When the call came, there was no doubt. Action was required. And fast.

The agent taking the call heard the person on the other end verbalize a plan to end their life with the means to enact the plan. The agent kept the person engaged while another agent contacted authorities.

Police officers were told that the caller was armed and a danger to themselves. The agent successfully stayed on the phone with the caller until the officers arrived, gently disarmed the caller and transported the person to a safe facility to get help.

Situations like these are why Scott Terres's firm, Alliance Work Partners (AWP), a provider of employee assistance services, added suicide counseling training to its skills database. Workplace suicides are on the rise, and in most cases those who consider suicide outside the workplace could receive help from their employers.

"Had our call center not been specifically trained on how to handle such high-risk callers, had we not gone through mock scenarios, and had we not had clear plans in place to assist the agent on the phone, the outcome may have been much different," Terres, vice president of the firm, said.

The rise of crisis counseling

According to Terres, crisis counseling for employees is on the rise, driven by an increase in occupational stressors (job satisfaction, workload, conflict) and domestic pressures, leading to incidents of domestic violence, extreme emotional distress and suicide. 

Nearly one in five Americans — 43.8 million adults — experienced mental illness in 2013, according to the U.S. Substance Abuse and Mental Health Services Administration. Ten million adults experienced a serious mental illness and 15.7 million adults experienced a major depressive episode in 2013.

Beyond the struggles of their employees, employers incur an estimated $100 billion annually in direct and indirect costs associated with depression, including as much as $44 billion lost to employee absences and lower productivity, according to a survey published in 2014 by Employers Health Coalition Inc., a Canton, Ohio-based not-for-profit health benefits service provider.

While not everyone suffering from a mental illness-related episode considers suicide, AWP decided to improve its handling of those calls when it saw a steady increase in the firm's percentage of high-risk cases — including employees exhibiting suicidal or life-threatening behaviors.

Terres says in Texas, where the company is based, more than twice as many people die by suicide than by homicide annually. It's the 12th leading cause of death in the state, and on average one person dies by suicide in Texas every three hours.

Given the severity — and delicacy — of the problem, AWP enlisted the American Association of Suicidology (AAS) for an objective look at their systems and procedures in order to assure that their crisis call center offers the most responsive, appropriate and professional assessment and treatment. AWP underwent a strenuous, year-long evaluation process, and is one of the nation’s few AAS-accredited EAPs.  

Terres says that due to the confidential nature of counseling sessions, there are differing definitions of what constitutes a crisis, so hard data on these issues can be difficult to attain.  

The American Journal of Preventive Medicine, however, reports that suicide rates have risen approximately 40% for Americans aged 40 to 64, since 1999. Across AWP’s book of business, crisis calls accounted for 13% of all calls in fiscal 2014 and rose to 16% in 2015.

How HR can help

HR and employers can step in. For one thing, they need to learn and train managers on knowing the warning signs of possible crisis or suicidal ideation.

Terres says one effective way to do it is through Texas' Ask About Suicide program, which trains designated staff on signs and signals of potential self-harm, and guides those staff through how to speak and ask about suicide in a frank and open manner.

He also suggests adding an Employee Assistance Program (EAP) to the collective benefit pool. Employers should seek out standalone, best-practice EAPs, with no ties to insurance companies, that can create meaningful utilization and outcomes for all staff, including those in crisis or who may be suicidal.

HR leaders already have very significant responsibilities, with more being added to their jobs every day. And that, Terres adds, can exacerbate the issue and lead to distraction on this specific concern.

"I don't believe the problem is being ignored," he says. "However, I also do not believe that many HR leaders or management staff are actively looking for warning signs, unless they are significant."

He points to contributing crisis factors such as tardiness/absenteeism, isolation and poor work performance that may go unnoticed initially, while more significant signs, such as physical or verbal aggression in the workplace, may be misconstrued as a performance or interpersonal issue rather than crisis behavior manifested in aggressive acting out.

The ever-present stigma of mental illness remains a challenge in every workplace — and one that can still sway employees to not seek help even when they need it.

"There is absolutely reluctance and fear on the part of the employee to come forward," Terre says. "Crisis situations or suicidal thoughts are often not even shared with close friends or family members, let alone co-workers or supervisors."

There also may be a fear of losing their job, a fear of confidentiality breaches by those an employee might confide in, or a fear of being seen as "crazy" or weak.

Of course, perception is only half the battle. A strategic partnership with a best-practice EAP, especially one accredited by the AAS as a crisis call center, is essential to ensure that immediate help is available from individuals equipped to assist with even the most significant issues.

"An EAP that allows for free management consultation or workplace referrals can alleviate the need for HR leaders and managers to work outside of their area of expertise," he adds. "One generally does not go to a mechanic for a haircut or a salon for an oil change. So this is about the best reason for HR to create a strategic partnership with experts. It can save employee lives."