CRISIS LINE, SOUTH AFRICAN STYLE
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.
ORDERING A PIZZA
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.
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