'Something Has to Be Done to Make Women Feel Safe': Women Veterans' Recommendations for Strengthening the Veterans Crisis Line

Women constitute a growing proportion of Veterans and represent 15% of Veteran callers to the Veterans Crisis Line (VCL), a free service that is available 24/7 via telephone call, text, or chat and is staffed by trained responders who can provide immediate crisis intervention, assessment, and connection to follow-up services. Although rates of suicide among women Veterans have escalated over the past decade,^[1] and experiences of gender-based interpersonal violence, including intimate partner violence and non-partner sexual violence, are prevalent among this population, there has been little research identifying the experiences and needs of women Veterans who use the VCL. This study identified women Veterans' experiences with and recommendations for strengthening VCL services specifically for women.

To elicit women's input about their experiences with and recommendations for strengthening the VCL for women Veterans, researchers conducted phone interviews in 2022 with 26 women Veterans across the United States who had contacted the VCL in the preceding year.

Participants were recruited from the national population of women Veterans with at least one VA healthcare encounter in 2021. The randomly selected sample was stratified by age (31 to 67), region (7 from North Atlantic, 7 Pacific, 3 Midwest, 6 Southeast, 3 continental U.S.), and race/ethnicity (11 White, 9 Black/African American, 4 Asian, 1 American Indian/Alaskan native, 1 Native Hawaiian/Pacific Islander, 3 Hispanic/Latinx).

Women Veterans' concerns centered on three aspects of the VCL: the VCL responder's gender, the scope of VCL services, and the consequences of contacting the VCL.

Responder Gender

A primary concern for women Veterans who contacted the VCL was the gender of the VCL responder. Women described having mental health needs and suicidal ideation related to trauma, especially sexual and gender-based violence that had been perpetrated by men. They were concerned that hearing a man's voice could be emotionally triggering and/or felt that a man would not be able to understand their experiences in ways that another woman would:

"I got hurt in the military by men, and I don't want to talk to a man about my feelings."

"When I'm in that type of crisis, I actually need a woman to talk to me, not a man. . . . I have PTSD from MST [military sexual trauma], and I've just had some really, really bad experiences with men. And so, I can't open up to them. I can't trust them."

Concerns about talking to a male responder inhibited VCL use, with women hesitating to call or hanging up when they heard a man's voice:

"The first time I called, I hung up because I was just like, 'Oh, it's a guy.' . . . I had so much anger towards males that it was like, 'I don't even want to hear your voice because it's, like, you're not going to understand it because you're the reason why I'm calling in the first place.' And then it kind of made me not want to call back."

"I didn't want to call because I don't want to talk to a male. . . . I'm probably not the only female that's said this-that males make me uncomfortable; I don't like talking to them."

Although many women said that they strongly preferred to speak with female responders, some women noted that a male responder is better than no responder:

"I think that if a woman calls in, she needs another woman to talk to, not a guy. . . . But, if worse comes to worst, whoever's available has to answer that call. . . . As a last resort, anybody can help. You just need a voice that cares."

In addition, a few women indicated that they did not have a gender preference, or suggested the possibility that some women Veterans may prefer a male responder:

"As long as he was, you know, was helpful, I didn't really care what gender he was. To me, it was more of someone that listened. I didn't see gender, really."

"You never know-there might be a female that just needs to talk to a guy maybe. . . . Sometimes a guy's advice is way different from a female's perspective."

Women recommended that the VCL offer callers the option to choose the gender of the responder and add an automated prompt to request the responder's gender. Women also suggested that more women may be willing to contact the VCL if they could choose the responder's gender:

"Before we even have to hear a voice of a male, like if it was a prompt that says, you know, 'If you prefer just a woman,' you know, 'press such-and-such.' That would be awesome."

"A choice [of] 'Would you rather talk to a man, or would you rather talk to a woman?' . . . [is] something that I would hope maybe would be available in the future."

"It may encourage more women to call in knowing that there's another woman that they could speak to."

Not Knowing What to Expect or If Needs Are Appropriate

Women noted that when they initially called the VCL, they did not know what to expect from the call, what the responder might do or not do, and what, if any, actions their call might prompt. They had concerns about the confidentiality of the call, including whether their contact with the VCL might be shared with their employer, family, or healthcare providers:

"I didn't know anything about the process. . . . Nobody gave me a heads-up like, 'Okay, this is going to happen: first [they're] going to ask you this and then they're going to tell you this, and then they're going to call other people.' None of that was explained."

Participants also expressed a lack of clarity about the scope of VCL services-they knew the VCL was available for suicidal crises but weren't sure if it is appropriate for non-suicidal crises. Participants expressed concern about being a burden on resources and wondered if their needs were valid for contacting the VCL, especially if they were not actively suicidal and perceived it to be a hotline specifically for suicide-related crises. These concerns made them hesitate to call:

"I hung up before anyone got on-but that was just [due to] my not knowing what to expect."

"At the time I called, I desperately needed to talk with someone. The only reservation I had was whether I was wasting anyone's time. . . . When you call into the general VA line, what you get is, 'If you are suicidal or thinking of suicide, please press this number.' And since I wasn't planning on it or actually wanting to be dead, . . . I wasn't sure if that was an appropriate use of the service. . . . We realize that there are limited resources . . . and if we're not in that situation, we don't want to be taking those resources because it could prevent the people who need them [from being able to use them]."

Some women noted that VCL responders allayed their concerns about being a burden or not being worthy of the resources:

"We addressed [my concern about the VCL being only for suicide-specific cases] first thing, and [the VCL responder] said, 'We are not the last ditch, [as in] you're standing there looking at pills or you're trying to figure out how to get a gun. . . . You don't have to be there; you just have to be where you are. You just have to feel that you need to talk to somebody and there is no one else for you to talk to at this time, and that's when you call us.' And that made me feel really good."

"I [was] feeling like I maybe was wasting their time, and they made me feel like I wasn't wasting their time and that they were there to listen no matter what."

Participants also said that additional detail in marketing the VCL might be helpful to clarify the scope of VCL services, beyond suicidal crises:

"Instead of getting an automated voice that says, 'If you are having thoughts of suicide,' it might be 'If you are having thoughts of suicide or if you really need to talk to someone.' That might be a better way to go."

"Maybe they need a commercial . . . letting you know 'We're here for you if you just need to talk, no matter what it is-nothing is too big or too small."

Concerns about the Consequences of VCL Outreach and Unwanted Intervention

Finally, participants expressed concerns about what might happen if they call-who might find out and what action might occur. Some participants worried that their VCL call would be documented in their records and might affect their employment, benefits, or other aspects of their lives, such as custody proceedings:

"A lot of Veterans are actually hesitant to be calling, especially if you believe that it could be in your records or anything like that that can be used against [you]."

"I was scared to call . . . because I had security clearances [as a government employee], . . . and I didn't want [the call] to be held against me in my government service and possibly [cause me to] lose my clearance or lose my job."

"I'm going through a divorce, and I hesitated to contact anybody or get the help I needed because I was afraid of losing custody of my children, or my ex using that against me in court. So, I avoided and I self-managed for a very long time."

Women expressed worry about their VCL contact triggering unwanted intervention in response to their crisis or perceived needs. Particularly, they expressed fear of being forcibly removed or hospitalized. Such concerns inhibited their reaching out to and/or being fully forthcoming with VCL responders:

"I was concerned . . . that somebody was gonna come to my house and rip me out of the house that night against my will, like an involuntary intervention. . . . I never called before, so I didn't know what to expect."

"I didn't know what to expect. Because I had thoughts [of suicide] but no formal plans or anything, I was afraid if I told them too much information that they would send the cops after me or the ambulance or whatever. . . . I wasn't totally 100 percent forthcoming until I finally understood that, okay, they're not calling the cops or anything unless I'm actively planning something."

"I will always have the same concern, and that is they're going to call someone and say, 'Please report to this residence. The Veteran is not safe. Take her away to the hospital.' I absolutely use false names, and I won't tell people where I am. I'm terrified because people do not understand self-harm is a struggle to stay alive."

Participants recommended additional communication to women Veterans about the scope of VCL intervention and what to expect, noting that knowing they will not experience unwanted intervention would help women feel comfortable to reach out:

"Something has to be done to make women feel safe. You know, [tell them] 'There are options, you are not being recorded, and we are not going to call 911.' And it has to be done not just when you're on the line; it has to be said by therapists, by VA doctors, by every single point along the line where you get the recording of 'If you are not feeling safe, hang up now and dial 1-877-blah-blah-blah.' And then it needs to be said [that] you can talk anonymously with someone-you know? The female population [using the VCL] would quadruple."

A trauma-informed approach is needed for women Veteran callers to the VCL. This includes prioritizing: women callers' physical and psychological safety; transparency to promote trustworthiness in the service; caller empowerment, voice, and choice; and recognition of cultural, historical, and gender factors that shape individual experience.

Melissa Dichter, PhD, MSW, is an investigator with HSR's Center for Health Equity Research and Promotion (CHERP).

Dichter ME, Agha AZ, Monteith LL, Krishnamurti LS, Iverson KM, Montgomery AE. "Something Has to Be Done to Make Women Feel Safe": Women Veterans' Recommendations for Strengthening the Veterans Crisis Line for Women Veterans. Women's Health Issues. March-April 2024;34(2):180-185.

^[1]"Something Has to Be Done to Make Women Feel Safe": Women Veterans' Recommendations for Strengthening the Veterans Crisis Line for Women Veterans - ClinicalKey

Public link

Please use the above public link if you want to share this noodl on another website.