Warning: This article contains references to traumatic events, including suicide, which some readers might find upsetting.
I can’t breathe.
I need to self-harm.
I want to end it all.
These are text messages that 29-year-old Amy, an HR manager from Birmingham, receives most days.
In her spare time, Amy is a volunteer for Shout – the UK’s first free 24/7 text helpline for anyone feeling suicidal or experiencing a mental health crisis. Launched in May 2019 by Prince William, Kate Middleton, Prince Harry and Meghan Markle as part of their mental health campaign, the service has since handled over 145,000 conversations, exchanging a total of 6 million messages. Many of which contain moments of severe despair.
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"Forty percent of messages we get reference suicide," says Amy from Shout’s HQ in west London, which has seen 900 conversations in the past 24 hours alone. "It doesn’t mean they are going to take their life, but it shows how many people are having these thoughts."
Sadly, she speaks from her own experience. "I attempted to take my own life several times after two decades of mental health issues. I’m in a much better place now, and want to do all I can to destigmatise mental health issues by talking openly about the fact I am a suicide survivor." It’s also why she volunteers. "There were times I considered calling a crisis line, but talking on the phone stopped me. If there had been a text service, I know I would have used it."
In our hyperconnected world, Shout is targeting people who need urgent help but prefer texting a problem to a stranger over calling someone for help, first. Developed to be as discreet and accessible as possible, there’s no registration process and it’s free, confidential and anonymous.
The system works like this: someone in what the team call a 'hot' moment – a crisis – sends a text at any time of day. An algorithm prioritises red flags, recognising words like 'die' and 'paracetamol', then the texter is connected to a volunteer who will guide them to a calmer state.
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It’s based on the US model, Crisis Text Line, which has received over 100 million messages. Shout’s CEO is Victoria Hornby, who previously worked for the Royal Foundation. "Our Heads Together campaign was all about getting people to talk about their mental health, but we knew in order to do that we’d need to find more places for people to actually have those conversations," she says.
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In our hyperconnected world, Shout is targeting people who need urgent help but prefer texting a problem to a stranger over calling someone for help.
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One area they felt needed more support? Digital. "Many people start looking for help with their mental health online – but that can be dangerous. During one of our focus groups, one teenager ended up down a YouTube rabbit hole, diagnosed himself with bipolar disorder and within 48 hours he was self-harming. It became more clear to us that if this is where people are looking for support – we needed to do something."
A meeting with Crisis Text Line’s cofounder Nancy Lublin followed – the service was looking to internationalise the platform at the time – and as well as being sold on the tech, Victoria says a lot of time was spent satisfying themselves that the service was clinically suitable.
"We were also drawn to the fact that it could provide a service for multiple mental health charities, so rather than everyone trying to set up a text service, which is very expensive, they could all use the one platform," says Victoria.
As a general election looms, mental health is firmly on the agenda. Labour has vowed to outspend the Conservatives in order to improve services. Meanwhile, 76% of GPs surveyed recently by the charity Young Minds expressed fears that the young people they refer for urgent mental healthcare are either being denied treatment or facing months of delays.
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In the end, a £3 million grant from the Royal Foundation helped get Shout off the ground, with further funds coming from Children in Need among others.
While the Cambridges and the Sussexes remain active supporters, it’s Shout’s plethora of volunteers who power the platform. "Our biggest fear was finding people who would be willing to volunteer – now we have 1,500," says Victoria. "We also have a 'spike team' of experienced volunteers who wade in when texts reach a significant volume – like on World Mental Health Day, when we handled our highest amount of conversations in one day: 959."
All volunteers work for the service remotely, having committed to at least 200 hours and been through a detailed application process and reference checks as well as completing 25 hours of online training.
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As a general election looms, mental health is firmly on the agenda. Labour has vowed to outspend the Conservatives in order to improve services.
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"Anyone can volunteer but we advise people really think about it, because it’s not for everyone," Victoria explains. Once qualified, all conversations are monitored by a team of (paid) supervisors who are experienced mental health clinicians, like Christine, 29, from London. "I’ve supervised hundreds of conversations, from someone feeling stressed about a change or work project to someone who suspects their partner is cheating on them," she tells me.
The clinicians are also the ones who can initiate an 'active rescue' – when the emergency services are called if a texter’s life is at imminent risk and they can’t plan for their own safety. "Around 3% of conversations require one," says Christine, adding that they always guide anyone whose life is at risk to contact 999 directly themselves. "I had one incident where a young girl texted to say she had overdosed, but while she was speaking to us she decided that she wanted to live. She then fell unconscious during the conversation, so we contacted the emergency services who revived her."
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Christine recalls another time when a man texted to say he was on a train and having suicidal thoughts, and was planning to take his own life by jumping off a bridge that day. "We listened and worked with him to get to a safe place. He ended the conversation by saying he was off the train and was going home to spend time with his children and call a friend to tell them how he’d been feeling."
Tragically, not all conversations end with a positive resolution. "I've lost several people," says Amy. "It's horrible – but our wellbeing is looked after by our supervisors, too." As well as putting personal views to one side, Shout asks volunteers to be aware of their own mental wellbeing and resilience. Being able to cope with someone on the brink of ending their life can extract a high emotional price.
"I remember one woman was 'circling'," says Amy. "She’d repeatedly text 'I can’t do this, I can’t do this anymore' and although she’d start to engage in my messages, she’d then panic and start saying those words again. I was really concerned but when she stopped responding, my supervisor guided me to end the conversation."
How does that feel, I wonder? "I’m not robotic with texters, I empathise with them a lot and I feel it’s okay to do that, but this was a really hard one to detach from. Some will always leave you thinking whether that person ended up going to bed that night."
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Being comfortable with not knowing what happens after saying goodbye is perhaps the crux of this type of volunteering. As is being able to climb inside a texter’s pain to feel empathy but not relate personally to a problem, or try and solve it for them. "I think the hardest thing for our volunteers is that we’re not fixers," says Victoria, who has also handled hundreds of conversations. "We try and prevent terrible things from happening, but we’re not a long-term therapy or emergency service; we’re there to take the heat out of an overwhelming moment and be there for them at that time."
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I'm not robotic with texters, I empathise with them a lot. Some will always leave you thinking whether that person ended up going to bed that night.
Amy
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There has arguably never been more need for a service like this – for someone to be there. New figures from the Office for National Statistics show suicide rates have reached a 16-year high across the UK, surging in the past year following half a decade of decline. Last year, 6,507 deaths by suicide were registered, marking a 12% rise on the previous year, and the highest rate since 2002. The rise appears to be driven by suicides among boys and men, but self-inflicted deaths among females under 25 reached the highest rate on record for that age group.
According to the NHS, one in four of us experiences at least one diagnosable mental health problem in any given year, and mental health problems represent the largest single cause of disability in the UK. Yet services are underfunded and overstretched, and while the NHS is doing good work, the overall care system for mental health has been labelled broken and in crisis itself.
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Eighty percent of Shout’s texters (who give their age) are under 25. "My hardest conversation was with a young teenager who messaged late on his first night in care," says Victoria. "His parents had been pretty terrible and he couldn’t sleep but staying with him and 'exploring' – which I always say is the crucial part – meant we were able to have a discussion about his favourite Star Wars films, and that seemed to distract him."
Does she feel Shout is picking up the slack of the state? "We could have taken the idea to the Department of Health but I think young people are actually more likely to trust us because we’re not a government service," says Victoria. "Would we ever want to get money from them? Possibly – as long as we didn’t have to do things too differently. But there’s a perception issue: if we’d have gone out as a state-run text version of NHS 111, people might have been more sceptical about whether it was actually confidential, especially as they contact us with their phone number. Whatever the issue or person in crisis is, from a reputation perspective, I think it’s important that we are seen as nonjudgmental, impartial and not connected to the government."
As well as being on the front line for people at high risk of suicide, people text Shout for other reasons too: depression and sadness, anxiety and stress, isolation and loneliness.
"A lot of messages are to do with self-harm, and I see a lot of marital and LGBTQ+ problems," says Amy, explaining that the busiest times are between 6pm and midnight and that she handles between five and seven conversations in a typical two-hour shift. Amy reckons the volume is also being fuelled by the "distressing" political, social and environmental climate. "Sometimes our ability to cope with the everyday is very much dependent on what’s going on in the world that day," she adds.
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The most surprising thing she’s noticed is the variety of people who use the service, and the age of texters, who have ranged from as young as eight to mid 50s. Her toughest text? "From a 13-year-old girl who was on the bus and said she 'needed to self-harm' when she got home – but she didn’t want to. I wanted to say I’d been there but I couldn’t, so we carried on messaging and when she got home, I asked if she could move the stuff she could hurt herself with into another room. During our conversation, her mum went to bed in that room and the girl said she was tired, too. I told her we’re always here."
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One in four of us experiences at least one diagnosable mental health problem in any given year, and mental health problems represent the largest single cause of disability in the UK.
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Having been through the care system herself, Amy argues that the state needs to do more for mental health. "It's sad people have to rely on charities such as Shout," she says. "We tell people it’s okay to talk and get help – but then what if they have to wait months to get that help? I have friends who have been on waiting lists for talking therapy for 12 months. It’s not the NHS' fault but it galvanises me because you see that it’s not fair how some places are underfunded and people can’t get access to resources."
What does she think will help? "More money needs to be given to mental health services. People are making these amazing charities but it’s not coming from our government. The mental health conversation is changing and growing faster every day. The pace goes hand in hand with the need for more resources, including digital ones, to be available for people to access at any time."
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She raises an important point: few mental health services can help beyond 'office' hours. Childline and the Samaritans do fantastic work, but there’s also a generation of young people who don’t talk on the phone anymore – they text, and that’s what Shout has tapped into. "Even if you’re feeling 100% okay, we all know it still takes a certain amount of energy to make a phone call, whether it’s to your doctor, bank or internet provider," says Amy. "If you take away that okay feeling, and you’re in a bad place, then psyching yourself up to make a phone call can be just too much."
There are also people who can’t make calls because of situations they’re in. "The upside of being glued to our phones is that it’s easy for people to look like they’re scrolling Twitter, but thanks to Shout’s accessibility and discreetness, they could actually be texting with someone from the service." Amy mentions one man she recently messaged for five minutes who was at a family event. "He was very anxious and felt like he couldn’t breathe. He said 'I haven’t got much time, I just need to say something.' I said it was really good that he’d texted us and asked if there was a physical thing he could do that’s helped him before – he said getting some air helps. He thanked me – and then he was gone."
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Giving texters the affirmation that what they are going through is real and normal is a recurring theme. "Sometimes people just want to hear that what they’re feeling is okay – and valid," says Amy. "It’s so important they have an empathetic person to speak to who understands regardless of how big or small they think their crisis moment is – the fact it’s causing distress is enough of a reason to text us. Most of the time, helping someone get out of their head and writing it down is cathartic in itself."
Texting may make it easier to get the words out but Shout is always encouraging texters to 'talk' to someone: a teacher, GP, parent. "We want the next step to be a human as that’s what’s going to keep them safe in the long term," says Victoria. "It’s about finding who that person is for them, or co-creating a plan to help them move forward, like preparing for a doctor’s appointment."
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I find it extraordinary that most people who text us don't believe they deserve any help. But that's what poor mental health does to you – and why people won't get help earlier. I see it as our job to get people to a point where they're confident someone will respond to their mental health.
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It’s also about getting a positive experience of reaching out for help. "If someone texts something awful, and they get a response that says 'it’s really great that you text us', the chances that they will try and get the help they need are higher," adds Victoria. "I find it extraordinary that most people who text us don’t believe they deserve any help. But that’s what poor mental health does to you – and why people won’t get help earlier. I see it as our job to get people to a point where they’re confident someone will respond to their mental health."
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Does she think they’re making a difference? "Absolutely," she says. "We are there for people who might not otherwise get help in the moment when they need it. Not only that, but we are training a number of people who will have the skills and feel able to have these important conversations with people at school, university, work, at home. There’s a ripple effect of spreading good practice in supporting other people."
The service might reward volunteers like Amy with mental health skills and knowledge, but it’s altruism that drives her to log on. "I volunteer because it’s a service that would have been an immeasurable help to me when I was in crisis, and I want to give the support I didn’t have to other people."
If you need help with urgent mental health issues, text Shout on 85258, visit giveusashout.org or please contact Samaritans on 116 123. If you or someone you know is considering self-harm, you can also contact Mind.