With COVID-19 continuing to spread in the United States, psychologists and other experts anticipate a rise in rates of depression and anxiety as people face emotional challenges related to unemployment, isolation, home confinement, and the illness itself. There are growing concerns about suicide, as well: A report by the Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, for example, predicts as many as 75,000 additional “deaths of despair”—from suicide and drug and alcohol problems.
But an increase in suicide rates is not inevitable, and population-level crisis interventions are one key way to help prevent such deaths from occurring, notes a commentary in The Lancetopens in new window (online April 21, 2020) by members of the International COVID-19 Suicide Prevention Research Collaboration. And so far in the United States, crisis and suicide hot lines appear to be meeting people’s needs, says psychologist John Draper, PhD, of Vibrant Emotional Health, a mental health, advocacy, and policy organization that manages the National Suicide Prevention Lifelineopens in new window, which is by funded the Substance Abuse and Mental Health Services Administration (SAMHSA).
“Many people are expressing anxiety about getting infected or having a loved one who's infected, or about losses and concerns related to finances, jobs, and the future,” says Draper.
Calls to the National Suicide Prevention Lifeline have remained stable since the beginning of the pandemic, at about 6,000 calls a month. Meanwhile, crisis calls related to anxiety and depression over the pandemic are being fielded by the SAMHSA-funded Disaster Distress Helplineopens in new window, launched in the wake of Hurricane Katrina to help people cope with the stress of such disasters. The helpline has received up to 10 times as many calls as it received before the pandemic, Draper says.
People have also been calling other federally supported mental health crisis lines linked to the lifeline, including the Veterans Crisis Lineopens in new window run by the Department of Veterans Affairs, and Lifeline centers that offer 24/7 Spanish-language services. People can also access help from Lifeline Crisis Chat, accessible through the lifeline’s websiteopens in new window. Also providing assistance are privately funded entities, including the Crisis Text Lineopens in new window and Seize the Awkwardopens in new window, which guides youth in developing communication skills to promote their ability to seek help when needed. In addition, there are many crisis lines at city, state, and county levels that are not part of the Lifeline network, which use differing definitions of “crisis” and vary in number from state to state.
Good crisis services serve as a kind of stop sign for people who are sufficiently distressed that they are contemplating suicide, notes psychologist Jill Harkavy-Friedman, PhD, vice president of research at the American Foundation for Suicide Prevention, which provides grants to study suicide prevention services.
“If you’re in intense emotional pain, it’s hard to gain access to your decision-making capacity,” she says. “Interventions that give people tools to manage their suicidal ideation head on” can help them through those feelings. “And we know that people are typically glad they’re alive once they’ve made it through.” The lifeline uses an established model of call flow that includes establishing rapport with the caller, asking about immediate risk of suicide, listening to the caller’s story, collaborating with him or her on a safety plan, and offering follow-up as needed. Follow-up calls take place 24 to 48 hours after the initial call and continue until the caller is connected to longer term services, no longer feels at risk, or says he or she doesn’t need further support.
Psychologists play essential roles in these services, involved as supervisors, program developers, implementers, trainers, and evaluators. But as helpful as crisis call services appear to be, are they effective?
There are no randomized controlled trials of mental health crisis lines, partly because it’s difficult ethically to conduct such studies. Furthermore, it’s difficult to measure the effectiveness of these hotlines because calls are anonymous and both sessions and follow-up are short-term.
However, a 2018 evaluation of the SAMHSA Lifeline led by Columbia University professor and psychiatric epidemiologist Madelyn Gould, PhD, found that nearly 80% of callers interviewed six to 12 weeks after calling the lifeline said the follow-up calls kept them from carrying out suicide and provided them with hope, made them feel cared about, and helped them connect with further mental health resources (Suicide and Life-Threatening Behavior, Vol. 48, No. 1, 2018).
Gould is now conducting an updated evaluation of lifeline effectiveness that will include questions about COVID-19 and stress and assessing the Lifeline’s Crisis Chat network.
One challenge of such research is that because they are designed for crises, it’s not clear how long the effects of these interventions last. It’s also difficult to say whether crisis lines and other services reach most of the people who need help. Data from SAMHSA and the Centers for Disease Control and Prevention estimate that each year more than 13 million people contemplate suicide, but the lifeline annually receives 500,000 suicide-related calls.
To expand these services, in 2022 the Federal Communications Commission plans to launch “988,” a new three-digit number for mental health and suicidal crises. At present, the lifeline network is expected to take these calls. Congress will eventually make further infrastructure recommendations, as it’s likely 988 will lead to a much larger call volume, Draper says.
“Just as 911 was a revolution for mobilizing law enforcement and emergency medical services funding and resources, 988 should significantly transform mental health crisis services in communities throughout the country,” he says.
And that will mean new opportunities for psychologists, he adds.
“We’re going to need a lot more person power out there,” he says. “So, it’s really important for psychologists to say, ‘Beyond my career in therapy, maybe there’s also a career for me in crisis services.’”
To volunteer or apply to become a staff member at one of the 170 crisis centers in the National Suicide Prevention Lifeline, contact your local center through the lifeline websiteopens in new window.
