[Content warning: Article mentions suicide]
KJIPUKTUK (Halifax) – I knew a young woman who died last year. Her name was Caitlan. She called the mental health crisis line but felt disregarded. She took her own life a couple of hours later.
I know another woman. Her name is Amanda. She called the crisis line this year to get help for a young person in distress. She couldn’t connect despite repeated calls. The crisis line was down for hours that evening but the public wasn’t notified.
I know others whose calls weren’t answered, whose messages weren’t returned, who experienced extensive delays connecting with someone, whose concerns weren’t taken seriously, whose doubts and fears prevented them from calling, and who refuse to call again.
Let’s talk about Nova Scotia’s mental health crisis line.
You’ve seen it advertised by the Nova Scotia government and health authority. They instruct us to call the Provincial Mental Health and Addictions Crisis Line (1-888-429-8167) if we need support managing a mental health crisis, including suicidal thoughts, psychotic symptoms, intense anxiety or depression, or difficulty coping. They mention it often. They also direct us to the Kids Help Phone (1-800-668-6868) and a crisis text line (Text NSSTRONG to 741741) to receive support from out-of-province trained volunteers.
Crisis line call centres are a core element of mental health crisis response and suicide prevention systems. They are a relatively cheap investment that provide accessible, around-the-clock support to people in distress regardless of where they live – as long as they have access to a phone. The Nova Scotia government invests hundreds of thousands of dollars in crisis lines. A few years ago, they expanded the toll-free Nova Scotia -based mental health crisis line – run by Nova Scotia Health – across the province, addressing a priority identified in Nova Scotia’s first and only mental health strategy released in 2012.
Clinicians trained in crisis counselling operate the Nova Scotia mental health crisis line, which is unlike many other crisis lines that are staffed entirely by trained volunteers. These clinicians provide phone-based support to reduce callers’ crisis states, psychological distress, and suicide risk. Typically, crisis counsellors draw from a range of brief crisis intervention techniques focused on an individual’s situation, such as evaluating the person’s needs and imminent risk of suicide, stabilizing the crisis, supporting and giving voice to the caller, teaching coping skills, identifying strategies for action and future goals, and referring to local resources and supports such as community clinics or emergency rooms. Periodically, they may dispatch the police-involved Mental Health Mobile Crisis Team, which is only available for callers in the Halifax area who don’t mind the police attending.
It has been reported that the Nova Scotia mental health crisis line receives around 80 calls per day and that the number of calls has grown by more than 30% during the pandemic. Other than these slim details and anecdotal accounts of people’s adverse experiences with the Nova Scotia mental health crisis line, no information has been publicly shared about the quality of services being provided to Nova Scotians who are at their most vulnerable. This isn’t surprising given the lack of transparency that prevails across Nova Scotia’s government and public institutions. However, there are important reasons to call for greater transparency and accountability from our government and health system in relation to the Nova Scotia mental health crisis line.
Although crisis lines are recognized as a critical component to a mental health crisis response system, their evidence is rather limited. An article published last year summarized the findings of over 30 crisis line studies – mostly in the US – and concluded that “high quality evidence demonstrating crisis line effectiveness is lacking”. Crisis line services have shown positive outcomes, such as decreasing callers’ imminent risk of suicide and reducing their distress during crisis calls. Other studies have also revealed negative outcomes, such as service user dissatisfaction and no change in callers’ suicidal thoughts. Despite the mixed results, low-quality evidence, and absence of long-term outcome studies, the authors conclude that “Current evidence supports the continuation and expansion of crisis line services as an important safety net for comprehensive suicide prevention care”. In general, studies show the beneficial outcomes of telephone crisis lines while also drawing attention to major gaps concerning what we know about their effects.
Given how heavily our government and health systems depend on the Nova Scotia mental health crisis line, it is prudent for them to invest in rigourous study of how well it is working, including whether the crisis line is meeting the needs of people experiencing mental distress, their support network, and the broader community. The Nova Scotia mental health crisis line is supposed to provide “immediate access” to “24/7” support with calls returned “within 30 minutes”, which are all performance indicators that should be routinely evaluated and publicly reported by our health system. The effectiveness of crisis lines hinge on the quality of services being delivered, including whether they are accessible to, and offer proper support for, people from diverse communities (e.g., African Nova Scotian, Indigenous, Immigrant). Public data or independent evaluations of the Nova Scotia mental health crisis line have not been produced or made available.
Meeting the needs of people experiencing distress also requires reconsidering Nova Scotia’s clinician-delivered crisis line model. Province-wide access to government-funded warm lines should also be a component of Nova Scotia’s mental health crisis response system. Warm lines are run and staffed by experienced and trained peer support workers who listen to, empathize with, and provide support to people struggling with mental health issues. People call warm lines when they’re struggling and need someone to talk to – usually before or after a crisis. Warm lines can fill an important void in the lives of people living with mental health issues including reducing isolation and decreasing their use of crisis services. Like the rest of the mental health system, peer support should be considered a valuable and necessary element of Nova Scotia’s mental health crisis response system.
I’m sure that the Nova Scotia mental health crisis line helps many people. But, I also would like to know how common Caitlan’s story and Amanda’s experiences are when people in distress, or a person in their support network, call the mental health crisis line. We all should be informed about the quality of such services so that we are confident in its effectiveness, which is a key driver of whether a person with mental health needs will seek help. At the very least, we should be notified when the mental health crisis line experiences technical issues preventing callers from accessing such an essential service. I’d also like to see the Nova Scotia crisis line model evolve, not just expand, by involving people with lived experience of mental health issues in its delivery as well as being responsive to the needs of African Nova Scotian, Indigenous, and other racialized or marginalized communities.
Jamie Livingston, PhD, is an Associate Professor at the Department of Criminology, Saint Mary’s University, in Halifax, Nova Scotia.
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