Crisis counselling and telephone befriending (Samaritans)

1. Introduction

Version followed: Samaritans (UK and Ireland) as it describes itself publicly in 2025–26: its contact and strategy pages, its SHUSH listening tips and DEAL schools listening resources, and its guidance for people supporting someone with suicidal thoughts. The internal volunteer training curriculum is not public [uncertain]. Older long-term "befriending" is described from a historical source only.

What it is. Samaritans is a volunteer emotional-support service, not a psychotherapy. It was founded in London in 1953 by Chad Varah, an Anglican minister. A Picture Post article by Varah led to its founding, and the befriending ethos of Toc H shaped it. Varah first gathered people who would talk to anyone with problems, by phone or in person. The service grew into "befriending", in which one volunteer was paired with one client and met them regularly, sometimes for months or years. It spread across the UK and Ireland in the 1960s [source: Huddersfield history blog]. The founding church (often given as St Stephen Walbrook) and the exact founding date are not confirmed [uncertain]. Today the organisation describes itself as "the charity that prevents suicide through the power of human connection". Its vision is that fewer people die by suicide [source: Samaritans, Who we are]. The core service is free, round-the-clock phone support on 116 123, plus a Welsh-language line, branch visits and a small web-chat pilot. The email and letter services have closed [source: Samaritans, Contact].

How change happens (as Samaritans frames it). People in emotional crisis are connected with a trained volunteer who listens without judgement. The volunteer does not tell them what to do, makes no decisions for them and supports the decisions they make [source: Samaritans, Contact]. Being heard is meant to make the person feel "valued and understood" [source: Samaritans DEAL, Developing listening skills]. Talking openly, including about suicide, relieves isolation and gives permission to name taboo feelings [source: Defra/Samaritans SHUSH blog]. Advice, diagnosis and treatment are not the mechanism. Change comes through human connection and the caller's own choices.

For the clinician. This guide has two uses: (a) adopting the Samaritans listening stance in your own crisis contacts, and (b) referring clients to Samaritans and working alongside it. Use (b) is mainly [synthesis], because Samaritans publishes little guidance for professionals that was found in this research.

2. Framework

Samaritans publishes no phased treatment model or session count. The contact is open-ended and led by the caller [source: Samaritans, Contact]. The structure below is how the published elements fit together. Its sequencing is [synthesis].

Format. The service is a single contact, repeatable at any time, mostly by phone. Calls go to one of 200+ branches across the UK and Ireland, and there may be a wait. Callers need not give a name. Volunteers do not see the caller's number. Calls are free and do not show on phone bills. Relay UK is available (18001 44 116 123). Branch visits are face to face and should be arranged ahead. Contact may be limited for anyone making 100 or more calls, or talking for 20 or more hours, within a rolling 30 days [source: Samaritans, Contact]. Historically, befriending meant ongoing contact between one volunteer and one client [source: Huddersfield blog].

Stages of a single contact [synthesis, built from the SHUSH tips and the Contact page]:

Connect. Goal: the caller feels safe enough to talk. Make clear that the contact is anonymous and confidential, and show attention ("Show you care"). Move on once the caller begins telling their story.
Listen and explore. Goal: the caller expresses what is happening and how they feel. Use patience, silence, open questions and "say it back". Move on once the main feelings and situation have been voiced, or when cues of suicidality appear.
Ask about suicide ("Have courage"). Goal: the caller can name suicidal thoughts openly. Ask whenever distress is significant. Do not wait for the end of the call.
Explore the caller's own options and decisions. Goal: the caller identifies what they want to do next, which may include other services. Samaritans may suggest specialist organisations but does not direct the caller.
Close. Goal: a clear ending, with the caller knowing they can contact again at any time. Breaching confidentiality to involve emergency services is reserved for the published exceptions (see Section 4).

Clinician's phases for referral and joint working [synthesis]: (1) assess and plan with the client, using your own service's risk-and-needs process; (2) introduce Samaritans as one listed contact in the client's safety plan, with consent and expectations set; (3) between sessions, the client uses Samaritans as needed; (4) review at the next session what the client chose to share about using it; (5) escalate to crisis or emergency services under your own duty of care whenever indicated. Samaritans does not take on that duty for you.

3. Guiding principles

Listen without judgement, whatever the person's background, beliefs, faith or identity [source: Who we are]. In practice, stay non-judgemental even when a caller's views offend you [source: Stylist volunteer feature].
Don't tell people what to do [source: Contact]. In practice, give no advice or opinions. Reflect and explore instead.
Self-determination: callers make their own decisions, and Samaritans supports the decisions they make [source: Contact]. Volunteers describe a "self-determination policy": they do not try to talk callers out of suicide [source: Stylist volunteer feature]. In practice, the caller keeps responsibility for choices. You explore those choices rather than persuade.
Confidentiality, which continues even after a caller's death, with listed exceptions [source: Contact]. In practice, state it plainly. Breach it only for the published exceptions.
Anonymity [source: Contact]. In practice, never require a name. Volunteers do not acknowledge a caller they meet in public unless the caller does first.
Turn no one away. No proselytising [source: Huddersfield blog, historical]. In practice, the service is open to anyone, and the volunteer's own beliefs stay out of the conversation. Prisoners get the same support as any other caller [source: Stylist].
Human connection as the active ingredient [source: Who we are]. In practice, presence matters more than problem-solving.
Courage to ask directly about suicide [source: Defra/Samaritans]. In practice, use plain words. Asking gives permission to speak.
Signpost, don't refer onward by force [source: Contact]. In practice, offer specialist organisations only as options.
Boundaries protect the service [source: Contact]. In practice, calls may end if a caller is abusive, threatening or sexually inappropriate, and very high call volumes may be limited.
Look after the listener [source: Stylist; Sheffield index of Samaritans guidance]. In practice, volunteers are debriefed after shifts, receive aftercare after hard calls and may take leave.

4. Intervention inventory

Samaritans publishes its listening skills as the five SHUSH tips: Show you care, Have patience, Use open questions, Say it back, Have courage [source: Equality Network citing Samaritans; Defra/Samaritans blog]. Items 1–7 are the listening skills. Items 8–12 are service rules and support practices. Items 13–16 are clinician-facing [synthesis]. All example wording is illustrative unless quoted.

1. Opening the contact and framing confidentiality

Purpose / when: at the start of every crisis contact, so the person knows the conditions they are talking under.
Steps: (1) Greet briefly and invite the person to talk, with no intake questions. (2) Make clear they need not give a name. (3) Say the conversation is confidential, and that you would act only if someone's life or safety were at serious risk as described below. (4) Hand control to the caller. [source: Contact, for anonymity and confidentiality; wording and sequence are synthesis]
Example language (illustrative): "You don't have to tell me your name. This is just a space to talk about whatever's going on. Where would you like to start?"
Watch for: long silences or hang-ups at the start. Fear about confidentiality is common, so restate it. Working when the caller begins describing their situation in their own words.

2. Show you care (attending)

Purpose / when: throughout the contact. It signals full attention, the difference between "hearing" (passive) and "listening" (effortful) [source: DEAL listening skills].
Steps: focus wholly on the person. In person: make eye contact, put your phone away, lean forward and nod [source: Equality Network/SHUSH; DEAL]. On the phone, convey the same through minimal encouragers ("mm", "yes") and an unhurried tone [synthesis].
Example language (illustrative): "I'm here, take your time."
Watch for: your own multitasking or rehearsing a reply. Working when the caller elaborates without prompting.

3. Have patience (including silence)

Purpose / when: when a person is slow to open up or pauses. It may take several attempts before someone opens up [source: Equality Network/SHUSH].
Steps: (1) Don't rush to fill silences. Wait, breathe, and let the person collect their thoughts [source: Defra/Samaritans]. (2) Don't interrupt. Wait for a pause before speaking [source: DEAL]. (3) Ask gentle check-in questions such as how they are feeling today. Dig a little deeper when their words don't match how they are acting [source: Equality Network/SHUSH].
Example language (illustrative): "You said you're fine, but you sound really tired. How are you actually doing today?"
Watch for: on the phone, a long silence can mean deep thought, tears, or a change in safety. After a while, gently check in ("Are you still with me?") [synthesis]. Working when the caller fills the silence with new material.

4. Use open questions

Purpose / when: to help the person talk freely and explore feelings. Volunteers encourage callers to talk about how they feel [source: Stylist].
Steps: (1) Ask questions that need more than yes or no. (2) Follow up with "Tell me more" [source: Equality Network/SHUSH]. (3) Prefer "how?" to "why?", which can sound accusatory [source: Defra/Samaritans]. (4) Ask questions that show interest in what the person is saying [source: DEAL].
Example language (illustrative): "How has this been affecting you?" "What's been the hardest part?" "Tell me more about that."
Watch for: stacked or leading questions, or questions that slide into advice ("Have you tried…?"). Working when answers become longer and more feeling-laden.

5. Say it back (reflecting, paraphrasing, summarising)

Purpose / when: to check you have understood and to show you listened, without interrupting or offering a solution [source: Equality Network/SHUSH; Defra/Samaritans; DEAL].
Steps: (1) Repeat key phrases the person used. (2) Periodically summarise what you have heard. (3) Ask whether you have it right [source: Defra/Samaritans]. Reflect feelings as well as facts [synthesis].
Example language (illustrative): "So since the job went, you've been on your own most days, and it sounds like you feel you've let everyone down. Have I got that right?"
Watch for: reflections that interpret or reframe too early. Working when the caller corrects or adds to your summary, or says "yes, exactly".

6. Exploring feelings rather than solving problems

Purpose / when: whenever the pull to fix arises. Volunteers give no advice and offer "a listening ear and a safe space" [source: Stylist]. Samaritans "won't tell you what to do" [source: Contact].
Steps: (1) Notice the urge to suggest a solution. (2) Turn it into a question about the person's feelings or their own ideas. (3) Accept that the caller's feelings may not be resolved by the end of the call [synthesis].
Example language (illustrative): "What do you feel you need right now?" "What have you thought about doing?"
Watch for: caller frustration at not getting advice (see Section 5). Working when the caller generates their own next steps.

7. Have courage: asking directly about suicide

Purpose / when: whenever you are worried someone may be suicidal. Asking directly can give permission to talk about feelings that are often treated as taboo [source: Defra/Samaritans]. Don't be put off by a negative response [source: Equality Network/SHUSH].
Steps: (1) Ask in plain, unambiguous words. (2) Stay calm and accept the answer without shock or judgement. (3) If the answer is yes, keep listening: explore what has led there and how the person feels now. (4) Then follow standard practice: ask about current intent and plans, access to means, what has stopped them so far, and who and what supports them. Do not score risk to predict outcome [synthesis, reflecting current professional practice; check your national guidance, e.g. NICE NG225 in England, uncertain].
Example language (illustrative): "Sometimes when people feel this low they think about ending their life. Are you having thoughts of suicide?"
Watch for: euphemisms such as "doing something silly", which invite denial. Relief after asking is common. Working when the person talks more openly about the thoughts. Samaritans' published material does not give a risk-assessment procedure for volunteers [uncertain].

8. Responding to a suicidal person within self-determination

Purpose / when: after a disclosure of suicidal thoughts, in a service that respects the caller's autonomy. Volunteers do not try to talk callers out of suicide. Some callers want only a friendly voice [source: Stylist]. Samaritans "will support the decisions you make" [source: Contact].
Steps: (1) Stay with the person and keep listening. Don't argue, lecture or rush to reassure. (2) Explore the ambivalence: the reasons for dying, and whatever is keeping the person going [synthesis]. (3) Explore the options the person can see, including other help. (4) If the caller appears unable to make rational decisions for themselves, the confidentiality exceptions apply (item 10) [source: Contact].
Example language (illustrative): "I'm not going to try to argue you out of how you feel. I'd like to understand it. What's brought you to this point tonight?"
Clinician note [synthesis]: Samaritans' self-determination stance is not the same as a clinician's duty of care. When you use this listening stance in clinical work, combine it with your service's own assessment, safety planning and escalation duties.
Watch for: sudden calm after agitation, statements of finality, or a plan already in motion. Working when the caller is engaged, less isolated and thinking about the next hours.

9. Signposting to specialist organisations

Purpose / when: when a need calls for specialist help (debt, abuse, housing, health). Volunteers "may suggest" specialist organisations, but advice is not their role [source: Contact].
Steps: (1) Ask what help the person has thought of or used. (2) Offer relevant options as choices, not instructions. (3) Leave the decision with the person [source: Contact; steps are synthesis].
Example language (illustrative): "Some people in your situation find it useful to talk to a debt advice service. Would it help to think about that, or not right now?"
Watch for: signposting used to end the conversation early. Working when the caller chooses a next step themselves.

10. Emergency action and the confidentiality exceptions

Purpose / when: for the rare situations where Samaritans may contact emergency services despite confidentiality. These are: a caller who appears unable to make rational decisions for themselves; a caller who discloses intended action carrying a risk of serious physical harm to a third person (with or without consent); and a child or adult at risk who is, or may be, harmed. Courts and nation-specific legislation can also require disclosure [source: Contact].
Steps [synthesis]: (1) Where possible, tell the person what you are worried about and seek their agreement to get help. (2) Gather location and immediate safety information calmly. (3) Contact emergency services under your organisation's procedure. (4) Stay in contact if you can. (5) Debrief afterwards. For lethal-means safety, limit yourself to asking the person to put dangerous items out of reach, or to agree to someone removing them, and to having another person with them.
Example language (illustrative): "I'm worried you're in danger right now and I don't want you to be alone with this. Can we get someone to you?"
Watch for: in your own clinical practice, your professional and legal duties set the threshold, not Samaritans' policy [synthesis].

11. Boundaries: abusive callers and very high call volumes

Purpose / when: to protect volunteers and keep the service available. Calls may end if a caller is abusive, threatening or sexually inappropriate. Callers making 100 or more calls, or talking for 20 or more hours, in a rolling 30 days may have their contact limited [source: Contact].
Steps [synthesis]: (1) Name the behaviour once, calmly. (2) State the limit. (3) End the call if it continues. (4) Debrief with your shift leader.
Example language (illustrative): "I want to keep listening, but I'm not able to continue if you speak to me like that."
Watch for: distress behind hostility. A boundary can be held while still treating the person with respect.

12. Long-term befriending (historical model)

Purpose / when: ongoing support for isolated people. One client was paired with one volunteer who met them regularly over months or years [source: Huddersfield blog]. Whether this one-to-one form is still offered was not found in current Samaritans pages [uncertain]. The current public offer is contact on demand.
Steps: detailed procedures are not given here [uncertain]. If you adapt the idea [synthesis]: agree the frequency and the limits of contact, keep the same listening stance, review regularly, and plan the ending from the start.

13. Supporter practices: being there, safety plan, support network, check-ins

Purpose / when: Samaritans' guidance for people supporting someone with suicidal thoughts covers: how to offer support, what "being there" involves, creating a safety plan, building a support network, how often to check in, getting additional help, and looking after yourself [source: Sheffield Suicide Support index of Samaritans guidance; topic titles only, content uncertain].
Steps (clinician adaptation, synthesis): (1) Write the safety plan with the person in their own words: warning signs, things that help them cope alone, people and places that distract, people they can ask for help, professional and crisis contacts (including 116 123), and making their surroundings safer. (2) Map the support network and get consent to involve named people. (3) Agree when you will next be in contact and who checks in before then.
Example language (illustrative): "Let's write down what you can do if tonight gets bad, starting with what's helped before."
Watch for: plans the person doesn't own, or a plan with no reachable people on it.

14. Listener self-care, debriefing and training practice

Purpose / when: after every shift and after difficult calls. Branches debrief volunteers at the end of shifts, check in the next day if issues arose, provide aftercare after traumatic calls and allow a temporary leave of absence. Training reported by volunteers: about three months of weekly group sessions with role-plays, then shadowing a mentor, then ongoing training [source: Stylist, volunteer accounts; may vary by branch, uncertain]. Samaritans' schools resource uses trios (talker, listener, observer) rotating through 5-minute rounds, followed by a debrief [source: DEAL].
Steps (for clinicians or teams, synthesis): practise SHUSH in trios with observer feedback, and arrange a debrief after every crisis contact.

15. Clinician: referring a client to Samaritans [synthesis]

Purpose / when: to give a client round-the-clock access to non-judgemental listening between sessions or while waiting for treatment. It adds to the client's crisis pathway and does not replace it.
Steps: (1) Check whether the client knows Samaritans and how they feel about it. (2) Explain what it is: free, 24/7, anonymous and confidential. Volunteers listen but don't advise or treat, and emergency services are involved only in the published exceptions. (3) Explain the practicalities: 116 123, the Welsh line, Relay UK, branch visits by arrangement, possible waits, and that email and letters have closed [source: Contact]. (4) Add it to the written safety plan beside your crisis team or out-of-hours number and the emergency route (999/112 or A&E). (5) Optionally rehearse a first sentence the client could say. (6) Make clear that Samaritans will not pass information to you.
Example language (illustrative): "If it's 3am and you need to talk to someone, Samaritans will listen. They won't tell you what to do. If you're in danger or can't keep yourself safe, that's when to call the crisis line or 999."
Watch for: clients who expect clinical help from Samaritans, or who use the line instead of urgent care when risk is high.

16. Clinician: joint working and reviewing use [synthesis]

Purpose / when: to integrate Samaritans contact into ongoing care.
Steps: (1) At each review, ask openly whether the client used any crisis or listening lines and what helped. (2) Treat what they share as material for the work: what triggered the call, and what eased the distress. (3) Update the safety plan. (4) Samaritans keeps no shared records with you, and no professional-to-professional referral route is given here [uncertain]. Coordination therefore goes through the client. (5) If the client is a very frequent caller, explore the pattern collaboratively rather than prohibit it.
Example language (illustrative): "Last time we put Samaritans on your plan. Did you end up calling? What was that like?"
Watch for: shame about calling, or a gap between how often the client calls and what they report in session.

5. Handling problems

Samaritans' public sources address only abusive callers, very frequent callers and emergencies [source: Contact]. Everything else here is [synthesis].

Silent or hesitant caller. Allow silence. Restate that the call is anonymous and confidential. Offer a low-demand opening ("You don't have to explain everything, just start anywhere"). It may take several contacts before the person opens up [source: SHUSH "Have patience"; rest synthesis].
Caller wants advice or answers. Acknowledge the wish. Explain gently that you won't tell them what to do but will help them think it through. Ask what options they can see. Signpost a specialist organisation if they want one [source: Contact; wording synthesis].
Words don't match presentation ("I'm fine" in a flat or tearful voice). Name the mismatch kindly and dig a little deeper [source: SHUSH].
Denial after you ask about suicide. Accept it without dropping the topic for good. Leave the door open ("If those thoughts ever come, you can tell me"). Don't be discouraged by a negative response [source: SHUSH "Have courage"].
Overwhelm or acute distress during the contact. Slow down and use shorter reflections. Bring attention to the present ("Where are you right now? Is anyone with you?"). Focus on getting through the next hour. If the person appears unable to make rational decisions, or is in immediate danger, follow item 10 [synthesis; exceptions per Contact].
Caller in immediate danger who refuses help. Within Samaritans, action without consent is limited to the published exceptions [source: Contact]. As a clinician, your legal and professional duties and local policy apply. Stay with the person, seek agreement, and escalate if needed. Never give or discuss method details. Confine means talk to removal, storage or putting distance between the person and dangerous items [synthesis].
Abusive, threatening or sexually inappropriate caller. Name it, set the limit and end the call if it continues [source: Contact]. Debrief afterwards.
Very frequent or dependent use. Samaritans may limit contact at 100 or more calls, or 20 or more hours, in a rolling 30 days [source: Contact]. Clinically, explore what the calls provide (company, regulation, structure) and build alternatives into the care plan with the client. Do not frame the calls as misbehaviour [synthesis].
Rupture: "they just listened, it was useless". Validate the frustration. Clarify what Samaritans offers and what it doesn't. Revisit the safety plan so it includes active clinical options alongside listening support [synthesis].
Client won't use the line (fear of being traced, shame, or past bad experience). Explore the fear. Share the published facts: the number is not shown to volunteers, calls don't appear on bills, and no name is needed [source: Contact]. Offer alternatives such as branch visits or text services available locally [synthesis].
Language, hearing or access needs. Use the Welsh line, Relay UK or a branch visit [source: Contact]. For other languages, check local services [synthesis].
Clinician discomfort with self-determination. Remember the boundary: Samaritans' non-directive stance does not limit your duty of care. Use the listening skills inside your assessment and safety planning [synthesis].
Listener burnout or vicarious distress. Debrief after shifts, check in the next day after hard calls, arrange aftercare and allow time out [source: Stylist]. Clinicians should use supervision after crisis contacts [synthesis].

Sources

Sources:

Further reading (not drawn on) [uncertain]: the Samaritans pages "Supporting someone with suicidal thoughts", "If you think it's an emergency" and "Talk to us on the phone", and the iHASCO SHUSH article. Also not drawn on: internal Samaritans volunteer training materials, which are not public, and national clinical guidance such as NICE NG225.

Books (not drawn on; for further reading): Varah, C. (ed.) (1965/1980s editions), The Samaritans: To Help Those Tempted to Suicide or Despair [uncertain: edition details not verified].

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