Crisis Hotlines have been around for over 40 years, and so have individuals that call regularly. These types of repeat calls are often referred to as exhausting, challenging and frustrating. Viewing these calls as such can introduce the danger that someone in actual need may not receive the full benefit of the services offered. Though the caller may not be presenting a crisis at the moment, your support and empathic listening can aid in the prevention of escalating into a crisis. Often times, the callers are utilizing the same unsuccessful maladaptive coping skills to try to resolve their situation. They have most likely burned many bridges, have very little or no support from family and friends, and feel lonely and isolated. They are often turned away and told no or that nothing more can be done. It is important to remember that these callers can also experience crises.
As many centers are adopting a trauma informed care approach, the use of recovery oriented language and care is emerging. The term Frequent or Chronic caller is being replaced with Familiar or Experienced caller, to name a few.
Some centers or crisis workers struggle with setting limits and boundaries. Callers can benefit from the structure and learn to develop and rely on their own strengths. The callers are the experts on what helps them and it varies for every person.
Challenge yourself and your center to create a thoughtful approach to handling these calls, while maintaining boundaries, consistency, and setting limitations. Establish firm and consistent boundaries in a respectful manner. Some centers have time limits per call, others have limits on how many times an individual can call. Once you decide on a limit, it is important for all crisis workers to remain consistent. Create a clear guideline for crisis workers to follow. Example below:
Initial call of the day:
Listen, reflect feelings
What has changed since your last call?
What was your plan when your last call ended? Have you tried…?
Have you followed through with your plan?
What else can you try?
When speaking with someone who has been contacting your center several times per day, it is okay to ask the individual:
To restate their crisis plan
Who else can they call besides the crisis hotline?
Be cautious of providing the same intervention techniques each time, it can be beneficial to treat each call like a brand new call every time. Perhaps something has changed and what didn’t work yesterday may work today. Remember there is value in listening and acknowledging their reality. Consider what it must feel like to live with this every day.
1. Help the individual identify the precipitating event that caused them to call/chat/text. “What has happened/changed since your last call?”
2. Help the individual prioritize and stay focused. Acknowledge that it seems there has been a lot that has affected their lives. “I’m wondering, which situation is most important for you to resolve.” “What can I help you with today?” “From what you have shared, there seems to be a lot going on for you. Which one is the most worrisome for you today?”
3. It is better to interact than react. Validate that they are doing the best they can. “It sounds like you are doing the best you can. What can you try differently to cope with this?”
4. Identify coping skills. “What has helped you in the past? Have you tried that today?”
5. Help them explore new, healthy coping skills. “I’m wondering if you have thought of new ways of coping.”
6. Explore the importance of retelling their story repeatedly, “How is this helpful for you?” “What are you hoping to get from this conversation today?”
7. Empower them to work toward recovery.
8. Limit exploration of the situation and problem solving.
9. Help the caller focus on what he/she can do to help him or herself today.
10. Support the caller in developing a reasonable, specific and attainable plan. Provide additional resources, such as a warm line for support.
Other helpful statements:
“You really seem comfortable doing what you have always done, that’s more familiar to you. How would it be for you to try…”
“It sounds like you feel scared to make any changes.”
“It sounds like you have a sense of what it is going to take to change and you’re not sure you want to do that.”
“It seems discussing your past experiences are more comfortable for you than trying to make changes.”
For research on Familiar callers, please use link below for information:
Depressive disorders are extremely common — 15.7 million American adults experienced a major depressive episode in 2014. It’s much more than simply feeling sad, it’s a medical condition with physical symptoms. Check out the infographic by Mental Health America to learn more as we continue our recognition of Mental Health Month, and be sure to visit their website for lots of great materials to help you spread the word to your community.
We’ll be bringing you some of these resources on the blog throughout the month. Starting with Mental Health America’s Infographic about Anxiety. Anxiety disorders are some of the most common mental health conditions — experienced by an estimated 21% of American adults. People living with anxiety describe it as, “Being so scared you’re paralyzed” and “Being powerless against your own mind.” Check out the infographic below for more information on what anxiety is, how it feels to those who experience it, and tips for tackling it.
Since 1949, May is recognized as Mental Health Month, thanks to efforts spearheaded by Mental Health America. In preparation for this year’s Mental Health Month, MHA has released its 2016 Mental Health Toolkit for download. It includes things like:
Media Materials including key messages, drop-in article, sample press release, and MHM Sample Proclamation
Infographic Fact Sheets that incorporate plain language explanations of diagnostic criteria for mental illnesses, first person accounts about how it feels, a breakdown of common myths and misperceptions, screening data from mhascreening.org and coping skills on the topics of Depression, Anxiety, Bipolar Disorder, Psychosis and Recovery
Worksheets that individuals can use to make a mental health plan to help them work through symptoms and challenge intrusive thoughts
Social media materials including sample posts and images
Banner images for your website or Facebook and Twitter accounts
Peer Supports for Transition-Aged YouthDate: Wednesday April 6, 2016
Time: 2pm EDT
Transition-Aged Youth(TAY), including foster youth, youth who have been through the juvenile justice system, and youth with mental health diagnoses, have unique needs that are often unaddressed. At this crucial stage . . . Read more and register
Peer-Run Respite ProgramsDate: Thursday, April 14, 2016
Time: 2pm EDT
Peer-Run Respite Programs serve as successful alternatives to hospitalization or other traditional crisis services with focuses on support, hope, and . . . Read more and register
Best Practices in the Use of Self-Directed Care to Support Recovery in WomenDate: Thursday, April 21, 2016
Time: 2pm EDT
Building relationships and support systems is an important part of recovery. Mental Health America’s highly innovative It’s My Life: Social Self-Directed Care program combined . . . Read more and register
Today’s a big day for Canadian mental health initiatives: It’s Bell Let’s Talk Day!
This annual event draws attention to mental health, particularly the stigma attached to mental illness that prevents many from seeking help. The idea is that if we all talk more openly about mental health and are open to conversations about it, it will lessen the shame attached to mental illness. Bell also champions access to care, workplace mental health, and research.
On Bell Let’s Talk Day, people are encouraged to take to social media and discuss the topics of mental health and mental illness, and use the hashtag #BellLetsTalk on Twitter. They can also share the Bell Let’s Talk image via Bell’s Facebook page. For each share of this image, and each Tweet using the hashtag, Bell donates $.05 to mental health initiatives and programs across Canada (including many services that are part of the iCarol family!).
To learn more, check out the video below which summarizes five years of Bell Let’s Talk. We hope you’ll follow us on Twitter and Tweet along with us to raise awareness and remove the stigma from the conversation about mental health!
Mental Health Professionals concerned that automated self-help programs will put them out of business can take some comfort in a new study — it found that when it comes to mental health care for depression, computerized self-help simulators offered no additional benefits over traditional therapies one might receive from their primary care physician. In fact, the study found that nearly 25% of participants dropped out within four months and failed to engage with the self-help program.
Dr. Christopher Dowrick of the University of Liverpool wrote an accompanying editorial in which he commented, “It’s an important, cautionary note that we shouldn’t get too carried away with the idea that a computer system can replace doctors and therapists . . . We do still need the human touch or the human interaction, particularly when people are depressed.”
Such simulators have been around for awhile and have increased in popularity as access to technology increases and the stigma surrounding mental health treatment continues. These programs are run purely on artificial intelligence, that is to say there is no human being at the other end giving their feedback or any empathetic response.
So, while it seems looking online for help is a growing trend, taking the human element out of that interaction may not be the best way to go. This is good news, however, for helplines, counselors, and others looking to offer live chat capabilities to their service. Clearly people want to take advantage of the anonymity, and desire a less-threatening way of asking for help, but connecting with a human being on the other end of the online conversation is an all-important element of that process.
NPR published an article about this study which you can read here, or read the study itself here.
A column in Psychology Today, written by Dr. Peggy Drexler, poses the question: Why do we fear mental illness?
In particular Dr. Drexler notes that often when people encounter signs of mental illness in another person, the instinct is to not get involved.
“when it comes to mental illness, helping is, unfortunately, not our natural response. Instead, according to the National Council for Behavioral Health, most people shy away from or avoid someone experiencing a mental health emergency. They think whatever the person is going through is “personal,” or that “it’s a family matter.” Often, they’re afraid to intervene or get too close. And so they don’t.
And yet it’s hard to imagine this same sort of reaction in other health contexts: witnessing someone slip and fall while crossing a busy street, for instance, or seeing someone have a heart attack or faint in a bookstore and passing by without stopping to help or make sure he or she is okay.”
A unique, and nostalgic, activity has gained quite a bit of attention in recent months.
I’m talking of course about adult coloring books. I first started hearing about them last summer and by the holiday shopping season ads and stories filled my news feed. I LOVED (seriously, I cannot emphasize enough just how much) coloring and drawing as a little girl, so the idea that this was now an acceptable past time for me 30+ years after I first used a crayon was exciting.
In addition to being just plain fun, there are many reasons to believe this activity has mental health benefits.
According to this article in Psych Central, part of soothing our stress comes from calming our amygdala, the part of our brain that alerts us to danger and gives us a panicked feeling. Problem is, if this area is overactive we might feel highly stressed even when we’re actually not being threatened, and that can lead to anxiety and levels of stress seen in other mental illnesses. Focusing on something like coloring an image can have a centering effect that gives your amygdala some time off, experts suggest.
Other experts note that when you color, you’re using both hemispheres of your brain. On one hand it’s a very creative activity, but behind that creative action is a focus on a strategy, whether or not you realize it at the time. You’re also making color choices as part of that strategy, and practicing fine motor skills.
Now where did I leave those crayons…
Engaging in coloring and art projects before bedtime can also help you sleep. Many authorities on sleep and circadian rhythm advise against using your mobile phone, computer, or watching TV within an hour or more of bedtime, because their screens and deeply engaging content have a stimulating effect. Like reading, coloring could be a great non-technology activity to help you wind down before your head hits the pillow.
Of course there’s something to be said for any activity that reminds you of back when you were a kid and had far fewer worries on your mind. We might not have realized it at the time, but being picked last for dodgeball or not being invited to the popular kid’s birthday party was small potatoes compared to the stressors we’d face in college, careers, relationships, raising kids, or caring for aging parents.
So not just because I used to love it so much as a kid, but also because I struggle with mild to moderate anxiety, I’m anxious (see what I did there?) to give it a try. Have you gotten in on this latest trend in mental health? Let me know how it turned out by leaving a comment.
For more on this topic, check out some of these articles:
An Op-Ed in Wednesday’s New York Times discusses the tragedy that can sometimes occur when police find themselves responding to a person with mental illness, and the investments needed to prevent it.
Nearly 20 years ago, I was a social worker in a county jail where I first began to understand just how frequently the police deal with people with mental illnesses. Run-ins with the police were a regular occurrence for many of my clients, with officers often knowing them by name.