Sam Lewarchick, a crisis therapist with Axis Health System, is a member of the team that responds to people who call the Axis care line seeking help with anything from anxiety to suicidal ideation. (Jerry McBride/Durango Herald)
Fears of bills, law enforcement response and shame can prevent those in need from dialing 988 or the Axis care line.
By Reuben M. Schafir Herald Staff Writer, Durango Herald
Editor’s note: This article discusses suicide and may be upsetting to some readers. If you or people you know are at risk of self-harm, call or text 988, or call the Axis care line at 247-5245.
The text conversation ended with a joke – a callback, specifically, to a comment that its initiator had made about being bothered by a mouse in her wall.
The mental health professional on the other end, someone named Andy, asked: Has your trust in your own safety gotten better? It had, the woman thought.
“Sounds like you’ve got some ideas for your safety plan and reaching out to your sister for some support later on after a shower, and maybe even yelling a little at the mouse,” Andy wrote. “I hope I was able to help you feel a little more heard today and thanks for reaching out to us. Please don’t hesitate to in the future since we’re here 24/7! Take care.”
And then the conversation was over. It had lasted about 20 minutes.
At her request, The Durango Herald is not identifying the 27-year-old woman who initiated that conversation. It occurred in mid-March, and the person on the other end was with 988 – the national suicide and crisis lifeline. The woman expressed fear of facing consequences in her professional life.
Axis patient experience specialist linda devore is the first person a caller speaks with when using the care line. She collects basic information before dispatching the call to a crisis therapist. (jerry mcbride/durango herald)
On the night in question, the Durango resident was having morbid thoughts, what she called the “textbook definition of suicidal ideation.” She knew those thoughts weren’t “her,” but the strength of their vortex spooked her.
As she sat home alone in the early evening, she knew she needed to express what she was thinking to someone – and the 988 line was the place for that.
“What if they send cops to my house?” she wondered as she researched the resource.
A law enforcement response is an unlikely conclusion to a call or text to a crisis line. Some people think they will get charged (they won’t) and feel ashamed, said Molly Rodriguez, director of crisis services at Axis Health System.
All these concerns can prevent those most in need – people who are frightened by their own thoughts of self-harm – from availing themselves of critical resources.
Seven people have taken their own lives in La Plata County in 2024, said Coroner Jann Smith.
There are several lines people in crisis can reach out to. Anyone in the country can call or text 988 and they will be routed to contact centers across the country based on their area code.
In Colorado, those calls are routed to the same contact center as Colorado Crisis Services calls.
Callers in Colorado with out-of-state area codes can call the state’s hotline directly at (844) 493-8255. The national line is increasingly trying to connect those contacting the line with services in the state they are in, rather than the one associated with their area code.
Axis provides care in west and Southwest Colorado. Patients can call 247-5245 at any hour of the day, Rodriguez said.
The 988 crisis line and the Axis care line are not the same.
A law enforcement response is an unlikely conclusion to a call or text to a crisis line. Some people think they will get charged (they won’t), and others feel ashamed, said molly rodriguez, director of crisis services at axis health system. (jerry mcbride/durango herald)
“They should think of (the Axis care line) as an extension of their community resources,” Rodriguez said. “(Someone) thinking about, ‘Hey, I need to talk to somebody right now, I would benefit from having a supportive person to speak with’ – calling our line is an option. If they’re needing something emergently, I think they should be calling 988 or the state hotline.”
The Axis line is not just for people in mental health crises or experiencing suicidal ideation. Callers may be experiencing a variety of things, including anxiety, difficulty sleeping or relationship problems.
In any case, there is no singular prescribed script for calls, although call-takers do follow specific training protocols.
Stefany Busch, a spokeswoman for the Colorado Behavioral Health Administration, said in an email that 988 calls typically end at the caller’s discretion, but can take any number of avenues to reach that conclusion.
“Our goal is to help you reduce stress and feel empowered to make healthy decisions,” Busch said. “You will be asked questions regarding your safety, feelings, social situation, and if you have any thoughts of suicide. If a trained care specialist feels you are in danger, with your consent, they will speak with you about accessing emergency services, and/or gather additional contact information to ensure your safety. The trained care specialist will work with you to create a safety plan if necessary.”
When someone calls the Axis care line, the call ends up with a patient experience specialist at the front desk, such as Linda Devore.
On both lines, the people responding will ask for basic information such as the caller’s name and ZIP code.
In rare circumstances, a caller to the axis care line might end up in the acute treatment unit in durango for a short stay to address psychiatric care needs. (jerry mcbride/durango herald)
Devore will route the call to the appropriate resources, including the on-call team of clinicians. A crisis therapist, such as Sam Lewarchick, will return the call.
In 2023, Axis took 4,004 calls on the care line and has averaged 11 daily calls over the last three years.
Therapists ask both open and closed-ended questions, the former to explore the caller’s experience and the latter to gather information in the event that there is imminent risk to the caller’s safety.
“That includes the quality and frequency of the thoughts they’re having about suicide, if there’s anyone at their current location that is a support to them, where is their current location?” Rodriguez said. “And then of course, if it were to go down that track related to suicidality, working toward creating a harm reduction or restriction of access to things that could be potentially harmful.”
Those can be tough, but important questions to answer, according to the Durango woman who texted 988 last month.
“You need to tell them that really gross stuff,” she said. “I can’t call my partner or my sibling and tell them the crazy details that are in my head, because it’s shocking and it’s hard to even say.”
She couldn’t tell those close to her that if she had a firearm, she would use it. But she was scared by the persistence of the thought.
“I just had to tell somebody,” she said.
Neither 988 nor the Axis care line are connected to law enforcement dispatch directly.
That was a concern for the Durango caller who wondered if police would show up at her door.
“That was my worst fear, because then that means I lose my job,” she said. “I just don’t want to do that again.”
The woman learned the hard way that, in some places, there can be consequences for expressing suicidal ideation. As a teenager in Georgia, the woman expressed having thoughts of suicide during an appointment with a therapist. The visit promptly ended and she was escorted to a police car.
In Colorado, this is an unlikely outcome for a 988 call.
In alignment with the Substance Abuse Mental Health Services Administration’s best practices, Colorado Crisis Services care specialists contact emergency services “only in cases where risk of harm to self or others is imminent or in progress, and when a less invasive plan for the caller/texter’s safety cannot be collaborated on with the individual,” Busch said.
Art work from clients who have stayed at the acute treatment unit at axis health system decorates chrys valdez’s office window. Valdez is the nurse manager with axis health system. (jerry mcbride/durango herald)
In some cases, CCS may contact a regional provider, such as Axis, to dispatch a mobile crisis response unit. A therapist, such as Lewarchick, might meet the caller at their home or some other agreed-upon spot.
Approximately 2% of calls in the state end with a mobile crisis response, Busch said, and less than 1% of calls are transferred to a 911 dispatch system.
Unlike 911 dispatch, 988 call centers do not have geolocational capabilities, meaning no dispatch can be made unless the caller discloses their location. That cuts both ways, Rodriguez said.
“I think that there is an advantage for anonymity, for people feeling like, ‘I can call, say anything (and) no one’s tracking me,’” she said. “… And as a person who has taken calls where there is urgency, it would be really difficult to not be able to send that person help.”
“Nothing necessarily dictates the end of a conversation,” Busch said of 988 calls. “We will work with the individual until they feel secured and empowered to make healthy decisions.”
A call to the Axis care line could last 10 minutes or 90 minutes, Rodriguez said. And because it fits into a continuum of locally available care, callers have a variety of options with respect to follow up. In less serious cases, care may end with the call. In extreme cases, the caller could visit the regional crisis center for a short-term psychiatric care at the Acute Treatment Unit.
“They may have been provided with skills or steps to take to help decrease the distress that they’re feeling,” Rodriguez said. “There may even be an agreement where they’re going to get a call back in four hours.”
When the 27-year-old texted 988, the conversation ended after the mental health professional on the other end helped the woman develop a “safety plan” with a specific list of people who are supportive, calming or distracting activities, and affirming personal strengths. She carries a printed copy of it in her car now.
As the conversation ended, Andy said he hoped the woman had felt more heard. She had.
In an email to the Herald following an interview, the woman compared herself to a tree along a river, being battered by depressive waves.
“This compassionate, forgiving, and understanding help from crisis responders helps us become centered and calm,” she wrote. “Someone just listening to my feelings of unbearable suffering helped me grow stronger roots, so when the waves come I can count on how less alone I am to bear living in the river. It gets easier to stand taller. I know these waves may not stop; but I can become lasting.”
rschafir@durangoherald.com