On June 29th, the Distress Centres of Dufferin/Wellington, Durham, Peel and Toronto joined together to launch an online crisis chat service. Texting through an unadvertised shortcode based on a service in the US or visiting our website provides access to a trained volunteer responder between 2pm and 2am.

After running the service for a few months, we’ve begun seeing some important elements emerge from the data. They include elements like the length of the chats, the service volume, the elements necessary for high-quality chats and texts,

Chat Length

The average interaction is 45-60 minutes. This is much longer than helpline conversations which tend to be closer to 20-30 minutes for individuals who are not in crisis. This is because of the time required to process what you’re reading and to consider writing your response.

Service Volume

The service operates for approximately 12 hours a day and fields an average of 10-15 text sessions and 5-10 chat sessions a day, but has received as many as 64 chat/text interactions in a week during periods of high volume.

Number of Responders

We are close to 150 responders covering a 12 hour period with double coverage. Because commitments can vary based on the partner Centres we estimated that we would need about 50 responders per Centre in order to meet this base level of service.

Level of Distress

Currently, there is a pre-chat survey for visitors entering the system where they can indicate their level of distress on a 5 point scale:

• 1 – I’m doing okay
• 2 – A little upset
• 3 – Moderately upset
• 4 – Very upset
• 5 – Extremely upset

At the end of the chat, they are redirected to a post-chat survey where they have the option to note if their level of distress has changed. Approximately 20% of the chat visitors complete the pre and post chat surveys.

The results of preliminary analysis show that their level of distress drops 1 full point from 3.8 to 2.8, on average after an interaction with a responder.

Chat and Text Issues

The most common issues that chatters report are anxiety, depression, relationship concerns and suicidal thoughts. This is very similar to the helpline, though the rate of suicidal ideation is 2-3x higher (10-15%) on the service than the provincial average on the helpline (approximately 5%.)

This range of issues is similar to the helpline.

Age Range

Right now the service sees 100% of it’s usage between 0-44, no visitors over 45 have visited. The most common age range is 15-24, though I’ve seen some as young as 12 accessing the service. Only 5% of the visitors on the telephone helpline are 15-24, suggesting the service is much more popular for youth.

Crisis Chat / Text Training

The training is approximately 4 hours in length and covers a review of active listening and emotional support, the DCIB Suicide Risk Assessment, how to use the iCarol messaging system and then some time for roleplays.

It’s important to recognize that there is a different skill set required for communication through a text environment versus communication over the telephone. For instance, the lack of voice tone makes it very difficult to recognize when you are de-escalating a visitor.

This required consistent checking in with the visitor to make sure they are actually improving.

Crisis Chat / Text Suicide Risk Assessment

The suicide risk assessment we use is the DCIB Suicide Risk Assessment. This assessment contains four elements: desire, capability, intent and buffers. This is different than our previous risk assessment, the CPR Risk Assessment.

Follow Up

An important element of working with suicidal individuals is follow up. Studies (e.g. Brown & Green, 2014) have demonstrated that follow up has the potential to reduce the likelihood of future suicide attempts and ideation.

Bibliography

Brown, G.K., Green, K.L. (2014) In Expert Recommendations for U.S. Research Priorities in Suicide Prevention, American Journal of Preventive Medicine. 47(3) Supplement 2:S209-S215 DOI: 10.1016/j.amepre.2014.06.006,