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Hello again friends.

I'm Jason Edens, your host of Lakeland Currents.

Thanks for joining the conversation today and thanks for your ongoing support of Lakeland Public TV.

It's probably fair to say that we've all experienced crisis at some point in our lives.

Maybe it was a financial crisis, a family crisis, a health crisis, we've all been there.

For nearly 30 years the Crisis Line and Referral Service has been providing support to those in crisis throughout our region.

24/7, 365 days a year you can call the Crisis Line and a supportive person will be there to help you and direct you to the resources that you may need.

It's hard to overstate the value to our communities and it is therefore my privilege to introduce the Executive Director of the Crisis Line and Referral Service - Mary Marana.

Mary welcome to the program and thanks for making time for our conversation.

Good morning.

I am so very thankful to be here and thank you for asking me.

Of course.

Well, for those of us who haven't heard of the Crisis Line, what is it exactly?

Well, as you kind of stated, we will be celebrating 33 years of being in existence as a non-profit on July 1st, 2022 and the Crisis Line began 33 years ago in Crow Wing County as a way to support those who were suicidal or in a mental health crisis and from there it did expand into the counties of Aitkin, Cass, Crow Wing, Morrison, Todd and Wadena counties.

So, 24 hours a day there are trained volunteers there to answer your call, to get you help, to whether you're in that crisis or before that crisis starts.

So, basically that's one part of it and the other part we do is education, outreach and suicide prevention trainings.

Interesting.

So, it's not just the line itself then you also do trainings for the community.

Can you give us an example?

Where have you facilitated a training recently?

Recently, I was in Aitkin school district yesterday in fact.

So, what type of trainings do you do at the schools?

Are you training them to be volunteers for the Crisis Line or?

Actually, that's a great question.

Every fall we go into the school districts and we do suicide prevention training for seventh graders but because of last year being shut down, distance learning, we did are doing this year seventh and eighth grade.

So, we do a suicide prevention training to those students.

We just talk to them about suicide prevention.

You know, what is depression?

What does depression look like?

Some of the symptoms and we talk about good coping skills.

What they can do and then if they need to talk to somebody that day because they might feel that they've been having these symptoms more than what's just typical then we can talk to them that day or if maybe there's a friend or somebody that they care about that's in stress.

Do students take you up on that opportunity?

Absolutely.

year but it ranges between eight to twelve percent of the body that we present to will come forward and ask to talk to somebody that day.

Now how often would you go to a high school for example?

Will you go back to Aitkin high school next year or?

Absolutely.

Okay, so this is an annual part of your program.

Absolutely and last year in Aitkin, they have a really great program map there as a lot of our school districts do.

It's a peer program where they have the older students mentoring younger students.

So, I did a QPR training for that group of students yesterday afternoon.

QPR?

Question, persuade and refer.

So, you know what CPR is, well CPR is for physical.

QPR is for mental health.

So, we teach individuals how to look at someone, question them to see if they are suicidal or in a mental health crisis, then we teach them how to persuade them to stay alive and how to refer them to get the help they need to do that.

Interesting.

So, QPR is basically an analog to CPR.

Correct.

You know, this brings up something I definitely wanted to ask you.

Which is, do you think that we as a society treat mental health in a way that's similar to physical health?

In other words, is it as much of a priority in your opinion?

That is a great question because there is a huge stigma against mental health, for getting good mental health treatment unfortunately.

Because there should be no difference but yet an individual after the onset of a mental illness may wait as much as 10 years before they get help because of that stigma and unfortunately may die 25 years sooner than someone their average age because of poor mental health care.

So, I'm hearing from you that we don't treat them equally?

Correct.

We don't.

Who calls the Crisis Line?

What types of crises do you encounter on the Crisis Line?

If it's a crisis people have called.

We've had people call because they need food for their family.

They are being evicted.

We have individuals that call and have a pointed loaded pistol at their temple and say give me one reason why I shouldn't pull that trigger.

Under those circumstances are your volunteers prepared to deal with that type of crisis?

Absolutely.

This is an incredible amount of, there's this group of volunteers is to de-escalate the situation and then provide a mental health backup person to take over.

But there is that initial de-escalation piece that they learn and they're very good at it.

I have had a volunteer with us for almost 30-some years.

Others, there's a a core group that have been with us for 29 to 30 years.

It's just incredible because you can volunteer from home, so your daily life really doesn't have to change as long as you have a private place to go to if there is a phone call.

And who provides that training?

Is that a training that you provide in-house at the Crisis Line?

We do.

We do.

We've done because of course the pandemic, we did do some online training through Zoom but mostly we do do the trainings and the place we do the trainings and this is really cool, CTC Consolidated Telephone houses the Crisis Line in their building in Baxter is a way that they can give back to the community and it's such a great thing for us as a non-profit to have that given to us, provided to us.

So, we do hold our trainings there at CTC in their boardroom.

You know you've mentioned Covid twice with regard to the schools and your trainings.

I'm curious.

Have you seen an uptick in the number of calls during the Covid pandemic?

Great question.

Last year during Covid, I really thought our suicide, not that I wanted this to be, but I thought our suicide calls should have gone up because we were seeing a lot of drug abuse, alcohol abuse, domestic abuse, anxiety, panic, depression, isolation, loneliness.

Our suicide calls did not go up.

Our call volume did.

So, then comparing our statistics to the State, we find out that the highest number of suicide calls on documented history in the State of Minnesota, happened in 2019 not 2020 during the pandemic.

Interesting.

Well who pays for this important service and how much does it cost?

To have the trainings done?

No I'm sorry not the trainings but the Crisis Line in general?

I mean this is obviously a critical safety net for the community.

So, how do you pay for it?

We are supported in partial by the six counties that we service and then civic groups, businesses, churches, individuals, grants wherever we can seek donations, we seek donations.

So, it's a private non-profit and you're filling this important need for the community.

Why is it that the public sector isn't shouldering this responsibility?

Is there any analog?

You know, at the county for example?

Explain that a little bit differently.

So, I guess what i'm asking is I'm surprised that a private nonprofit is responsible for such a critical service in our region.

So, what iIm asking you, is why is it that the public sector our counties, for example, our county governments, our city governments, our state government, why aren't they responsible for this service?

In part they are.

We have great partnerships with the counties, with the cities, with the townships.

We are so greatly supported by all of them especially like the directors of the six counties for social services and I think because we are and this might be a little bragging, we are an amazing service.

I don't think people realize what the Crisis Line does for our people in our communities.

You know, it's we're kind of like that hidden treasure that people really don't know about until they need us and we spend a lot of time doing marketing and outreach and education but still we haven't reached everybody.

Which is, you know, shame on us, let's do a better job.

We try to do our best but we are greatly supported by them and.

I'm sorry I don't mean interrupt.

That's okay, but do the counties contract with the Crisis Line then to ensure that this?

Yes.

So the residents have access?

Absolutely.

Because the county's contract with you?

Absolutely.

So, how many volunteers does it actually take to staff the phones the entire year?

Now this is my boohooing because everybody is in the same boat.

We're all looking for employees.

We're all looking for volunteers and after the pandemic that all changed.

I think we possibly lost one of our very best demographics of volunteers, our older generation.

We on a great day would have 45 to 50 volunteers which we have carried for a very long time but now we're probably down to 38 volunteers.

Because every place that we would go to seek volunteers have been cancelled as far as health fairs and things of that nature.

So, it's hard to find volunteers but when we do we treat them like gold because they are such a treasure.

So, if anybody out there wants to find a way to give back right from their home, I'm going to have a training coming up in a couple weeks and then another one in December.

So, where and how do our viewers learn about how they can become a volunteer?

They can call our office at 218-828-4515 and if nobody is in the office to answer it, leave a message and I will get back to them or they can also go onto our website and connect with us that way and that's just simple crisisline and referralservice.org.

So, right now there's a dearth of volunteers.

You need more volunteers.

And all of us nonprofits need more volunteers.

Absolutely.

So, under normal circumstances that perfect day that you described where you have 45 to 50 volunteers, it's possible for that group of people to staff the phones all year long?

Absolutely.

So, there's a rotation?

There is.

How does that work?

Four shifts a day.

Okay.

Seven to noon, noon to five, five to ten, ten to seven AM.

So, I bet you can't tell me which is our busiest shift and what day it is?

I'm going to guess it's the evening shift, the latest shift.

I have no idea.

Do tell.

Thursday 12 to noon and then Monday and Tuesday follow 12 to noon.

Why is that?

Well, that's a good question and if I had the answer we'd probably both be rich.

But, I think it's because people are realizing the weekend is coming and if they need help they better seek it now because a lot of services are closed over the weekend and so that Thursday time span becomes very, very important for people to get help.

So, they're experiencing anxiety because they might not be able to find help over the weekend.

Right.

Interesting.

So, I spoke with one of your former volunteers who had somewhat of an uncomfortable experience when she was volunteering.

She received a call from the same person time and time again who said some inappropriate things to her and I guess what I'm wondering is do your volunteers ever experience any trauma from volunteering on your behalf?

Our volunteers have and can be triggered by situations that they are asked to help with especially if they are a veteran or they have PTSD from a life event and that person calls.

So, yes we have safety nets provided so that if a volunteer needs to debrief, de-escalate, we have mental health professionals that can do that for them because we do have a person on call 24 hours a day just for individuals calling the Crisis Line and if the volunteers need to have help.

Interesting.

You know, I just recently learned about a national suicide prevention hotline.

I believe it's 988 if I'm not mistaken and it's my understanding this literally covers the entire nation.

So, how does that work with a more regional legacy crisis line like yours?

There is a national suicide hotline that is in existence now and I am not that familiar to know if that will take over that one and just be 988 in place of it, which I think is going to happen.

So, then in our State of Minnesota there are five call centers set up and then the national 988 as I understand, it will direct it to one of the call centers which then have all the information for all of us covering the rest the whole State of Minnesota.

So, like our call center is 2-1-1 and I think it's out of Fergus Falls.

So, if a call came from the national line, it would go to the 2-1-1 and then it would be directed to us.

So, and and I think that national lines are great, however, if you have and some of our counties don't have the existing crisis line services that we have available in our six counties.

See I would prefer people to call us directly if they can but if that information isn't readily available for them or we haven't gotten that information to them, I'm thankful that we do have our national hotlines.

It's just that it's maybe a little more difficult because there's more layers for them to get to than being directed right to us.

Because if someone would call our Crisis Line, hopefully nothing goes wrong and you know we're human and technology isn't always perfect, we can have them connected to a licensed mental health professional within three to four minutes.

Time is of the essence.

So, you just mentioned a layer that I wasn't familiar with.

So, 211 is yet another layer in this layer cake.

So, this is a state-based suicide prevention line?

The five call centers, yes.

And that's not being replaced by this new national?

No.

Interesting.

No, not not as I understand it and I believe it takes effect in July of 2020, yes.

So, have your volunteers ever misdirected a call or overstepped any bounds and how do you monitor quality assurance?

I don't think our volunteers have ever stepped out of bounds.

I, you know, if you're familiar with Myers-Briggs.

If our volunteers were all in a group and did the Myers-Briggs personality profile, I think their profiles would be almost identical.

These are people who have servant's hearts, who are dedicated, who do what they're supposed to do when they do it.

It's kind of like a 9-1-1 operator.

I mean these volunteers are amazing in what they do because they handle some calls that are very very difficult.

Calls that in reality should have gone to 9-1-1 but they didn't.

So, that volunteer takes over and does what they need to do and, you know, the training states where those boundaries are because you mentioned a caller that called and called and called and was inappropriate.

Our volunteers need to know what to do to take care of that situation because it's not fair to a volunteer to be abused and they don't need to be.

We're not there as a paid 800 crisis line.

Right.

So, I'm curious, you know, as part of your training, how do you prepare people for some of these difficult conversations?

I can imagine that having some of these conversations can be very difficult for the first time.

How do you prepare them for that?

Is there role-playing?

We do role-play.

We do a lot of role-playing.

Interesting.

Yes we do.

So, does the Crisis Line depend on private individuals for donations?

Can I, as a citizen donate?

Absolutely.

So, you're a private non-profit correct?

Correct 5013c.

Okay.

Interesting.

Well, you mentioned 9-1-1 and I've been wondering how a volunteer on the Crisis Line, how do they know when it's time to call 9-1-1 or is that not really an option?

For a caller?

Correct.

Our call, let's see, our callers do not call out because with technology I can't block their information.

I mean I could but with everybody changing phones and numbers it would be impossible.

So, for their safety they don't call out.

So, what we do is, if someone is in crisis they are de-escalated to the point where there is a safety plan in place and that person is safe for the time it takes to get the mental health professional to call them back because they will call with blocked and restricted numbers.

So, that's what we do.

We are there almost like a 9-1-1 operator.

I see.

So, we we can give out resources.

We can get them help and we can direct them to what they need to get stabilized.

Is there any point though at which one of your volunteers would say I need to call 9-1-1 on your behalf or you need to call 9-1-1 or this is something that's outside of my scope?

Absolutely.

It, you know, for instance, someone may call and say I am having chest pains.

I don't know if I'm having an anxiety attack.

Well, anxiety attacks and heart attacks pattern each other.

Sure.

So, in that case the volunteer would say you need to go to a hospital.

Do you need help getting there?

Are you by yourself?

Because, if you've never had an anxiety attack or a heart attack, you don't know which it is.

So, yes, we do call in help if we need to.

Absolutely.

And your volunteers are trained to make that distinction?

Right.

Interesting.

Not between a heart attack or an anxiety attack but, right to get them help.

Sure.

Yes.

Well, can you share with us a success story?

Obviously no individual information but I'm wondering, do you know or are you aware of some of the successes that are a result of your work?

Wow, yes.

There was a caller that was pretty much in crisis, mental illness, unstable, calling the Crisis Line a lot and once the individual got connected and this is kind of a kudos to one of the other agencies, a counseling agency in town was connected to Mobile Crisis which is a part of Northern Pines who we collaborate with.

She got into a counseling stabilization with a counselor who stabilized that individual to go out and flourish, get a job, go on vacation and just thrive by just making that call to the Crisis Line.

Amazing.

We've had, I mean, there's a lot of success stories and because of HIPPA, we may not know.

We have had police officers call the Crisis Line back and say thank you for being there because you were, we were able to save that person's life.

Remarkable.

So, to use your own words, it's not just survive but sometimes you actually help people thrive.

Well, I want to ask you a little bit, I want to zoom out a little bit and ask you a little bit more about mental health generally.

If I were to give you a magic wand and you could use it, what would you do in order to minimize the amount of people in crisis right?

How, what would be the one thing that you would do in order to minimize crisis in our country or crises?

I don't know if we can minimize it at this point in time because I think we're all dealing with acute stress from the pandemic.

You know, whether we admit it or not I'm sitting here thinking, if I drink out of this cup will I get Covod?

Sure.

Or if I touch a doorknob will I get Covid?

You know, I know better but my brain is still processing strangely.

If I had a magic wand, I would first have a pot of gold appear and our mental health system, I don't believe is broken, I think it just needs to be expanded.

We need more beds for individuals who need to be stabilized in a stable environment and if I could build lots of different clinics or like crisis beds, I would do that and especially in a hub so people don't have to go outside of their living area.

Because, if you have a child, a teenager who needs and not that these are not good places, but to go to Duluth or to Fargo for stabilization in a bed and you're working full time, how do you support that child?

So, in the same way with an adult.

If the adult doesn't, can't be stabilized with their network around them, how does that work?

You know, we all know if you are in a crisis situation and you can be stabilized in your home that's much better because then you have that family support system there.

So, if we could just expand it and make it bigger and better and have the people that are trained to be in those facilities.

You know, it's interesting that you mentioned beds.

In preparation for our conversation, I learned that there are 97 percent fewer beds in the United States than there were in the mid-1950s.

So, is there then some sort of legislative solution in order to address mental health more broadly?

I suppose there could be.

You know, I think they try to do the best they can and provide those fundings but you can provide the funding but if there aren't people that are trained and want to be in the field or can be in the field, you know, what have you gained?

So, I think it's, you know, somebody smarter than me that's going to have to figure this out but I know we need to expand, you know, even to our schools.

Our school-based programs are short staffed, our hospitals, our nurses, our doctors, you know, it's just it's across the board.

So, there was a call to the Crisis Line, individual in a mental health crisis, couldn't get in to an ED, the wait was for three hours.

In ED?

I'm sorry.

Emergency department.

Got it.

Or, someone would call the Crisis Line and say I need to go to a crisis bed.

A crisis bed is where a person can go after they've been medically cleared to stabilize in a mental health crisis and if the crisis beds are filled and you're on a waiting list by the time and I have to say this very gently, by the time there's an opening, the crisis is over or you have decided something else to do with your life.

So, you know it's an interesting problem that we need to find the solutions for because we're all doing the best we can do to provide those services and I got to tell you, when i look around the state, I think, I know that our crisis services in our six counties are among the top.

The way they're set up and the way they function.

The individuals that I collaborate with are incredible.

So, six counties, but we only have about a minute left, I want to make sure that everyone's well aware of the service.

Do enough people know about the Crisis Line in your service territory?

No, because people come and go and if you've never had a crisis, how would you know about the Crisis Line?

So, we keep, that's one of the biggest things we do is outreach and education, marketing.

We want people to use our services.

So, your number is of course at the bottom of the screen here so that our viewers will know it.

But how do you make sure that number's out in the public?

Oh, wow we go to health fairs, to fairs, any place I can go and talk I go.

I go to service community or civic groups.

I go to, well to the colleges.

I go to the schools.

I go to every place any place.

Wherever I am invited, I go.

So, if someone calls from Hubbard County, will you help them?

No, but I'll find somebody that can because it's outside of our area.

Well, Mary I really appreciate the work that you do on behalf of our communities and thank you so much for joining me today.

Thank you.

I appreciate it.

And thank all of you for joining me once again.

I'm Jason Edens, your host of Lakeland Currents.

Be kind and be well.

We'll see you next week.