June 2007


By:  Jeanette Duncan

Want to learn about the role of a suicide crisis line in a developing country?  Here is an overview of an article that recently appeared in Suicide and Life-Threatening Behavior 37(1) in February 2007.  The article is called “Analysis of a National Toll Free Suicide Crisis Line in South Africa” and is written by Sue-Ann Meehan, MA, and Yvonne Broom, PhD.   
Facing a higher-than-world-average suicide rate, South Africa opened its suicide crisis line in October 2003. Operating from 8am to 8pm on Monday to Friday, and 8am to 5pm on Saturdays, trained volunteers offer counsel, education, and mental health referrals to callers. 

What are the problems that contribute to the suicide rate in South Africa?

South Africa deals with issues of poverty and unpredictable social change.  Many people live without adequate house, electricity, or running water.  Unemployment is high. 


As well, tools of suicide like guns and drugs are easily available.


South Africa has very few mental health workers, far below world averages, all the way from psychiatrists to social workers who specialize in mental health.  Additionally, only a fraction of South Africa’s health budget is dedicated to mental health.  Worse, many mental health workers are concentrated in cities, leaving rural areas highly under-serviced. 

Can a crisis line help?

A crisis line offers some benefits other programs can’t provide.  People who can’t afford to travel to a mental health facility in a larger city can access the toll-free line.  As well, the crisis line is confidential, whereas traveling to a clinic might be more intimidating. With South Africa’s under-developed infrastructure of mental health care, and a limited budget, would a suicide crisis line prove to be an effective use of limited resources?  


The authors of this study looked at three questions:  What demographic is using the crisis line, and more specifically, which age groups?  Is there a link between suicide prevention programs in an area and number of calls to the crisis line? And thirdly, do callers feel their needs are being met by the crisis line?

Who is calling?                                                

Demographically, most of the callers were 16 to 18 year old adolescents, an age group with a high incidence of suicide.  The least represented age group was adults between the ages of 54 and 70.  Most of the callers lived in urban centers and close to 60% of callers were women. 

The authors point out that the high incidence of urban callers doesn’t mean rural areas are less affected by suicide, but could rather be a reflection that urban areas have had better mental health education and also better access to telephones.  This is something the authors would like to explore in future studies.


Turning at-risk people into callers

People can’t call a crisis line if they don’t know it exists. The areas the callers were from corresponded with areas where mental health workers had done suicide prevention campaigns.  Yet when asked, most callers said they had heard of the service through media ads on TV or radio.  But older people, who had also been exposed to the media campaign but not to the education in the schools, were not greatly represented in the callers.  Thus the study authors concluded that combining a media campaign with local mental health education seemed to be the most effective method to help people both know about the service and feel comfortable enough to call.   

Educating the public

Not everyone who called the line was suicidal; some called for friends or family members.  Crisis line volunteers rated almost 60% of callers as having no suicide risk. South Africa’s crisis line is a little different from some other crisis lines in that it markets its suicide line as more than just a crisis line.  Anyone is free to call, even if they aren’t experiencing a crisis but just want information. Educational resources can be mailed to a caller’s home, and volunteers also make callers aware of local mental health services.  The high number of callers who were not suicidal shows the great need for mental health education in South Africa. 


Over 97% of callers were very satisfied with the services, feeling that their needs were met.


For a country like South Africa, with limited financial and mental health resources, a crisis line is an essential part of its mental health strategy.  As well as helping people in crisis, the crisis line is also an inexpensive and efficient way to educate the public about mental health issues, an important part of lowering suicide rates.









We begin by picking up a plastic object called a telephone and dialing seven one-digit numbers.  Even that is easier than it used to be because many people now have Touch-Tone phones rather than dial phones.  And if we have automatic dialing, it may take only one little push of the finger before we’re in touch with the restaurant.In less than an hour there is a delivery person knocking at the door with a pizza.  How did that happen?  Well, this person took the pizza from the restaurant to the care and drove all the way to our home to bring us our pizza.  He went out of his way to find our house or apartment, perhaps in the dark.  Fortunately, someone made a map of our neighbourhood.  He had to risk his life driving a car in traffic.  People are killed every day driving cars.  Delivery people are robbed delivering pizzas.  He risked his life and welfare so we could have a pizza.Of course, someone made and baked the pizza.  And others assembled, sold, and maintained the delivery care.  Someone constructed the ovens so the pizza could be baked.  Electricity was needed to operate the ovens.  People built the pizza restaurant.  Someone paid for the advertising so we could look up the phone number in the telephone directory.  Or perhaps we called directory assistance and received help from! some stranger who was willing to give us the correct phone number.  An entire telecommunications system allowed us to call and say, “What’s the phone number of the Pizza Place?”What about the ingredients themselves?  Where did the crust come from?  How is cheese produced?  What about tomato sauce?  What’s involved in getting sauce to the restaurant from a tiny tomato seed somewhere on a farm?  Ingredients came from all over the country, maybe even the world.  Plants were nourished by the sun and rain and harvested by farmers and delivered by truck drivers.  Factories were built to package the ingredients.  Cans were made to preserve their contents.Roads, trucks, cars, factories, phone lines, plants, dirt, sun and rain, cows—all and more were made use of—so we can open the door and find a pizza ready to eat.  And it’s hot.  Someone even put it in a box for us.  Part of a tree sacrificed its life so we could get our pizza in a box.  The history of an entire universe is revealed by a cardboard box.  Close your eyes and ready it.Then we sit down and eat, and it’s pretty tasty.  And we did so little for the pizza.  All we had to do was press the buttons on our phone, say, “we’d like a pizza,” and pay money that someone was kind enough to give to us in the first place.What an incredible and complex process it is to receive a pizza.  And yet how often is such a gift ignored!  How often is our response, “How come it took so long? They said it would only take thirty minutes and it took forty-five minutes.”  Or perhaps, “it’s not hot enough.  It should be hotter than this.”  Or maybe we begin to eat and we notice it has green peppers and we say, “I didn’t order green peppers.  What did they put these stupid green peppers on my pizza?  Now I’ll have to pick them all off.”  Perhaps we call the restaurant to complain.  How often have we called and said, “I just wanted to let you know how much I liked the pizza you made for me.”Isn’t this just a microcosm of much of our life?  Despite all the effort that went into giving us that pizza, our attention shifts to the fact that it isn’t “perfect.”  Our mind scouts around and embraces something that doesn’t quite meet our expectations.  But frequently it is perfect: everything came out the way we like it.  So now what do we do?  Mostly, we don’t do anything.  We eat.  We don’t even notice this perfect pizza right in front of us.  We’re too busy watching the movie or reading or talking with out people.Maybe we deserve a hot, fast, fresh, tasty pizza.  Maybe we’re entitled to f! riendly, helpful service from the person who takes our order.&nb sp; Maybe it’s our right to have everything come out perfect according to our desires.  If we conclude that we have always perfectly fulfilled the desires, needs, and expectations of those around us, then we have reason to expect the same from the world.  But as I reflect on the ways in which I have caused trouble, the times I’ve been late, the times I’ve made mistakes, the rarity with which I’ve done a “perfect” job for others—as I reflect on these things, I cannot help but be deeply touched by all the effort that went into brining me a pizza.  So to those people and objects who have been responsible for all the pizzas I have received since I was a child, Thank you!  I may not know who you are, but I know what you did. By:  Gregg Krech

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