Strengthening Suicide Helpline Services Requires Better Funding and Staff Support

Systemic improvements are urgently needed in suicide helpline services (SHSs) worldwide, particularly in funding, staff training, and quality assurance, to enhance their effectiveness in crisis intervention, according to study results published in The Lancet Psychiatry.

Researchers conducted a multinational cross-sectional survey between September 1, 2022, and February 28, 2023, to assess the operational characteristics, challenges, and managerial satisfaction levels of SHSs globally and identified areas for improvement. Data were collected via an expert-developed questionnaire and a total of 446 responses from SHSs across 105 countries were analyzed to identify predictors of managerial dissatisfaction with SHSs. Key variables assessed included service availability, workforce composition, training protocols, funding sources, and operational challenges.

Most services (74.1%) operated nationwide and had been in existence for a mean (SD) of 19.26 (11.99) years. A significant proportion (92.2%) supported individuals experiencing suicidal thoughts or suicide attempt survivors, while 85.7% assisted survivors of suicide loss. The most common service modality was telephone support (88.3%), followed by in-person counseling (51.6%) and video calls (49.3%). Services were generally available seven days a week, with 81.6% operating 24/7.

Funding was a major challenge, with 63.5% relying on charitable foundations, 58.1% on fundraising campaigns, and 43.3% on crowdfunding or individual donations. More than half (55.8%) reported a decrease in funding following the COVID-19 pandemic, while 62.3% noted a substantial increase in service requests during that period.

Regarding staffing, most SHSs had fewer than ten full-time suicide crisis helpline staff (71.7%), and nearly two-thirds lacked dedicated volunteers. Over half of SHSs employed fewer than ten full-time staff with mental health degrees, and most lacked part-time or volunteer staff with formal mental health training. Training gaps were notable, as nearly half of SHSs (47.8%) provided no pre-start training, and 63.2% lacked refresher training. The most common training topics included suicide risk assessment (44.8%) and prevention (38.8%), but only 18.8% covered culturally competent crisis response.

Quality assurance efforts included team debriefings, recorded call reviews, and peer monitoring. However, 61.4% of SHSs had no clear policy for active rescue situations, and 59.4% maintained records, but did not share them. Insufficient funding (79.4%), low compensation (62.6%), and staff shortages (42.6%) were the most commonly reported challenges.

A multivariable regression model identified that pre-start volunteer training (OR 0.16, P<.001) and the presence of a quality assurance structure (OR 0.15, P.030) were significantly associated with lower dissatisfaction levels, while infrequent staff training (every 2 years or less) was linked to higher dissatisfaction (OR 2.87, P=.016).

The study authors concluded, “To address these problems, we suggest establishing a global network for training, certification, and operational support, providing comprehensive online training and robust information management systems to enhance SHS effectiveness in suicide prevention.”

Study limitations include the lack of generalizability of the findings, response bias, and the lack of investigation of the extent to which trained managers and supervisors acquire essential knowledge to enhance the quality of services they provide influences their sense of satisfaction.

This article originally appeared on Psychiatry Advisor