Safe Social Spaces program run by Lines for Life uses social media to help youth in crisis

For the past five years, Oregon’s Lines for Life has been running a youth program called Safe Social Spaces. Now, an OHSU study published in the journal Psychiatric Services suggests the program may have prevented more than 160 suicide attempts since it began. The program uses social media to find youth struggling with suicidal ideation and provide support through social media’s direct messaging systems. We hear more from Angie Nielsen, the nonprofit’s YouthLine assistant director of clinical operations who co-authored the study, and Genevieve Castle, a social media crisis intervention specialist.

If you or someone you know is struggling, you can call or text 988 to reach the suicide and crisis lifeline or contact the YouthLine. Help is available 24 hours a day, seven days a week.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. For the last five years, Oregon’s suicide prevention nonprofit Lines for Life has been running a youth program called Safe Social Spaces. Specially trained people use a handful of social media sites to find young people who are struggling with suicidal ideation. Then they reach out and offer support through direct messages. A new OHSU study suggests the program may have prevented more than 160 suicide attempts since it began. Genevieve Castle is one of the social media crisis intervention specialists for the program. Angie Nielsen is the nonprofit’s YouthLine assistant director of clinical operations. She’s also one of the co-authors of this new study. They both join us now. It’s great to have both of you on Think Out Loud.

Angie Nielsen: Hi, thanks so much for having us.

Genevieve Castle: Thank you

Miller: Angie first, can you just describe the basics of how this five year old program works?

Nielsen: Yeah. So Safe Social Spaces is an innovative way of looking at support and crisis intervention, in a way where it’s basically like a reverse crisis line. We are actually reaching out to people who are looking for support on social media. When we see someone who might be struggling with mental health challenges, thoughts of self harm, thoughts of suicide, then we in turn, reach out to them, we offer a caring ear and offer to help them work through what they’re feeling.

Miller: Genevieve, what kinds of messages in particular are you searching for?

Castle: I’m usually looking for things along the lines of invitations for suicide. Common phrases can be “I’m so tired of it all,” “I just don’t want to wake up tomorrow,” “I can’t handle it anymore.” Things like that, that kind of imply that that person might be struggling with thoughts of suicide. Similarly with self harm, people that are feeling like they’re really struggling with those urges, posting things like “I just don’t think that I can stay safe for the rest of the day,” “I really think the only way I can cope with what I’m going through is self harm.”

Miller: Angie, what social media platforms are your team members looking through?

Nielsen: We’re on four social media platforms. We are on Discord, Reddit, TalkLife, and Vent. Discord and Reddit I think are a little bit more well known with everyone. TalkLife and Vent are specifically for mental health. And so we scour either certain subs or certain message boards that are focused a little bit more on mental health when it’s a broader social media app like Discord or Reddit. Gen and the rest of the team look for those posts of people who might be struggling, to offer some help.

Miller: We heard from Genevieve the sort of triggering kinds of comments that specialists are looking for. How many are found in the course of a given day?

Nielsen: That’s a great question because it could be so many. When our social media crisis intervention specialists are searching for these posts, they’re looking for keywords like “suicide,” like “self harm,” like “depression.” But we also have to take into account what those messages might be saying underneath it all. Looking for those invitations like she said, “let’s explore this a little bit more. Could this person be just having a bad day or could this person really be thinking about some harmful stuff?” It’s really amazing, we’re just showing that someone is paying attention to what people are posting online and someone actually cares.

Miller: So Genevieve, let’s say you find one of these posts. What do you do?

Castle: The first step is identifying that post, finding a post that has those invitations, or sometimes it’s literally as clear as “I’m going to take my life today,” or tomorrow, or whatever timeline that person is dealing with. Then from there, I will click on their profile, send them a message just being like “Hey, I saw your post. It sounds like you’re going through a really hard time. I know how hard it can be to feel really isolated and like you have no one to talk to. It looks like you are in that position. If you want to talk to me, I’m here. I’d love to support you. Totally OK if you don’t want to talk to me, I can also send you resources.” That’s kind of vaguely what my opening message usually is, is just “How are you doing? Do you want to talk to me? No worries, if not, but here’s someone you can talk to.”

Miller: And do you say “I am a professionally trained adult who does this as my job”?

Castle: We don’t outright say that just because for a lot of people, part of why they’re not reaching out to crisis lines is because of that mistrust of the system. A lot of people that struggle with mental health and mental illness, they don’t trust crisis lines, they don’t trust the hospital, they don’t trust professionals, because they’ve had such bad experiences. So right out the gate, I’m not saying “Hey, I’m on here doing crisis work.” I’m more coming at it as “I’m just a person who saw what you post and I want to make sure that you’re OK.”

Miller: But you’re not saying “I’m a 14 year old who is just a peer.” You’re just omitting that information.

Castle: Yes. I still say that I’m 25. We have some people on our team that are a little bit older and may say like “I’m 24,” but maybe they’re 27, just to be a little bit closer to the youth age. Still an adult. And then on my profile, I always say that I work at a “youth crisis center.” So it’s not like I’m hiding that information.

Miller: So they can easily click on that and see who you are.

Castle: Yeah, absolutely. And then we use an alias. So I don’t use my real name. I have a name that I go by online. So people can see that I do have some experience, but they don’t know that I’m necessarily reaching out because of that.

Miller: How do you decide that the people that you’re reaching out to are the ages that you’re hoping to help? This is for young people, up to young adults, 23 or 24. But how do you decide that somebody’s that age? They don’t always say their ages, right?

Castle: It depends on which social media I’m on that day. Some social media, people do say “I’m a minor” or, “I’m under 18.” People will put a range, like on Discord it’s really popular to put a range of like, “I’m in between 15 to 18,” “I’m in between 13 to 15.” Sometimes that helps. Sometimes people will put their ages, like “I’m a 16 year old girl” or whatever.

But sometimes it’s really just picking up on those context clues of what someone’s posting about. Someone’s like “I’m drowning in homework and my parents grounded me,” stuff like that that really implies youth is really easy for me to pick up on. Even just sometimes the way that they type or the language they use, the situations that they talk about that really do have that implication of being young. There’s definitely times where I take a risk and I’ll reach out to someone and be like “I really think that they’re young, but I’m going to find out because this person still needs help either way.” So even if I reach out and they’re not a youth, which doesn’t happen very often, I’m still going to send them resources. It’s still someone that deserves help, even if that’s not what the program is for, it’s for youth. Most of the time it works out.

Miller: Angie, when you looked at five years worth of data, I’m curious, can you give us a sense for the rough percentage of people who got these messages of help from people like Genevieve, and the percentage who actually responded?

Nielsen: Yeah. So we keep track of two major statistics, and that is our response rate and our conversation rate. What we classify as a “response” is if someone acknowledges our DMs, says like “yes, I’d love to talk” or is just like “no, I’m okay, but thanks for reaching out.” We have a 60% response rate, which is unheard of for basically cold calling. If you look at the stats on just cold calling, it’s between 1% and 3% that you’ll get someone to actually respond. And we have a 60% response rate that people are acknowledging our DMs that Genevieve and the rest of our team is sending.

When it comes to conversation rate, that is when we are actually having a conversation with this person offering support and making sure that they’re OK. And that is at around 30%, which is still just absolutely remarkable.

Miller: That’s not 30% of the 60%, but 30% – almost one in three people that your specialists reach out to. They actually end up having some kind of a hopefully meaningful back and forth with this young person in crisis?

Nielsen: Yes. And it just shows the power that social media has, and that it is an untapped way that we can communicate with folks and talk about mental health. It’s kind of a new and innovative way to offer support and to help people who are really needing it.

Miller: Genevieve, what are some of those conversations like? Obviously, you can’t talk in details about specific people. But broadly, what are those back and forth like?

Castle: I think a lot of it is talking to people about feeling isolated. A lot of youth talking about not feeling understood. Our program talks to a large number of LGBTQ youth, just because LGBTQ people have always found community on the internet. And that’s like a community that posts a lot and is looking for support a lot. So I have a lot of conversations with youth about “my family doesn’t accept me,” “I’m getting bullied,” “I don’t know what’s going on with my gender and sexuality, and it’s really stressful for me and scary.”

Miller: So you have specific resources you can share with young people in those situations?

Castle: Depending on what that person is dealing with, we have a huge list of resources, and I will just hand pick which ones that person would need or want. Things like BlackLine, a crisis line specifically for Black people. That’s a resource that I think is really important. Sometimes people will identify their race as something that they’re dealing with bullying, they’re dealing with discrimination, and that’s leading to these feelings of isolation and thoughts of suicide. So those like cultural resources and resources that are really specific to your identity are really important.

Miller: Am I right that the idea here is not for you, and other people who have your position, to develop even medium-term relationships with these young people in crisis, right? This is a very short-term back and forth. So what’s it like when you have to end it? This is somebody who, they were a kind of needle in a haystack. They put out a cry for help in a void, sort of. You saw it, you reached out, they said yes I do want to talk, and then at a certain point after you give them resources, do you have to say we’re done now? How does the ending work?

Castle: It can definitely be really hard. I’ve definitely had times where I felt really bad. A lot of the times the younger youth that I’ll talk to, like 12 to 15, are the ones that will be like “thank you so much for talking to me. Can I be your friend?” And that’s really hard because that kid is feeling really isolated, and I showed them that someone cared and someone thinks that they deserve to be heard, and that’s such a special connection to make. That’s where we explain more of what we’re doing, towards the end when it comes up, like “hey, let’s talk again tomorrow.” That’s when I’ll be like, “I come on here once a week and I reach out to people that need support. So unfortunately, I can’t be your friend, but I was so happy to talk to you today, and everything you shared with me was so valid and so important. And the conversation we had today was really special.”

Miller: I should remind folks, as you noted at the beginning, this is a kind of reverse crisis line. You’re reaching out to people who have put messages, sort of urgent messages out into the world. But there is an established way for people who are ready to make a phone call and need help. If you or someone you know, is struggling, you can call or text 988 to reach the suicide and crisis lifeline. They are available 24 hours a day, seven days a week.

Angie, how is it that you were able to come up with that number – more than 160 youth suicide attempts potentially prevented or halted since this launched five years ago?

Nielsen: We take into account the context of the situation. So how did they present at first? What were they putting out there in their initial post? And then when our social media crisis intervention specialist started speaking with them, what were they talking about? What level of risk were they at? Did they have a plan for suicide or for hurting themself?

Using those cues, we kind of give them a score of where they were at when it comes to their risk level. After our intervention, then we kind of look back at what are the protective factors that are now in place. What are the things that we establish? Did we establish a safety plan? Did we identify a trusted adult that this person can go to? Are they going to be reaching out to a therapist or reaching out to YouthLine for a little bit further crisis support? That also receives a score.

Based on those two scores, then we kind of plug it into a rubric that was developed by a former social media crisis intervention specialist. And it gives us a rough idea of how our intervention helped, and what it could have prevented.

Miller: You mentioned earlier Angie that overall this program shows the potential power of social media to find people to reach out to them and to provide help. It reminded me that just a couple of weeks ago, the US surgeon general said he wants Congress to put a warning label on social media platforms stating that “social media is associated with significant mental health harms for adolescents.” How do you sort out the good from the bad, the helpful from the harmful when it comes to social media and kids in particular?

Nielsen: Whenever I speak to people about what I do and this program, I get a lot of people that immediately go to the bad, social media and how horrible it can be for some people. And I think that the good that social media is doing, the good that this program is doing and that our social media crisis and prevention specialists are doing, you kind of have to search for it a little bit. There is good that is happening out there on social media. Like Genevieve said, there is community that is being built for these young folks that don’t have anywhere to turn, who aren’t being accepted either at home or in their communities. And they’re finding community and like-minded individuals online. And it’s so important for people’s mental well being to have that connection. Social media is just one new avenue for someone to get that connection.

Yes, we absolutely have to be on our toes, and be careful about who we’re talking to and what we’re talking about. But it’s a fabulous way for people to know themselves better, and help themselves and help others.

Miller: Genevieve, in terms of helping others, you’re responding privately to these comments or posts that you find. When you see these posts, how often is it that other people have commented publicly, to do a maybe a less professional version of what you’re doing? How much community support do you actually see when someone says “I have suicidal ideation.”

Castle: I feel like I actually see more than most people would expect. These communities are really strong, and people genuinely do care and want to help people. And for the most part, pretty much everyone I respond to I feel like has gotten at least one public response from someone that’s like “hey, if you want to talk to me, I’m here” or “don’t give up,” words of encouragement. And I’m usually the one that’s doing it privately. But I can almost guarantee that most of the time there’s at least one response, if not a stream of people responding.

Miller: Angie, what kind of a relationship, if any, do you have with the social media companies – four sites – that you’re looking at? Do you have established official relationships with them?

Nielsen: So that is one of the goals of this program is to really establish a relationship with these social media apps, and also to take this program bigger, to the apps and the communities that everyone knows about: the Instas, the Facebooks, the Snapchats. Right now, even though we have reached out to the creators of the apps that we are on to let them know what we’re doing, to hopefully establish a partnership, unfortunately we haven’t gotten a response. We keep doing what we’re doing. We keep reaching out to those folks, letting them know the good work that is happening.

Miller: Do these companies have their own policies for how to deal with the exact kind of posts that you’re identifying?

Nielsen: Some of them do. However, some of them, it’s a little disheartening because they will look for certain keywords like suicide or self harm, it’ll be flagged, or maybe someone will see the post and they’ll be like, “I’m concerned about this person” and they’ll flag that post. And the procedure is send them a canned message, like “someone’s concerned about you, here are some resources.” And then they’ll delete that post. So that person who posted that they are needing help, just got their post deleted. And now no one can support them and they got kind of a canned message that’s really informal, saying like “Hey, it looks like you’re struggling. Try this.”

What we’re doing, there’s an actual person behind it, someone who cares. “I’m here to talk. If you don’t want to talk to me, that’s fine. Here are some things that you can look up on your own time. But I saw what you said and I’m genuinely concerned.”

Miller: You mentioned that you haven’t gotten responses back from these four companies, but you also want to expand this, ideally Snapchat, Instagram, Facebook. I don’t have the numbers at the top of my head. But I imagine that you’re talking about hundreds of thousands of comments or posts a day, if not more. And we’re also talking about actual human beings, Genevieve is one of them, going comment by comment, thinking hard about the context for them and the person behind them. How does this scale?

Nielsen: AI is definitely something that we’re looking into. Right now, when our social media crisis intervention specialists come in, they are searching, by hand, posts that they might want to reach out to. And because they’re working a four hour shift, a five hour shift, there’s only so many that they can respond to, so they have to pick and choose and make sure that we’re talking to people who are at the highest acuity. We’ve looked into possibly automating this procedure. And so when our social media crisis intervention specialists come in, there might be a list of posts waiting for them.

Miller: That have been vetted by an algorithm that these are more likely to be a youth in crisis. You, human, take a look and see what you think.

Nielsen: Exactly. We can look and see what we think, and be like “yes, we should reach out to this person, this person we can reach out to a little bit later in the day.” Prioritize who’s at the highest acuity, who needs our help.

Miller: Is that something that you should be doing, do you think? Or social media companies? The ones who are making money from these sites?

Nielsen: That’s a really great question. We have the training. We know what we’re looking for. And we know what those invitations might sound like. Like Genevieve was saying, it might sound like “I’m really struggling today.” It might be a little bit more vague than that. Social media companies, I’m not sure if things like that would stand out to them. That’s also a goal of this program is to possibly get connected with these creators of these apps and offer giving them training around mental health, or encourage them to factor that into maybe their onboarding or continuing education, what to look for when they are seeing these different posts on their site and how they can best handle them.

Miller: Genevieve, we heard that your response rate overall is way higher than what a cold caller would ever dream of. But even so, you and your colleagues end up having real conversations with about one out of three people that you reach out to. How do you handle the uncertainty, putting these messages of help out, and for the majority of the young people, who are pretty clearly in crisis, you never hear from them or you never have a real back and forth with them?

Castle: There’s definitely some discomfort when you first get into this work, crisis work in general. I have this interaction, we have a safety plan, and then we leave it there. Learning how to have those boundaries with yourself – “I did what I can do.” And that’s kind of become a mantra for me in my own career – “I’ve done what I can do.”

And not underestimating the power of that interaction that shows someone that community exists, empathy exists, compassion exists. Humans can work together to help each other, and that there are people that care. I remind myself that I’ve done what I can do, but also, that can be so powerful. We need to see the value in how even just one conversation can really change someone’s path. I try to just rely on having that boundary, and then also reminding myself that maybe I won’t change that person’s life, but maybe I remind them in the back of their mind, for the next few months, “Hey, that one person said this thing to me, and it helped me get through a really tough time. Maybe if I remember this, it will continue to push me down my path of recovery.”

Miller: Has doing this work affected the way you see people in real life? If you go to a coffee shop or a supermarket or a mall, and you see young people, do you think differently now about their lives because of your online work?

Castle: For sure. I definitely see things differently. I know what I went through when I was a teenager. I’m 25 now, and it wasn’t that long ago that I was a teenager. I remember struggling with suicidal ideation myself, struggling with self harm myself, struggling with my own mental health. And so I feel like I already had that perspective of going into the supermarket, like you said, and seeing everyone and knowing we were all teenagers at some point, we all know how hard it can be. So I already had that perspective of I know that every person I see has had to go through really tough times. And I know that everyone has a story that we don’t usually talk about. We don’t talk about those darker parts of mental health, very openly, casually. But I definitely think having this career in mental health and crisis work has added an extra layer of that, knowing that everyone has a struggle that we’re not talking about.

Miller: I want to remind folks one last time that if you or someone you know is struggling, you can call or text 988 to reach a suicide and crisis lifeline. Their help is available 24 hours a day, seven days a week.

Nielsen: And I just want to remind folks that YouthLine is available for phone calls, texts and chats. Phone calls, we are open 24/7, and our number is 877-968-8491. Our texting and chatting is open from 4 to 10 every single day. Our young people answer those texts and chats. Please go to theyouthline.org. It’s for everyone, not just in Oregon, aged 10 through 24.

Miller: Angie Nielsen and Genevieve Castle, thanks very much.

Castle / Nielsen: Thank you.

Miller: Angie Nielsen is the YouthLine assistant director of clinical operations for Line for Life, co-author of this new study. Genevieve Castle is a social media crisis intervention specialist with Lines for Life.

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