An Evaluation of Crisis Hotline Outcomes Part 1: Nonsuicidal Crisis Callers

Article · July 2007with481 Reads
DOI: 10.1521/suli.2007.37.3.322 · Source: PubMed
Abstract
The effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers' crisis state from the beginning to the end of their calls to eight centers in the U.S. and intermediate outcomes within 3 weeks of their calls, was evaluated. Between March 2003 and July 2004, 1,617 crisis callers were assessed during their calls and 801 (49.5%) participated in the followup assessment. Significant decreases in callers' crisis states and hopelessness were found during the course of the telephone session, with continuing decreases in crisis states and hopelessness in the following weeks. A majority of callers were provided with referrals and/or plans of actions for their concerns and approximately one third of those provided with mental health referrals had followed up with the referral by the time of the follow-up assessment. While crisis service staff coded these callers as nonsuicidal, at follow-up nearly 12% of them reported having suicidal thoughts either during or since their call to the center. The need to conduct suicide risk assessments with crisis callers and to identify strategies to improve referral follow-up is highlighted.
    • We identified 21 articles that reported on 19 separate studies, 11 of which were call record audits[2,6,9,12,15,16,[25][26][27][28][29][30], five of which were follow-up surveys of callers[1,[31][32][33][34][35], and three of which were intervention studies[5,13,36]. The published studies provided us with some insights into frequent callers.
    [Show abstract] [Hide abstract] ABSTRACT: Background This paper describes a program of work designed to inform a service model to address a challenge for telephone helplines, namely frequent callers. Methods We conducted a systematic literature review and four empirical studies that drew on different data sources—(a) routinely collected calls data from Lifeline, Australia’s largest telephone helpline; (b) data from surveys/interviews with Lifeline frequent callers; (c) data from the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) study; and (d) data from Australia’s National Survey of Mental Health and Wellbeing. Results Frequent callers represent 3 % of callers but make 60 % of calls. They are isolated and have few social supports but are not “time wasters”; they have major mental and physical health problems and are often in crisis. They make use of other services for their mental health problems. The circumstances under which they use telephone helplines vary, but current service models reinforce their calling behaviour. Conclusions The findings point to a service model that might better serve the needs of both frequent callers and other callers. The model involves offering frequent callers an integrated, tailored service in which they are allocated a dedicated and specially trained telephone crisis supporter (TCS), and given set calling times. It also involves promoting better linkages between telephone helplines and other services that provide mental health care, particularly general practitioners (GPs) and other primary care providers. The next step is to refine and test the model.
    Full-text · Article · Dec 2016
    • " ) which we use as our conversation quality ground-truth (we use binary labels: good versus same/worse, since we care about improving the situation). In contrast to previous work that has used human judges to rate a caller's crisis state (Kalafat et al., 2007 ), we directly obtain this feedback from the texter. Furthermore , the counselor fills out a post-conversation report (e.g., suicide risk, main issue such as depression , relationship, self-harm, suicide, etc.).
    [Show abstract] [Hide abstract] ABSTRACT: Mental illness is one of the most pressing public health issues of our time. While counseling and psychotherapy can be effective treatments, our knowledge about how to conduct successful counseling conversations has been limited due to lack of large-scale data with labeled outcomes of the conversations. In this paper, we present a large-scale, quantitative study on the discourse of text-message-based counseling conversations. We develop a set of novel computational discourse analysis methods to measure how various linguistic aspects of conversations are correlated with conversation outcomes. Applying techniques such as sequence-based conversation models, language model comparisons, message clustering, and psycholinguistics-inspired word frequency analyses, we discover actionable conversation strategies that are associated with better conversation outcomes.
    Full-text · Article · May 2016
    • The complex health needs of frequent users mean that they are likely to require a range of healthcare services, yet their health service use patterns are poorly understood. Some authors have suggested that frequent users have an inappropriate reliance on telephone helplines and they continue to call because their needs are not being met by other areas of the healthcare system (Gould et al. 2007; Kalafat et al. 2007). If this is true, then improving the response local healthcare services provide to frequent users might decrease their calls to telephone helplines.
    [Show abstract] [Hide abstract] ABSTRACT: We examined the relationship between frequent use of telephone helplines and health service use over time in a cohort of 789 general practice attendees with depressive symptoms. Telephone helpline use (no use, non-frequent use, frequent use) was measured at 3, 6, 9 and 12 months and analysed using ordered logistic regression. Sixteen participants (2 %) reported frequent use of telephone helplines. Reporting frequent use was associated with visiting multiple general practitioners, using emergency services and visiting mental health specialists in the previous 3 months. Despite this pattern of service use, there was evidence that these services were not meeting the needs of frequent users of telephone helplines, as they were also more likely to report dissatisfaction with their access to health services compared to non-frequent and non-users of telephone helplines. Our findings suggest that a model of care which addresses the complex needs of frequent users of telephone helplines is needed.
    Article · Sep 2015
    • Crisis helplines have provided support to individuals in the community who are experiencing personal crisis (including risk of suicide) since they were introduced in the 1950s and 1960s (Lester, 2002). Helplines are generally staffed by trained volunteers or para-professionals, allow callers to remain anonymous, and only cost the caller the price of a standard telephone call (Coman et al., 2001; Hall and Schlosar, 1995; Kalafat et al., 2007; Lester, 2002; Sawyer and Jameton, 1979). Many, though not all, are available on a 24-hour basis.
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Frequent callers present a challenge for crisis helplines, which strive to achieve optimal outcomes for all callers within finite resources. This study aimed to describe frequent callers to Lifeline (the largest crisis helpline in Australia) and compare them with non-frequent callers, with a view to furthering knowledge about models of service delivery that might meet the needs of frequent callers. Method: Lifeline provided an anonymous dataset on calls made between December 2011 and May 2013. We assumed calls from the same (encrypted) phone number were made by the same person, and aggregated call level data up to the person level. Individuals who made 0.667 calls per day in any period from 1 week to the full 549 days for which we had data (i.e. 4.7 calls in 7 days, 20 calls in 30 days, 40 calls in 60 days, etc.) were regarded as frequent callers. Results: Our analysis dataset included 411,725 calls made by 98,174 individuals, 2594 (2.6%) of whom met our definition of frequent callers. We identified a number of predictors of being a frequent caller, including being male or transgender, and never having been married. The odds increased with age until 55-64 years, and then declined. Suicidality, self-harm, mental health issues, crime, child protection and domestic violence issues all predicted being a frequent caller. Conclusions: Collectively, frequent callers have a significant impact on crisis lines, and solutions need to be found for responding to them that are in everybody's best interests (i.e. the frequent callers themselves, other callers, telephone crisis supporters who staff crisis lines, and those who manage crisis lines). In striking this balance, the complex and multiple needs of frequent callers must be taken into account.
    Article · Jun 2014
    • Many countries have helplines offering crisis help specifically targeted at suicidal persons. Few studies have examined the effectiveness of these helplines, but most studies show a positive effect (De Leo et al., 2002; Mishara et al., 2007; Kalafat et al., 2007; Leitner et al., 2008). A recent online survey of callers contacting the Samaritans (national suicide prevention helpline of the UK) found that the callers reported high levels of satisfaction with the service and perceived the contact to be helpful (Coveney et al., 2012).
    Full-text · Article · Jan 2014 · Australian and New Zealand Journal of Psychiatry
    • However, outcomes on suicide specific measures were not reported. A highly cited, although uncontrolled study, used a follow-up design (pre-post outcomes) to evaluate the effectiveness of a crisis line for non-suicidal crisis callers (n=1617, of whom 801 provided follow-up data) [4]. Callers' levels of crisis and hopelessness were rated during the calls and found to decrease during the course of the call.
    File · Data · Jun 2013 · Australian and New Zealand Journal of Psychiatry
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