Frequent users of crisis helplines: Who are they and why do they continue to call?
Document TypePhD thesis
Access StatusOpen Access
© 2017 Dr. Aves Primula Audrey Middleton
Crisis helplines were established in the 1950s to provide an immediate telephone response to anyone in an acute crisis. They now operate around the world, and Lifeline is recognised as one of Australia’s largest national crisis helpline services. A disproportionate number of calls to crisis helplines come from frequent users, who make multiple calls over an extended period of time. It has long been thought that frequent users are isolated individuals who call about non-crisis related issues; however, this assumption has never been investigated. Service providers struggle in knowing how to respond to frequent users while still addressing the needs of other callers. An evidence-based approach is required. AIM: The aim of this thesis was to investigate the socio-demographic characteristics of frequent users of crisis helplines and the factors driving their frequent use. Specifically, it answered the research questions: 1. What is the socio-demographic profile of frequent users of crisis helplines? 2. What are the reasons for frequent users’ continued use of crisis helplines and how do they differ to those of other callers? 3. What are the health service use patterns of frequent users of crisis helplines? METHODS: Three studies were conducted to address the research questions. Study 1, a brief survey of callers to Lifeline, investigated the socio-demographic characteristics of frequent users and differences in their reasons for calling compared with episodic and one-off callers. Quantitative analyses were conducted using ordered logistic regression. Study 2 involved interviews with Lifeline frequent users. Inductive thematic analysis was used to generate common themes to understand why some users may call crisis helplines frequently. Study 3, a longitudinal analysis of data from the diamond study, examined the relationship between frequent use of crisis helplines and health service use patterns over time. Crisis helpline use was measured at 3, 6, 9, and 12 months and analysed using ordered logistic regression. RESULTS: Compared to other callers, frequent users were more socially isolated individuals and lacked people to turn to in moments of despair. They had come to rely on crisis helplines for support; although, this was not the only factor driving them to call. They also reported disabling and chronic mental health issues, physical illnesses, and ongoing crises. The circumstances under which they called varied, but there was evidence to suggest that the current service model was not meeting their long-term needs and may in fact reinforce their calling behaviour. Frequent users also visited the general practitioner, psychiatrist, psychologist, and the emergency department at rates higher than other callers; yet, they were less satisfied with their access to these services. CONCLUSIONS: Frequent users have a genuine need for crisis support, yet, they use crisis helplines in a manner different from their intended use. They account for a substantial number of callers to crisis helplines and service providers may benefit from recognising frequent users as a legitimate group of service users. This might have implications to how counsellors approach these users and may require a change in the operation of crisis helplines.
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