Georgia Tech Research Outlines Barriers to Effective Mental Health Helplines
Helplines can be beneficial, but technological and social challenges must be addressed
Consider this troubling scenario:
You are struggling with depression and need immediate professional assistance. You dial a national helpline designed to serve this purpose, but the number continues to ring with no answer. In hopes of finding someone to talk to you, you go through a trial-and-error process, iterating through the many different lines available to no avail.
Finally, at the end of all of this, you get a message: “Sorry, this line is closed on Sundays.”
“You can’t hang up,” said Georgia Tech Ph.D. student Sachin Pendse, who recently led a study on mental health helplines in India. “You need help in that instant, and to have the phone ring continuously breeds so much more anxiety and stress.”
In India, as in the rest of the world, helplines are often the first pathway to mental health treatment. The study, being presented at the 2021 ACM Conference on Human Factors in Computing Systems (CHI 2021), outlines some of the key barriers to effective assistance and their impacts on the overall treatment journey.
“This study builds on a CHI 2020 paper, which was based on interviews with the helpline volunteers,” Pendse said. “They act as broad conduits for mental health resources, directing traffic for many different languages and needs. They do this given resource constraints, and are understandably proud of the work that they do.”
And yet if you were to try the search query “suicide hotlines India,” the results are not so positive. There are tweets and articles about how they don’t work, leading one to question why, if so many resources are being put into helplines, why is there this disconnect on efficacy?
Pendse and his research partners spoke to about 20 people: eight who were connected, seven who were unable to get connected, and three or four who intentionally decided not to call. There were reports of long wait times, including one participant who reported not being able to connect because it was Sunday.
“Some said this wait made them feel better. They had a moment while waiting for someone to pick up to reflect on their thoughts,” Pendse said. “But for the most part, it’s not fun and it makes the feelings worse.”
More troubling is that outcomes are largely based on structural challenges within society. Class and identity-based aspects influence how people use the helplines and what help they’re ultimately able to get.
Pendse reported participants who avoided helplines because of past experiences with clinical psychologists.
“One was queer, and their psychologist said that they didn’t know whether they were actually queer or not,” he said. “So, it’s very invalidating. Based on that experience, they determined they would probably encounter something similar if they called the helpline.”
What happens is that because of a cycle of coercion, poor experience and then avoidance, there is a lack of trust in the mental health infrastructure.
“Care isn’t an individual point on this pathway – it’s the whole pathway,” Pendse said.
Pendse and collaborators, as a result, use a justice framework based on the work of Indian economist Amartya Sen, who says that policies and institutions must meet people where they are. One can invest plenty of money into mental health, but if people don’t trust the institutions thy won’t take advantage.
“Justice must be felt from the perspective of the person in need,” the paper notes.
To deliver that, the paper offers recommendations from both a technical and social design perspective. It isn’t enough just to create a technical solution for long wait times – transferring calls to open operators, for example – because of differing cultures. One mental health approach for upper caste Indians may not be appropriate for others.
“Broadly, India needs a national helpline and when evaluating whether it is effective, there must be rigorous understanding of what people’s experiences are with it,” Pendse said. “Those need to be integrated into the design of the helpline – not just a cookie cutter solution.
“Outside of the Indian context, I think when we think about doing justice to people’s needs it is important to not think about one individual point but to consider the overall pathway to care. When they feel distressed, what does that look like to them and how do we meet them there?”
The paper, titled “Can I Not Be Suicidal on a Sunday?”: Understanding Technology-Mediated Pathways to Mental Health Support, is co-authored by Pendse, Amit Sharma (Microsoft Research), Aditya Vashistha (Cornell University), Munmun De Choudhury (Georgia Tech), and Neha Kumar (Georgia Tech). The work was supported partially through a Microsoft gift to De Choudhury and Kumar, as well as a grant from the National Institutes of Health.