Research suggests integrating suicide prevention hotlines, health systems

Findings from the RAND Corporation indicate that suicide prevention hotlines in California could be improved by expanding digital offerings, integrating with health care services and systems and increasing seamless access to necessary resources for callers.

“Our evaluation shows that suicide prevention hotlines available to California residents provide a trusted and valuable service, but much can be done to make them more accessible and to improve the quality of their services,” Rajeev Ramchand, PhD, of RAND Corporation, said in a press release. “For example, digital services lag behind a growing demand and integrating more hotlines into existing health care systems could better connect callers to needed mental health services.”

Rajeev Ramchand

In 2013, RAND conducted a statewide telephone-based survey of adults in California. Study participants (n = 2,568) were asked about their knowledge of resources for suicide and how likely they would be to use those resources. RAND followed up with 50% of the original respondents from May to December 2014.

Seeking in-person help from a mental health professional was the most commonly reported preference (78%), followed by in-person help from family and friends (72%), visiting a website (66%), calling a crisis line (62%), using a web-based crisis chat service (46%) and texting a crisis line (43%).

Researchers found slight preference differences between Asian-American, black and Latino adults.

In 2014, RAND raters conducted live monitoring of ten suicide prevention hotlines supported by California Mental Health Services Authority. An average of 24 calls per center were rated.

One-third of calls were from repeat callers, 57% of callers were women and the average call duration was 14 minutes.

Seven percent of calls were put on hold. Five centers did not have any calls put on hold.

Thirteen percent of calls were from someone concerned about another individual.

Approximately 50% of callers showed mental health or substance use problems. Other commonly mentioned problems included physical health challenges, interpersonal problems, work, housing and financial problems.

Twenty-six percent of callers brought up suicide during a call and 21% were thinking about committing suicide.

Overall, 69% of callers were asked about current suicidal ideation, 25% were asked about recent ideation and 21% were asked about past attempts.

Referrals were required among 30% of calls. Half of calls that required referral were rated as limited. In many cases, required referrals were beyond the reach of counselors’ typical knowledge, resource guides were hard to navigate or outdated, or there were no adequate community resources to meet needs.

On a scale of 1 to 5, with 5 indicating high satisfaction, researchers rated overall caller satisfaction as 3.4, with minimal variability across centers.

“Our evaluation revealed uncertainty about whether suicide prevention hotlines are meeting the needs of at-risk populations in California. However, to date, there have been no statewide studies assessing the need for suicide prevention hotlines or the capacity to meet these needs using the types of data collected by call centers. [Therefore], more research is needed to identify the reasons for these preferences, as well as barriers and facilitators to seeking help,” the researchers concluded. – by Amanda Oldt

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.

Reference:

Ramchand R, et al. Suicide prevention hotlines in California: Diversity in services, structure, and organization and the potential challenges ahead. Santa Monica, CA: RAND Corporation, 2016. http://www.rand.org/pubs/research_reports/RR1497.html.