Voices in the night: Frequent callers to a crisis intervention center

Abstract

Chronic or frequent callers represent a significant issue for all telephone-based mental health services, whether crisis intervention/suicide prevention hotlines, or the more comprehensive array of interventions connected to some such services today. While comprising only a small fraction of callers, they constitute anywhere from 25% to as much as 50% of all phone contacts. These frequent callers raise practical management as well as important clinical questions. The practical problems include demands on time, and the emotional drain on counselors. The clinical issues include assessing whether significant therapeutic gains accrue to these callers from these repeated contacts.;While several articles have been written highlighting these concerns, only a few studies have empirically investigated the characteristics of this group, and these have produced inconsistent results. Some have found no differences between frequent and non-frequent callers; others point to major differences in terms of diagnosis, psychiatric history, and suicide risk. Significant methodological problems limit the validity of these studies, however, including an absence of comparison groups and tests of statistical significance, differing definitions of frequent callers, and an exclusive reliance on a limited set of demographic and psychological variables taken from contact records.;The present study proposed to correct for some of these limitations and to explore a number of these factors in greater depth. Results indicated that frequent callers differed from non-frequent callers in several respects. Frequent callers evidenced significantly greater psychiatric impairment including a markedly higher number of psychiatric hospitalizations, higher incidence of psychotic disorder, and greater involvement with ongoing outpatient psychiatric treatment. Frequent callers also evidenced significant differences in terms of demographic variables including a significantly lower incidence of living as married, a higher incidence of living alone, and a high incidence of being unemployed and receiving social security. Finally, differences in presenting problems were evident, with a significant tendency for counselors to rate frequent callers as having problems with anxiety, and non-frequent callers as having problems with depression or mood disorder. No differences were found in terms of suicide risk, borderline symptomology, or consumer satisfaction.