Preventing suicide requires more attention on technology-based crisis support services

To the Editor,

Increased government spending, largely on clinical services, for suicide prevention has not led to meaningful changes in Australian suicide rates (Snowdon, 2015). Crisis intervention strategies that include readily accessible support without referral requirement are a fundamental suicide prevention strategy, meaning that Australia’s ability to ensure that individuals have access to crisis intervention requires serious discussion and action (National Coalition for Suicide Prevention, 2014).

Within Australia, non-clinical telephone and online crisis support services provide essential infrastructure and suicide prevention intervention for individuals in suicidal crisis. Service operational data show that up to one-third of callers to telephone crisis lines and half of all visitors to crisis chat services may be suicidal at the time of contact, and could not or would not access clinical services in their suicidal state. These data also show that telephone and online crisis support services significantly reduce caller suicidality and often facilitate engagement with necessary intervention (Lifeline Australia Research Foundation, 2013).

Benefits of technology-based crisis support services include being immediately available for rapid crisis intervention, anonymous, cost-free and available 24 hours a day. Drawbacks include the volunteer nature of crisis support staff, inability to screen for caller needs prior to cold-call and thus exacerbated staff vulnerability to volunteer overload, cognitive drain and burnout. As contacts with technology-based crisis services continue to increase each year (Lifeline Australia Research Foundation, 2013), an urgent need for ongoing service development is to identify the impact of the role on crisis support staff wellbeing, determinants of staff wellbeing in the crisis support context and the extent to which the wellbeing of crisis support staff impacts their performance and caller outcomes. Such research must be multidimensional and be driven by an integrated model of staff education and service support that examines relationships between (1) recruitment, (2) training, (3) skill assessment, (4) personal development and individual processes to maintain wellbeing (e.g. self-care), (5) supervisor training and staff support strategies (e.g. learning, teaching and facilitating a reflective practice model for supervision and staff professional development) and (6) service support strategies (e.g. organisation personal and professional support strategies that compliment staff supervision). The dimensions can be conceptualised as the faces of a cube.

As Australians continue to adopt technology, telephone and online crisis services will continue to have a key role in the national suicide prevention strategy. Implementing an integrated approach to strengthen the efficacy of these services is essential.