Crisis Text Line


Crisis Text Line is a global not-for-profit organization providing free mental health texting service through confidential crisis intervention via SMS message. The organization's services are available 24 hours a day, every day, throughout the US, UK, and Canada and can be reached by texting HOME to 741741, 85258, or 686868 respectively. Crisis Counselors help texters move from a "hot moment to a cool calm" through an approach that is centered on empathetic listening, collaborative problem-solving, and referral suggestions. Crisis Text Line has been growing extensively in popularity since its launch in 2013 and seeks to expand its services to Ireland, Australia, South Africa, and Latin America. As of December 5, 2019, Crisis Text Line has processed over 105 million text messages.
The text line is notable among hotlines for its triage system, in which conversations are assessed by an algorithm for severity and queued accordingly, as opposed to being queued chronologically. Crisis Text Line is also notable for possessing the largest set of mental health data in the world. The organization uses anonymous aggregated texting data to share prevalent mental health trends across the United States and to continuously improve the quality of its crisis intervention services.

History

Crisis Text Line was conceptualized as a result of Do Something's mobile interactions with its members. Nancy Lublin, Do Something's former C.E.O., began creating Crisis Text Line after members of the Do Something organization started reaching out via text for personal support. Shortly after, the crisis intervention service was given a quiet launch in August 2013 through a text message to Do Something members in Chicago and El Paso, and was soon being used by texters in every United States area code. By 2015, the text line was being contacted by more than 350 texters-in-crisis every day.
In early 2015, Lublin corrdinated meetings over a week "to raise her first round of funding." And "y the end of the week, she had her 'angel' round of philanthropic capital, $5 million, mostly from tech entrepreneurs."
In July 2015, it was announced that Verizon, Sprint, and T-Mobile would be waiving fees for use of the service, and that texts to Crisis Text Line would not appear on billing records, amidst privacy concerns. AT&T then followed suit.
In September 2015, Crisis Text Line announced via the Do Something blog that it would be taking steps to become a resource for people who are Deaf or hard of hearing including training and education for its Crisis Counselors.
In January 2016, Chief Data Scientist Bob Filbin was highlighted in The Chronicle of Philanthropy as one of their 40 Under 40 for his work using data to inform Crisis Text Line's efforts. He explains that Crisis Text Line's data collection is centered on "people in their greatest moment of crisis," and that "most of the other data on mental health and crisis is survey data, which is collected after the fact."
On June 16, 2016, Crisis Text Line announced that it has raised $23.8 million from Reid Hoffman, Melinda Gates, The Ballmer Group, and Omidyar Network who are tech titans.
In March 2017, Crisis Text Line began offering its services via Facebook Messenger and reported passing its 100 million message milestone in March 2019.
In 2018, Crisis Text Line launched its services in Canada through a partnership with the Kids Help Phone organization. In May 2019, they launched their United Kingdom affiliate, Shout, with the Heads Together Foundation. The text line plans to eventually have at least one affiliate in every country.
In April 2020, Business Insider reports that the novel coronavirus pandemic has caused "a dramatic spike in people seeking help from crisis text hotlines...The spike coincides with the worsening of the novel coronavirus worldwide, as well as historic layoffs in the US". In just a number of weeks, "the number of texts to the hotline has been 47% to 116% higher than an average day".
On June 12, 2020, the Board of Directors voted unanimously to terminate CEO and co-founder Nancy Lublin after three days of a Twitter campaign #NotMyCrisisTextLine

Administration

The board of directors is responsible for overseeing the organization's activities and goals, and includes founder and CEO Nancy Lublin, Danah Boyd, Ph.D., the principal researcher at Microsoft Research, and Elizabeth Cutler of SoulCycle. Crisis Text Line also has a clinical advisory board that works to improve Crisis Counselor trainings and texter outcomes. Other boards include a Data, Ethics, and Research Advisory Board as well as a Legal and Public Safety Advisory Board.

Crisis Counselors

Crisis Counselors are volunteers who are at least eighteen years old, and must apply for acceptance into the training program. They are required to submit a background check, complete thirty hours of training, and pass a final evaluation. Graduated Crisis Counselors commit to a minimum of 200 volunteer hours. While taking shifts, Crisis Counselors are supervised by paid Supervisor staff members who typically have advanced degrees in counseling, mental health, or crisis intervention.

Strategy

Crisis Text Line believes that everyone deserves immediate "mental health support at their fingertips." People who are in any type of crisis can reach out to the text line and expect to be connected with a Crisis Counselor in under 5 minutes, although wait times may vary during high-volume moments. Once connected, a Crisis Counselor will introduce themselves and encourage the texter to share their feelings at a comfortable pace. Crisis Counselors actively listen, build rapport, and engage in collaborative problem-solving with the texter in order to identify potential coping strategies. An individualized short-term action plan is created to help the texter cope with the crisis and to remain safe. At the end of every conversation, texters are given the option to provide feedback about their experience with the Crisis Counselor. Conversations usually lasts anywhere from 15-45 minutes. If the texter is in imminent risk of suicide or harm and is unwilling to separate themselves from the means of harm and create a safety plan, emergency services may be contacted in order to ensure the safety of the texter. This is a last resort. Active rescues are carried out in less than 1% of conversations.
Crisis Counselors also share a variety of resources with texters such as referrals to advocacy networks, hotlines, and mental health support websites. Crisis Text Line upholds specific criteria for referrals and does not endorse products or services that contain fees.
The nature of Crisis Text Line's services is not long-term counseling. The text line should not be viewed as a substitute for mental health treatment or professional health care. Crisis Text Line helps texters reach short-term solutions to crises but cannot serve as any type of therapy.

Data collection

Crisistrends.org was launched in August 2014 to collect and analyze anonymous texting data derived from the activities of the Crisis Text Line platform. The data is used to display crisis trends according to texter gender, age, race, and ethnicity. It is shared with the public to help decrease stigma around mental health support. Research agencies and institutions also can have access to this data for research purposes.
Crisis Text Line has many open data partnerships, one of them being a collaboration with the Lawrence Berkeley National Laboratory that aims to predict and prevent veteran suicides. Since Crisis Text Line's launch in 2013, there have been 8 research papers published based on Crisis Text Line's data. More papers are expected to emerge as more data is collected.
In 2014, the organization found that 3 percent of texters were using 34% of organization resources. These texters were continuously using Crisis Text Line's services as a long-term "replacement for therapy," which prompted the development of systems to identify these "circling texters" and to address the imbalance in resource application.

Use of algorithms

Crisis Text Line uses a triaging algorithm to identify texters who are at most imminent risk for suicide. Conversations that contain high-risk words and phrases are marked by the triage system and moved to the front of the texting queue, allowing Crisis Counselors to immediately respond to high-risk texters in under 5 minutes even during high-volume times. Crisis Text Line also uses an algorithm to predict spikes in texting volume. This technology enables spikes to be detected 6-8 times faster, allowing for quicker staffing of Crisis Counselor volunteers on the platform.

Crisis trends

According to the data found on Crisistrends.org, approximately 75% of texters are less than 25 years old and encompass a wide variety of demographics. 19% of texters are from the 10% lowest-income zip codes in the United States, and 14% of texters identify as Hispanic/Latinx.
In December 2015, Crisis Text Line releasing data indicating that bullying and harassment against Muslims was on the rise. They experienced a noteworthy increase in volume immediately after Donald Trump's election as President of the United States. There was also a spike in conversations that dealt with issues such immigration, sexual assault, and LGBTQ+ rights during this time period.
The Wall Street Journal reported on Crisis Text Line's data about prom-related crises, noting that financial concerns were the most prevalent cause of prom-related conversations with the service.
Analysis of the service's data around military texters revealed that active duty service members and veterans make up 2.4% of texters, and that these texters are more likely to be struggling with suicidal ideation or substance abuse.
Crisis Text Line's data also reveals that sadness is more likely to be reported in conversations around the summertime, particularly with LGBTQ+ texters who may be returning home to "unaccepting families." This is indicated by the frequent use of words such as "lesbian, virginity, and dumped."

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