Content warning: this article contains mentions of suicide.
Tragedy does not wait for a convenient time or place to strike. It can be anything from the compounding effects of untreated mental health issues to a kidnapping in broad daylight, neither of which are anticipated by their victim.
Prior to the rise of smartphone technology, medical personnel and law enforcement were the primary care providers on scene during a crisis. In the event that an elderly person fell or a teenager was hypoxic, protocols were nearly muscle memory to the millions of licensed professionals that chose a career in first response. Officers would clear the surrounding area while paramedics bandaged the wound.
However, smartphones with messaging capabilities and an appeal to younger people opened a new avenue of crisis response: text lines. At the most basic level, someone in need simply sends an initial text to a short hotline number that assigns them an operator to chat with for the duration of their crisis.
The diversity and breadth of services offered by crisis text lines is quite remarkable. They can offer tailored help — for domestic violence, trafficking, eating disorders, suicide or LGBTQ+ support — at different times of day, at national or local levels, anonymously or with police themselves. The University of Michigan is proud to offer its own 24/7 hotline through the Counseling and Psychological Services.
The core function of crisis text line operators is to diffuse or deescalate situations of self-harm or violence, with the ultimate goal of transferring care. At first glance, crisis text lines seem like an amazing and life-saving resource to turn to, especially when people would otherwise lack immediate mental health resources or the comfort of anonymity. However, these same selling points are also the reason why text lines don’t work well.
The very nature of messaging platforms reveals a glaring limitation of crisis text lines. Text messaging lacks the nuances of verbal communication, such as tone of voice and facial expression, which can make it difficult for crisis operators to understand the full extent of an individual’s distress. Research demonstrates that physical gestures send crucial information between parties, such as feelings of trust and confirmed empathy. Additionally, delays in between messages can make it difficult for counselors to respond quickly and effectively to an individual in crisis as well as provide follow-up support. That is, if you are even paired with an operator in a timely manner to begin with.
In 2022, I reached out to a crisis text line for the first time. I had witnessed the graphic death of three teenagers (people my age) who my colleagues and I were unable to resuscitate during a routine EMT shift, and I knew I needed help processing my guilt and blame. After texting HOME to 741741, I was put in a queue that lasted 37 minutes. This length of time was perfectly acceptable for someone in my “shoulder to lean on” situation. Had I been in imminent danger, however, it’s clear that lethal outcomes could’ve resulted in that time frame. Harvard University reports that in a study of 153 nearly-lethal suicide attempts, one in four survivors noted that their duration of suicidal ideation lasted less than five minutes before the real attempt.
To make matters worse, the short and surface-level training that operators receive prior to taking the stand generally offer band-aid solutions to victims, once they are finally connected to the platform. During roughly 30 hours of training, crisis operators are taught scripts, how to gather information, build rapport and refer to licensed mental health professionals. These tasks aren’t something that just anyone with empathy and communication skills can do efficiently, let alone accomplish without any prior experience or licensure.
Additionally, the volunteer nature of text lines almost devalues the work of mental health clinicians — as if anyone can just pick up a laptop and triage the exact kind of help victims need. Operators are also in a catch-22 of sorts — if they deviate from the scripted responses, they risk providing advice inappropriate for that specific crisis, but on the flip side sound like a robot if they stick to the generic “I hear you” and “That must be tough.” It is important to note that if the texter has a means, intent and a plan for self-harm, supervisors can step in to make the call of an active rescue. But why have we collectively let mental health services become so distant and electronic in the first place?
The answer is cheap convenience. The University of Michigan made a recent move to partner with Uwill, a tele-mental health platform, where every student gets six free 30-minute sessions with a licensed counselor. While this is a huge step up from a text line, the objective connection between mind and body is still missing from virtual mental health check-ins. Place and presence have an impact on communication and de-escalation of mental health situations, and students are being discounted when their therapist or advisor isn’t able to receive and respond to the signals that can only come across face-to-face.
Of course, if anonymity is essential, then telehealth is a great service. But, as with any digital ecosystem, complete privacy is elusive. Privacy International, a London-based charity focused on privacy rights, found that 133 of the 136 mental health websites and online services checked contained a third-party element, which enabled targeted advertising for specific treatments, services or financial products. The lack of data protection is especially concerning for minors and LGTBQ+ folks, whose vulnerable identities are at the discretion of companies looking to sell your mental health problems to the world.
Ultimately, no text line claims to be a substitute for comprehensive care, and in no way am I advocating that we abolish these services completely. Instead, I hope that the need for them becomes obsolete in the face of more focus and funding to on-the-ground resources. We must shift our anger toward health insurance companies that charge higher prices for in-person services and online telehealth models that ignore systemic issues. Whether “preventative help” looks like referring a friend to mental health resources on campus, carrying Narcan or taking a self-defense class, we need to accept that well-being resources are best when multi-faceted, longitudinal and tangible.
Moses Nelapudi is an Opinion Columnist who writes about science, research and healthcare for The Daily. She can be reached at nelapudi@umich.edu.