Exquisite Listening: America’s First Suicide Prevention Hotline Celebrates 50 Years

She sometimes consulted me about the details of her plan. “What should I do with the keys after I park? Bring them, or leave them? What if they don’t find me? If I bring the keys and they don’t find me, you won’t be able to start the scooter.”

I didn’t know what to say about the keys.

In fact, although I had a year to practice, I never really figured out what to say when she was most acutely suicidal. Sometimes I took her threats too casually. At other times, I took her threats too seriously. If she mentioned suicide, or even just seemed to be brooding on it, I did my best to smother the impulse, like her suicidality was a flaming carpet that I could stamp out.

But she stumped me with the scooter keys. As horrifying as it was, it was actually a valid, logistical question.

So I said nothing. And in saying nothing, I finally listened to her. She didn’t say much, but I didn’t say much, either. I sat with her and let her feel suicidal. And eventually, she felt less suicidal, and we were able to get back to living.

Dealing with a suicidal loved one is terrifying. We feel crippled with the fear and guilt of doing something wrong. In our frenzy to help we do everything possible—call family, say how much we love the person, beg them to stay alive, call 911, rush the person to the hospital—all of it frantic actions, like we’re trying to put out a fire. But the most helpful action might be the most counterintuitive. What suicidal people often need most is not doing, but listening.

Bernard Mayes understood this. In 1962 he created the first suicide prevention hotline in America, based on the gut instinct that suicidal patients just needed to be listened to. With no training as a psychiatrist, Mayes institutionalized a groundbreaking idea: that it doesn’t take a Ph.D. or M.D. to save someone’s life; what it takes is a willingness to listen. He travelled to San Francisco to create a program based on this concept, and launched the San Francisco Suicide Prevention organization—a telephone crisis center staffed with volunteer, unskilled, regular people. Their job was take calls, and stay on the line.

The suicide hotline has since been replicated by hundreds of organizations across the country, and today is heralded as a major factor in cutting a community’s suicide rate. Last month marked the 50th anniversary of its creation. In honor of that, I went to talk to Mayes at his home in San Francisco. I wanted to meet him and learn more about the beginning, when skeptics doubted how much good listening would do.

His once-booming voice has softened with age, replaced with the shaky quiver that you might expect from an 83 year-old man in the early stages of Parkinson’s disease. He shuffles around his house, and paints and writes to keep himself busy and active.

In addition to pioneering a groundbreaking suicide prevention method, Mayes has had a remarkable life full of celebrated accomplishments. He was one of the cofounders of National Public Radio, and served as its first chairman. He created San Francisco’s local public radio station, KQED. A BBC radio reporter, he voiced Gandalf in the station’s broadcast of “Lord of the Rings,” and eventually narrated over 50 audiobooks. He was a leading advocate for gay rights during the 1970s and 1980s, and taught English at the University of Virginia, where there is an award named after him for student-leaders in the gay community.

Still, Mayes knew he wanted to do something to help prevent suicide. When he travelled to San Francisco in 1960 determined to tackle the problem, he was going into the belly of the beast. The city’s suicide rate was the highest in the country, second in the Western Hemisphere only to West Berlin. Still today, more people have killed themselves at its fabled Golden Gate Bridge than at any other location on earth. When Mayes arrived, he saw a headline in the local paper that read: “Suicides? San Francisco Couldn’t Care Less!” he recalls in his memoir, Escaping God’s Closet.

At that time, a suicidal person had three official recourses, none of them good. If you called 911, you’d get thrown in jail instead of taken to the hospital; suicide was still technically illegal. If you called a priest, you might be lectured for considering a mortal sin. If you called a psychiatrist, especially off-hours, you most often got an answering machine saying they’d call you back later – not very helpful for patients contemplating taking their life.

There were only three suicide prevention organizations in the country. One was research-based, started by medical professionals in Los Angeles. The other two—one in Boston and one in New York—were affiliated with churches, which treated suicide as a sin that required holy intervention. St. Augustine institutionalized suicide as a sin in the 5th century, largely to address the problem of zealots who were killing themselves as martyrs, and the church hasn’t wavered on the position since. Kenneth Murphy, the Catholic priest who started his suicide work in Boston in 1959, said that by rejecting the sanctity of life, suicide is “the worst kind of sins,” because the person is not just destroying himself “but, by his action, he is killing all of mankind.”

Into that cultural temperature entered Mayes, with the radical idea of listening to people and giving their feelings merit without condescension. On the first night of the hotline’s operations, Mayes received just one call. He used the pseudonym “Bruce” when on the phone with callers to assure anonymity. To spread word of the hotline, he wrote “Thinking of ending it all? Call Bruce” on matchbooks and scattered them in bars throughout the city.

He eventually recruited a team of volunteers so someone was always around to answer the phone. They need not have a professional background—Mayes also created an extensive training program—but they did need an interest in answering phone calls from the suicidal, at all hours of the day, without pay. Today, San Francisco Suicide Prevention fields 200 calls a day -- 70,000 calls a year.

Mayes told me about one of those early calls. The person on the other end of the phone held a revolver, spun the cylinder close to the phone, and loudly flicked the hammer back and forth. “See, it’s ready! I’ve got it ready!” he kept saying.

“Let me ask you, what should I say here?” Mayes asked me. A medical professional would probably ask, “What is your name?” because protocol is to first ascertain patient information. But on the phone Mayes didn’t want a name, he wanted the caller to put the gun down. “That’s the first thing I’d say. Put the gun down, and let’s talk.”

On another early call, a volunteer answered the phone and heard only guttural sobbing on the other end. “The volunteer continued to listen, without interruption, until at last the caller breathed deeply and asked, ‘Are you still there?’ ‘Yes,’ replied the volunteer quietly, ‘I’m still here.’”

Eve Meyer, the current executive director of San Francisco Suicide Prevention, calls the approach “listening exquisitely.” No interruption, no clamoring to solve the problem, but active, focused listening.

Mayes created 10 hour-long audiotapes to train volunteers in this art of exquisite listening. “The opening words and their intonation were crucial to the success of a call,” he told me. “Winning the caller’s trust, and evaluating the lethality of the caller’s situation, took considerable practice.” With trust established, and the risk assessed, the volunteer could then determine what type of action need take place, if any. “I invented the whole thing,” he said. “I am surprised that it was so successful, and remains so.”

What Mayes knew then I learned naturally during my wife’s struggle with depression. I spent the first few months of her suicidal phase appealing to her reason, or her fond memories, or a vision for the future. Those approaches didn’t help her, and only made me more exasperated. I ultimately discovered that the most effective thing I could do when she was acutely suicidal was to simply sit by her side and listen. I let her cry and wail in desperation and didn’t make any promises I knew I couldn’t keep about when things would get better. I just listened. And eventually, the wailing and sobbing and desire to die faded.

Of course, listening has its limits. You might be able to listen someone out of overdosing on medicine, or pulling the trigger, but you can’t listen them out of a deep depression. You can’t listen them back into the marriage that failed or the job they lost. I listened my wife out of suicide many times, but I couldn’t listen her mental illness away. Ultimately, I think it was the combination of professional treatment, medication and my support that allowed my wife to have a full recovery.

Mayes agrees that listening is only the first step to recovery.“I always regarded the hotline as a link between the people and the help that they need,” he told me. “It cannot provide the actual help, but it takes the person by the hand and shows them where they can go to get help. It’s a vital link between the two.”

He knew he needed a reliable network of resources in San Francisco that he could recommend to callers to in case action was necessary. So he did his homework, and prepared a list. He pretended to be suicidal himself, and dialed up hospitals, psychiatrists, and churches. Some places were rude and impatient. Others were sympathetic and helpful. He wanted to make sure that if “Bruce” was going to recommend a homeless shelter for a bed, or a therapist, or even an emergency response team, they needed to be respectful.

Today, the center does much more than only answer the phone. Like most of the other 500 suicide prevention centers that are now in the country, it also works within local communities to conduct trainings in suicide prevention, and even some research into understanding the problem.

Science still has yet to fully understand suicide. Sometimes it accompanies depression, but not all the time. Many studies lead to dead ends. A decade ago, new discoveries linked suicide to low levels of serotonin in the prefrontal cortex, but attempts to increase serotonin have not been effective in preventing suicide. Some of the statistical insights from the research over the years are just silly, like the most suicidal day of the week (Wednesday) or the most suicidal jobs (marine engineers are number one, doctors two).

Two years before Mayes arrived in San Francisco, three psychiatrists—Norman Barberow, Robert Litman, and Ed Schneidman—founded the Los Angeles Suicide Prevention Center, the first research center in the U.S. devoted to scientific inquiry into the problem of suicide.

Schneidman would go on to spearhead the first nationwide suicide prevention program, in conjunction with the National Institute of Mental Health and the American Association of Suicidology, which remains the focal point of prevention research in the country. One of the most important contributions to our understanding of the problem came out of Schneidman’s research: that suicidal impulses are brief, not enduring. While depression can last years, the desire to kill oneself comes and goes, surging like the tide. The key is to be there to intervene when the impulse reaches fever pitch.

Mayes sought out Shneidman for guidance on his own endeavors. Shneidman told him to forget it, saying Mayes wasn’t a professional psychiatrist so he wasn’t qualified to help. Later, he even attempted to close down the hotline. “Ed Shneidman was a very clever man, but he was professionally very greedy,” Mayes said. “For him, suicide prevention had to be the professional approach, or nothing at all. Unless you were a psychologist or a psychiatrist, you shouldn’t touch suicide.”

Unfortunately, most psychiatrists didn’t want to touch it either—or couldn’t. Professional psychiatrists were well-equipped to treat the long ache of depression. But when it came to the suicidal impulse, their limited hours and booked schedules didn’t allow for the full-time support suicidal patients needed. And the logistical conflicts were just the tip of the iceberg. Many psychiatrists entrusted with caring for the suicidal were loathe to help in the first place—a stigma that hasn’t entirely faded. Mayes says he once spoke to a psychiatrist friend who admitted that mental health professionals “don’t like to have suicides on their record” because “they’re bad for business.”

Andrew Solomon writes in his book Noonday Demon that when he was struggling with depression, a psychiatrist insisted he would only accept him as a patient if he promised not to commit suicide. Solomon analogized this “to having a specialist in infectious diseases agree to treat your tuberculosis as long as you never coughed again.” For a psychiatrist, taking on a suicidal patient could mean career suicide.

Mayes was deeply frustrated with the conditional help offered by medical professionals. But he was even more wary of the religious approach. “When you call a priest, you’ve already seemed to confess that you’re a sinful person,” Mayes told me. “I am not against suicide,” he continued, his voice regaining some of the strength from his broadcasting days. “I don’t think it’s a sin or a crime. I think it’s a sign of real pain and misery. I believe there are reasonable and rational circumstances for wanting to kill yourself.”

He was determined his fix would be non-religious, non-professional, available at all hours of the day at no charge, and free from judgment. Others would soon follow. As early as 1965, even the once-skeptical Shneidman had adopted a volunteer-based hotline at his own prevention center.

Suicide is the 11th leading cause of death in the United States. Someone takes their own life every 15 minutes. There’s a very good chance that you will someday know someone who will either attempt, or succeed, at killing himself. While rates range within the population—white, rural, single, elderly men have the highest likelihood in this country—no portion of society is exempt. It’s a human problem.

But things are getting better. Suicide hotlines have sprung up all over America, and even Facebook has integrated a chat-based prevention service into its site. The national suicide rate has dropped in recent years. In 2003 about 13 in 100,000 people killed themselves, down to 10 per 100,000 today. In San Francisco, the decline was considerably more dramatic, dropping by half in the last 50 years.

There are a handful of possible reasons why. Research into the problem of suicide has become more sophisticated, and medication for mental illness has improved dramatically. Also, recent evaluations of the efficacy of hotlines confirm they are a contributing factor in the reduction of the suicide rate, says Dr. Lanny Berman, the executive director for the American Association on Suicidology. What statistics will never determine is the far-reaching impact of the underlying message of the hotline’s existence: The suicide hotline is an unabashed endorsement of listening, and that message is still echoing into the 21st century.

Another reason for the declined rate is that the taboo of suicide has receded—somewhat. It’s not gone. There’s no denying that even today, 50 years after Mayes read about San Francisco’s indifference to suicide, there is a strong stigma attached to it. Americans kill themselves at twice the rate that they kill other people, but we are still extremely uncomfortable talking about it.

When I contacted Mayes, he was surprised at my interest in the topic. “The odd thing about it is that suicide is not a subject that you talk about. Nobody wants to talk about it. It’s not something I can easily discuss at a dinner party,” he told me. “Even people who have read my memoir don’t bring it up.”

I encounter this stigma frequently. In a discussion with Meyer, he told me that 40 people a year jump off the Golden Gate Bridge. “If 40 people a year died from food poisoning at a restaurant, the place would be shut down,” she said. “But nothing is done to prevent access to jumping off the Bridge.” When I told a friend of mine about the exchange, she kind of rolled her eyes and said, “Yeah, but those people choose to jump off the bridge. There’s a difference.”

There is, and there isn’t. The main difference is that with food poisoning, you know who the victim is, and who is at fault. It’s not so easy with suicide. Is the person who commits suicide a victim, an aggressor, or a little bit of both? It’s a complex question. But the complexity hasn’t prevented society from judging the suicidal, rather than empathizing with them. The unwavering stigma still attached to suicide makes having an anonymous hotline all the more important. Callers can reach out knowing that the person on the other line won’t hang up on them, and won’t accuse them of being weak or selfish.

Like mine, Mayes’ interest in suicide was personal. When he was in his mid-20s, his beloved high school headmaster—one of his teenage heroes—hung himself. No note, no explanation. He just strung a rope over a banister, looped the rope around his neck, and stepped off the stairs.

Born in London in 1929, Mayes spent his adolescence huddling in basements waiting out bombing raids, and feeling a budding sexuality that was shunned by his society—he recognized he was gay by age 7. At that time, gays were committing suicide at alarming rates. In 1960, homosexuality was considered a sin, an illegal act, and a mental disorder. It would remain a “disorder” until 1973, when the American Psychiatric Association removed it from the DSM. Asking for help, whether from a priest or a psychiatrist, meant double judgment—first for being gay, and second for wanting to kill yourself. Though Mayes didn’t feel the need to hide his feelings or be ashamed, he drew inspiration from knowing the hardships gay people faced in a society strongly adverse to homosexuality.

Nevertheless, Mayes joined the church as an Anglican priest in his early adulthood. Mostly, he wanted to help people. Throughout the rest of his career as a journalist, professor and advocate he remained a priest—though more in name than in practice, he admits. From the start, Mayes felt a nagging queasiness with religious life.“Half the priests were also homosexual, but they were all closeted and sleeping with each other,” Mayes told me. He quickly gained a reputation as an unorthodox thinker. And he was deeply opposed to how the church handled suicidal cries for help—a perspective that eventually fed into his idea for a nonjudgmental prevention hotline.

Mayes was at San Francisco Suicide Prevention for 10 years before passing off the reigns. A true pioneer, he knew that his best work was in creating things. On May 1, 2012, the center celebrated its 50th anniversary with a big gala. It was a lavish event: plates cost $500, and the silent auction held tickets to the Emmy Awards and weekend stays in Napa Valley. Mayes was there, as was Meyer, who has run the center for the last 20 years. Representatives from the mayor’s office attended. Rep. Nancy Pelosi and Sen. Dianne Feinstein sent in signed letters gushing with congratulations for the accomplishment. Throughout the dinner, I found myself continually scanning the room, looking at the several hundred well-dressed guests. Who had they saved? And who had they lost?

When Mayes was called up on stage he received a standing ovation. He looked dapper in his suit, and wore a big smile. He kept his remarks short. “We have to thank and remember all the volunteers who served day and night without stopping, year in, year out, and devoted themselves to others,” he said. “And so it has been ever since, so that we can go on and on, and listen, and accept people’s problems, and help them to survive.”

And with that, he slowly walked back to his table to enjoy the event. Here he was at a dinner party where suicide was all anybody wanted talk about. Finally.