Helping Mend Minds
With mental health emerging from the shadows, INTOUCH examines the support and counseling work of TELL, the beneficiary of the Women’s Group’s Carpet Auction on February 2.
Read a hundred stories on mental health in Japan and you’ll see the same disembodied declarations a hundred times: startlingly high suicide rates, low access to affordable treatment and an oppressive stigma on discussing the topic at all.
Those stories rarely reveal what Selena Hoy sees on a regular basis.
“I’ve heard from people who’ve said, ‘I want to kill myself, but I can’t call the ambulance. The neighbors might see,’” says the outreach coordinator for TELL, a support and counseling service in Japan.
Hoy oversees TELL’s promotional events, including pub trivia nights, nature hikes and anything else that connects people and sparks conversations on mental health. When she presents at international schools and colleges, Hoy is often the first person many students in Japan have ever heard speaking openly about living with a mental illness.
“Sometimes the kids are pretty silent,” Hoy says of the stigma against the very discussions she tries to encourage. “Later, some of them will come up to us when it’s one on one. They’ll e-mail me or they’ll talk to a teacher. Even if we can’t see it, it’s progress.”
Progress, however incremental, is TELL’s mission. Founded in 1973 as Tokyo English Life Line, an English-language crisis hotline, TELL has expanded over the years both functionally and geographically. Clinical support is available at the head office in Minami Aoyama and at a center in Okinawa that opened last year (a branch in Kyoto will open soon). In addition to the phone Lifeline, trained nonclinical volunteers staff a chat-based service from computers across the country.
TELL’s original purpose remains. Every day, from 9am to 11pm, the Lifeline is live. Every Friday, Saturday and Sunday, from 10:30pm to 2am, chat volunteers help people through the night.
Hoy’s evangelism is part of a wider effort that has seen Japan’s annual suicide rate drop by more than 13,000 over the last 15 years. In 2017, however, authorities reported 250 suicides of elementary, middle and high school students, the highest in three decades.
With 50 percent of all mental health problems manifesting before age 14 and 75 percent by the age of 24, explains Vickie Skorji, TELL Lifeline director, there remain sizeable challenges in the very conception of mental health stewardship.
“Every parent probably goes out and buys a book on the physical health of a child,” says Skorji. “What parent has a book on mental health problems?”
Theories abound as to why conversations on mental health make so many so uncomfortable when the same discussions about physical illnesses give very few any pause at all. According to Billy Cleary, TELL’s clinical director, supporting someone with a mood or anxiety disorder requires a skill in increasingly short supply: unconditional empathy.
“If we can put away our own fear of our need to fix or solve and work more though the channel of empathy,” Cleary says, “that person will more likely feel like someone’s right there with them. But there’s often an ambivalence about being able to do that. It’s very challenging.”
These are skills Japan, the United States and societies everywhere struggle to encourage, but the Lifeline volunteers put them to use every day.
In 2018, just shy of 9,000 people dialed the Lifeline or logged into TELL’s overnight chat. Whether they were isolated English teachers, homesick trailing spouses or frustrated Japanese returnees, all had no idea who would answer when the ringtone stopped or the chat window blinked live. But when it did, there was always a TELL volunteer on the other end.
They are American, British and otherwise. Some are in their 20s, others are well into their 50s. They are Japan’s teachers, computer programmers, part-time workers and stay-at-home parents. But when they answer a call or a chat from someone in crisis, who they are is irrelevant. All that matters is that they are there and ready to listen.
“People just want to be heard and feel like their problems are being understood,” says one anonymous volunteer (in accordance with TELL privacy policies, volunteers cannot be identified).
The Lifeline may not be staffed by clinicians, but they are far from amateurs. Every volunteer has completed a nine-week, 69-hour crisis counseling training program. The client-centered method trains volunteers “in empathic listening, not in advice giving.” TELL training documents describe successful volunteers as those who “can respect others’ views and can refrain from imposing their own personal values, beliefs and ideas on others.”
In other words, volunteers must never offer suggestions, solutions or advice.
This is instrumental to the success of a crisis hotline, according to Skorji. Advice would introduce a volunteer’s prejudices. In addition, seemingly constructive guidance can make callers dependent on a helpline or exacerbate an already critical situation.
“That’s why friends can’t be counselors—or family members,” Skorji explains. “A role as a counselor or support worker on the line is very different.”
TELL’s volunteers describe this as one of the more difficult skills to master. During seminar, role-play and discussion sessions, volunteers’ well-intentioned instincts are replaced with the responses of a trained crisis counselor.
“It was tough mentally and emotionally opening yourself to new skills and ways of looking at life,” says one volunteer. “But totally worth it. I don’t see my role as being someone who ‘fixes’ other people’s problems.”
People who reach out to TELL inevitably ask for advice, and volunteers must steer them toward a more helpful path.
“My role is to listen, be supportive and help the caller understand their own situation to the extent where they can make the best choice by themselves,” says a volunteer.
Despite contacting TELL of their own volition, some people are unwilling to open up to a stranger. In other cases, callers in evident distress hang up abruptly or disconnect their chats without warning.
“That never feels good, even if it turns out to be a connection issue,” says one volunteer. “All I can do is ask myself what I could have done differently and then try to do better the next time.”
After a sudden disconnection, multiple volunteers say they need to take a moment and a few deep breaths before accepting the next call or chat. Many imply they imagine the worst.
“I keep the phone off the hook for a bit after abrupt hang-ups,” says another volunteer, highlighting the emotional toll of the work.
But for the calls and chats that go well, progress is relative. For those whose first attempt to seek help is through the Lifeline, any positive development—a plan to access treatment, a coping strategy for the next episode or simply an improvement in mood—is a success.
“Ideally, there would be a sense of progress, big or small, in the caller’s situation,” says a volunteer. “That they understand something more about themselves or their situation than they did at the start of a call.”
“It’s also down to us realizing that therapy and counseling are not ‘quick cures,’” says another. “Healing takes time, just like with any physical injury, and there can be scars that last.”
For more than four decades, TELL has helped thousands begin the healing process. And it’s done it without guaranteed financial support.
In Japan, nonprofits are entitled to reimbursements only for purchases for which they can produce receipts. That means the salaries of all paid employees, including the team of certified clinicians, must come from TELL’s coffers. The electricity that keeps the phones running is also ineligible for government funding.
In recent years, avoiding insolvency has become a troublingly regular mission for those running the nonprofit. Were its volunteers paid even a token fee, it is unlikely TELL would be operating today.
At this month’s Carpet Auction, hosted by the Women’s Group and Eastern Carpets, Members can do their part to help TELL literally keep the lights on. For the first time, proceeds from this annual fundraiser will benefit TELL.
“It’s vital to support TELL to continue helping so many people in need,” says Tomomi Fujita, the Women’s Group’s director of charities. “Despite affluence, gender, age or race, mental illness could be a serious problem for anyone.”
And each day the phones and chats stay open is another chance for TELL to possibly save a life.
“That’s often the biggest hump for people to get into therapy—that initial call or initial e-mail,” Cleary says. “But don’t wait. Make the call as soon as you can.”
Words: Owen Ziegler
Illustration: Odding Wang
February 2 | 4:30–10pm