World Mental Health Day — California takes initiative in battling depression

Today is World Mental Health Day. And, California, a state with 10 percent of the U.S. population, just announced that it’s introducing the first toll-free statewide mental health line for non-emergency emotional support and referrals. What a wonderful way to kick off this occasion. This Peer-Run Warm Line is a reason to celebrate.

As a psychologist, I’ve witnessed first-hand the emotional pains people carry, and how hard it is for them to come in for formal therapy. There are so many stigmas and practical barriers to getting one’s mental health needs addressed, that this telephone line seems like a no-brainer. The effects are likely going to be positive; particularly given that studies on various mental health hotlines, including suicide hotlines, show beneficial effects.

But, in all my enthusiasm, I figured I’d pause and ask some of the national mental health-care scholars I admire what they thought of this new line.

Dr. Ken Pope, an internationally-known and highly-regarded psychologist said, “Once again California leads the nation in responding creatively to the needs of its residents. Making free mental health support available by phone to all who are struggling will likely catch problems in their earliest stages, when they can be more easily addressed. This may help countless people lead happier, more meaningful, more fulfilling lives. It may also save money that would otherwise have been needed for more serious interventions, like hospitalization.”

Exactly. It’s one of those times I’ll just echo, “What he said.”

According to Dr. Jeffrey Sonis, a physician and associate professor of family medicine at the University of North Carolina at Chapel Hill, “Anytime you do screening for any type of illness, there are harms of false positives and false negatives. A false positive would be if someone who calls the hotline is told that they need mental health care, and then are found to not have mental illness when they are seen by a mental health professional. 

There might be some unnecessary cost as a result of those false positives, but I don’t think that there are really any harms.” Dr. Sonis, continued, “A false negative would be someone who is told by the hotline professional that they’re just upset and don’t need mental health care, when in fact they do. Someone like that might delay seeking appropriate mental health care. I’m guessing that the rate of this would be fairly low, but it’s probably not zero.”

Indeed, there are always potential risks when creating new avenues to deliver support.

Dr. Sonis added, “One additional concern would be the linkage between the hotline and receipt of face-to-face mental health care. Dozens of studies have shown that screening for depression in primary care is completely ineffective in lowering rates of depression or improving treatment outcomes, unless the practice has systems in place that link screening to diagnosis, treatment and follow-up. 

That’s why the U.S. Preventive Services Task Force did not endorse screening for depression in primary care until randomized controlled trials showed that depression outcomes improved when screening was explicitly linked to diagnosis, treatment and follow-up. 

A mental health hotline is not really screening, because screening is a search for illness among someone without symptoms/signs of disease, while a hotline is an intervention for people who have symptoms to reach out for care. However, I suspect that the issues about linking the phone call to receipt of appropriate mental health care will be similar in the hotline situation.”

Indeed, there are kinks to work out. 

Dr. David Susman, a psychologist who has an award-winning blog with stories of hope from individuals with lived experience of mental health difficulties, made another good point. “This “peer-run warm line” is not for crisis situations, but rather for support.  Peers are amazing, and this service sounds wonderful, and so forward-thinking. But, who will folks call when they are having a mental health crisis? This would typically be the National Suicide Prevention Lifeline (if suicidal), a local community mental health center crisis line, or a call to 911, or going to a local hospital emergency room.”

For sure, the effectiveness of this warm-line will depend on the quality of the person who is answering the hotline, and the quality of their training. But opportunities for peer-based support are common in mental health care nowadays, as proven out in the use of mutual self-help groups, like 12-step programs.

However, the utilization of peer specialists, those given formal coursework, on the job training, and certification, is somewhat less common. Studies show that peer specialists improve client engagement in mental health treatment, along with numerous other advantageous outcomes, such as increased feelings of acceptance by others.

Nonetheless, there are still important issues to think through. The as yet lack of 24/7 coverage for the warm-line might be a problem for people in crisis. People will likely call outside of business hours. Additionally, a good plan needs to be put in place in the event of call surges, which can happen after horrific national shootings or a celebrity death. And, there needs to be some procedure worked out in regards to frequent callers.

This California warm-line seems to dovetail nicely with some of the things this large state is already doing in relation to the suicide prevention hotlines they operate. It also seems to align well with the movement to create a three-digit national phone number (like 911) for people who are feeling suicidal or are going through any other mental health crisis. 

Despite some potential snafus, enthusiasts are likely going to say, “The helpline is a good start,” “Something is better than nothing,” and “Where else will people go?” In addition, the helpline is an innovative way to destigmatize seeking support for mental health issues.

It also may encourage delivery of mental health interventions via tele-health, and in turn, increase access to mental health services. Hopefully, the line will help people be more proactive in seeking help and promote overall health and wellness. Finally, this hotline can have a very large effect in rural communities that often do not have any access to mental health services/resources.

Thank you California for having the courage, and taking the initiative, to set up this Peer-Run Warm Line. Many of us are rooting for you, and looking forward to learning from your innovation.

Joan Cook is a psychologist and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors and people who escaped the former World Trade Center towers on 9/11.