Crisis Hotlines Provide Essential MH Safety Net as Usage Grows

In their presentation at APA’s Spring Highlights Meeting this past weekend, Kimberly Williams (pictured at left), president and CEO of Vibrant Emotional Health, and two of her colleagues at Vibrant explained why crisis hotlines are key to transforming mental health care delivery—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-line services to millions of people across the country, often in partnership with local, state, and federal governments, as well as the private sector. In 2018, 2.3 million people called Vibrant’s National Suicide Prevention Lifeline. 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 three-digit, nationwide number for mental health crises and suicide prevention. Implementation is still years away, but if it does occur, it will be a game changer in terms of increasing people’s access to care and reducing mental health stigma, said John Draper, Ph.D., Vibrant’s executive vice president of national networks.

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 is receiving upward of 600, Draper said. With people isolated in their homes, the kinds of services that crisis hotlines can provide are essential, he added.

Vibrant’s NYC Well, the support, crisis intervention, and information and referral service for people living in New York City, was 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. Since the COVID-19 pandemic, NYC Well has seen a surge in calls, Clarke noted.

Draper explained that Vibrant established national standards for suicide 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.

If a caller is at imminent risk, the crisis centers follow additional protocols that involve engaging those people in the least invasive way possible, implementing 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.

“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.” ■