2016 Runner Up: Text Message Crisis Counseling

The high and rising rate of suicide in the United States is a source of elevated concern for mental healthcare professionals, policymakers, and other stakeholders. The trend towards higher suicide rates touches all regions of the country and cuts across demographic divides. Though people under 20 have always comprised a small proportion of suicide victims, suicides in this cohort have been increasing over the past 15 years—especially among whites and American Indians.

Reaching these young people with timely crisis counseling is vital, but traditional suicide hotlines have not been effective in engaging this group. The Txt4Life program, a collaboration between the Carlton County (MN) Public Health and Human Services department (CCPHHS) and Canvas Health, a human services nonprofit, was conceived as a way to reach people under 20 in need of help.

The coordinators of this program found that teenagers were reluctant to use traditional phone-based suicide hotlines because of their unfamiliarity and cultural discomfort with phone calls, especially on such sensitive topics. They decided to reach young people by providing the same crisis intervention resources as a traditional hotline in a more comfortable medium: the text message.

The results show enormous impact. In 2010, prior to the program’s introduction, the Minnesota suicide hotline had been taking about 25 calls per month from teenagers and young adults; the Txt4Life hotline now receives as many as 1,000 texts monthly, following a grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) that allowed for considerable expansion within the state.

From 2012-2015, this program achieved more than 8,000 referrals for follow-up appointments and resulted in 388 emergency interventions. User surveys and testimony suggest that those who use the resource have high levels of satisfaction with its results, and feel that it provides meaningful support. Txt4Life’s professional counselors are trained extensively to help young people with coping skills, provide referrals, conduct risk assessment, de-escalate dangerous situations, and help formulate long-term plans, in much the same way a hotline operator would. Most importantly, the huge increase in the number of young people seeking and receiving help suggests that the program is reaching individuals who might otherwise attempt suicide.

At its inception, the program focused on northern and western Minnesota counties – largely rural areas with limited access to mental health resources. This part of the state has higher rates of poverty, and encompasses 6 of Minnesota’s 8 Indian reservations, which have above-average rates of suicide. CCPHHS and Canvas Health are seeking to expand the program to cover every county in Minnesota, and to provide tele-presence mental health counseling to areas without traditional care providers. Federal grants, along with funding from the Minnesota Legislature, are enabling this growth.

While some programs (most notably the Crisis Text Line, a national text-based hotline) have embraced a similar concept, Txt4Life is set apart by its strong connections with schools and community stakeholders in the areas it serves. Those that designed the initiative have reached out to teachers, school administrators, clergy members, tribal authorities, community centers, athletic coaches, and many others to ensure that they are aware of the services it provides. The program’s coordinators have also merged a traditional media awareness campaign with social media advertising designed to reach the initiative’s target audience.

The technological infrastructure is easy to replicate, and, aside from the hiring and training of staff, the startup costs of the program are very low. In Massachusetts, this program could connect residents of the state’s more rural regions – where care is not as readily accessible as in the Boston area – to access care. Youth from all backgrounds appear more apt to use texting than phone hotlines to communicate with crisis consultants, and increased contact means a better chance of stopping tragedy.

Txt4Life uses a unique connection with the communities it serves and an innovative, technology-based model to achieve meaningful results. By coming to youth where they are, the program has reached many more individuals than would a traditional crisis hotline. This has undoubtedly saved lives, and Txt4Life’s expansion will allow it to save even more.

Better Government Compendium of Winning Entries 2016: Improving Care for Those with Mental Illness by Pioneer Institute