When help stops at hello

CHENNAI: It’s only about a few months ago that tele-mental healthcare services helpline – 14416 for mental health services was launched, as a part of the Tele Mental Health Assistance and Networking Across States (Tele-MANAS) initiative by the Union Health Ministry. The 104 Helpline was already catering to concerns on mental health and several NGOs have also been working towards the same.

However, in the absence of a proper system of follow ups to these calls, helplines might not really be able to prevent unfortunate incidents, even when an individual reaches out to them.

Experts say that people with mental health issues don’t open up about it casually even if they call the helpline. It’s common for those with suicidal tendencies to not describe how they feel, as they often break down and disconnect the call.

Call disconnected

It was 2.42 am. Shruti* (name changed) was experiencing a plethora of thoughts on self-harm and death. She had seen the news and read messages on several platforms about mental health helplines or psychological help in such cases.

Even when her mind was a whirlpool of harmful thoughts, she braved them all to finally ring one of the helplines.

The responder answered with a hello but as Shruti was unable to speak. She was trying to catch her breath and muster the courage to speak when the call was disconnected, because she failed to respond immediately.

She waited for a follow up call but there was none. After about 12 minutes, she called again and now she was sobbing. The responder answered with a ‘Hello…sollunga…’ and then nothing. The call was disconnected.

Shruti blamed herself, of course. She thought that her reaction time was not quick enough, and this added to her distress. She also believed helplines were not the right choice because nobody was available to listen and understand her ordeal. Battling these thoughts, Shruti spent the night weeping.

The following day, however, she sought professional help at the Institute of Mental Health.

Systemic problem

Shruti was lucky and incredibly self-aware to have survived harmful thoughts but there are several others who don’t.

Those with mental health problems, often, do not realise they have a diagnosable and treatable medical issue. And even if they know enough to label it, they’re clueless about where to seek help.

While government-sponsored helplines look good on paper, its implementation leaves a lot to be desired. Helplines are often the first point of contact for those struggling with mental health issues. The way they’re spoken to would decide the outcome – life and death – literally! And this is where training plays a crucial role.

It begins with understanding of core issues on mental health coupled with training to answer phone calls. Using prompts to keep callers talking and the diligence to follow up when calls disconnect are all systemic problems that need to be addressed.

Exclusive training

“Helplines don’t help if professionals are not trained right. It’s important to appoint mental health professionals exclusively or at least train people before letting them answer calls from those struggling with life-and-death questions. Else, they’d end up triggering the person instead of helping him/her,” says consultant psychologist Meghna Minhas.

Representatives from the Tele-MANAS helpline 14416 say that people with mental health issues need an exclusive approach since such callers don’t talk immediately, and often cry when they call. Responders are trained to initially analyse if a person is in distress or depression and has suicidal thoughts or was it just temporary.

“There are about 100 calls per day and youngsters form a major part of them. We try to give them time to calm down because they break down when we speak. If nobody talks, we attempt to build a rapport with them and we keep them online,” explained a representative. “We follow up on every call as an emergency to make sure they’re doing well. We also try to alert the families and local social workers or police to respond immediately if someone is attempting a suicide and they tell us about it.”

The representative also admitted that call-takers at helplines must be trained to manage any given situation. The tone they use, and their patience in listening, understanding when to speak, and what to say, determines the response they’d get from a caller with suicidal thoughts.

Dr Lakshmi Vijayakumar, psychiatrist, founder of SNEHA, says that attending calls of people with suicidal thoughts cannot be limited to a specific duration. Certain calls even go on for hours.

“We need to talk to the person and acknowledge their feelings. You cannot make them feel overwhelmed, as it makes it more difficult for them to open up. We make sure that the caller is comfortable, speak to them until their feelings of self-harm subside and make them choose life. We also guide them to other resources that can help with their mental health,” said Dr Lakshmi.

On follow-up calls, she insists on taking permission from the caller to call them back. “We must make sure they’re comfortable when we call. SNEHA has signed an MoU with the 104 Helpline to train call attendants in handling the calls of people with mental health concerns and redirect them to trained psychologists,” clarified Dr Lakshmi.

‘No standard protocol’

Saravanan, a nodal officer at 104 Helpline, pointed out that over 50% of total calls to the helpline is from people who require mental health support and are unaware of whom to approach.

“There is no standard operating procedure to follow in all cases. We identify cases based on the conversation. We must analyse based on the details shared by the caller. If the person insists on talking to a counsellor, we direct them to a mental health professional. If we suspect any kind of suicidal tendencies in them, we talk to them and try to prolong the conversation to get more details from them. We try to prompt them to talk but we must be careful that we do not over-do or under-do anything. We also alert local cops and social workers to attend to people in distress in person,” he said.

He added that if the person disconnects without sharing any details, you must call back especially “if we catch on any feeling of distress but since there is no standard protocol, it changes case to case. All calls might not have a follow back”.

Know someone with mental health issues? Here's how you can help

How do we have a first-aid kit to treat an individual if they are physically wounded? There are some ways we can help someone if they are mentally unwell.

Support them with psychological first aid. It is a paramount element and everyone should be educated. Here are some few steps to give someone mental first aid:-

*Listen with patience to whatever the person is talking about.

*Do not be judgemental

*As a third person, who is non-psychic, we cannot provide a solution, so don't assume and cut conversation with your opinions.

*We have to give them open-ended questions to answer.

*Encourage and educate them to look for professional help

*Look for the signs of self-harm.

Search engines have attempted to get guidelines for suicides like this. Someone who is very close to us would exhibit their thoughts if we monitor that, as an individual, we can stop the suicide of our loved ones.

- Dr Vasanth, consultant psychiatrist at Fortis Malar Hospital