California Suicide Hotlines Get Good Grades But Could Improve, Study Says

Some of California’s suicide hotlines provide a “valuable and trusted service” to callers in distress, but they could be doing an even better job, according to a new study released Tuesday.

Researchers at the Rand Corporation, a Santa Monica-based think tank, found that hotline staff had good rapport with callers and were able to ease their distress in some cases. But the hotlines could better integrate their services with existing health care providers and add new ways to connect with the public, such as online chats, the study said.

California’s suicide rate is the ninth lowest in the nation. But still, 4,214 state residents took their own lives in 2014, and Californians made 33,350 emergency department visits for self-inflicted injuries, according to federal and state health data.

The Rand researchers evaluated the performance of 12 suicide prevention hotlines in California that have received funding from CalMHSA, a coalition of counties working on mental health issues with funding from Proposition 63, also known as the millionaire’s tax. The hotlines are among an estimated 90 operating in California, according to the study.

The researchers surveyed hotline callers and listened to live calls at some of the hotlines to rate their performances. They found that the hotlines mostly followed the best practices recommended by mental health experts.

Calls to the hotline relieved the distress of about half the callers while they were on the line, according to the Rand study. For the other half, there was no change in the level of distress. Overall, caller satisfaction scores averaged 3.4 out of a maximum of 5.

“These suicide prevention hotlines are so relied upon that we need to ensure they are adequately funded,” said Rajeev Ramchand, the study’s lead author. “They need to provide high quality care and be monitored to improve upon that care. We hope that our research contributes to that effort.”

Ramchand said most calls to suicide hotlines are not considered “high risk.” Some people simply may want someone to chat with; others seek resources for a friend or family member.

Hotlines can prevent suicide in two ways: They can help ensure immediate safety for suicidal callers by contacting emergency responders to go help them, and they can connect high-risk callers such as mentally ill or homeless people to other resources, including mental health counseling and housing assistance.

Ramchand said suicide hotlines have become increasingly busy. An estimated 1 million people receive help each year from the National Suicide Prevention Lifeline network, which includes some of the California hotlines that Rand evaluated.

Yet not much research exists on the effectiveness of hotlines in actually preventing suicide.

Ramchand and his colleagues recommended that hotline organizations improve the quality of their services by:

  • Monitoring calls and providing additional responder training
  • Promoting hotlines that are integrated with health care systems
  • Increasing the availability of chat and text services
  • Improving the referral process by developing a centralized directory of mental health and other resources

Those recommendations are in line with initiatives that are already underway at some California call centers, said Eve Meyer, executive director of the San Francisco Suicide Prevention call center.

The center, which started more than 50 years ago, already monitors calls closely and provides significant training to staff and volunteers, Meyer said.

The San Francisco call center is also developing a texting system. Meyer noted that other call centers in the Bay Area already provide such a service. The center tried a web-based chat system in the past, but it was not very popular, Meyer said.

Referring some high-risk callers to outside resources also can be complicated, and it isn’t always effective, Meyer said.

“These are people who have flunked out of the mental health system, the health care system,” she said. “They have already been referred to places, but their needs haven’t been met. Another referral doesn’t help them.”

“Our job is to listen and figure what will work for them,” she said.

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