The Crisis Text Line with Dr. Shairi Turner

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies, and all the folks in between. Let's explore what's working, what's not, and what's next. Welcome back everyone, to the Mental Health Evolution podcast where we talk about how the landscape is rapidly evolving in the mental health industry. Today we are joined by Dr. Shairi Turner, Chief health Officer at Crisis Textline. Crisis Textline is a nonprofit organization that provides free 24.7text based ment support and crisis intervention through a community of trained crisis counselors. It meets people in their most difficult moments, wherever they are. You can reach them by texting home H o M E to 741741 or through WhatsApp and web chat, both in English and Spanish. In 2025, more people reached out to Crisis Text Line than any year since its founding, with only over1.5 million conversations. The most common issues were relationship stress, anxiety and suicide. Among texters under 18, suicide was the most discussed topic. If you can let that sink in for a moment, that's a pretty significant circumstance. And nearly 2/3 of people reaching out from rural areas said they had no one else to talk to. Dr. Turner leads Crisis Text Line's public policy, advocacy and crisis supervision teams. A trained internist and pediatrician with deep expertise in trauma informed care, she has spent her career working to reach people who are often overlooked, from justice involved youth in Florida to anyone who picks up their phone and types for help. Today we are going to talk about how Crisis Text Line works, who it is reaching, and what the organization is building for the future. So as always, before we talk to our guest, we'd like to bring up some relevant articles related to our topic today. These may be helpful for listeners who want to learn more and dive a little deeper. One of the things I like about these articles specifically for today is they also have some great data points that help us kind of understand who's using this, what the needs are, and those kind of things. So the first one Here is from NPR. It's titled 988 Mental Health Lifeline Helps 5 Million in First Year. This is from July 2023. 988 is now the sort of 911-ish-number for mental health emergencies and support. And this NPR piece takes a close look at why text based crisis support works so well, particularly for young people. Counselors described receiving texts from people on public buses, from kids in school, and from people in the same room as someone who was harming them. People who simply could not pick up a phone and call. It's a useful window into the why the format of reaching out matters as much as the support itself. So that is the first article to kind of take a look at. The second article is identifying one of the underreached populations that we like to talk about. This one's from NBC News and it's called why Depression Goes Undetected in teen Boys from June 2024. And this piece looks at why boys are quietly disappearing from mental health care. Depression in boys often looks different than it does in girls, showing up as irritability, risk taking and aggression sometimes rather than sadness. And those signs are frequently missed by parents, teachers and clinicians. It connects directly to what Crisis Text Line is seeing in its own data, where boys under 14 are reaching out in crisis at striking rates. And then lastly, we have an article that Crisis Text Line published called Annual Trends 2025. And this is where we're going to dig in even more in our conversation. But this is data looking from over 1.5 million conversations in 2025, kind of synthesizing the data and taking a look at what people are reaching out about, what they are seeing among boys and men and what the data tells us about rural communities and how their volunteer counselors are contributing real economic value to an already stretched mental health system. It's the most direct window into the work Dr. Turner will be talking about today. So we will have all of those links for you in the show notes. But together, all of these pieces bring up the same reality. The need for mental health support is growing and the people who need it most are sometimes the hardest to reach through traditional channels. And that's where this idea of text based platforms are meeting people where they are. So, Dr. Turner, welcome to the show. We're really glad to have you here.

Thank you, Rachel, thank you for summarizing just a very, very important topic.

Agreed. You know, and I think it's interesting as someone who's been in the mental health industry for a long time, for a long time, there was a thought that you can't text and provide mental health support. And I think counselors, social workers, psychologists are often still trained in that. And so what I love about what you are doing here is kind of talking about how we actually can and how we can utilize this in a way that can also reach people. So let's kind of dive in. What actually happens? I know I described in the intro someone can literally dial 741741 in their little text bubble of the two line, right? And then they just type the words home, H O M E and they hit send. What actually happens next?

Right. So they text in their main area 741741 and then in the first message they'll text home. And once they do that they are connected to crisis text line. They will receive an immediate message just acknowledging that the text was received. Then they will receive our terms of service and then they will be connected to a live volunteer trained crisis counselor who will start by asking what their crisis is. Right. So helping them to identify what the crisis is so that the volunteer can then engage in a series of steps towards de escalation. So taking the hot moment to a cooler calm through identifying the crisis, helping the texter to talk about their coping strategies and ultimately de escalate the conversation so that they can close out and give them some resources. The key is really well, first of all, the volunteer has gone through a 15 hour training. So they are trained in de escalation every conversation, even if someone is texting in about their homework or relationship as young people often do, the conversation that the volunteer knows how to in a clear and kind way assess for suicide risk. So we never want to miss someone who in the background is having suicidal ideations or thoughts of suicide. So through every conversation the the an assessment of suicide risk is made. Once the volunteer is certain that there is no imminent risk of suicide, they continue with the working on coping strategies and deescalating the crisis itself. We say a crisis to you is a crisis to us. So our volunteers are prepared for anything that a young person or any person texts in about. And lastly, every conversation is supervised by a mental health professional who is on our staff, paid staff person who monitors the conversation and assists the volunteer, ensuring that the texter gets the highest quality conversation.

Yeah, so if I can rewind for a second the part about the terms of service stuck out for me because I think that's really important. Right. In our field we talk about informed consent and so can you talk a little bit like high level about what's in that terms of service that people are agreeing to before they start texting?

Yes, the terms of service. Well actually Rachel, I don't have the terms of service memorized. We have updated them. So.

So but generally it's. Is it similar to what might be an informed consent for counseling, service, limits of confidentiality, that sort of thing.

Yeah.

Okay.

So generally it's purposefully because some of our texters are younger, we have a terms of service that is as simple as and as basic as possible. Yeah. So that the texter knows that the information is confidential and anonymous and that you know that there are insights that are utilized by crisis text line.

Yeah. And then that leads me to. I love all of the training and the supervision and the de escalation. I guess one of my questions is maybe what happens if someone is not able to de escalate via text? What are your options then?

Yes, that's a very important question because last year 2025, as you mentioned, we had over 1.5 million conversations. About 1%, only 1% were, were not able to be de escalated. So what? That does show.

Wow.

Yeah.

That is incredible.

Yes. So only 1% went on to an emergency service intervention which speak.

Wow.

The efficacy of this text based crisis support.

It sure does. It sure does. I would not have expected that.

That's very cool.

Yeah.

Again, it's a tried and true way to support people in their moment of need. It's in the moment support. That was originally when we first developed our training. It was based on the telephonic hotline model of training and de escalation. So it is the foundation was there when we began. And one of the keys to what we do is that we teach our volunteers how to engage in active listening and collaborative problem solving through text. So through the text, through the words that they use and the way that they reflect back to the texture helps them to really demonstrate empathy which is, which is key to the work that we do.

Yeah, that's great. I think I got you off track. If we circle back to the 1% only, which is a phenomenal number of people that might need additional support, how does that happen?

Right. So if someone, if the volunteer crisis counselor in collaboration with the mental health professional staff are not able to de escalate the conversation and the person is at imminent risk of suicide, then at that moment the, our mental health professional staff will take over the conversation. So meaning no change in the experience for or communication on the side of the texter. But now the mental health professional staff is leading the conversation. So they will ask and let the texter know that they are concerned about not being able to de escalate or safety plan with the texter and collaboratively ask to do a wellness check, essentially, which means reaching out to first, asking for the texter's address, location, and then reaching out to the local PSAP Public Safety Access Point, better known as a 911 call center, and working with the call center to dispatch local resources for a wellness check. So that would be, in ideal situations, a mobile crisis unit or EMS or law enforcement. And that's really very dependent upon what resources are available in the textures community.

Right, right. Okay. And so that also does depend on the texter being willing to give their address and location.

Yes, it does. We are able to. In those instances where the texter is not able to give their location, and we feel like it is very much of an imminent risk of suicide for the texture, we are able to work with that PSAP and the local network. So the phone network to locate the texter and send, you know, wellness check. Or a wellness check.

That's great. I'm curious about some of the etiology of this idea. I don't know if you can speak to how this organization sort of came to be and where this idea of text intervention came from.

The founding story. Yes. So our founder was previously the CEO of DoSomething.org and DoSomething, for those who know, do something back in the early 2000s, mid 2000s, they're a volunteer organization, and they were using text to really mobilize young people to join together in volunteer efforts. So it was very much of an outgoing text platform. So they would send out messages about volunteer opportunities. Well, what happened was there was an instance where someone texted back in, a young person texted in, and as the story goes, this young person reported sexual abuse by a parent, and they were asking for help. And it really sparked a moment for the founder of crisis text line, because the thought that a young person had nowhere else to turn but to really an unknown platform, not knowing who was on the other side, but reaching out for help in the moment, it still gives me goosebumps because it speaks to just the level of desperation and the need that can exist for young people even in their own homes. So that sparked the idea to look at text as a means of support, because what. What that instance showed was that text is quiet, it is confidential. It allows for the ability to deal with a crisis silently in a way that no one else might be aware of. And that's still the case. And one of the main reasons I. We believe text and crisis text line appeals to young people because you can be anywhere. Your bedroom, your classroom, you know, for people who are working. You can be in the boardroom and receive in the moment support, and no one has to know.

Yeah, yeah. And I feel like some of the data that you share in that report, the annual report from 2025, is so interesting. I mean, it tells you that people are carrying. I think you said relationship stress, anxiety, and suicide were the top issues.

Which.

Which doesn't surprise me at all. That seems like what. The things that a lot of us carry. Right. In some way or another. And then people in rural communities were a big group, 2/3 of people that are reaching out to you, which again, speaks to just maybe where there aren't as many resources or where there aren't as many obvious like mental health clinics or whatever else to be able to go to.

Yeah, access. Access is still very much of an issue. And whether it's geographic isolation or provider shortage, you know, in some rural communities, the number of providers versus the number of people in need is disparate. And then insurance, Right. So some providers don't take insurance, some people don't have insurance. So those three things really contribute to a gap in care and coverage and service. And, you know, people who are in need and in pain and in crisis, we have to bridge that gap. And being able to provide a free mental health support, no matter where you live, in a moment of distress for people, is huge.

It really is. And I'm also really struck by your volunteer counselors. Like, the number was 700,000 hours donated.

Yes. Our volunteers are the heart and soul of the work that we do. Obviously, each of them is supervised by mental health professional staff, but they come from all walks of life. Really. The only requirement is that you are over the age of 18 and that you take the training. But our volunteers come from all professions and they are just some of the most giving individuals day and night. They are staffing our platforms and providing this service to people who are in need. And, you know, we're not a, you know, formal mental health system, and we're not trying to be, but we are able to, through. Through the help of these incredible volunteers, we are able to bridge that gap and provide that immediate support in a moment of need. And our volunteers are just incredible with the lengths that they go to supporting texters and the community they build as volunteers. We have a very robust volunteer community.

I mean, clearly, yes, that's a lot of hours you bring up something about the mental health system per se, and I hear how you connect to the crisis system. Are there any connection points for your organization to referrals, maybe for people that aren't in immediate crisis but could benefit from ongoing services? How does that piece kind of work in Your organization?

Yes. So we don't have direct referrals, meaning if I'm living in New York City and I text into crisis text line, we do not have the capacity to refer you to a specific clinician. One of the reasons that we don't do that is because we really are committed to, to staying anonymous and not gathering any personal health information that would include insurance information.

Right.

So that what we do provide from a very rich and robust database are resources. So resources that are relevant to relationship issues, bullying, suicidal ideations, stress. So those resources are links that the volunteer will text to the texter so that after the conversation is over, they have something to go back to that was relevant to the conversation. And we have 700, 800 different resources that are nationally available. So we really are very committed to not gathering personal health information or insurance information. So it's not part of our model to, to refer to like a specific clinician.

That makes sense. I like that. I like those resources so that, you know, in a moment of crisis, a lot of people are not going to retain whatever or discussed for, for good reason. It's the way the brain works. And so I love having those as an afterward, like can go back and review. So, yes, additional support. That's fantastic. I'm wondering, as we're just about out of time, if you had one thing that you sort of wanted to leave our listeners, whether they are clinicians or business owners or people that utilize mental health resources themselves, what is the one thing that you want people to know, that you want people to be left with from this conversation today?

Well, one, I want them to really understand the depth of, of the mental health issue for young people through our men and boys report, through the articles that you referenced, that there is a silent epidemic among our young men and boys. And we have a hundred men dying by suicide every day, and that is four times the rate of women. And that has been rising steeply for decades. And what it's important for us to know is that we are seeing this in our conversations. Nearly one in three boys under the age of 14 are reporting suicidal thoughts. And that suicide presents differently in men and boys. It can present as anger, impulsiveness. So it's not the classic that we sort of attribute to young women. You know, there's a teariness, there's a, you know, there can be irritability as well. But we often miss the signs in our young men and boys, and we're losing them because of that and because it's seen as a sign of weakness to ask for help. So I would say ask young men and boys how they are doing if they are having thoughts of death or dying. Because I want to point this out, the data, our data and other data show that asking someone in a clear and kind way about thoughts of death or dying or self harm will not prompt them to attempt suicide or try to harm themselves. But in that moment, that can be a life or death moment and you do not have to be a therapist to ask those questions.

Right?

You can then proceed to say let's get help, let's find help, let's text crisis text line together, right? Because I think one of the hardest things for anyone who's dealing with depression or anxiety is to potentially elevate a conversation about self harm or thoughts of death and dying. And I believe for our men and boys, given these statistics and given the mentions of suicide that we are seeing in young boys that we have to, it is mandatory that we start having these conversations across the dinner table in groups. You know, where dads and sons like are are able to get vulnerable because it's critical because if they're not acknowledged able to acknowledge it, then they're definitely not going to get services. Sharing Crisis text line Texting home to 741741 is a resource for every men and boy out there.

Thank you so much for bringing awareness to populations that don't always have the support that they need for providing access and just for spreading the word. So thank you for sharing your time and being willing to be here today. Dr. Turner thank you Rachel and for our listeners. We hope you enjoyed this episode and hopefully you can find a way to share this with someone in your life. Stay tuned for our next interview where we explore everything that is changing about the mental health landscape on the Mental Health Evolution Podcast. Thanks for listening.