Feeling her anxiety rising, a Minnesota woman picked up the phone. It was the middle of the night, and she was certain that the handful of friends and family members she was comfortable talking to about her mental health were all fast asleep. She didn’t want to wake them up and risk straining their relationships, especially since she thought her loved ones were getting tired of talking her down every time her worries started to escalate.
So the woman made another call, to MN Peer Support Connection Warmline, a statewide phone line set up to support people experiencing emotional distress. A step down from a suicide-prevention hotline or a crisis line, a warmline typically provides information about mental health resources or, more often than not, a sympathetic listening ear in a tough time.
Jode Freyholtz-London, founder and director of Wellness in the Woods, the Eagle Bend-based nonprofit that recently took over operation of the statewide warmline, explained that the caller was seeking reassurance and support.
“She said, ‘I am just extremely anxious,” Freyholtz-London recalled. “We asked, ‘What have you done before when you were anxious? She said, ‘I sometimes end up in the emergency room.’”
These kinds of calls aren’t all that unusual, Freyholtz-London said. One of the goals of a warmline is to help a caller in distress think about practical options for treating their mental health concerns — to avoid more drastic measures like a trip to the ER when a more practical solution might suffice.
If a warmline operator senses that a caller is in the middle of a serious mental health crisis, they will connect them to a crisis line, Freyholtz-London said: “That is not what we’re about. What we are is a listening ear. We have people who call and talk to us about anything, including grieving the loss of a family member or just how hard the holidays are. Our job is to listen to our callers’ concerns.”
After hearing the caller’s story, the MN Warmline operator asked if she had other options for working through her anxiety. The caller said she could go to the nearby 24-hour gym, but she felt nervous about walking there alone.
“She asked the operator,” Freyholtz-London said, “’Could you stay on the phone with me while I walk to Snap Fitness and work off my anxiety? Then I can I call you back when I’m done and you could stay on the phone with me when I walk the three blocks home.’”
The operator agreed to the woman’s plan. “And it worked,” Freyholtz-London said. “When the woman called us back, she had worked through the anxiety and she was ready to go home and go to sleep.”
A new statewide option
Wellness in the Woods has been operating a warmline in Central Minnesota since 2016. In early 2019, the Minnesota Department of Human Services (DHS) awarded the nonprofit, which uses a peer-focused approach to advocate for people with mental illness, a three-year, $300,000 annual grant to turn MN Peer Support Connection Warmline into a statewide service. This meant hiring up to 20 staff members, adding new technology and expanding the service’s outreach to underserved communities across the state. The statewide service has been available since Sept. 1.
MN Peer Support Connection Warmline operators are available seven days a week from 5 p.m. to 9 a.m. All calls or texts to 844-739-6369 are directly routed to Warmline operators. All calls are confidential.
“We asked people who were potentially going to use the warmline when would they would be most likely to use this service,” Freyholtz-London said. “They told us, ‘We want this service overnight. That’s when we don’t have anyone to call.’ For many people with mental illness, nights get lonely.”
Two-thirds of the grant proceeds are used to cover staff payroll, Freyholtz-London explained: “All of our folks work from home. They make $15 an hour with a stipend for their cellphone and paid training time.”
When the warmline moved to a statewide service, Wellness in the Woods staff braced themselves for a significant increase in call volume.
“One of the things that was a concern was once we became the statewide warmline would we get an overabundance of phone calls,” said Warmline Coordinator Carrie Jonson. So far so good: “Even though we’ve seen quite an increase in the number of callers, so far we’ve done well with not feeling stretched.”
The increase has been significant, Freyholtz-London said. “In July, before we had the [statewide] contract, we were getting 300 calls a month. Now we are getting about 900 calls a month.”
Freyholtz-London believes that MN Peer Support Connection Warmline is successful because it is staffed by peers. The majority of the service’s phone counselors are certified peer support specialists, individuals who have personal experience with mental illness and have completed a state-sponsored program to become direct-service mental health staff.
“We named our warmline the ‘Peer Support Connection,’” she said, “because we wanted people to know that it is staffed by peers who have been through an experience with mental illness.”
Since being granted the DHS contract, Wellness in the Woods has been working hard to recruit certified peer support specialists to work on the MN Warmline. “We go to peer support specialist graduations around the state,” Freyholtz-London said. “We invite them to apply for the position.” Recruitment efforts have been focused on members of underserved communities.
While all MN Warmline counselors have personal experience with mental illness, not all are certified peer support specialists. Freyholtz-London said that her nonprofit is working to change that.
“Our goal is within the first year, of our 20 staff, 75 percent will be certified peer specialists,” she said. “Right now we have a number of staff who aren’t peer specialists but would like to be. I asked DHS to bring a peer support specialist training to central Minnesota so more of our staff could take part. We have one scheduled in Brainerd in May.”
Wellness in the Woods was founded on the idea that people who have experienced mental illness are best qualified to provide services to others with mental illness.
“All of our board members and staff are living in recovery,” Freyholtz-London said. “We are 100 percent consumer run. We are the largest organization that says we’re the voice of people with a lived experience. That’s what makes us different.”
Johnson said that callers appreciate hearing that MN Warmline operators have personal experience with mental illness.
“Our main objective is to be a peer who is a listening ear for people,” she said. “We’re there to encourage them. We’re there to help lighten the load and help people stay in recovery and never need other services.” That peer-to-peer approach often feels comforting and empowering, Johnson added: “A frequent response we get from our callers is, “It’s just nice to know that somebody else has experienced the same thing.’”
People with lived experience can provide a level of insight that isn’t always readily available in traditional mental health treatment, Freyholtz-London added. Warmline users say they can sense the difference.
“A lot of people who call us say they just want to know that somebody else is out there. They say, ‘I’m glad to know I’m not the only person who is experiencing this.’”
Outreach to underserved communities
Part of the DHS contract stipulates that MN Peer Support Connection Warmline promote itself to communities across the state that have limited access to mental health services, including immigrants; the LGBTQ community; tribal groups; the elderly; and rural residents, particularly farmers.
For Freyholz-London and her staff, this means traveling to meetings and events around Minnesota, speaking to groups and handing out wallet cards and postcards with information about the warmline and its services.
Freyholtz-London said she has been working particularly hard to make inroads into the state’s Native American communities. “We went to the Native American Opioid Summit in Cass Lake and passed out information,” she said. “We have partnerships with the White Earth Tribal College.”
Another good sign is an invitation to present in January at the Native American Mental Health Advisory Council. “I’m honored that we have been invited into the Native American community,” Freyholtz-London said. “It has been a long journey of building trust.”
With a goal of recognizing different cultural attitudes around mental health, MN Warmline operators all complete a mandatory cultural awareness training program.
“We have in-person and virtual training as well as cultural training,” Freyholtz-London said. “How do we support individuals from other cultures who are calling in?”
Increasing awareness among MN Warmline operators is key to the program’s success with underserved communities, Johnson said.
“We wanted to make sure we are being inclusive to everyone in the state of Minnesota. With certain cultural groups there is a stigma overall around dealing with mental health. With some of these cultural groups, it can be very shaming to say anything about needing help. There can also be a secondary stigma if they come to a new country and feel like they need help. It can be a double barrier. We want to make sure that we are reaching people who need our help, to make sure our staff understand these barriers and how to best help someone who is struggling with them.”
MN Peer Support Connection Warmline has assembled a cultural advisory committee staffed by people from the target cultures they wish to serve, Johnson said.
“We have a committee of individuals from all different cultures, from the LGBTQ community, from the African and Asian communities. Our goal was to figure out how can we train our operators to be culturally sensitive, how can we best serve the different communities? Members of the committee are giving us guidance on that, as well as what community events to attend, where to put our cards and who to talk to.”
In an effort to make the service available to callers with limited English skills, MN Warmline is adding a software program that can translate calls into many commonly used languages. The program is scheduled to be up and running by Jan. 1.
The translation service works when callers indicate their language preference by selecting a specific telephone extension, and the translation system automatically kicks in, simultaneously translating the conversation between caller and peer support using a computerized voice.
“They do a pretty good job of not having it sound robotic or monotone,” Johnson said.
Practical and cost effective
While it takes money to staff a warmline, in the end the goal is that the service will more than pay for itself in reduced emergency room visits, police calls and hospitalizations. Stacy Twite, DHS interim assistant commissioner, said that a warmline is a safe and supportive place for callers experiencing emotional distress to talk to a caring person.
“The line provides a cost-effective and nonintrusive, voluntary way to help people who are working through a mental health challenge,” she said.
Like the anxious woman who asked a warmline operator to stay on the line with her while she walked to the gym, many callers are able to avoid more costly services after spending time on the phone with a supportive peer.
“Without support services such as the warmline, some people might find themselves having to call a crisis team or go to the hospital, when in fact they would have done well with a lower level of care,” Twite said.
Johnson said that MN Warmline operators often hear that their conversation helped to head off a more drastic action. “There have been some callers who said that if they hadn’t called Warmline they might have attempted suicide, gone to the ER or called police,” she said. “We are helping to alleviate those steps by helping them to stay well and practice self-care. We are helping them to not utilize the resources that they don’t need.”
Often a listening ear is all callers need, Johnson added.
“We get comments from callers like, ‘the warmline is my safety net,’ or ‘I’m so grateful for you guys. This is what I need to get me through the day.” One frequent MN Warmline caller seeks grief support after losing a son to suicide several years ago: “Certain dates are triggers for her. Her family is supportive, but they’ve also told her to that she needs to move on. That makes it hard for her to feel supported. She’ll call us and say, ‘I’m having a hard time getting started. Can I talk to you?’ At the end of the call, she always says, ‘I’m so grateful for you all.’”
Research backs up the idea that by providing direct, understanding conversation and connections, warmline calls can provide much-needed support and help reduce costs, Twite said.
“National research shows that warmlines can prevent trips to the local emergency department. One study found that callers saw a reduction in both the use of crisis services and feelings of isolation. They also found that keeping telephone lines open after 5 p.m. was especially helpful, as they were available after most office hours. Having the right services at the right time means people can use the least intensive and intrusive services resulting in better care and lower costs.”
While keeping costs down is important, Johnson said that she believes that the most important impact of warmline services is triggering the larger wave of support that can occur when one person helps another make it through a difficult time.
“At the Warmline, we’re making a difference when we help other people through their struggles,” Johnson said. “When we help others, that in turn encourages them to help other people. We’re hoping to create a ripple effect with the work we do toward keeping all Minnesotans well.”