Trigger warning: This article mentions suicide.

Two things are crucial in the world of Tracy Feinstein (59), call centre manager for the South African Depression and Anxiety Group (Sadag): that callers to Sadag’s helplines are helped with speed, compassion and effectiveness, and that the counsellors assisting them receive support and a safe space in which to grow.

Feinstein has been involved with Sadag for about 10 years, having started as a call centre volunteer with a 4pm-to-8pm shift every Thursday. Today, she manages and supports the call centre’s more than 200 volunteers.

“I know that we do make a difference to people’s lives, just by taking one call a day,” she said. “Of course, it’s not one call that we do. We’re handling over 3,000 calls a day.”

Tracy Feinstein, call centre manager at the South African Depression and Anxiety Group, started as a helpline volunteer and has been with the organisation for about 10 years. (Photo: Supplied / Tracy Feinstein)

Sadag provides mental health and suicide crisis helplines, among others. Speaking to Maverick Citizen during Teen Suicide Prevention Week, Feinstein noted that there had been a rise in the volume and intensity of teenagers calling the helplines since the Covid-19 lockdowns fell away.

“It really is, in many ways, wonderful that these teens are brave enough to reach out and get support. On the other side, it is incredibly concerning that our teens are that desperate… they are hopeless, they are feeling overwhelmed,” she said.

“It has just been… a massive increase in the number of calls that we are getting from teens, and they are younger every year… Whereas a few years ago, we might have said teens are those people that are phoning from the ages of 15 to 16, now we’re getting calls from 12- and 13-year-olds, even 11-year-olds.”

Academic stress, relationship issues and conflict with parents are some of the primary reasons teenagers call the helplines, according to Lara Ellwood (29), training coordinator at Sadag. Ellwood first started at Sadag as a volunteer in 2016, driven by the role the organisation plays in breaking down stigma around mental illness.

“I also think [teenagers are] just generally finding their fit and their space in the world. Teens are really at that point where they’re identifying and figuring out who they are,” she said.

Read in Daily Maverick: “Suicide is a global emergency and the second-leading cause of death among our young people”

Lara Ellwood, training coordinator at the South African Depression and Anxiety Group, says the common stressors that drive teenagers to reach out to Sadag include academic stress, relationship issues and conflict with parents. (Photo: Supplied / Lara Ellwood)

Kia Cordeiro (26), a social worker and Sadag’s Cape Town coordinator, identified an increase in self-harm among young people, as well as higher levels of anxiety and family issues. She has been with Sadag for three years, seeking to make mental health services more accessible for South Africans.

“There are a lot of child-headed households in South Africa. So, kids who are maybe 15, 16 years of age are now looking after siblings four, five, six years old – making dinner, making lunches, needing to come home and still study and do homework, as well as fill the role of a parental figure… there’s a lot of stress around that,” she said.

Lilah Davies, a 13-year-old anti-bullying and mental health activist, says teenagers can look after their mental health by putting themselves first and surrounding themselves with positive people. (Photo: Tamsin Metelerkamp)

People should be more open to investigating mental health struggles in younger children, according to Lilah Davies (13), an anti-bullying and mental health activist. Having been bullied about her hair when she was younger, Davies has been engaging in school talks and other programmes against bullying for the past few years.

“[Child mental health struggles are] actually a lot more common than you think, and especially mental health around social media because… at a younger age, children are being given access to social media,” she said.

“Cyberbullying is very prominent, even in things that aren’t supposed to be dangerous like online games… Online games that are supposed to be safe spaces can also have people who are just trying to be negative.”

Davies encouraged young people to look after their mental health by putting their well-being first, and surrounding themselves with positive people who support them.

Sadag counsellors encourage teenage helpline callers to approach an adult in their lives and share their situation, according to Cordeiro. However, counsellors also provide self-help techniques.

“We teach them a lot of grounding techniques, breathing techniques around anxiety… [and] also equip them with that language to be able to go to someone and ask for support or ask for advice,” she said.

Responding to crisis callers

In a crisis situation, helpline counsellors constantly navigate between gathering information about a caller – where they are, if they are alone – and ensuring that the caller feels heard, according to Feinstein.

“Especially if perhaps they have overdosed, they may have cut themselves, they may have swallowed a concoction that is not going to be good for them, we need to get them to a place of safety, and medical intervention is always paramount,” she explained.

Read in Daily Maverick: “Students and suicide – where to get help and be heard before crisis strikes”

No two crisis situations were the same, and counsellors often needed to “think outside the box” to ensure a caller was helped, continued Feinstein. Sometimes the addresses of callers were unclear due to their homes being in informal settlements, and counsellors needed to coordinate with emergency services to get them to the right places.

Counsellors might also try to get a phone number of a friend or family member from the caller, and contact them for help on the caller’s behalf.

“We have, over time, also encouraged callers to even call an Uber if that’s going to be quicker than waiting for an ambulance,” said Feinstein.

“When we are talking about a crisis, the caller is feeling overwhelmed and they don’t know how to get additional help. Our job is to make sure that we are calm, we think logically, we engage the support of the rest of the team… and we can ensure that that person… is able to get medical intervention.”

Cordeiro described the counsellors as “emotional paramedics”, responding to emotional crises.

Counsellor support

Sadag has a support team of supervisors who engage with helpline counsellors while they are on calls, to ensure there is a network of support in crisis situations, according to Feinstein.

Cordeiro recalled the first time she handled a suicide call, while volunteering from home during the Covid-19 pandemic. She asked Feinstein for help in handling the situation.

“From miles and miles away, through the phone, [Tracy Feinstein] supported me through every single step of that crisis call, until we got the person to a hospital,” she said.

Each counsellor at Sadag has their own reason for volunteering and faces their own challenges, according to Ellwood. At times, they will have to deal with extreme calls, or even health system failures – an ambulance arriving late or a clinic turning away a referral.

“We offer our counsellors debriefing. We also have a weekly support group meeting where our counsellors will come and have an opportunity to… discuss these kinds of cases,” she said.

“There’s always an ear to listen or a shoulder to lean on, and the counsellors are never dealing with these calls on their own. There’s always a team behind them, supporting them and guiding them.” DM/MC