toll that this job can have on the listeners as well, one of the reasons for the extensive suicide prevention and crisis management training each volunteer receives before working at any given crisis center. Some calls that are emotionally tough to deal with, and in Strong’s case these difficult calls were far more frequent than she hoped.

“While I’ve had many conversations with suicidal callers where we were able to turn things around, these are the hardest calls for me because it makes me realize how bad the world can be."

Mental health is heavily stigmatized in modern media. After the death of Robin Williams in 2014, magazine headlines offensively sensationalized his death and minimized his pain. “Robin Williams SUICIDE MYSTERY SOLVED! Secret battle with dementia. Hallucinations and voices,” read one headline from The Globe shortly after his death.

Unfortunately, this is not a new phenomena. After Kurt Cobain’s death in 1994, headlines were plastered with phrases like, “I hate myself and I want to die: Kurt Cobain’s suicide has turned him into a slacker martyr.” This style of reporting, of sensationalizing and minimizing tragedies in a way that portrays the person as weak or incapable, is the exact stigma that suicide prevention services are working against.

Our daily lives are made up of consistently high-pressure environments. Whether you’re a high school freshman trying to navigate your way through the cafeteria or a businessman with a quota to make by the end of the year, everyone seems to face stress at some point in their lives. We often fail to realize the toll that these high-pressure environments can take on someone. We skip over anything that is messy or requires extra work, because we’re too preoccupied with our own problems to address those of our loved ones. We throw around words like “crazy” without realizing the implications of using it.

This word, used as early as 1570, was originally intended as a way to describe someone as “diseased,” or “sickly.” During this time, there was a plague in London that killed upwards of 20,000 people, which may be the cause for how quickly this phrase grew in popularity. Ten years later, it was used to describe someone “with cracks and flaws,” or that of an “unsound” mind. In the jazz age it moved into different meaning, where something described as “crazy,” meant cool or exciting. But, more often than not, crazy does not come with a good connotation.

Everyone’s heard of what used to happen to patients with mental illness in the early days of medicine. The insane asylums, state hospitals, prison wards, even hospitals. Even in cultures as early as the Egyptians and the Mesopotamians, mental illness was treated as something originating out of evil. People would try to pray these things away, or perform exorcisms to “banish the evil spirits overtaking them.” These people were seen as an embarrassment to their families, and once mental institutions became more popularized, many families would drop off “crazy” relatives and leave them there for the rest of their lives.

Although we have updated our definition of mental health to be more humane and empathetic, things have not improved altogether. For example, there is still an incredible degree of shame and disapproval associated with mental health issues. Though we can now correctly label and hopefully help people with bipolar disorder, others experiencing manic or depressive episodes are not always given the time off work they need to recover. Though depression is a very common mental health issue, we’re still telling people to perk up. We know what anxiety is, but when someone has a panic attack, they don’t always receive the understanding and empathy they need.

“Suicide is something that people turn to when they feel like they have no other option, and it’s terrible that they think that’s the only thing left to do,” said Strong. “I was glad for every call I received because even if I didn’t necessarily help the caller, they were brave enough to reach out, and that’s something everyone can come to be proud of. But every time I would hang up the phone, I would always think about all the suicidal teens who weren't calling, or couldn't bring themselves to, and that hurts…Those teens might not know that someone cares,” Alex continues.

So in a society where we’re educated enough to understand our mental illness, why is it that we’re still so afraid to talk about it? Are we afraid of showing vulnerability? Alex seems to think it’s about objective listeners. “Even when you have your family or people you can call close friends, they have a bias towards you because they know you. Sometimes that bias is helpful, and sometimes it isn’t. Since there are instances when it would be easier to speak to a stranger, that’s where crisis hotlines come in. There are some struggles that your family or friends just won’t understand, and if they do, they might not give you the space you need. I’ve encountered a slew of people who believe that talking to a stranger would be awkward because people to get defensive. But you’d be surprised by how honest people are to strangers.”

Crisis lines are always there when people have nowhere left to turn. Open twenty-four hours a day, hotlines like the National Suicide Prevention Lifeline have saved countless lives.

“They’re calling because they want to talk to someone, because they want help in some form. Crisis hotlines are necessary because you can talk to a stranger, and that makes it easier to be real and honest with yourself,” said Strong.

When discussing one’s personal experience with crisis hotlines, one caller finds herself at a loss for words. At sixteen years of age, this caller found herself with a bottle of pills and no one left to turn to. While she prefers to remain anonymous, she wants to emphasize the importance of these hotlines.

“Whoever answered the line that night, they saved my life,” she says. “I’ll never have the chance to thank them. I don’t even know their real name. But they were there for me at my worst moment. They’re the reason I ended up in rehab later that year. They’re the reason I’m still here. I wish I had some way to thank them for that.”

Crisis lines are made of empathy. The callers can grasp onto an innate human connection from simply making a phone call while those who work at the lines rely on the vulnerability and shared understanding of pain to help those who are struggling face their lives. Crisis hotlines are about dialogue. They focus on active listening as a means to understand the lives of others and through this callers are able to work with those on the lines to address their pain in whatever way makes the most sense to them.

While people in dangerous situations undoubtedly find their way to the lines, sometimes a caller is just looking for someone to listen to them. They’re looking for someone to understand their side of the story. And sometimes, that’s all it takes.