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In 2013, at one of the lowest points in her life, 44-year-old software engineer Greta Martela placed a call to the National Suicide Prevention Hotline. She had been hospitalized five times for being suicidal, starting at age 28, when she realized she was transgender. But she was still struggling with coming out to the wider world. When she disclosed to the counselor that she was transgender, he was confused about what that meant. Once she explained, “he got off the phone as quick as he could,” she said.
Martela went to the Berkeley, California, hospital he recommended, but the ER staff there was similarly ill prepared to work with transgender clients. “I had to argue with them about my gender pronouns,” she recalled. She was soon checked into a psychiatric hospital, where she waited for 24 hours to speak to a doctor. When she did, the psychiatrist spent less than 10 minutes with her.
“I actually did a Google search for ‘transgender suicide hotline,’ and nothing came up,” she said, recalling the experience. “I was surprised even then.”
As a Mormon teenager moving around California, Martela had run away from home and gotten involved in the Goth scene because of her parents’ issues with her gender presentation. After her experience in Berkeley, she decided to come out and begin her transition. Just a year later, she launched the first suicide and crisis counseling service created specifically by and for transgender and gender nonconforming people.
While research into transgender mental health issues is still scarce, what little there is suggests that her experience is common. Rates of attempted suicide are 35 percent higher for transgender people than among the general population, and medical services often pose additional obstacles to transgender people seeking care. According to a 2011 report based on the national transgender discrimination survey (a joint project of the National Gay and Lesbian Task Force and the National Center for Transgender Equality), 28 percent of respondents reported being harassed in medical settings, and 19 percent said they were refused care because of transphobia. Half the respondents said they had to explain to their medical provider what “transgender” meant.
“Being exposed to these further stressors when you’re at a point of crisis already can be really tragic,” said Ry Testa, an assistant professor of psychology at Rhodes College in Tennessee. “So a lot of transgender people may be leery to seek out those resources.”
Early in her transition, Martela started volunteering as an outreach coordinator for a transgender social organization in San Francisco. Her position involved monitoring the group’s 800 number and returning calls left on its answering service. She discovered that the vast majority of calls were from people in crisis who were simply looking for help envisioning life as an out, happy transgender person. Many were avoiding calling established emergency services because they suspected that mainstream organizations would not be able to help with transgender issues. “Most people are pretty aware of how [poorly] transgender people are treated,” she said.
Although Martela had no prior mental health training, she decided to do something about the lack of trans-specific emergency services. Last November, using $250 she raised from friends and open-source software she found online, Martela and her wife, Nina Chaubal, who is also a software engineer, started the Trans Lifeline (TLL).
They spread the word online and began recruiting operators from all over the country. “We had 18 operators by the end of November, but we had no idea what the call volume would be,” Martela said. On Nov. 20, the Transgender Day of Remembrance (an annual memorial for all the trans lives lost that year), Time.com published a brief article about the line. Within a few weeks, the TLL was receiving upward of 60 calls a day — far more than it was prepared to answer.
Eli Perry was one of those first callers. He had a history of depression. His partner had just broken up with him, on Christmas, and he was having trouble with his family. When he decided to call the hotline, he was so nervous, he said, that “it took four tries to actually physically pick up the phone.”
He tried other suicide hotlines before, but they left him feeling worse. Like Martela, he found himself having to explain what “transgender” meant over and over again. “It left me feeling like this person literally does not understand what I am going through,” he said.
Suicide prevention professionals have long recognized the importance of services targeting specific populations. According to Testa, tailored services are better prepared to deal with the particular stresses that callers may be experiencing and are better able to offer advice and provide a sense of community.
The Trans Lifeline has trained 160 operators from across North America and has a waiting list of over 1,000 people who want to receive training.
Julie Cerel, an associate professor at the University of Kentucky who studies suicide prevention, said that while there is no research on the efficacy of matching suicidal people with demographically similar counselors, she believes it has a positive effect. “To know that the person on the other end of the phone is someone who has had experiences similar to yours is exactly what’s needed for people who are reluctant to use more mainstream resources,” she said.
For Perry, that was one of the most important things that the TLL had to offer. “It inspired me just knowing that you can be a happy trans adult,” he said. Nearly a year later, he now volunteers as a counselor on the line.
Martela said the TLL is still in “emergency mode,” so operator training relies on a “two-hour crash course” so they can have as many people as possible working on the line. Volunteers are evaluated by a trainer, and more-experienced operators periodically listen in during calls to help them improve their skills.
From the start, raising money has been difficult. After Leelah Alcorn, a transgender teen in Ohio, killed herself late last year, the TLL received a flurry of online donations. This enabled Martela to leave her job and work full time on the line. Still, she estimated that TLL raises “about 25 percent of the money that we need on a monthly basis,” even as demand grows. In a little under a year, the hotline has logged over 20,000 calls from 5,500 people around the United States and Canada.
To date, the TLL has trained 160 operators from across North America and has a waiting list of over 1,000 people who want to receive training. Without adequate staff, however, operators miss calls every day. “We answer as many as we can, but we’ve never been able to handle the entire volume,” she said. “There’s just more need than we’re really funded for.”
The hardest part of the work, Martela said, is that occasionally the only recourse available to callers is to leave the situation they’re in. She recognizes that this is unorthodox advice and perhaps not what other suicide prevention hotlines might recommend. But this gets back to the very reason for the TLL’s existence: Its operators grasp the lived experience of being transgender in America and understand that, sometimes, starting over is the best bet.