Hold On Podcast Summary with Advertisement, Lulu Miller, Latif Nasser, George Colt, Simon Adler, Donovan McBride, Suicide and Crisis Lifeline, Stephanie Grosser, Ed Shneidman, Porochista Khakpour, Sean Carey

Hold On

1-Page Summary

Improving the on-hold experience for 988 callers

To enhance the on-hold experience for callers of the 988 mental health hotline, technological and qualitative improvements are being implemented to mitigate caller drop-offs due to funding and resource limitations.

Under the leadership of technology lead Stephanie Grosser, examination of workflows and caller feedback reveals the positive impact of hearing reassuring messages. Efforts to keep callers engaged are hindered by funding shortages, leaving the hiring of additional staff as an unviable solution. As a compromise, the script and voice of the call line are refined based on user feedback and syllable count for better resonance with callers.

Another focus is the selection of music played while callers wait. After extensive research and testing, including an A-B test at public locations and a national comparison, a new selection of music has shown a slight but meaningful increase in the number of callers who remain on the line, demonstrating a successful intervention in enhancing the caller experience.

The origin of suicide prevention hotlines can be traced back to Dr. Ed Shneidman's response to veteran suicides in 1949, who alongside his colleagues, initiated a hotline in Los Angeles. The value of actively listening to people contemplating suicide was quickly recognized. Following Marilyn Monroe's death, the concept of hotlines spread across the nation.

Despite their proliferation, the lack of training among volunteers raised concerns about the quality of crisis intervention. With instances of poorly handled calls, the initial unregulated approach of hotlines shifted towards more structured, government-managed services, ensuring a higher professional standard to support individuals in critical need.

1-Page Summary

Additional Materials

Clarifications

The 988 mental health hotline is a national crisis hotline in the United States that provides support and assistance to individuals experiencing mental health crises or emotional distress. The hotline is designed to offer immediate help and resources to those in need, connecting them to trained professionals who can provide guidance and support during difficult times. The number "988" is intended to be a shorter, easier-to-remember alternative to the traditional 10-digit hotline numbers, like the National Suicide Prevention Lifeline (1-800-273-TALK). The implementation of the 988 hotline aims to improve access to mental health services and crisis intervention for individuals across the country.
An A-B test, also known as an ABX test, is a method used to compare two choices of stimuli to identify detectable differences between them. In the context of the text, an A-B test was conducted to compare different selections of music played for callers of the mental health hotline to determine which one led to a better caller experience. The test involved presenting two known samples (A and B) followed by an unknown sample (X) to assess if callers responded differently to the music selections. The results of the A-B test helped in selecting a new music option that showed a slight but meaningful increase in caller engagement on the hotline.
Dr. Ed Shneidman was an American clinical psychologist, suicidologist, and thanatologist known for his significant contributions to suicide prevention. He co-founded the Los Angeles Suicide Prevention Center in 1958 and later established the American Association of Suicidology. Shneidman's work focused on researching suicide, developing crisis interventions, and promoting understanding of suicidal behavior. He authored numerous books on suicide and its prevention, leaving a lasting impact on the field of suicidology.
Crisis intervention is a short-term method aimed at stabilizing individuals experiencing acute psychological distress or facing significant life challenges. It involves immediate support and strategies to help individuals cope with overwhelming emotions and situations. The goal is to provide timely assistance to prevent further escalation of the crisis and promote emotional well-being. Crisis intervention typically focuses on addressing the immediate needs of individuals in distress and connecting them with appropriate resources for ongoing support.
The "unregulated approach of hotlines" refers to the early days of suicide prevention hotlines when there were minimal guidelines or oversight in place for how these services were operated and managed. This lack of regulation led to concerns about the quality of crisis intervention provided by volunteers, as there were no standardized training or protocols in place. Over time, this unregulated approach evolved into more structured and government-managed services to ensure a higher professional standard and consistency in supporting individuals in crisis. The shift towards regulation aimed to address the initial challenges and improve the effectiveness and reliability of suicide prevention hotlines.
Government-managed services typically involve outsourcing certain functions or processes to external service providers under government oversight and regulation to ensure quality and standards are met. These services are often utilized to improve efficiency, reduce costs, and access specialized expertise in various sectors. The evolution of managed services, including government-managed services, has seen a shift towards more structured and regulated approaches to ensure high professional standards and quality of service delivery. This approach is particularly important in critical areas like crisis intervention and support services for individuals in need.

Counterarguments

While technological and qualitative improvements are important, they may not address the root causes of mental health crises or the need for more comprehensive support systems beyond the hotline.
The positive impact of hearing reassuring messages might not be sufficient for all callers, and some may require immediate human interaction to feel supported.
Relying on script and voice refinements may not be as effective as increasing the number of trained staff available to answer calls, even if funding is limited.
The slight increase in the number of callers who remain on the line due to new music selection may not translate into improved outcomes for the callers once they are connected to a counselor.
The historical context of suicide prevention hotlines is important, but it does not necessarily inform the current challenges and best practices in crisis intervention.
Structured, government-managed services may improve professional standards, but they could also lead to bureaucratic inefficiencies or a one-size-fits-all approach that may not be suitable for all callers.

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Hold On

Improving the on-hold experience for 988 callers

With the aim of enhancing the on-hold experience for individuals calling vital mental health services, efforts focus on balancing funding and resource constraints against the imperative to minimize hang-ups.

Balancing limited funding and insufficient mental health resources with the need to reduce hangups

Despite the complexity involving funding and resources, Stephanie Grosser, a technology lead, is dedicated to improving access to care for callers to the 988 hotline. Workflows and feedback are analyzed to understand when callers were likely to disconnect. Specifically, those who have experienced suicidal thoughts have emphasized the importance of hearing affirming messages like "we want to talk to you, please stay on the line" while on hold.

The ideal resolution to cut down wait times would be to employ more staff, but persistent challenges in securing sufficient mental health funding make this difficult. As a result, improvements to the existing on-hold experience are being explored. For example, the script the callers hear has been refined with regard to wording and syllable count, based on specific feedback. Additionally, a new voice has been selected for the 988 call line.

A careful selection of potentially soothing music is another area of improvement, aimed at achieving both calm and encouragement for the caller. Out of 30 to 50 songs, four top choices were identified through independent ranking and public research conducted at locations such as the National Mall. Furthermore, a national A-B test comparing reactions to the old on-hold music, characterized by "snazzy jazz," against the new musical selection led to a marginal yet significant 0.7% increase in callers staying on the line, which equates to approximately 36,000 individuals.

The history and motivations behind suicide prevention hotlines

The concept of suicide hotlines arose from the work of Ed Shneidman, a psychologist at the Los Angeles Veterans Center in 1949, who responded to the tragedy of veteran suicides. Along with colleagues Norman Farberow and Robert Litman, he opened the Los Angeles Suicide Prevention Center on September 1, 1958. The trio, initially believing they were con ...

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Improving the on-hold experience for 988 callers