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Health Care Strategies: Treatment Settings for Adults 

Health Care Strategies: Treatment Settings for Adults
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date: 18 August 2019

This chapter reviews the evidence of the effectiveness of telephone crisis services (‘hotlines’) as a suicide prevention strategy. Hotlines are a ubiquitous source of help internationally, but the evidence for their effectiveness is equivocal. Recent research provides support for crisis hotlines’ role in reducing callers’ crisis and suicidal states, bearing in mind the lack of control conditions. However, studies have also raised concerns about the extent and quality of suicide risk assessments and crisis interventions by hotline staff. A particular challenge is making hotline services attractive to youth. These concerns have prompted current efforts to enhance risk assessments, training and outreach strategies in telephone crisis centres.

Crisis hotlines are ubiquitous sources of help worldwide. A rationale for the role of crisis hotlines in suicide prevention is that suicidal behaviour is often associated with a crisis (Mishara and Daigle 2000). The psychological autopsy research generally supports the association of stressful life events, such as interpersonal losses and legal or disciplinary problems, with suicide (Runeson 1990; Brent et al. 1993; Gould et al. 1996). Furthermore, suicide is usually contemplated with psychological ambivalence—surviving suicide attempters often report that the wish to die coexisted with wishes to be rescued and saved (Shaffer et al. 1988). This can result in a ‘cry for help’, which can be addressed by those with special training (Litman et al. 1965). Lastly, crisis services may provide relief to an individual who is in the ‘final common pathway to suicide’ (Shaffer et al. 1988) by providing the opportunity for immediate support at these critical times. The goal of crisis hotlines is to prevent deleterious outcomes for callers by reducing their current crisis and/or suicidal states and identifying alternate coping approaches, including referrals to formal and/or informal community resources. Crisis hotlines have the practical advantage of providing temporally, financially, and geographically accessible services.

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