Background: Helplines are a significant phenomenon in the mixed economy of health and social care. Given the often anonymous and fleeting nature of caller contact, it is difficult to obtain data about their impact and how users perceive their value. This paper reports findings from an online survey of callers contacting Samaritans emotional support services. Aims: To explore the (self-reported) characteristics of callers using a national suicide prevention helpline and their reasons given for contacting the service, and to present the users’ evaluations of the service they received. Methods: Online survey of a self-selected sample of callers. Results: 1,309 responses were received between May 2008 and May 2009. There were high incidences of expressed suicidality and mental health issues. Regular and ongoing use of the service was common. Respondents used the service for complex and varied reasons and often as part of a network of support. Conclusions: Respondents reported high levels of satisfaction with the service and perceived contact to be helpful. Although Samaritans aims to provide a crisis service, many callers do not access this in isolation or as a last resort, instead contacting the organization selectively and often in tandem with other types of support.

This paper discusses volunteer strategies for handling and assessing calls to Samaritans emotional support services for the suicidal and despairing. It presents findings from the qualitative components of a twoyear mixed methods study based on an online caller survey, branch observations and interviews with volunteers and callers throughout the UK. A thematic analysis of the qualitative data analysis was undertaken using the principle of constant comparison. Many calls fell beyond the primary remit of a crisis service, and called for rapid attribution and assessment. Uncertainty about identifying 'good' calls and recognizing those which were not caused difficulty, frustration and negative attribution towards some callers. This paper presents our analysis of volunteers' accounts of how they configure the caller in intrinsically uncertain and ambiguous encounters, and how such strategies relate to the formal principles of unconditional support and non-judgemental active listening espoused by the organization.Keywords: active listening; helplines; negative attribution; Samaritans; self-protection; suicide; volunteering IntroductionSamaritans is a volunteer-based charity established in the UK in 1953 as a crisis support service for the despairing and suicidal (Varah 1988;Armson 1997). In 2011, 15,516 volunteers in 202 branches throughout the UK responded to 2,868,899 dialogue 1 contacts from callers (Samaritans 2012). The majority (83%) of dialogue contacts are by phone, but email and SMS text messages are increasing and callers may also make contact by letter or by visiting a branch. Volunteers aim to provide a confidential, anonymous, nondirective, active listening service which offers callers the opportunity to reflectively explore their feelings of emotional distress and so, ideally, gain insight into how they may start to address their difficulties and 'move on' in their lives. Samaritans hope that their emotional support will help callers to identify options other than suicide, and a core aim of the service is to work towards a reduction in deaths by suicide.However, another key principle is respect for self determination. Only the caller has the authority and responsibility to make decisions about his own life, including the judgement that his best interests are to end it. Unlike many suicide crisis helplines (de Anda and Smith 1993;Mishara 1997;King et al. 2003;Barber et al. 2004;Kalafat et al. 2007;Ingram et al. 2008), Samaritans will not advise or actively intervene to deflect a caller who declares intent to die by suicide. Volunteers aim to offer the caller unconditional, nonjudgemental acceptance and support. However, the caller remains in charge of his/her life, both in defining the nature of their problems, and taking responsibility for decisions about how best to deal with these (Nelson and Armson 2004;Samaritans 2009).In view of the anonymous and confidential nature of the service the information available to Samaritans about individual callers is very limited. National statistics are co...

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