At first, coronavirus-related calls to the crisis hotlines at Didi Hirsch Mental Health Services came in a trickle: In February, just 22 callers mentioned the virus.

By the end of March, that number had skyrocketed to more than 1,800.

With an average of 10,800 calls on any given month, Didi Hirsch’s hotlines are constantly ringing. Based in California, it is one of three crisis centers nationwide that takes calls through the Disaster Distress Helpline, a 24-hour hotline that helps people cope with anything from natural disasters to public health emergencies.

The center is also one of more than 160 centers around the country that takes calls from the National Suicide Prevention Lifeline.

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But the coronavirus has felt different than past events that prompted a spike in calls, such as wildfires, mass shootings or celebrity suicides, say those who answer the phones. Unlike the pandemic, which seems to worsen by the day, those tragedies had a clear end to them, and did not necessarily have a direct effect on crisis counselors who take calls or answer online chats.

“We’ve never had some type of societal change or epidemic that has both impacted within our organization and everyone outside of it,” said Carolyn Levitan, Didi Hirsch’s Crisis Line director. “Suddenly our counselors are experiencing some of the same crises that callers and chat visitors are.”

Across the country, as crisis hotlines are inundated with calls from an anxious public, those who pick up the phones are dealing with the same fears and disruptions to their own lives.

Their call centers — many of which are housed in office buildings that do not meet social distancing guidelines — have had to undergo rapid technological transformations so crisis counselors can receive calls at home. Some crisis counselors have even tested positive for the virus themselves.

While the call volume has increased, many hotlines are seeing trained volunteers offer to pick up more shifts — some because they have lost their jobs due to the coronavirus and now have more time to give, others because volunteering feels therapeutic during this time of uncertainty.

At Didi Hirsch, which has 10 locations throughout Los Angeles County and Orange County, the pandemic has hit close to home.

In late March, both a crisis line volunteer and a staff member tested positive for COVID-19, the illness caused by the coronavirus.

“We’re trying to balance the emotional and physical health of our counselors with the needs of our callers and our chat visitors, and it’s a very fine line.”

Because the staff works in close quarters — where it is encouraged to check in on one another after tough phone calls with a conversation to debrief or sometimes just to provide a hug — about 35 people who had had potential exposure to the sick individuals had to be quarantined afterward, Levitan said. (No one else has since tested positive.)

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“We’re trying to balance the emotional and physical health of our counselors with the needs of our callers and our chat visitors, and it’s a very fine line,” Levitan said. “Counselors may be stressed or triggered by calls because it might remind them of a stressor in their own lives related to COVID, and they also have had to wonder if they are exposed to COVID.”

Didi Hirsch had an emergency preparedness plan to route calls outside of the Los Angeles suicide prevention office that houses its crisis call center, should an earthquake or other disaster hit. But the plan involved sending calls to their other sites — not to crisis counselors at home. After a frenzied two weeks, the online chat program has been made accessible remotely, and by next week, all calls to crisis lines should be ported outside the call center for counselors to answer remotely.

Meanwhile, at the Long Island Crisis Center in Bellmore, New York, a plan was devised several years ago to allow staff to take calls at home — but no one there envisioned it would be implemented under a global pandemic, said Joe Walsh, the center’s director.

“Crisis centers have to be on the cutting edge of technology to stay 100 percent up during times of extreme need like this.”

“Long Island has been affected by other crisis situations. Hurricane Sandy was one that was part of the motivating factor,” he said. “Crisis centers have to be on the cutting edge of technology to stay 100 percent up during times of extreme need like this.”

In the last two weeks, more than 50 percent of the calls to the crisis hotline have been about the coronavirus, with an uptick in calls about financial problems, alcohol use and thoughts of suicide compared to the preceding two weeks, Walsh said.

Since the staff can no longer gather in-person, they have been doing twice-weekly video chats to talk through challenges, he added.

“It’s hard for everyone,” Walsh said. “It’s hard for helpers, too.”

At Crisis Text Line, a text message-based help network, crisis counselors have always done their shifts from home, said co-founder and CEO Nancy Lublin. But with text volume doubling in the past several weeks, Crisis Text Line has wanted to make sure its all-volunteer team of counselors have felt they have the support they need, offering them free memberships to the meditation app Headspace, among other tools, Lublin said.

Being able to empathize with texters’ concerns since the coronavirus started has been helpful, said Sara Schaller, a Crisis Text Line crisis counselor.

“I’m human and I have those fears, so it’s telling them, ‘You’re not alone. It makes complete sense to be afraid of the unknown,’” Schaller, of Ann Arbor, Michigan, said. “We all feel it — not to diminish theirs, but reassuring them that they’re not alone in these fears.”

“There’s a collective feeling of grief,” she added. “It’s more of a collective trauma.”

But there have been obstacles. A lot of the tips that crisis counselors around the country normally offer — such as leaving the house if you feel suicidal to go to a safer environment or meeting up with friends to combat feelings of loneliness — are not possible while social distancing.

Practicing self-care, even in quarantine

However, psychologists say there are still many forms of self-care that people can practice, whether they are the ones fielding the calls to crisis hotlines or the ones making them.

Staying physically active, through a daily walk if it is safe to do so or an online workout, is crucial for maintaining mental health, said Lynn Bufka, senior director at the American Psychological Association. So is keeping in touch with meaningful people in your life, whether it’s through phone or video calls.

"Your cognitive capability is pretty maxed out dealing with this situation.”

“If you’re able to figure out ways that work for you and don’t require a lot of decision-making, that’s helpful, because your cognitive capability is pretty maxed out dealing with this situation,” she said.

Other people might find comfort in churches and synagogues that are streaming their religious services online, or in yoga or meditation apps, said Dana Garfin, a psychologist and assistant adjunct professor in the Sue & Bill Gross School of Nursing at the University of California, Irvine.

Garfin, who is doing a study on the psychological effects of the COVID-19 quarantines, also recommended not getting bombarded with news.

“You don’t want to not know what’s going on, but there’s a difference between checking the news once or twice, and having the TV on in the background all day,” she said.

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Despite the difficulties counselors are dealing with themselves, all the crisis hotlines encouraged anyone feeling overwhelmed to reach out at any time.

Kita S. Curry, the president and CEO of Didi Hirsch Mental Health Services, said she feared the emotional toll caused by the coronavirus was just beginning, especially as its effect on the economy grows.

She said despite her staff’s own worries about the coronavirus, they are more dedicated than ever to helping callers to the crisis hotline.

“It’s really stressful,” Curry said, her voice breaking, “but it’s very rewarding to be able to help people in their darkest hour.”

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.