Just a Phone Call Away- A Brief Exploration of Suicide Helplines

Suicide is the fourth leading cause of death among 15-29 year-olds, with more than 700,000 people dying each year (World Health Organization, 2023). The sheer statistics combined with the cyclical nature of the stigma pertaining to suicide underpins the need to continue developing preventive interventions. The current leading means of suicide prevention are suicide helplines, where individuals can reach trained professionals in moments of crisis at any time of day; particularly when other help is less accessible. These are intended for people who have any form of Suicidal Ideation or those who are concerned about others experiencing such thoughts. Yet, they hold a certain level of mystery and concern; particularly regarding how they work, how much a phone call can actually help, and what alternatives exist. 

In the context of helplines, the term suicidal carries a range of meanings, where any kind of suicidal thought or concern is a valid enough reason to reach out (113, n.d.). Suicidal Ideation may manifest across the entire mental illness spectrum and is particularly comorbid with depression, psychosis, and substance use disorders. For this reason, suicide helplines are faced with providing a broad range of support methods that starts with thorough need assessment (Brådvik, 2018)

On a global scale, the WHO (2018) reports an estimated 1000 suicide helplines present in the world, where increasing trends can be attributed to promising effectiveness paired with developing access to phones. Due to varying funding and national health protocols, these may differ in structure and general approaches, but the principle remains the same: they serve as a safe place for individuals struggling with suicidal ideation/thoughts to turn to in a comfortable and anonymous capacity. Most helpline organisations consist of volunteers who have a background in mental health. These volunteers are trained in suicide intervention skills, which typically consist of empathetic and non-judgemental listening, problem-solving strategies, and building a rapport with the callers (Jacob & Dubey, 2022). The core of their expertise lies in need-assessment, where the call starts by systematically determining the callers’ state of mind, what they need, and tailoring the phone call towards that. Specific training will differ per country and organisation, but the aforementioned are vital elements of all helplines (WHO, 2018).

The Dutch National Suicide Prevention Center, 113 ZelfMoordPreventie (113), is an example of a suicide helpline organisation that goes beyond just phone calls. In identifying the need to reduce stigma, they place immense emphasis on psycho-education, which is primarily accessible through their website. Here, individuals can find informative articles, video testimonials of callers and volunteers, online courses, tests, and a chat function. Although most of their website is in Dutch, they have an English webpage and the volunteers are proficient in both languages. Their phone number (0800-113) is only accessible to people located in the Netherlands, but individuals abroad can still reach 113 through the chat function (113, Zelfmoordpreventie, n.d.). The phone call is not limited to one conversation; volunteers are equipped to encourage long-term care through referrals, online courses, psycho-education, and creating safety plans (113 Zelfmoordpreventie, 2022). While the website is visually appealing and interviews may be convincing, there are still barriers against the use of these helplines that need to be identified and tackled in order to address the increasing global suicide trends (WHO, 2023). 

Within the Netherlands, a study by van der Burgt et al. (2023) identified primary barriers as fear of the conversation itself, concerns about the effectiveness of the counsellor, and emotional concerns about discussing suicidal thoughts. Additional research finds stigma to be the core barrier against suicide prevention efforts, which may also add to the specific barriers and negative perceptions people have around suicide helplines (Masoomi et al., 2022). 

Due to confidentiality standards, empirical evidence regarding the effectiveness of suicide helpline phone calls is scarce. A meta-analysis by Menon et al. (2018), identifies overall reduction in suicidality and hopelessness across a few studies conducted. However, due to the practicality and confidentiality of research, this remains limited in both quality and quantity. 

In terms of the typical demographic that contacts suicide helplines, little is known. However, research by Krishnamurti et al. (2022) suggests that females worldwide contact suicide helplines more frequently than males do. This, in combination with increased suicide completion rates in males, underscores a need to develop methods in reaching males through mental health services. In light of limitations faced, additional research on suicide helplines focuses on alternative means of reaching individuals struggling with suicidal thoughts, like websites and chat functions. 

Chat services have shown to be a promising addition to the phone calls, where individuals can send anonymous texts to the mental health volunteer instead of having to speak over the phone. This has been found to reduce distress and suicidality whilst maintaining the feeling of being understood (Gould, et al., 2021). Additionally, volunteers reported that longer texts help individuals convey their thoughts better than over the phone, and feel less distressed about maintaining anonymity (113, 2022). However, Mokkenstorm et al. (2017) found that although the 113 chat function was mostly positive, it lacked clinical practice standards, which yielded unfocused conversations. Furthermore, it is a relatively young intervention, which indicates the need for further research and standardisation of chat functions.

An additional interesting element of the 113 website is access to self-tests. Here, users can complete online anxiety, depression, and suicidal thoughts questionnaires containing multiple choice questions that lead to a score intended to provide an indication of the severity of their symptoms. This data remains anonymous, but is believed to ease people’s concerns about their symptoms and worries about not warranting help (113, n.d.). In a study examining the barriers of contacting the 113 helpline, researchers found that a majority of individuals who took the test passed the severe suicidal thoughts cut-off, yet less than 10% continued navigating the website to reach the helpline. This raises the question of the utility of these tests and a need to further improve their use (van der Burgt et al., 2023). Moreover, in spite of the positive intentions, it should be noted that these tests could also have opposite effects, where individuals become more distressed by their scores.

One may also wonder who is actually on the other end of the line and how prepared they are to tackle the issue presented. In the Netherlands, volunteers have minimum requirements of being in the second year of a psychology bachelor and attending the 113 multi-day mandatory training. A number of clinically certified (GGZ) psychologists are also present to oversee the volunteers and provide additional help where needed. The nature of volunteer work allows for individuals to work when highly motivated and be prepared to handle challenging cases (WHO, 2018). Longitudinal research by Spafford et al. (2023) followed crisis line volunteers and identified high levels of compassion satisfaction and mental wellbeing. They further determined the importance of social support and call-taking preparedness in maintaining volunteers’ mental health and avoiding burnout. 

Suicide helplines are a method of crisis intervention that essentially utilises human beings’ basic need to socialise and interact as a means to help individuals in deep distress continue living. Alternative helplines exist for a multitude of struggles beyond suicidal ideation, such as substance use, eating disorders, and interpersonal conflicts. An example is All Ears Amsterdam; an UvA student-led initiative that provides short-term mental health support to students. This takes the form of phone calls or chats and often has specific opening hours that may change as per volunteers’ availability. All volunteers have completed the Practical Training in Psychological Communication course and receive additional, All-Ears specific training (All Ears Amsterdam, n.d.). 

Suicide helpline organisations are a multifaceted area of crisis intervention that face the difficult task of supporting individuals in extreme distress. Despite this responsibility, research gaps persist in terms of the demographic trends and effectiveness of suicide helpline interventions. Additionally, stigma remains at the core of the barriers identified that prevent individuals struggling with suicidal thoughts from seeking help. Ultimately, continuing to speak up, reach out for help, and start conversations about suicide are small but necessary steps towards reducing this stigma and in turn, aiding individuals seek the help they need. 

If you or anyone you know is struggling with any form of suicidal ideation, please reach out. Some resources are as follows: 

Dutch Suicide Helpline: 0800-113

Visit: www.113.nl/english

All Ears Amsterdam: https://www.allearsamsterdam.com 

All Ears Instagram: @allearsamsterdam