The following is a conversation between Dena Trujillo, President & CEO of Crisis Text Line, and Denver Frederick, the Host of The Business of Giving.
Denver: Crisis Text Line provides free, 24/7, high-quality, text-based mental health support and crisis intervention by empowering a community of trained volunteers to support people in their moments of need. And here to tell us more about this work and the impact the past two years have had on young people’s mental health is Dena Trujillo, the president and CEO of Crisis Text Line.
Welcome to The Business of Giving, Dena.
Dena: Hi, Denver. Thank you for having me. I have to admit I’m a huge fan of your show, and I love listening to the ideas and lessons from other fabulous organizations around the world. I’m excited to be here.
Denver: Thank you so much for saying that. So how did Crisis Text Line come to be?
Dena: Crisis Text Line came out of the reality and the idea and experience that young people didn’t have a place to reach out for help. There were phone lines as helplines, but that was not the primary mode of communication that young people use. And so studies show that young people use text or text-based platforms. And so Crisis Text Line was really developed in order to meet that need. And it has grown; it has met that need and continues to grow not only for young people, but for people of all ages.
Denver: That’s great. And I also imagine if you’re in a crisis, you don’t want anybody overhearing you talking on the telephone, so it’s a way to stay under the radar. What are some of the most common issues that people contact Crisis Text Line about?
Dena: That’s right, Denver. Texting can be discreet and inconspicuous for anybody to use it at any time. Think about it, when you are watching somebody text, you don’t think they’re reaching out for help. So that means that kids text us when they’re at lunch experiencing bullying, when adults are in a boardroom experiencing anxiety, when people are in the presence of an abuser, they can text us… and do text us asking for help.
When kids are at a party asking for help in how to avoid the peer pressure of doing drugs…so this texting service can meet people’s needs whatever they are, wherever they are, while keeping them safe.
Really, Denver, people contact us for anything. You can imagine we’re like a mental health emergency room.
Denver: Oh, I like that.
Dena: So really the top issues that we consistently see, Denver, are relationship issues, depression and sadness, suicide, anxiety, isolation, and loneliness. But we also s ee plenty of self-harm and grief and bullying and body image. Those are consistent, but we don’t see the high percentages that we do for depression, suicide, and loneliness being the top issues.
Denver: So Dena, how does this work exactly? When a young person contacts Crisis Text Line, how do things, generally speaking at least, unfold from there?
Dena: So a person texts 741741 from anywhere in the US at any point in time with any kind of emotional or mental health crisis. And they will receive an automated response to let them know that they’ve reached Crisis Text Line and ask them to share a bit more about their crisis.
We then have a machine learning algorithm running in the back to help triage conversations in order of severity rather than time. So while most crisis lines respond to texters in the order in which they arrive, you can think of us more as a mental health emergency room. People come to Crisis Text Line with whatever is the crisis for them, from loneliness and anxiety… to eating disorders, or suicidal ideation.
And just like a hospital, the triage is based on severity. We identify within those first couple text messages who is most likely at imminent risk to harm themselves or others. And they are quickly moved to connect with a crisis counselor. This is time saved. This is so important.
So we typically respond to imminent risk texters in less than a minute, but this is where we can really bring color to this during the end of 2020– which as you recall was a stressful time for the country with COVID and the presidential election. We had some of our biggest spikes and saw conversations at eight times our normal levels.
And while some texters had to wait beyond our five-minute goal, we were still able to make sure that those high-risk texters were served in an average of 39 seconds.
Dena: Right? And shorter wait times means saved lives. So here we go. So once, whether you are at imminent risk or not, either way as quickly as possible, you are connected to a volunteer crisis counselor. And that volunteer helps to support the texter in working through their feelings, by asking questions and empathizing and active listening. The goal is to move them from a state of crisis to a state of calm and centered, and getting a plan, creating, co-creating a plan to stay safe and healthy.
And then this whole process is overseen by our professional supervisors, our paid staff who oversee every single conversation. So texters have the benefit of the volunteer and the benefit of a paid professional supervisor to ensure that they are getting the highest quality service every time.
Dena: An important part of understanding the demographics of our texters and volunteers is age. And so while we get engagement from our texters of every age– from 10 to 75 and beyond– the primary demographic is still that Generation Z. From age 25 and under makes up about 60% of our texters, and actually the same as for our volunteers… So from the ages of 18 to 25, over 50% of our volunteers fall within that age range.
Denver: That’s great. They really understand the issues better then than, let’s say, someone such as myself.
Dena: Absolutely. Dena: But Denver, no matter what age, we find that, first of all, empathy and these skills are absolutely teachable, right? Like studies show 70% of empathy is teachable. And we don’t see any difference in service. We connect strangers to strangers– any age, any demographic, and the quality of service remains the same. That is part of the magic of this service.
Denver: Mm-hmm. You mentioned ‘our volunteer crisis counselors’ and I sat up and took notice of that. Tell us about who are these crisis counselors who volunteer.
Dena: Our volunteers are people just like me and you, Denver. They’re anybody, they’re everybody who wants themselves to learn a little bit more about how our system works. They are people like you and me; they are anybody that wants to learn a little bit more about mental health and supporting others. And they come, and they do 30 hours of training. And that 30 hours of training consists of active listening, empathy skills, de-escalation skills, crisis management skills, and cultural competence skills.
Because our texters are diverse. They represent diversity in gender, in socioeconomics, in race. And so our crisis counselors have got to be as equipped as possible in meeting the needs and meeting our texters where they are. And after they do that training, then they have an entry period. They have coaches to support them.
And one of the most important things about our model, Denver, is that the volunteers are not alone. So the way our system works is that our volunteers, you have one volunteer to one texter, but we have professional supervisors that are observing every single conversation. And that means that you are getting the benefit of multiple people, and we’re able to, we believe, have a higher quality of service as a result.
Denver: Oh, that’s a great model. How many crisis counselors do you have?
Dena: Since our inception, our creation in 2013, we have trained over 50,000 volunteers. And in the last 28 days, we have had almost 7,000 crisis counselors supporting our texters.
Denver: Is there a second-order benefit to come from this? When you train that many individuals to be crisis counselors beyond the direct work they’re doing for the organization, does that seep into the community and society at large?
Dena: Denver, you just hit the nail on the head. This is one of the things that we are so excited about because yes, we have anecdotal evidence of that. As you’ve worked in philanthropy a long time, so you know the existing research out there about the benefits of volunteering, both for themselves and for communities.
But when we look at these specific topics: empathy, active listening, de-escalation, and mental health crisis, yes, we believe and know and are doing more and more research– that we look forward to sharing when complete– that our volunteers not only gain the benefits of being a volunteer— the increased happiness, satisfaction, sense of connection; they are accessing mental health coping skills to support themselves and the volunteers.
But also we get tons of reports on people being better parents, being better community members, being able to support other folks in crisis. And we’re very curious to see what happens if we really scale the number of volunteers. What happens when a certain percentage of university students have completed this training and then volunteer? Does that change our way of connecting to people’s loneliness levels, people’s support levels? We’re very excited about that.
“We are in a mental health epidemic, and we believe we are quite frankly at the beginning of one because the trauma of COVID, of the isolation, of the grief, of all of the other results of the last couple of years of stress have increased the awareness of mental health, right? But the reality is trauma has a long tail, and so we think we are really just at the beginning.”
Denver: I talk to a lot of nonprofit organizations, and they’re all going to say, boy, they have already scaled! This is so many volunteers compared to what others are able to do. And also there, they seem to be really used wisely, leveraged intelligently. That really is quite an achievement.
Dena: It is, Denver, and we’re very proud of it. We are very proud of our use of technology and the model that really utilizes trained mental health professionals and volunteers. And I have to tell you, in this moment in time, we are looking forward to helping to spread this impact because we’re in a mental health epidemic.
When you look at, I don’t know if you saw the Surgeon General’s Report last year with Dr. Vivek Murthy; he put out a very rare public advisory about the youth mental health crisis. And this is his second term in being Surgeon General. He served all of the years under Obama, and he never put out a public health advisory.
We are in a mental health epidemic, and we believe we are quite frankly at the beginning of one because the trauma of COVID, of the isolation, of the grief, of all of the other results of the last couple of years of stress have increased the awareness of mental health, right? But the reality is trauma has a long tail and so we think we are really just at the beginning.
And the challenge is that we do not have enough mental health workers, enough mental health supports and systems in this country to meet the need. And so that is why, yes, we have had the beginnings of scale, but the need is so much greater, both in this country and in the world. And so we need to scale access to our service.
And what we know is that when people find out about us, people use us and need us. It isn’t a matter… when people find out about Crisis Text Line, they use and need our service. We need to scale the number of volunteers, both to support this fabulous service, but also to spread these mental health coping skills and empathy throughout the country and the world.
And we want to contribute to building more of our mental health workforce through our platform, both by attracting people to the field, but also, Denver, we have been piloting a practicum program, a student learning program where Masters in social work can complete their practicum hours with us.
And we’ve done just an initial project and we’re looking very much forward to scaling that as we look at the country and see the need for more and more support in creating more mental health workers in this country.
Denver: Yeah. I think you’re right on so many different levels. And I was speaking to somebody the other day who was into education and reading with young people. And they say, these six- and seven-year-olds who’ve lost two years of learning how to read, it’s going to take a decade for them to catch up.
So along those same lines, I think people think when COVID is over and we get back to normal, there’ll be a little bump in the road. But there’s a generation here who’s really going to have a lot of issues. And you can only do what you can to try to be prepared with the resources in terms of creating mental health professionals. It sounds like you’re doing it, but as you say, it is an enormous task.
Dena: It is.
“And research indicates that language is a primary barrier to Spanish speakers getting the mental health support that they need, so we are very, very proud that we are the first in-text mental health provider in Spanish.”
Denver: You talked a little bit about the diversity of your texters. Give us a little idea about your demographics. And I know you’re doing things in Spanish now, so tell us about that as well.
Dena: Yes. We are so excited about our Spanish launch, but let me first answer your question about demographics. So our texters, what happens is after a conversation, they are given a voluntary, post-conversation survey. And about 21% of our texters answer that survey.
And so, these demographics statistics are of course not a hundred percent accurate because a hundred percent of our texters didn’t complete it. But what we can tell is that we have about 4% of our texters identifying as Native and Indigenous. About 6% identifying as Asian or Pacific Islander. About 14% identifying as Black, and about 18% identifying as Hispanic or Latinx.
And when we look at those statistics, and we look at our service, we know that we already have such a large percentage of our users identifying as Latinx, as part of the Latinx community. That, and by the way I will say, Denver, we say Latine because over 50% of our texters identify as LGBTQ, and Spanish is a very gendered language, and Latine is a gender-neutral way of identifying the community.
And Spanish, we already have such a large percentage of our community identifying as Latine. We know that we need to meet that community with Spanish service. And the reality is that the US is the second largest Spanish-speaking country behind Mexico. And only 5.5% of US psychologists say that they’re able to administer any kind of mental healthcare in Spanish.
And research indicates that language is a primary barrier to Spanish speakers getting the mental health support that they need, so we are very, very proud that we are the first in-text mental health provider in Spanish. And we launched last October.
Denver: You were talking a moment ago, Dena, about just the spike in terms of messaging you’re getting, and all that’s happened as a result of COVID and the pandemic in the last two years. Has your technology had to change in any way in order to be able to address that?
Dena: Denver, no, I wouldn’t say our technology had to change in order to address COVID necessarily, or that spike. I will say we are constantly evolving our technology in order to address the increase in demand for our services. And so as a result, we actually have just hired a new chief technology officer and are in the process of instituting even more user-focused product design and adding more efficiency to our systems.
We talked earlier about triage… and so really looking at the system to say, “Okay, how do we keep improving the experience for our texters and for our volunteers?” And so we’re constantly improving.
Dena: Denver, I would say that we are always improving our technology and looking at ways to add features to support our texters and support our crisis counselors, and improve their experience. And one of them actually came about because of our Spanish launch. We have added WhatsApp to our services.
So typically, you can text 741741, but we know that a lot of our Spanish-speaking texters may not have their own devices, or may not have mobile plans with some of the major carriers. And so to make access free for them and to meet them where they are and where they spend their time, we have added WhatsApp to our service.
Denver: That’s fantastic. That’s empathic, to say the least, in terms of going where they’re at and helping them out. Let me turn our attention to fundraising for a moment. And there’s a general assumption that trying to raise money for causes like mental health and addiction and things like that is really, really difficult. Have you found that to be the case, Dena? And if so, do you see it changing?
Dena: Yeah. Well, Denver, there’s always a need for more funding. So in a service like ours that is growing, then that means that budgets grow as we expand to meet those needs. And so we are always needing to look for additional sources of funding.
One of the great things, or one of the benefits I would say, of COVID over the last two years is that mental health is now in the map. So for the previous years, it was very difficult to find funding for mental health because most foundations, most funders don’t have mental health as a category.
Denver: Yeah. That’s a good point.
Dena: But now since COVID, and since we have as a society acknowledged that we are in a mental health epidemic– since the President even mentioned mental health in his State of the Union for the first time ever– more and more funders are starting to look at mental health and realize that it requires funding.
“We really looked at equity over the last couple of years and realized that we cannot achieve our mission unless we really understand and look at the impact of race and gender on mental health in the sector, both how it impacts and increases mental health challenges and reduces access…”
Denver: Mm-hmm. Crisis Text Line is really centering equity, and they’re doing that in several ways. You’re transforming your culture; you’re strengthening your services, you’re expanding your impact. And I know that’s difficult work. What are some of the things you’re doing to help bring this about?
Dena: Thank you for bringing this up. Denver, we really looked at equity over the last couple of years and realized that we cannot achieve our mission unless we really understand and look at the impact of race and gender on mental health in the sector, both how it impacts and increases mental health challenges and reduces access… really influences how much access folks have.
So I want to point to a couple of things. I talked earlier about the Surgeon General’s advisory in 2001, and he talked about how one in three high school students, and half of female students, reported persistent feelings of sadness and hopelessness, which is a 40% increase since 2009. Since 2009, a 40% increase, right?
And that mental health and gender non-conforming individuals are impacted in a very profound way as well. Between 2014 and 2019, the suicide rate increased by 30% for Black individuals and by 16% for Asian and Pacific Islander individuals. So we have to work to ensure that we are operating in a racially sensitive and trauma-informed framework in order to make sure that our texters are at the center of our work and we’re supporting their needs.
And in order to do that, we have to look inside first. So we have really gone deep to say: How are we addressing equity internally in our culture? How are we doing it in our product and service? And how are we engaging more broadly in public policy and beyond so that we can have a positive impact in moving the needle in the other direction, if you will.
So a number of the things we’re doing internally as we really looked at our diversity and representation, and as I’ve said, we improved the representation of our leadership team and our staff, moving up to over 50% representative at every single level– from the board, the executives, and through staff representatives as Black, Indigenous, or a person of color… on all levels of our team.
And then we did everything, including revamping our benefits. So when we did our employee engagement surveys, we go deep… and we’ve analyzed that by demographic– and we did the same with our benefits and compensation surveys. And we found that what people wanted and needed for their lives actually was different by demographic.
And so we prioritized some of the benefits that our Black and Latine staff really called out. And that included providing wellness and mental health stipends, providing student loan assistance. This one was so easy, and I’m surprised more organizations don’t do it. Automatically providing retirement funding rather than waiting for a match, because there’s an assumption of a socioeconomic benefit there that isn’t quite fair. And our staff has really appreciated that.
Denver: Yeah, that’s pretty insightful because I think there’s so many organizations out there that are concerned about the wellbeing of their team. But you almost find out that wellbeing has to be individualized because everybody’s coming from a different place. Some people like to be public about it. Some people are very private about it, but as you say, the benefits almost have to match what the needs of that person and their family is at that particular moment.
Dena: Absolutely. And all of this equity work, Denver, really starts with creating the space for learning and that uncomfortable space sometimes for learning and discussion. And we’ve been doing that work, not just doing training, but engaging in dialogue and hard conversations within our team, and also having cultural competence training, not just for our team, but also for our volunteers.
“As a leader, I have to be willing to have hard conversations and acknowledge that our younger generations are not totally bought into hierarchy. Like we still have to operate with clear decision frameworks. Everybody needs clarity, but we need to engage in more dialogue and deep conversations and listening, and that is required for trust. It takes more time.”
Denver: In addition to what you just stated so well, have you found the nature of leadership changing? The expectations of leaders are not what they were even two years ago. What have you observed, and how have you adapted?
Dena: We plan on writing whole articles about that, Denver, so we’re just going to scratch the service because, let me tell you, we have learned a lot in the last couple of years, and we’re still learning, right? So both the focus on equity, but the focus on a new type of leadership, really, I think we’re just at the beginning. And part of it is being okay with being uncomfortable.
As a leader, I have to be willing to have hard conversations and acknowledge that our younger generations are not totally bought into hierarchy. Like we still have to operate with clear decision frameworks. Everybody needs clarity, but we need to engage in more dialogue and deep conversations and listening, and that is required for trust. It takes more time.
Denver: It takes more time. And I think organizations are very uncomfortable with conflict, but you need to have conflict. It can be healthy conflict; it can be constructive conflict. But when you try to bury it and think that everybody’s going along, you get a lot of things underneath the surface that are going to come up and bite you in the back.
Dena: That’s exactly right. And I will tell you, I’m very grateful that I have some meditation practice as it can help me to be grounded in those moments of hard conversations. And I will tell you, I’ve done a lot of, I don’t know if you follow Brené Brown, but like: How do we create those spaces for trust and rumbling at every level of the organization, while still making sure that we move forward together, aligned because at the end of the day, our texters and our volunteers need us.
Denver: As you have alluded to there, I think that sometimes all innovation and all great ideas are preceded by pause. And sometimes having that moment with your meditation, you need to quiet everything down so you can see things differently and more clearly, and then go into action.
Dena: And interestingly enough, the reality is what we teach our volunteers… is also what we need to do as we manage the organization… to that point… to pause and to reflect and to listen, and then to focus on the plan forward, right? Those same skills that we teach our volunteers are the leadership skills that we need today.
And earlier, Denver, you asked about the secondary benefits of being a volunteer, and I think back to some of my old work previous to joining Crisis Text Line, in working in education systems… and the conversations around 21st century skills that we need to make sure that our young people are learning.
And the reality is that these communication skills are just as critical for work as they are for self-regulation.
Dena: Our volunteer training teaches that.
Denver: Finally, Dena, you have so many things going on. What has you really excited and energized at this moment? What initiative?
Dena: Denver, it is hard to prioritize the number of initiatives that I’m excited about. I am excited about our launch into Spanish. This is a community that deserves and needs and is long overdue for mental health support in their language. So I am so excited and looking forward to… if you know anybody that can volunteer, please come and join our bilingual crisis counselor team.
I am very excited by just expanding our service. The reality is that our young people specifically, everybody needs this service, unfortunately, but our young people, especially. And so I’m excited about our efforts to spread the word about Crisis Text Line because the reality is that most people still don’t know about us. And so very excited about that.
And finally, I’m excited about what the next six months, three years, five years look like for us because we have really expanded our team. So we have just added a new chief technology and product officer, a new vice president of JEDI– which is justice, equity, diversity, and inclusion– a new chief research impact officer, a new chief operating officer.
Our team is really leveling up and taking us to the next level of scale. And so while we have already had a significant impact, the impact that we will soon have will significantly exceed that.
Denver: Well, all the time frames you mentioned there, I’m going to pick up with you in six months and see if you can come back then and tell us how things are going.
Dena: Looking forward to it, Denver. Thank you so much.
Denver: For listeners who want to learn more about Crisis Text Line, or maybe volunteer, become a crisis counselor, tell us a little bit about your website and the kind of information we’ll find on it.
Dena: So please join us at www.crisistextline.org. And if you need help, that is the first priority. It is when you first come to the website, it will tell you how to text or WhatsApp to get the immediate help that you need.
But second, you can find resources there to spread the word. So please let people know about our service. There is no need for anybody to be alone in their moment of crisis.
The second, become a volunteer to support strangers in need of your empathy and compassion, but also do it for yourself. Learn great skills for your own coping skills to support your family, to support your community.
And then third, donate if you can, because even $5, $10, whatever is available to you, because this service is free. And the more we get support, the more we are able to grow while maintaining those services free.
Denver: Thanks, Dena, so much for being here today. It was a real pleasure to have you on the program.
Dena: Thank you, Denver. The pleasure was all mine.
Denver Frederick, Host of The Business of Giving serves as a Strategic Advisor and Executive Coach to NGO and Nonprofit CEOs and Board Chairs. His Book, The Business of Giving: The Non-Profit Leaders Guide to Transform Leadership, Philanthropy, and Organizational Success in a Changed World, will be released in the spring of 2022.
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