Virtual Crisis Intervention: Wave of the Future?

Crisis intervention, once primarily delivered over the phone is increasingly being delivered through the computer and via text. Social Workers and other helping professionals need to be aware of the benefits and drawbacks of these methods of communication. Whether you work for an employer who may allow or require you to begin using these technologies or you are in private practice, learning more about text and chat for crisis intervention can enhance your practice.

Who uses text and chat?

Adults still primarily prefer to use the telephone or in-person communication to get their mental health needs met. In one large Canadian crisis service (the ONTX Project), the majority of the contacts via text message come from youth, while the majority of the computer chats come from adults.

LGBT youth – especially trans youth, may be more likely to use text and chat services because they don’t have to worry about “passing” or blending, being recognized as the gender they identify as. Via text and chat messaging there is no need to fear being mis-gendered if a client identifies as a woman but has a deep voice, for example.

How is it different from other forms of support?

Text and chat communications are slower, sometimes much slower. This means that it will take you more time to collect the same amount of information. Expect a 20 minute phone call to take closer to an hour with text and chat.

Because this method of communication is more resource intensive, you will need to carefully manage the conversation. Youth especially can talk for hours via text if they are given the option, but your therapeutic boundaries and agency policy may not permit you to engage them this long. Making an action plan to meet their immediate needs and inviting them to access the service again another time can be very helpful.

You can’t demonstrate empathy with your voice tone (obviously), so you have to be very careful to write out your empathic statements. “From what you’ve said, I really get the feeling that you felt alone.” This helps ensure that your client really feels heard.

Suicide risk assessment via text and chat

Suicide risk assessment is a more challenging task over text and chat. It’s important to make sure you firmly ask if the texter has done anything to kill themselves or end their life as soon as you determine they are suicidal. If they have, you can jump right to the active rescue procedure. You may need to adjust how you ask questions about suicide in order to fit them into 140 character limits some services have.

Accessing emergency services

This is one area that is significantly different. A lot of crisis agencies have close relationships to the police and EMS can trace phones in cases of imminent risk. On the computer though, this is a lot more difficult or even impossible. You will need to rely on your ability to build a strong rapport in order to convince your client to access active rescue.

Many texting services do not allow clients to hide their number from you, which is different from telephone services where you can block your phone number from the responding hotline worker. This can make identifying texters at imminent risk somewhat easier.

How can you build text and chat skills?

If you don’t currently have the opportunity to perform crisis intervention over text and chat through your employer, consider the ONTX Project in Canada or the Crisis Text Line in the US. These organizations allow you to volunteer to staff a web and text crisis line through the Internet, and volunteer virtually. After completing training, you’re able to volunteer between 4 and 16 hours a month for a year to help you add these valuable skills to your resume and improve your ability to serve your clients.

Will text and chat replace in-person counselling or therapy?

Some proponents of e-counselling think that text or chat will replace telephone helpline services for immediate support, but this is unlikely. Text and chat is a great introduction to helping support, but clients likely won’t be able to get all their needs met in this manner. Once they’re comfortable, you may find it more helpful to transition them to telephone or in-person support at your agency.