A soft-voiced man with kind eyes and an impeccably trimmed white beard, Patrick Arbore is Director and Founder of the Center for Elderly Suicide Prevention & Grief Related Services, now housed within the Institute on Aging in San Francisco. Back in 1973, he also founded the Friendship Line, which now also operates out of the Institute.

The service literally saves lives—taking telephone calls from seniors in crisis, or simply providing a friendly voice or willing ear to those in need of a connection.

“It began in response to the high rates of suicide among older adults in the San Francisco Bay region,” Arbore says, adding that the “traditional suicide prevention centers” were often not able to serve the specialized needs of older people, whose lives are more likely to become crowded with issues of illness, isolation, loss, substance abuse, and grief.

Suffering from a double stigma, the topic of suicide among the elderly went largely ignored in the past. But Arbore offers some recent statistics that paint a sobering picture:

• Among people of all ages, one in 12 suicide attempts results in death; among those 60 and older, the death rate is one in every four attempts
• About 84% of elderly suicides are male—a rate more than five times greater than females, and
• The greatest increase in female suicides in the last decade was among women aged 60 to 65—a leap from 4.4 to 7 per 100,000.

“Older people are simply less ambivalent about whether they want to live, more determined to die,” Arbore says. “At the Friendship Line, we want to prevent them from getting to that point.”

Now National—and Accredited

More than 40 years after its founding, The Friendship Line remains unique: the nation’s only combined crisis line and “warmline” for non-urgent calls focusing on disabled adults and people age 60 and older. It’s also among the few call centers operating around the clock, and the only such service in the country accredited by the American Association of Suicidology.

The Friendship Line handles about 8,500 calls monthly, about half from people who call in—often referred by doctors, therapists and other healthcare providers, in addition to those who learn about it by word-of-mouth or from one of Arbore’s many lectures throughout the country. Many of those who call report that it’s the only human voice they’ve heard all day.

Targeted training helps assure that all of the 85 volunteers and 7 staff members who answer the phones there are well-versed in handling the calls that come in, many of which are emotionally charged.

“We do a total of 16 hours of didactic training—held over two Saturdays,” explains Tim Riel, the Friendship Line’s Volunteer Coordinator. “Participants learn active listening techniques, suicide assessment, roleplays, how to handle difficult callers and address the needs of callers with disabilities, how to detect elder abuse and report it if need be—and importantly, get sensitized to the various ways ageism plays out in our society.” In addition, each volunteer must listen in on calls for three four-hour shifts before handling one alone.

In addition to receiving incoming calls, the Friendship Line also offers outreach to a list of about 200 people scheduled to receive regular calls, from daily to weekly, to help monitor their physical and mental health concerns. Many family members, especially those who live distantly, herald the call-out service as a godsend.

“When I took over the leadership of the Friendship Line, I was concerned about the difference between those who would call and those who would not call,” Arbore says. “I wanted to focus more on those experiencing isolation and fierce loneliness.”

And so was born another feature of the Friendship Line: A Loneliness Assessment Survey aimed at ascertaining and rating the level of loneliness some of the callers report. If people call in and are determined to be extremely lonely, the volunteers may suggest they be added to the regular call-out schedule.

The Importance of Unplugging

A self-described Luddite, Arbore also cautions against embracing email and text and FaceBook messages as substitutes for human interaction, and firmly believes there’s a connection between the increase of technology and the increase in people who report feeling lonely. “I think the Internet is good for finding information and for sharing pictures of family members,” he says. “But it’s just a tool and cannot replace the human voice and the human face.”

Arbore also laments the lost art of conversation. “The Friendship Line allows people to have a meaningful conversation—and that’s particularly important as people age in an ageist society,” he says. “We find older people aversive, repulsive—or just plain don’t want to be around them. It’s a stigma that’s hard to change.”

Ironically, many of the Friendship Line volunteers are young—students working on degrees in social work or psychology who are required to put in a specified number of practical work hours each semester.

“When I first started here, I was terrified to pick up the phone; I really only text these days,” says one of them, who says his work on the Friendship Line has instilled in him a new ease in talking with others—and with using the telephone.

Loneliness Interventions

It can sometimes be difficult to “diagnose” loneliness—particularly in older people, who often attempt to disguise it because of being embarrassed by their feelings—or further isolate themselves from others by spending more time sleeping or at home alone.

But Arbore offers a number of ways that caregivers, family members, and others can help diffuse the feelings in those they suspect may be harboring feelings of loneliness.

• Ask specially about loneliness, and how it feels.
• Spend time with the person—in silence or in conversation.
• Help the person get or keep in contact with other people who are important to him or her.
• Explore the nature of loneliness with the person.
• Help develop community support for the individual you suspect is lonely.

“But perhaps the best intervention is simply to be interested in the person,” he says. “He or she can usually let you know how to help best.”

The toll-free Friendship Line is available 24 hours every day of the year at 800-971-0016 or 415-972-3778.