Editor’s note: This story includes the mention of suicide and its impact on a community. If you or someone you know is having suicidal thoughts, you can reach the national crisis hotline at 800-273-8255 or by dialing 988.

Erin Brooker Lozott (Photo courtesy of the Els for Autism Foundation)

Erin Brooker Lozott has worked in the field of autism and mental health for 29 years. She answers calls from people in crisis every day. But she never expected the call to come from someone in her own family.

“When that happens to somebody that you care about, it doesn’t matter how well trained you are,” she said.

Before last year, Lozott said it would have been harder for her to help that family member. But with the new 988 number for the National Suicide and Crisis Hotline, she has options.

“Once you call 911, if a police officer comes to your house, whether it’s a non-emergency line or the emergency line, your ability as a parent to make a decision, if you want to change your mind, it stops,” she said.

Lozott currently works as a program director for the Els for Autism Foundation, a global nonprofit dedicated to providing services to people with autism, including speech language therapy, occupational therapy and mental health counseling. Her voicemail, as well as the voicemails of all mental health employees at Els, includes the 988 number.

“Knowing that something that’s constant like a 988 for anybody, no matter where you are in the country, is available when that cycle comes to a head and you just need that space and that person to have no judgment and to be able to call and feel that you can have a place to get help, is significant,” she said.

988 went live in July 2022. Since then, the national hotline has received almost 5 million contacts, up 33% from the previous year.

Director of the Alachua County Crisis Center Alexandra Martinez said in the months leading up to the number change, the county was preparing for an influx of calls. But along with the new number, the national hotline also implemented location-based routing changes that actually decreased the number of calls the county got from 988 in the first year, from 11,563 to 9,850.

“However, we did see about 20 to 25% increase in May. So, we think now that the routing changes have kind of settled out, we will start seeing what will end up being true to our area and our crisis center,” Martinez said.

Martinez emphasized the hotline isn’t just for those experiencing suicidal thoughts. Even those just having a really stressful time can call and talk.

“Oftentimes, the misconception is that people are calling looking for an exact answer, when for the most part people are just needing somebody to listen and really give them their full attention and give them validation about what they’re going through and give them a sense of connection,” she said.

Mellonese Mayfield, director of the SMA Healthcare crisis response team, said her center also didn’t see a huge uptick in calls after the number changed.

“We’ve worked on other initiatives within our community where everyone says, ‘Oh, you’re going to receive a lot of calls’ and we do not. So it doesn’t always necessarily mean because something has changed that it’s going to actually impact us in such a dramatic way,” she said.

SMA has a mobile response unit that responds to mental health emergencies in Marion, Volusia, Flagler, Putnam, St. John’s and Citrus counties. The national hotline will sometimes patch local callers through to them if they need more specific help, but Mayfield said there’s a catch.

“With 988, the callers are anonymous,” she said. “They can choose if they want to divulge their name and information and location and all of that.”

If the caller doesn’t disclose that information, Mayfield said it creates a barrier to care.

“It makes it a challenge when you’re wanting to assist someone in the community and you do not have all the information that you need in order to reach them,” she said.

And it’s not just the anonymity that mental health experts take issue with. Lozott said there’s still more work to be done to train 988 hotline workers on how to help people with autism.

According to a press release from the Autism Society of America in 2022 regarding the 988 hotline, “30% – 40% of people with (intellectual and developmental disabilities) are likely to have co-occurring mental health disabilities.” For people with autism, that number increases to 70%.

The Centers for Disease Control also reports that adults with disabilities are over three times more likely to report suicidal ideation compared to those without disabilities.

“I still feel that more autism specific training to the hotline, the people working at the hotline taking the calls must occur because autism is so complex and unique to each individual person,” Lozott said.

In her ideal world, Lozott said 988 would have a video call option for people with autism to be able to pick up on more nonverbal cues.

“You already have a hard time processing language, and now you have a hard time with social communication, and you’re on the phone, and you can’t even have the opportunity to pick up on someone’s nonverbal cues, their social language, their gestures, and you’re trying to explain to somebody on the phone that you don’t know that you need help from a suicide standpoint,” she said.

But until then, Lozott is happy she has the option to call if she needs it.

“Moments of suicidal ideation are going to kind of pop up, they’re going to kind of show their face and emerge from this world. Everybody could, the person could feel perfectly fine and happy. And all of a sudden a wave of depression kicks in that is just too much to not fall off the cliff,” she said.

“No one ever forgets 911. No one ever forgets 411. And now, no one will ever forget 988.”

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Empathy, the ability to emotionally understand and feel what others experience, has been identified as a critical skill in a variety of settings such as leadership, healthcare, and education.

The emphasis on the cultivation of empathy is understood. Caring about others benefits society. Empathy serves as a catalyst for altruistic behavior, which reinforces prosocial behavior and reduces human suffering. Without empathy, our world would collapse into a scary abyss where violence and dehumanization prevail.

In addition, empathy is therapeutic. Feeling seen and heard on a deep, emotional level is a healing experience.

Think about how much time we spend putting on a façade and projecting a persona of who we are. We often hide our thoughts and feelings from our closest friends and family members to shield them from the emotional pain we carry. Such secrecy paradoxically serves as fertile ground for painful emotional experiences to thrive and gain a deeper hold of us.

As a psychiatrist, I can attest to the therapeutic benefits of empathy. I have worked with countless people who benefited tremendously from having a safe space to express thoughts and feelings they had kept hidden for a lifetime. Empathy is an essential ingredient of the therapeutic process, the framework on which healing occurs.

However, empathy also comes with potential pitfalls. When untamed, empathy can cloud one’s judgment as they strive to alleviate suffering.

Imagine an anguished parent who wants to save their adult child tangled in a web of substance use. In this common scenario, the child is running low on money because they have squandered a fortune on their substance use. Their addiction may also prevent them from holding a job and may have resulted in legal fines. In such a scenario, the child may ask their parent for financial assistance. Handing over money to the struggling child may seem like the empathetic thing to do. However, if the money is used to purchase more of the drug, then the parent has enabled their problematic behavior. As we can see, blind empathy can result in collateral damage.

In addition, empathy is inherently biased. Evidence shows that we are less likely to empathize with people who are from different racial and cultural groups than our own, merely by virtue of who they are and not based on anything they have done. Such bias only exacerbates the problematic prejudice that is wrecking our society.

Finally, empathy can have a negative impact on an empath’s emotional state. Overidentifying with one’s suffering can lead to emotional exhaustion and feelings of helplessness.

It takes great effort and intention to understand someone on an emotional level and not have it impact other parts of your life. From personal experience, I have found myself emotionally depleted at the end of a hectic workday with limited emotional reserves for loved ones at home.

Pointing out the pitfalls of empathy is not intended to start a crusade against this virtue, which is essential for healing and connection. However, when left unchecked, empathy can negatively impact both the empath and its recipients.

Here are ways to utilize empathy more effectively and mitigate its downsides.

1. Empathy must be accompanied by boundaries. Without boundaries, empathy can serve as a catalyst for enabling behavior through which you inadvertently reinforce one’s unhealthy and destructive habits. This only hurts those you are trying to help. Setting boundaries is essential to ensure empathy does not cloud your judgment as you look for ways to help others.
2. Empathy must also be accompanied by some action. It is not enough to empathize with one’s suffering. You also need to take some action to alleviate it. As an example, our society is filled with discrimination based on one’s gender, race and ethnicity. It is not sufficient to empathize with one who faces discrimination. It is essential that we take action to eliminate all forms of discrimination. On a personal level, it would be a disservice if my efforts to help patients were limited to empathy and did not include any evidence-based psychiatric and psychological interventions to alleviate their suffering.
3. Accept your limits when helping others. I have worked with people who were paralyzed into nihilistic inaction because, on a grand scale, they felt their contributions were a drop in the ocean compared to the collective suffering in the world. In such scenarios, I remind people that every bit of help matters. Your efforts are meaningful to someone, even for a brief moment. Volunteering at a local food bank does not eradicate world hunger but it provides valuable relief to those in dire need.
4. Prioritize your health. Finally, one cannot consistently practice empathy without prioritizing self-care. Identifying with one’s emotions can put you in vulnerable emotional states. It is imperative that you take time to recharge your batteries and replenish yourself in order to continue to help others.

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