Crisis lines

Crisis lines provide free and confidential counseling via telephone-based conversation, web-based chat, or text message to individuals in crisis, often those with severe mental health concerns such as suicidal thoughts. Crisis line counselors provide emotional support to callers, assess suicide risk, and refer callers to resources including counseling, social services, and emergency services. Counselors can be professionals or volunteers ().

Expected Beneficial Outcomes (Rated)

  • Improved mental health

Other Potential Beneficial Outcomes

  • Reduced suicide

Evidence of Effectiveness

There is some evidence that crisis lines reduce suicide risk and depressive symptoms among callers (, , , Coveney 2012). Additional evidence is needed to confirm effects.

Assessments of crisis hotlines in the US and the UK indicate that callers experience reductions in suicidal thoughts, self-harm ideation, distress, and hopelessness at the end of their call (, , , Coveney 2012). Volunteers and professionals both appear to effectively conduct suicidal risk assessment and show empathy to callers; however, counselors with more experience appear to provide greater benefit than counselors with less experience (Mishara 2016). Suicidal callers who speak to counselors with training in suicide intervention show greater reductions in suicide risk and depression over the course of a call than callers who speak to counselors without such training (Gould 2013).

A survey of the National Suicide Prevention Lifeline (NSPL) suggests that 50% of those who call a suicide hotline and are referred to mental health services access those services (). Researchers suggest counselor training, integration with health care systems, and creation of protocols for call monitoring and suicide risk screening are needed to increase crisis line effectiveness (RAND-Acosta 2017).  

An evaluation of the NSPL’s initiative that provides follow-up calls to high-risk callers and individuals discharged from inpatient or emergency department settings suggests that follow-up calls may reduce the risk of future suicide attempts (, NSPL 2014).

Impact on Disparities

No impact on disparities likely

Implementation Examples

The National Suicide Prevention Lifeline (NSPL), funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides telephone-based hotline and online crisis chat services to anyone in suicidal crisis or emotional distress in 164 local crisis centers in 49 states (NSPL). SAMHSA’s Disaster Distress Helpline (DDH) offers trauma crisis counseling and support for those who experience mass violence or natural disasters via call or text (DDH). Both NSPL and DDH have a Spanish line and provide an interpretation service for more than 150 languages. The Veterans Crisis Line and Crisis Text Line are two other examples of hotlines that serve individuals across the country (VCL, Crisis Text Line).

Examples of local initiatives include Nevada’s Crisis Call Center, which provides telephone-based hotline and text message crisis intervention services 24 hours a day, and California’s Suicide Prevention Initiative, which offers telephone-based hotlines as well as web and text-based chat services (Crisis Call Center, RAND-Acosta 2017). 

Citations - Evidence

* Journal subscription may be required for access.

Gould 2012* - Gould MS, Munfakh JLH, Kleinman M, Lake AM. National suicide prevention lifeline: Enhancing mental health care for suicidal individuals and other people in crisis. Suicide and Life-Threatening Behavior. 2012;42(1): 22–35.

Gould 2007* - Gould MS, Kalafat J, HarrisMunfakh J Lou, Kleinman M. An evaluation of crisis hotline outcomes. Part 2: Suicidal callers. Suicide and Life-Threatening Behavior. 2007;37(3):338-352.

Ramchand 2017* - Ramchand R, Jaycox L, Ebener P, et al. Characteristics and proximal outcomes of calls made to suicide crisis hotlines in California: Variability across centers. Crisis. 2017;38(1):26-35.

Tyson 2016* - Tyson P, Law C, Reed S, et al. Preventing suicide and self-harm: Evaluating the efficacy of a helpline from a service user and helpline worker perspective. Crisis. 2016;37(5):353-360.

Coveney 2012 - Coveney CM, Pollock K, Armstrong S, Moore J. Callers’ experiences of contacting a national suicide prevention helpline: Report of an online survey. Crisis. 2012;33(6):313-324.

Gould 2013 - Gould MS, Cross W, Pisani AR, Munfakh J Lou, Kleinman M. Impact of Applied Suicide Intervention Skills Training (ASIST) on National Suicide Prevention Lifeline counselor: Interventions and suicidal caller outcomes. Suicide and Life-Threatening Behavior. 2013;43(6).

Mishara 2016 - Mishara BL, Daigle M, Bardon C, et al. Comparison of the effects of telephone suicide prevention help by volunteers and professional paid staff: Results from studies in the USA and Quebec, Canada. Suicide and Life-Threatening Behavior. 2016;46(5):577-587.

RAND-Acosta 2017 - Acosta JD, Whitley MD, May LW, Dubowitz T, Williams M, Chandra A. Suicide prevention hotlines in California: Diversity in services, structure, and organization and the potential challenges ahead. RAND Health Quarterly. 2017;6(3).

Gould 2017* - Gould MS, Lake AM, Galfalvy H, et al. Follow-up with callers to the National Suicide Prevention Lifeline: Evaluation of callers’ perceptions of care. Suicide and Life-Threatening Behavior. 2017.

NSPL 2014 - National Suicide Prevention Lifeline (NSPL). Crisis Center Guidance: Follow-up with callers and those discharged from emergency department and inpatient settings. December 2014.

Citations - Implementation Examples

* Journal subscription may be required for access.

Crisis Text Line - Crisis Text Line. Support for teens, 24/7.

Crisis Call Center - Crisis Call Center. 24-hour crisis hotline.

RAND-Acosta 2017 - Acosta JD, Whitley MD, May LW, Dubowitz T, Williams M, Chandra A. Suicide prevention hotlines in California: Diversity in services, structure, and organization and the potential challenges ahead. RAND Health Quarterly. 2017;6(3).

NSPL - National Suicide Prevention Lifeline (NSPL). Together, we can change lives.

DDH - Substance Abuse and Mental Health Services Administration (SAMHSA). Disaster Distress Helpline (DDH).

VCL - Veterans Crisis Line (VCL). Confidential help for veterans and their families.

Date Last Updated

Dec 18, 2017