988 crisis hotline counselors are sometimes targeted by sexually abusive callers

This story contains descriptions of sexual activity.

In 2023, Lily Lantz started a full-time job as a crisis counselor at PATH Crisis Center in Bloomington, Illinois. It’s part of the national network known as the 988 Suicide & Crisis Lifeline.

It was her first job out of college, and it was common to have back-to-back calls with people who didn’t see the point in living anymore, she said.

Sometimes the work was difficult and draining, but she had always wanted a job helping people and felt called to the work.

If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

But there was a job hazard she never expected: almost every shift, she said, she spoke to people who would masturbate on the call.

“They would sometimes say things like ‘Your voice sounds so good right now, you’re making me feel so good right now,’” Lantz said.

NPR interviewed 10 current and former counselors from five different call centers who also experienced similar sexually inappropriate behaviors. They’ve become a chronic and troubling problem in the hotline industry.

There are also other types of abuse, such as pranks, racist or sexist insults and personal attacks on the crisis counselors. At the 988 Suicide & Crisis Lifeline, those who perpetuate such behaviors are known as “abusive contacts.”

The number of abusive contacts isn’t tracked nationally, but since 988 rolled out nationally in 2022, the network of call centers has received over 10 million contacts.

Data from one local crisis center in Portland, Oregon, Lines for Life, shows abusive contacts accounted for slightly more than 1% of the nearly 5,000 monthly interactions.

Counselors emphasize that even one harassing phone call can be distressing, and there aren’t enough measures in place to prevent such calls or help them cope when they do occur.

The impact on 988 retention

Five former 988 counselors told NPR that because of the sexual harassment, they no longer wanted to work for the hotline.

Another crisis counselor, Daisy, said she quit because of the abuse. Daisy was the name she used with callers in her job at the PATH call center. She does not want to be identified by her legal name while discussing this issue, because she doesn’t want her personal or professional networks to know about the abuse.

The incidents were traumatizing. “I did not sign up to be a sex worker,” Daisy said. “I signed up to help people who are having a difficult time.”

Lantz lost her job in June during layoffs at PATH. The only reason she hadn’t left the job sooner, she said, was that she got switched to the day shift, where abusive calls were less frequent.

After the layoff, Lantz decided not to pursue another 988 job, because of the sexually abusive calls.

Instead, she is getting a master’s in social work to be a trained therapist. (The counselors who answer 988 calls are only trained in crisis intervention, and 988 is not intended to be used as ongoing counseling. In some states — including Illinois — 988 counselors are not required to have psychology-related degrees.)

“We’re losing good people because of the emotional toll,” Lantz said.

A longstanding problem for hotlines

Managers of crisis centers are very much aware of the problems, but say there aren’t easy solutions.

Abusive callers have targeted crisis hotlines for years, according to Greg Borders, chief clinical officer at Lines for Life in Portland.

“It’s certainly not anything new,” he said. “I’ve been at Lines for Life for 12 years, and it existed long before I got there and it continues to exist.”

Deterring or punishing abusive callers is difficult. Calls to 988 are anonymous to protect callers’ privacy, so there’s no way to see who is calling or what location they are calling from.

The only information available to the counselor is the phone number.

Counselors cannot block numbers linked to abusive callers — ever — because someone with that number could have a real mental health crisis in the future.

Another obstacle is the strict rule that for every single incoming call, counselors have to ask if the person is at risk of harming themselves. That part of the conversation is mandatory, even when an abusive caller keeps redialing.

At PATH, this means counselors may hear verbal abuse repeatedly before they can transfer the person to a pre-recorded message line.

Some repeat abusive callers knew about the policy and used it to trap her, Lantz said.

“They would say they were suicidal,” she said. “Whether that was true or not, I can’t really say, but they were masturbating on the phone.”

Protective protocols may vary

The 988 system is administered by Vibrant Emotional Health, a nonprofit that has a federal grant to oversee the 207 crisis centers in the national network.

Vibrant has suggestions for crisis centers facing this issue, but most of them are optional, said Shye Louis, who works on clinical standards and training for Vibrant.

That flexibility is necessary because individual centers may be subject to different regulatory requirements from state agencies or accrediting bodies, such as the American Association of Suicidology.

Managers at crisis centers have attempted to tackle the issue. In 2020, Lines for Life in Oregon started allowing counselors to transfer abusive calls to a supervisor, Borders said.

In Illinois, PATH implemented a new policy in 2023. If abusive contacts continue to call the center after being warned of their inappropriate behavior, they can be transferred to a pre-recorded message.

The message tells people their recent calls have been “deemed inappropriate or potentially harassing” and firmly requests they stop calling since it interferes with legitimate calls.

Both PATH and Lines for Life allow the counselor to hang up if a caller becomes abusive, but only after the counselor has already determined they are not at risk of harming themselves — a Vibrant rule.

In Colorado, six former counselors are suing Rocky Mountain Crisis Center in federal court because they allege the organization made it overly complicated to disconnect from abusive callers.

In an email to NPR, the crisis center denied the claims. “RMCP has maintained protocols that empower our team members to set a limit when such a call is suspected and to terminate the call,” an email statement reads. “Such protocols are guided by and in alignment with Vibrant Emotional Health, the administrator of 988.”

One of the plaintiffs in the suit, Myriah Montoya-Gallegos, told NPR about an incident involving a man who was masturbating on the phone. The supervisor who was listening to the call did not give her permission to hang up, she said.

Instead, she was told to redirect the conversation and focus on the caller’s emotions, she said. “When he finished [orgasmed], he laughed about it, and he thanked me, and then he hung up,” she said.

Iris Halpern, the attorney for the former counselors in the lawsuit, claims the crisis centers are legally obligated to act.

“In the Colorado Anti-Discrimination Act, it specifically says even if harassment was common in the past… you have to do something,” she said.

Solutions to keep 988 sustainable

Tackling this issue is important for the future of 988, said Adam Carter, the CEO at PATH.

Abusive calls can sap resources and increase wait times for people who are truly in need, he said. He’d like the Illinois legislature to help by designating 988 counselors first responders.

In Illinois, first-responder status protects workers from civil liability in an emergency and provides added benefits, such as access to a preferred mental health provider.

Counselors at several crisis centers believe that stronger state laws could help deter abuse.

In the 911 system, local laws frequently bar repeated misuse of that line. Caller identification and services that allow police to track caller location can help officers respond to abusive calls to 911.

None of that exists for 988.

Daisy said Illinois “has a responsibility to protect (its) crisis counselors,” since 988 is partially funded through state grants.

“There are people misusing the line, and there are excuses being made for why we can’t have ramifications for that action,” she said.

Other affected counselors say they want change, but still believe in the future of the 988 Lifeline.

“It’s a great resource for individuals who are in crisis when it’s utilized appropriately,” said Angel Elrich, another plaintiff in the Colorado lawsuit. “I have so much faith… I think 988 is amazing. I just really want it to be sustainable.”

This story comes from NPR’s health reporting partnership with WGLT and KFF Health News.