Curbing suicide with a text

A simple text message can have a bigger impact than you may realize. Messages like this from Dr. Ursula Whiteside—and the science behind them—actually traveled decades to arrive on someone’s phone.

The story begins in World War II.

Jerome Motto, a 23-year-old First Lieutenant from Santa Barbara, California, was doing his best to survive the war. While transporting soldiers to and from combat—many of them shell-shocked or injured—Motto kept receiving caring letters from a distant acquaintance back home.

He barely knew the sender, but the correspondences kept him going. They were a lifeline for him, a kind, consistent connection while he was surrounded by the trauma of war.

After surviving his tour, Jerome became a psychiatrist and—decades before the term “post-traumatic stress disorder” came into use—started to test the impact of caring messages on people experiencing extreme mental duress, like suicidal patients.

Dr. Motto sent letters to a test group in suicide recovery that were brief and simple, like a quick text message: “Dear Paul, it’s been a while since we talked, and we hope you are well.” The other half of the group got nothing. Over the course of the 10-year study, Motto and his team determined that secondary suicide attempts in the test group were 50% less among those who received caring messages.

His study was the only experiment at that time in the United States that showed the potential to dramatically reduce suicide deaths—an incredible finding that was all but ignored by the experts in suicide prevention.

The crisis of suicide in the US

Every day, more than 132 people take their own life, resulting in 48,000 deaths per year, twice the number of homicides. Another 1.4 million people attempt suicide each year.

Despite the statistics, there are indications that suicide prevention is still under-researched and under-resourced. What’s more, it’s stigmatized. Most medical schools don’t include suicide care in their curriculum, and many religions consider suicide a sin. Historically, doctors have been known to openly tout their success at avoiding suicidal patients.

In the midst of this crisis, one clinical psychologist is using a simple tool to spread positive connections and curb suicide: the text message.

Leveraging the work of her unorthodox predecessors, Dr. Ursula Whiteside, a clinical psychologist in Seattle, Washington, has created a digital support system of suicide care unlike any other. Her vision is a world where everyone has the skills to get through the emotional fire of a suicidal moment. She calls it the “Stop, drop and roll” of suicide prevention.

“If we can do it with CPR, we can do it with suicide prevention,” she suggests.

Debunking the “phenomena of crazy people”: Radical suicide care

In the 1980s, Dr. Marsha Linehan unearthed Motto’s groundbreaking study. Universally regarded as a legend in the field, Linehan was the first person to speak loudly and passionately about Motto’s data and the inhumane treatment of suicidal patients. “People who are suicidal,” says Ursula, “we almost didn’t look at them as human, but she did. Suicidal patients were seen as this phenomenon of crazy people.”

Linehan knew that people turned to suicide for very practical reasons, like their history and biology, not just because they are “crazy.” She knew there was a way to understand it, a way to help people change. That approach was drastically different from how anyone else was treating suicide prevention.

Typically, if someone was having suicidal thoughts, they were sent to the emergency room. “But Dr. Linehan’s position,” says Ursula, “was to avoid emergency rooms and hospitals at all costs. Because once you go into the hospital, you’ve lost an opportunity to learn how to adapt to pain in the real world. Your brain is told you can’t handle pain. And that can be devastating.” Some people have a hard time ever coming back from that experience, she says.

As a child, Ursula combatted her own psychological struggles and loneliness, growing up in a family that was constantly on the move. Changing schools nine times before the ninth grade, Ursula looked for community in sports teams, the school paper and part-time jobs, but nothing ever eased the isolation she felt.

Until, that is, a professor at the University of Minnesota told her she should look into Linehan’s work. “I discovered there was research that showed how the lonely could be reached,” says Ursula, “tools that could help them, professionals who were doing things that made a difference.”

Ursula decided to go learn with the master herself, transferring at the end of her sophomore year to the University of Washington, where Linehan was teaching and researching. Ursula was drawn to Linehan’s development of Dialectical Behavioral Therapy, or DBT—the idea that everyone has the gift of wisdom and the ability to redirect suicidal thoughts into a life worth living. She stayed for almost 10 years, completing her undergraduate, masters and PhD while working with Linehan.

From the depths of despair, a new way forward

As part of the final requirement of her PhD training, Ursula took an internship in the psychiatric department of a medical center in downtown Seattle. It was in many ways a microcosm of the problem of suicide prevention. Deeply underfunded, the focus of the institution was getting patients stabilized and out the door. There were no resources to do anything else. It was here that Ursula met suicide patients from all walks of life.

Doctors could only refer patients to other clinics—which these patients would likely never visit—or place them on waiting lists for therapists. She noticed most patients just wanted kindness and were in need of serious care that they were often not receiving.

She decided to give her own phone number to the patients leaving the clinic, desperate to reach these people who were leaving without any real support or plan.

The helplessness weighed on Ursula. She spent months trying to track these patients down, to no avail. One evening she went home overwhelmed, drank a bottle of wine and hoped she wouldn’t wake up. It was then that she felt what it was like to be suicidal.

During a visit to her therapist, as she talked through the hopelessness of her work, Ursula remembered learning of Dr. Motto’s study in undergrad—those simple notes, little messages that had such a big impact. Tears came with the epiphany: Maybe this was the way forward. She set out to explore Motto’s approach in her own clinical practice, this time with a modern twist, a simple caring text message.

Caring messages and building connection

“A caring message,” she says, “let’s someone know you’re thinking of them, is non-demanding and has no judgment.” In her clinical work, Ursula uses calls, text messages, any kind of quick, friendly correspondence. “I’ll send texts of a joke I heard, a pun, a cat video, or anything they might like. Or I’ll just call people out of the blue,” says Ursula. “In fact, right before this interview, I called somebody who was having a hard time. We chatted for a few minutes.”

This approach is unorthodox. Clinicians are taught to keep “in session” and “out of session” times very separate, as to establish an emotional distance from their patients, avoid burnout and maintain objectivity.

Some are reluctant to adopt such an approach. Many clinicians practice defensively, concerned that text messages to help suicidal patients could expose themselves to various risks. Ursula takes a different approach.

“If the data is saying this is helpful,” says Ursula, “and the clients or patients are saying this is helpful” then she believes clinicians ought to listen to them. She views her approach as an evidence-based approach that often requires movement outside a person’s comfort zone.

Ursula puts measures in place to protect herself and her patients. First, her patients must agree to receive her texts. Second, they do not have to reply. But if they do, they understand that Ursula may not be able to respond immediately.

Calm. Steady. Caring.

After six years of implementing the work, Ursula has learned what can make caring messages the most impactful and effective. Things like timing and frequency. “It’s like after somebody loses a family member,” she says, “they get all the support upfront and then six months later, everyone has forgotten. But that might be the hardest time of the year for them because it’s an anniversary, or it’s a birthday. So it’s important to not just send a caring message once, but to do it across time.”

Caring messages shouldn’t be long and heavy. The casualness of a quickly written text is more personal than something scripted. “If an email or text is taking me more than 90 seconds,” she says, “I’m overthinking it. It just needs to be a simple reminder that the person is in your thoughts.”

Mentioning a shared memory is one way to do that. “For example,” she says, “‘I’m thinking of you, and I remember the time we went snowshoeing and I fell in the snow and you picked me up.’ Having that personal connection with someone who likes us and remembers us is very important, someone who doesn’t judge and just says that you make sense. That makes a huge difference.”

All the days between

For Ursula’s clients, these messages break down barriers of the rigid 50-minute sessions. The messages give them something to hold onto between sessions, often when they need it most. “Don’t stop sending them,” they’ll say.

Researchers across the world have applied similar methods inspired by Dr. Jerome Motto with significant results. In Australia, researchers sent illustrated postcards to trauma patients over the course of a year and saw a 50% reduction in suicide attempts. In Iran, sending postcards with inspirational quotes to suicidal patients had a similar impact. In Switzerland, doctors are using storytelling between patient and therapist to produce an 80% reduction in suicide attempts.

This impact is magnified when one considers the effect upon the sender. Ursula explains that caring messages aren’t only something for healthy people to send to people in pain. One of the best things about sending a caring message is the relief it brings the sender.

“I might not care at all about myself,” says Ursula. “But if I think, ‘Oh how is Rick? He just lost his mom,’ I get a little break from thinking about me. I think about him, and I get this positive impact. I encourage people to send caring messages when they themselves are suffering. It will help the recipient, and it turns out it might help the sender, too.”

Want to send a caring text? 5 things to keep in mind

Dr. Ursula Whiteside’s clinical work has shown the big impact that a simple message can have on people’s well-being, particularly those in recovery. Here’s how you can apply her work with your own community.

Specific

• Personalize your message. Reminisce on a shared memory, mention their pet, or reference their favorite teams, character or recipe.

Sans judgment

• Oftentimes, people who are suicidal are withdrawing. A caring message is not the place to ask things like, “Did you make an appointment to see your doctor?” or “Have you sent out any job applications?”

Selfless

• The caring message is meant to uplift, not burden. Be selfless with your message without expecting anything in return. Never place guilt on someone for not replying. Send a message of hope, something as simple as, “I look forward to seeing you again!”

Spontaneous

• Remember to connect when things are going well too, not just when people are struggling. People often receive an initial outpouring of support, but it can fade over time.

Speedy

• Texts and emails should not take more than 90 seconds to write. Keeping it quick makes the message more natural and genuine. If they’re taking you longer, you’re probably overthinking it.

Hacking suffering: A guide to getting through

Caring messages are a keystone of Ursula’s work, but she insists they are not enough. People need the support system to actually make change. Otherwise they’ll stay in a negative cycle. So Ursula launched Now Matters Now, a comprehensive website—and the only one of its kind—with an aim to hack suicide. “It’s a step-by-step guide to getting through suicide,” says Ursula, “techniques that have been proven in research to be effective for reducing attempts and self-injury.”

Twenty percent of visitors are clinicians who can take Ursula’s courses on suicide prevention. But the most important part for Ursula was making it free and open to everyone: survivors, loved ones, clinicians, anyone looking for answers.

Ursula and her team of experts—all of whom have lived experience—create helpful videos on the site that revolve around real stories. Like Jonathan White-Cloud Courtney, a Native American and US Army Veteran who battles PTSD and alcoholism, or Iden Campbell, a transgender male who has struggled with suicidal thinking since the third grade, survived an attempt and lost his partner to suicide. A person with lived experience can be someone who has attempted suicide, has a loved one who has committed or attempted suicide, or has suicidal thoughts.

“That person with lived experience,” says Ursula, “is going to give you a more nuanced version of how to get through it because they’ve been there. When we see someone else going through it, it lessens this internal stigma that there must be something wrong with us.”

The website is full of very simple resources for feeling better. Like the cold water method or paced breathing or tips for coming out about your own suicidal experience. They’re tried and tested by people with lived experience, and Ursula includes the scientific backing to boot. “There are these really simple things that you can do to reduce pain and suffering really fast,” she says, “but people live their entire lives not knowing. I don’t mean they’re easy to use, but they are practical tools that you can learn. That’s the idea—let’s find a shortcut. You don’t have to be in pain all the time.”

Putting out emotional fires: The stop, drop and roll of suicide prevention

Thousands of people have visited the site in what Ursula calls their hottest emotional state, their most suicidal moments. For people on the verge, Now Matters Now connects them to one-on-one help with a real human via the Crisis Text Line.

For people who want to talk, there is the Suicide Prevention Lifeline (1-800-273-TALK (8255). The Lifeline answers more than a million calls each year. But, when states are under-resourced, calls are redirected to national backup call centers that end up answering 30% of all calls, leading to longer wait times, backlogs and fewer links to local care.

“Right now,” she says, “you call a line, you wait till you get someone on the line. And then, its talking and assessing risk, but often it’s not getting someone coping tools they could use in the moment.”

The lines just don’t go far enough. So Ursula developed the stop, drop and roll of suicide prevention and embedded a video demonstration at the top of her Crisis Help page, where the most at-risk visitors frequent. “The ‘drop’ when you’re actually on fire is to drop to the ground,” says Ursula. “The ‘drop’ when you’re in an emotional fire is to put your face in cold water. It teaches you how to use cold water to manage those urges and hot emotions while you’re texting or waiting for a phone call with a crisis line or someone you trust.

“I’d like for things to be more directly helpful when you’re on the phone with a counselor,” she says, “to move from assessment of a problem to some things that you could do together. I’d like it if they had tools that helped guide that call and could do the coping strategies alongside the caller.

“Imagine you were in a crisis. You could call someone with lived experience and get immediate coaching on how to get through that crisis using proven skills like stop, drop and roll. They’d say, ‘Okay, are you in the kitchen? All right. I want you to pull out the biggest bowl you have. Oh, you don’t have any bowls? Okay. Let’s fill up your sink. I want you to turn it to cold and turn it to the coldest cold there is. Okay. I’ll wait while you do that. And in fact, I haven’t done it in a while, so I’m going to do this with you. Okay, tell me when you’re ready. Let’s do it. Now, how did it go?’

“At some point in our lives, we’re all going to have intense emotions and we will need tools to manage them. Just think of all the people that would die in fires if they didn’t know stop, drop and roll. We have no idea how many people would survive suicidal crises if they knew what to do when they were on emotional fire. It feels unbearable and people, they just don’t know what to do so they react.”

The Federal Communications Commission recently announced that it would implement a three-digit alternative—988— to the Suicide Prevention Lifeline, and companies like Verizon are working with the FCC to make this change starting in July 2022.

Suicide during COVID-19

Now during a global pandemic, these kinds of tools—always available online and over the phone—are more important than ever. “People are really, really concerned about what’s going to happen in the fall,” says Ursula. “There’s this prediction that the rates of suicide death and attempts are going to go way up. The isolation during quarantine is difficult, particularly for people who live alone or aren’t partnered during this time. We’re more reliant than ever on our phones for connection.

“There has been positive forced change, too,” she says. “We have much more flexible ways to deliver care than we have before. So it’s made it easier for the person who can’t get out of bed to get to therapy. We have to meet people where they’re at, which is on their phones and in their beds. If we’re not doing that, then we’re missing a significant opportunity.”

In honor of World Suicide Prevention Day on September 10th, Verizon is asking its employees to participate in Cycle Around the Globe, a worldwide event that encourages cyclists to log their miles between September 10 and October 10 to help raise awareness of suicide and to fund suicide prevention activities.

Editor’s note: This story references throughout the work of writer Jason Cherkis for HuffPost in his groundbreaking article, “The Best Way To Save People From Suicide” from November 15, 2018. Interviews with Dr. Ursula Whiteside, along with an article she wrote for Guideposts, also provided insights into her personal history and work.

We recognize that suicide prevention is a complex and challenging field with literal life and death considerations. While Ursula's approach is not yet mainstream, this article looks into Ursula’s unique use of technology and her compelling purpose behind it.

Know someone who’s creating a positive impact using technology and connectivity? Send us a message at story.inquiry@verizon.com. They could be next in our story series.