What is a "crisis hotline"?

An effective crisis response system is built from many pieces, each piece designed to provide an interrupt, or stop, where folks can breathe and disrupt the escalation of their crisis. The initial interrupt occurs at the point the person reaches out for formal assistance. (Technically, the first interrupt is when the person realizes they are overwhelmed, in crisis, and uses their personal resources and friends, sometimes called "natural supports", to resolve the crisis. While these informal efforts may not be recognized as deescalation attempts they are very important to management of the crisis.) One point of entry into the system is through the telephone crisis hotline.

“Crisis hotline” is the generic name given to services designed to provide immediate, usually, telephonic response for persons experiencing an acute crisis event. The hotline may serve various purposes, including Information and Referral (I&R) warmlines, telephonic crisis counseling, and dispatching mobile interventions and rescue efforts.

In some regions specialized services exist for specific populations and problems; in other regions calls may be answered by generalists who have experience in a wider variety of problems. One area I am familiar with has the 911 emergency response for medical/fire/law enforcement response, a dedicated domestic abuse response line, and a behavioral health line. They work together to route callers to the most appropriate responder.

Hotlines are staffed with trained persons who may be licensed mental health professionals, unlicensed mental health specialists, or peer supporters. In some states, Ohio, for instance, the term "counseling" may only be used by a licensed counselor. So, while the caller may not receive “counseling” services on the phone, they will be talking with a trained phone responder who may provide a suicide risk assessment, crisis intervention, and referral to community services as needed.

Albert Roberts, PhD created the 7-stage crisis intervention model in use by many crisis lines. The model's seven stages are:

1. plan and conduct a thorough biopsychosocial and lethality/imminent danger assessment;
2. make psychological contact and rapidly establish the collaborative relationship;
3. identify the major problems, including crisis precipitants;
4. encourage an exploration of feelings and emotions;
5. generate and explore alternatives and new coping strategies;
6. restore functioning through implementation of an action plan;
7. plan follow-up and booster sessions.

Early crisis lines were organized in the 1950’s to provide suicide prevention services and have grown into networks of crisis centers able to respond to specific populations and circumstances nationwide. Suicide is now seen as a public health problem by policymakers and resources are available to strengthen a national network of suicide prevention call centers. "Many people trace official interest in the subject to a Senate resolution, introduced in 1997 by Senator Harry Reid, Democrat of Nevada, whose father killed himself, which proclaimed reducing suicide a national priority."

Mobile technologies offer challenges to rescuers and opportunities for folks to get help. As technology changes it is essential that crisis systems evolve. Call centers are learning to use social media, SMS/"texting", internet chat, and other technology to give folks options for confidential help with crisis intervention and de-escalation. Stop Teenage Suicide is an example. SAMHSA and Facebook teamed up in Dec 2011:

"The new service enables Facebook users to report a suicidal comment they see posted by a friend to Facebook using either the Report Suicidal Content link or the report links found throughout the site. The person who posted the suicidal comment will then immediately receive an e-mail from Facebook encouraging them to call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or to click on a link to begin a confidential chat session with a crisis worker."

Besides adding points of access for those in crisis, chat and texting extend the availability of staff resources. While Information and Referral (I&R) warmlines and runaway assistance centers can often operate on a limited-time schedule, acute crisis response hotlines must be available with 24-hour telephone service 7 days a week to provide counseling, guidance, emotional support, information and referral, and rescue interventions.

Mobile phones challenge emergency responders to locate suicidal callers due to the very advantage of cellphones: mobility. When you can't locate a caller, response time may be extended. Increasing the sensitivity of GPS tracking with smartphones offers promise but raises privacy concerns.

Examples

• 1-800-SUICIDE 1-800-784-243
• 1-800-273-TALK 1-800-273-8255
• 1-800-799-4TTY (4889) Deaf Hotline 
• 1-866-COP-2COP

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