Can a text conversation provide the support needed when someone is seeking help during a mental health breakdown?
New research from UBC Okanagan is saying yes, crisis text lines are useful and effective.
Dr. Susan Holtzman, who teaches psychology in the Irving K. Barber Faculty of Arts and Social Sciences, explains that mental health crisis services have expanded recently beyond telephone hotlines to include communication methods such as live chat and texting.
Dr. Holtzman notes there is growing pressure in Canada to create one three-digit suicide crisis hotline which would be similar to the one launched recently in the United States. If implemented in Canada, not only would it be easier for Canadians to immediately access help, it would also confirm that Canada sees mental health care and suicide prevention as serious matters of concern.
"Every year, millions of people all over the world reach out to crisis text lines," Dr. Holtzman says. "However, because crisis text lines are anonymous, very little is known about the user experience. And despite rising mental health problems worldwide and a high uptake of crisis text line services, they remain understudied."
Dr. Holtzman's team, led by clinical psychology doctoral student Alanna Coady, turned to Twitter posts to examine how crisis text lines users responded to their experiences with the crisis lines.
Analyzing 776 tweets the research team examined six main themes including approval, helpful or unhelpful counselling, service delivery issues, accessibility and whether the service suits multiple mental health needs.
Overall, results determined text-based crisis support works, as many users reported positive experiences of effective counselling including helpful coping skills, de-escalation and reduction of harm.
"The goal of this project was to gather first-hand accounts of people who use crisis text lines to better understand the benefits and limitations of these services," explains Coady. "Many users preferred the discreetness of texting over calling a crisis line, and the majority of tweets indicated that users found the service helpful."
However, she notes there are drawbacks to texting crisis lines, including long wait times. Users also noted that some responses from counsellors were described as cliché, overly scripted or invalidating. This could be somewhat related to the texting platform, she explains, which can be more prone to misunderstandings.
"While some people may encounter negative reviews of crisis text lines on social media, our findings suggest that positive experiences are much more common and users report a wide range of benefits, including feelings of validation and concrete coping strategies," Coady adds. "Overall, crisis text lines appear to be a promising method of delivering crisis support."
Dr. Holtzman notes the study, published recently in Internet Interventions, did not make a direct comparison between telephone and text-based crisis lines. The purpose of the research was to examine user response. Results also identified areas for improvement, particularly ensuring more timely service delivery and effective communication of empathy.
"Our findings highlight that more research is needed to understand how we can effectively communicate empathy and understanding through texting," she says. "At the same time, this research suggests that even a brief text-based conversation with a trained counsellor can lead users to feel safe and supported during their darkest hours. Given the many barriers to mental health treatment in our society, as well as the further strain caused by the pandemic, text-based crisis lines warrant much more attention from researchers than they have been given in the past."
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