Crisis Line Research Articles

Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area

BackgroundThis report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. MethodsPatients seen for emergency psychiatric evaluation during the height of the COVID-19 period (March 1-April 30, 2020; N = 201) were compared with those in the immediate Pre-COVID-19 period (January 1-February 28, 2020; N = 355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative on the same outcomes. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. OutcomeThe most common psychiatric diagnoses and presenting symptoms during both periods were depression and suicidal ideation. Comparing the Pre-COVID-19 and COVID-19 periods, a significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/suicidal compared to their COVID-negative counterparts. ConclusionThis report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic and the need for clinical and diagnostic COVID-19 screening of psychiatric emergency patients. New and severe pathology underscore the need for enhanced outpatient access to tele-mental health, crisis hotline and on-line psychotherapeutic services, as well as psychiatric inpatient services with capacity to safely care for COVID-19 patients.

Advocates praise new National Suicide Prevention Lifeline law

Calling it a “groundbreaking moment,” mental health advocates are applauding the designation of 988 as the new, universal hotline telephone number for suicide prevention and mental health crises. The bipartisan National Suicide Hotline Designation Act of 2020 was signed into law by President Trump on Oct. 17. The new number is expected to be active by July 2022.

Hotline Use in the United States: Results from the Collaborative Psychiatric Epidemiology Surveys.

Crisis hotlines are a fixture in providing mental health services to individuals experiencing mental and behavioral problems in the United States (U.S.). Despite this, and the growing need for easily-accessible, anonymous, and free services amidst the suicide and opioid crises, there is no study reporting U.S. national prevalence and correlates of hotline use. Data on n = 18,909 participants from the Collaborative Psychiatric Epidemiology Surveys (CPES), a group of three nationally-representative, population-based studies, were used to estimate the prevalence of lifetime and past 12-month hotline use. A series of logistic regression models examined sociodemographic, clinical history and service use correlates of hotline use. Lifetime and past 12-month hotline use was estimated at 2.5% and 0.5%, respectively. Being female, having a mental or behavioral disorder, experiencing suicidality, or interacting with other formal and informal sectors of the mental health service system were significant correlates of use. This study provides the first national estimates of crisis hotline usage in the U.S. Hotlines are more likely to be used by certain sociodemographic subgroups, but these differences may be due to differing psychiatric history and service use patterns. Efforts should be made to ensure that crisis hotlines are being utilized by other marginalized populations at high risk of suicide or overdose amidst the current public health crises in the U.S., such as racial/ethnic minorities or youth. To evaluate the role that crisis hotlines play in the mental health service system, national surveys should aim to monitor trends and correlates over time.

Prospective study of association of characteristics of hotline psychological intervention in 778 high-risk callers with subsequent suicidal act.

This study aimed to assess the association of the quality scores of hotline psychological intervention and the reduction of subsequent suicidal acts among high suicidal risk callers. High-risk callers at a national crisis hotline service in China were recruited and prospectively followed for up to 3 months after receiving a hotline psychological intervention. The quality of the intervention was evaluated by supervisors who listened to the tape-recorded calls using the Counseling Skills Rating Scale for Psychological Support Hotlines, which assessed three counseling domains: process, attitude and communication skill. The primary outcome was the occurrence of suicidal acts during the follow-up period. Secondary outcomes were before versus after changes during the intake intervention call in hopefulness, psychological stress and suicide intention reported by the callers. Over the 3-month follow-up, 45 of 778 high-risk callers reported 61 suicide attempts, and 3 other callers died by suicide. Subsequent suicidal act was significantly more common in callers classified as being at higher risk during the intake call. Higher scores on the quality of suicidality assessing of the Counseling Skills Rating Scale for Psychological Support Hotlines were associated with reduced risk of suicidal acts during follow-up (hazard ratio = 0.38, 95% confidence interval = [0.18, 0.85]). Higher scores on the communication skill domain were associated with increases in hopefulness (β = 0.09) after the intervention, and higher scores on the counseling process domain (β = -0.12) and higher suicidal risk scores (β = -0.12) were associated with decreased suicide intention after intervention. Several characteristics of a hotline intervention for suicide prevention were associated with decreased risk of suicidal acts during follow-up. Intervention skill training for hotline operators should emphasize these specific counseling skills.

Field lauds congressional support of 988 suicide prevention, MH crisis line

It seems only fitting that during a month designated as National Suicide Prevention Month, the U.S. House of Representatives on Sept. 21 would vote unanimously to pass the National Suicide Hotline Designation Act (S. 2661), which creates a universal three‐digit number (988) for suicide prevention and mental health crises. The bill is now awaiting the president's signature.

In Case You Haven't Heard…

Advocacy organizations around the country, including Mental Health America (MHA), are calling on Congress to complete the work already started by voting to turn the National Suicide Hotline Designation Act into law. The National Suicide Hotline Designation Act establishes 988 as the easy‐to‐access three‐digit dialing code for suicide prevention and creates funding support through states and wireless phone carriers, similar to what the country has for 911. In July, the Federal Communications Commission made the historic announcement that it had unanimously voted to prevent suicides by designating 988 as the universal three‐digit dialing code for the National Suicide Prevention Lifeline. MHA on Sept. 15 sent out notices urging consumers to push Congress to make history on this designated number and make mental health services more accessible to save lives.

Bill Aimed at Replicating Oregon Mobile Crisis Program

Bill Aimed at Replicating Oregon Mobile Crisis Program

Perceptions of Public Messaging to Facilitate Help Seeking during Crisis among U.S. Veterans at Risk for Suicide

Objective The primary objectives of this study were to (1) examine how veterans at risk for suicide understand and interpret suicide prevention messages, and (2) identify message features that support (or hinder) help seeking behaviors. Method Individual virtual interviews (N = 40) were conducted from August 2018 to April 2019 with a nationwide sample of veterans who had a recent non-fatal suicide attempt. Participants were exposed to three messages in public circulation that promote help seeking during crisis and an interview guide steered open-ended conversations on the mechanisms of persuasive communication. Interview transcripts were analyzed using a constant comparison analytic strategy in Atlas.ti. Results Preferences for particular kinds of messages and features emerged during interviews based on a need for novel, emotionally intense stimuli among veterans. Specifically, messages with solemn themes and darker, more provocative imagery were believed to be particularly potent for engaging those at high risk. Although the goal of promoting help seeking was discernable, actionable steps (crisis line use) were not clearly communicated potentially preventing messages from increasing help seeking behaviors. Conclusion While messaging was perceived as capable of intervening to promote help seeking, participants reported distinct communication preferences and needs during periods of high risk. Findings underscore the significance of involving those with lived experience to inform the effective design and use of help seeking messaging targeting veterans at risk for suicide. Highlights Public messaging (campaigns) is a portable suicide prevention intervention Careful study is needed to effectively communicate help seeking messages Findings inform the effective use of campaigns with veterans at risk for suicide

Supportive effect of body contact care with ylang ylang aromatherapy and mobile intervention team for suicide prevention: A pilot study.

ObjectivesTo assess understudied, alternative suicide prevention modalities in a mental health care setting.MethodsThis was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery–Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits.ResultsThe interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%).ConclusionsThe results favour the implementation of integrated care and maintaining contact in suicide prevention.

Critical Foundations for Implementing the VA's Public Health Approach to Suicide Prevention.

Critical Foundations for Implementing the VA's Public Health Approach to Suicide Prevention.

Los Angeles' mental health businesses respond to COVID‐19 crisis

Four months into a global pandemic, Los Angeles' mental health industry is in high demand, the Los Angeles Business Journal reported July 27. The devastating economic impact of COVID‐19 and the seismic social changes buffeting the city are taking a toll on Angelenos, leading to increased activity for therapists and other self‐care businesses. Kindman & Co., a therapy group based in Highland Park, saw an increase in clients after switching to online therapy sessions, an option previously unavailable to 95% of the practice's customers. After seeing a slowdown in sessions when the office first turned to teletherapy in mid‐March — Kindman lost a third of its clientele initially — by May, the practice had taken in six times as many new patients as it received in March. “People are starting to realize that online therapy isn't going away; it's staying as the new normal,” said co‐founder Kaitlin Kindman. In April, the Didi Hirsch Mental Health Services Center in Los Angeles saw an 8,000% jump in calls to its suicide hotline, an increase of more than 1,800 calls from March. Headspace Inc., a Santa Monica–based meditation app, recently reached 62 million users and 2 million paid subscribers. The app also reported 10 times the regular number of users listening to stress meditations and 12 times the usual number of users listening to anxiety meditations.

FCC votes to designate 988 as new MH crisis hotline

The Federal Communications Commission on July 16 adopted rules to establish 988 as the new, nationwide, three‐digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors, according to an FCC press release. The rules require all phone service providers to direct all 988 calls to the existing National Suicide Prevention Lifeline (1‐800‐273‐TALK, or 1‐800‐273‐8255) by July 16, 2022. The new rules will apply to all telecommunications carriers as well as all interconnected and one‐way voice over Internet Protocol service providers. During the two‐year transition to 988, Americans who need help should continue to contact the National Suicide Prevention Lifeline by calling and through online chats. To ensure that calls to 988 reach the National Suicide Prevention Lifeline, all covered providers will be required to implement 10‐digit dialing in areas that both use seven‐digit dialing and use 988 as the first three numbers in seven‐digit phone numbers.

Venezuelan migrants in Colombia: COVID-19 and mental health

Venezuelan migrants in Colombia: COVID-19 and mental health

A health care workers mental health crisis line in the age of COVID-19.

IntroductionThe COVID‐19 pandemic has brought a health care crisis of unparalleled devastation. A mental health crisis as a second wave has begun to emerge in our front‐line health care workers.ObjectiveTo address these needs, The Healthcare Worker Mental Health COVID‐19 Hotline, based on crisis intervention principles, was developed and launched in 2 weeks.MethodsUpon reflection of why this worked, we decided it might be useful to describe what we now recognize as 13‐steps which led to our success. The process included the following: (1) anticipate mental health needs; (2) use leadership capable of mobilizing the systems and resources; (3) convene a multidisciplinary team; (4) delegate tasks and set timelines; (5) choose a clinical service model; (6) motivate staff as a workforce of volunteers; (7) develop training and educational materials; (8) develop personal, local, and national resources; (9) develop marketing plans; (10) deliver the training; (11) launch a 24 hr/7days per week Healthcare Worker Mental Health COVID‐19 Hotline, and launch follow‐up sessions for staff; (12) structure data collection to determine effectiveness and outcomes; and (13) obtain funding (not required).DiscussionWe believe the process we used is specifically useful for others who may want to develop a COVID‐19 hotline services for health care workers and generally useful for the development of other mental health services.ConclusionWe hope that this process may serve as a guide for other heath care systems.

Developing and Testing Crisis Line Facilitation to Encourage Help Seeking in Adults Receiving Inpatient Treatment for a Suicidal Crisis

Military veterans are at overall greater risk of suicide than nonveterans and have experienced increases in rates of suicide that are on par with or exceed those of the general population. The Department of Veterans Affairs has undertaken several initiatives to reduce suicide among veterans, including the development and expansion of the Veterans Crisis Line (VCL). The VCL has the potential to reduce suicidal behaviors, but it is likely underutilized by high-risk veterans. This paper describes the development of Crisis Line Facilitation (CLF) a brief intervention, designed to increase use of the VCL in this high-risk population. In a single session, CLF presents psychoeducational information about the VCL, discusses the participant’s perceived barriers and facilitators to future use of the VCL, and culminates in the veteran calling the VCL with the therapist to provide firsthand experiences that may counter negative impressions of the line. The intervention development process, intervention and control condition, and self-reported change indices are presented. Preliminary results (N = 301) suggest that veterans receiving CLF may experience a significant increase in comfort with, and confidence in, using the VCL during future crises compared to those in the control condition.

Mississippi sees jump in suicide hotline calls during virus

Calls from Mississippi to the National Suicide Prevention Lifeline have increased by 20% since the start of the COVID‐19 pandemic, according to a leader at the state Department of Mental Health, Gulflive.com reported. “There are severe mental health challenges going on as a result of this virus,” Gov. Tate Reeves said at a press briefing with Wendy Bailey, chief of staff at the Mississippi Department of Mental Health. “There is fear, there is pain and there is anxiety in this country and in our state and those cannot be overstated.” The number of people seeking mental health services in the state has increased across the board since February, Bailey said. These challenges can be spurred by changes in eating or sleeping habits, anxiety about one's health or the health of loved ones, stress over the loss of a job or increased use of substances, something that is common during a major event like the pandemic, Bailey said. Bailey and Reeves took time to share mental health resources, including the 24/7 mobile crisis unit in each of the state's 82 counties that responds to mental health emergencies. “We need to face the depression, anxiety and fear that are plaguing us,” said Bailey.

Crisis Hotlines Provide Essential MH Safety Net as Usage Grows

Back to table of contents Previous article ProfessionalFull AccessCrisis Hotlines Provide Essential MH Safety Net as Usage GrowsKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:6 Aug 2020https://doi.org/10.1176/appi.pn.2020.6a19AbstractThe integral role of crisis hotlines as a mental health safety net across the country suggests the prospective implementation of a three-digit, nationwide hotline number could be a game changer.In their presentation at APA’s virtual Spring Highlights meeting in April, Kimberly Williams, president and CEO of Vibrant Emotional Health, and two of her colleagues at Vibrant explained why crisis hotlines are key to transforming the delivery of mental health care, a topic made all the more relevant, Williams pointed out, due to the COVID-19 pandemic.“Crisis hotlines are a core part of our nation’s mental health safety net, particularly at a time like this,” Williams said. Vibrant provides 24/7 crisis hotline services, often in partnership with local, state, and federal governments, as well as the private sector.In 2018, 2.3 million people called into Vibrant’s National Suicide Prevention Lifeline, and Vibrant projects that the Lifeline will receive almost 2.9 million calls in 2020. The Lifeline relies on a national network of crisis call centers. Vibrant also offers text and online crisis services.The Federal Communications Commission has recommended that 988 become the new three-digit, nationwide number for people experiencing mental health or suicidal crisis (see Psychiatric News). If the number is implemented, it will be a game changer in terms of increasing people’s access to care and reducing the stigma of mental illness, John Draper, Ph.D., Vibrant’s executive vice president of national networks, said.“Today we are now seeing, with people isolated in their homes, that the kinds of services that crisis hotlines can provide are absolutely essential,” Draper said.Due to the COVID-19 pandemic, calls have increased to Vibrant’s Disaster Distress Helpline. Usually it receives about 50 calls a day, but recently it has been receiving upward of 600.Vibrant’s NYC Well—the support, crisis intervention, and information and referral service for people living in New York City—launched in late 2016, said program director Kelly Clarke. In 2017, 300,000 people reached out to NYC Well through phone calls, texts, and online chats. In 2019, that number rose to 350,000. “And we’re on track for more growth again in 2020,” Clarke said. NYC Well has also seen a surge in calls due to the COVID-19 pandemic.Draper explained that Vibrant established national standards for risk assessment with four core principles: assessing the caller’s desire to die by suicide, their intent, their capability to die by suicide, and the buffers that may prevent them from following through.For callers at imminent risk, the crisis centers follow additional protocols that involve actively engaging these callers in the least invasive way possible, implementing active rescue through emergency services agencies, and collaborating with those agencies.“The evidence shows we are effective,” Draper said. Lifeline’s policies for reducing imminent risk have been shown to enhance crisis centers’ ability to collaboratively de-escalate people at the highest risk for suicide without having to use involuntary or rescue services.“And our follow up calls have been shown to save lives,” Draper said. “Eighty percent [of callers] said these calls helped keep them alive, with half of them saying it’s the reason they are alive.” ■ ISSUES NewArchived

APA’s District Branches Take Lead in Helping Psychiatrists Adjust to New Way of Working

APA’s District Branches Take Lead in Helping Psychiatrists Adjust to New Way of Working

Illinois rolls out COVID‐19 MH crisis hotline as cases climb

After another deadly 24 hours in Illinois, Gov. J.B. Pritzker announced a new program to connect scared and depressed Illinois residents to badly needed mental health services, Block Club Chicago reported April 11. In the 24 hours in question, 81 people died from COVID‐19 and 1,293 new confirmed cases were reported. Hoping to help those in need of mental and physical health care during the crisis, the state has created programs that will help people from afar. Call4Calm, a free emotional support text line, was created to serve Illinois residents “swimming in the stress and uncertainty” caused by COVID‐19, Pritzker said. To connect with a counselor, people can text “TALK” to 552020 or text “HABLAR” to the same number for counseling in Spanish. Users will remain anonymous, and the state has partnered with mental health organizations to have counselors respond. Once a resident texts the hotline, they'll get a call from a licensed counselor within 24 hours. The program was announced as the state reached 19,180 confirmed COVID‐19 cases, said Dr. Ngozi Ezike, director of the Illinois Department of Public Health.

Impact of Crisis Line Volunteering on Mental Wellbeing and the Associated Factors: A Systematic Review.

Crisis line services, operated by volunteers, have been proven to be effective in decreasing psychological pain and preventing suicidality. Although working at the crisis line may be rewarding, for some the confrontation with highly complex topics (i.e., suicidality, abuse, and loneliness) in combination with inappropriate calls (i.e., sexually abusive calls), may lead to distress or vicarious trauma. The aim of this paper is to systematically review the studies that have examined mental wellbeing of crisis line volunteers and the factors associated with it. Thirteen published empirical studies on the topic were found. These showed that crisis line volunteers are at increased risk of declined mental wellbeing. However, a wide range of operationalizations were used and most studies did not use validated instruments. On the other hand, studies showed that many volunteers experience satisfaction and gratification from their work. This review gives insight into some of the work-related, organization-related, and volunteer-related factors that may be associated with the decrease of mental wellbeing. More high quality, comprehensive, and quantitative research using validated instruments is urgently needed to assess the impact of the work on mental wellbeing and the relative impact of influencing factors.