‘A tidal wave of problems’: texting on the mental health frontline | Society

The computer dashboard at Shout, a suicide prevention text service, flashes up with a new cry for help every minute or two. The really worrying ones are highlighted in yellow by software that attempts to detect if a texter is about to try to kill themselves. Words and phrases such as “overdose” or “I can’t do this any more” trigger an urgent priority flag, and a trained volunteer armed with a laptop starts trying to calm down, reassure and then help the texter.

This is the new digital frontline in the fight to deter young people from taking their own lives or even thinking about it. Since Shout was launched last month as part of the Duke and Duchess of Cambridge’s mental health campaign, its operators have been handling 500 conversations a day, 70% from women and girls, sometimes from classrooms and playgrounds. The crises are often so severe that the emergency services have had to be despatched in “active rescues” as often as 22 times a day.

Suicide rates in the UK have been falling slightly in recent years and the most vulnerable group remains men aged 45 to 49. But Shout is catering to younger people who might not pick up the phone or talk to friends or family but are happy text their problems to a stranger who will try to guide them to professional help.

At just before 5pm during one session, 12 people were texting at once, ranging from someone having an anxiety attack because of a problem at school to another sitting with a lot of pills. One person said they were struggling to cope with suicidal thoughts.

“We’ve had a couple of texts this morning from school about bullying and relationships,” said Dr Fiona Pienaar, the chief clinical officer at Mental Health Innovations, the charity that runs Shout. There was talk of postpartum depression, feeling lost and in some cases just having a bad day. Many people are repeat texters.

The texts are picked up by volunteers across the country and in some cases as far away as New Zealand. They are tasked with calming people down so they are no longer in danger, offering them links to resources where they can find further help, and simply listening without judgment Sometimes they can juggle as many as five conversations at once. Qualified clinicians supervise all of the interactions and can step in at any moment if they feel the volunteer is making a mistake.

Angus Fowler, a father of two teenage daughters in west London, volunteers from home for two hours daily Monday to Friday. He times his sessions to coincide with school lunchbreaks and home time, when there seems to be considerable demand. He said being on the system was like seeing “a tidal wave of mental health problems coming at us”. Recently, he said, one girl texted from a PE lesson.

Fowler said texting, rather than seeking help face-to-face or through a phone call, gave people “enough room to open up and not feel exposed”. He admitted it is hard not to worry sometimes. “If I have a hard conversation where it is an immediate risk and they start to disengage, I do really worry,” he said. “You can’t hear them, and while you can get a sense of tone through text, it is detached.” If it was his own daughters, he would want to keep checking on them, he said. But the system isn’t built for that.

NHS figures from last year suggest one in eight people aged under 19 in England have a mental health disorder, and almost one in four girls aged 17 to 19 have a mental disorder. Half of the latter group said they had self-harmed or attempted suicide.

“We hear from hundreds of people across the UK each day who are vulnerable and isolated and don’t feel they have anyone they can reach out to,” Pienaar said. “Many of our texters tell us they have struggled to get help either because they have not felt able or willing to reach out for help themselves or they have reached out but have had difficulty in getting into mental health support services. The anonymity of texting means that often they are telling us something they haven’t told anyone else.”

Analysis of the conversations over one recent seven-day period showed that 35% were about suicide and depression, and the next most common issues were anxiety, relationships, loneliness and self-harm.

“It is attracting a different generation into volunteering,” said Victoria Hornby, the chief executive of Mental Health Innovations, said of those answering the texts. “It makes sense to them. They can do everything remotely.”

A fictional example of a Shout conversation

Anonymous 2232: I’m in so much pain.

Shout auto response: Thanks for sharing. It might just take a moment to assign you to someone.

Tim: Hi my name is Tim and I am here to support you today. Can you tell me a little more about what’s going on?

Anon 2232: I can’t stop crying and my health is out of control. I just feel like no matter what I do I can’t get better.

Tim: It sounds like you are handling a great deal right now. It took tremendous strength to reach out for support.

Anon 2232: I’ve been overwhelmed for years. It just won’t stop. I feel like I have let everyone down. I am out of control. I just want to end it. I am ready to kill myself.

Tim: I want to make sure I am giving you the best support possible. Have you planned how you will do this?

Anon 2232: I have. I want to do this tonight after dinner with my family.

Tim: Thank you for answering so honestly. Can you tell me a little bit about what led you to this point.

[Anon 2232 talks about his family and what his sister might think.]

Tim: Despite the tough time you have been having, I keep hearing from you that there is a lot that you are still living for.

Anon 2232: It’s weird saying it all out loud because it doesn’t sound that bad. But how do I stop feeling like this?

Tim: You deserve support. You don’t have to do this by yourself. You speak a lot about your family. There is clearly deep connection there.

Anon 2232: Yes I love my nephews. We play Lego together. It is a really special time.

The conversation ends after one hour and seven minutes. Anon 2232 will invite his sister to stay to help him stay safe. He agrees some coping mechanisms and has the Shout text line number, Samaritans and emergency services contact details.

The service can be reached by texting SHOUT to 85258.

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