Development, Implementation, and Evaluation of a Psychiatric Crisis Hotline During the Pandemic: A Pilot Study in a Middle-Income Country

Background: Crisis hotlines have become a popular means of providing mental health support during crises, particularly during the COVID-19 pandemic. Objectives: Our aim was to establish and evaluate the implementation of a freely accessible psychiatric crisis hotline in Iran. Methods: During each call, crisis counselors conducted crisis assessments, applied behavioral techniques, provided referrals, and evaluated service satisfaction. Likert scale questions were used during both the initial and follow-up calls to measure the callers' distress level. Suicide risk and the degree of aggression were assessed using a modified list of questions taken from the Iranian Mental Health Survey (IranMHS). We performed the Wilcoxon single-rank test and linear regression analyses to evaluate and compare changes. Results: A total of 3633 calls were responded to over six months. We assessed 737 calls at baseline, of which around 30% (N = 221) were re-interviewed in the follow-up call. Females constituted 71% of baseline calls (N = 523), and 53.6% of the callers (N = 395) were under 25 years old, while 63% (N = 465) were single. Approximately 41.5% (95% CI [0.542, 0.615]) of the callers (N = 306) reported suicidal ideations at the baseline call, and suicidal risk was assessed as moderate-to-high in 227 callers (37.5%, 95% CI [34.1, 41.1]) at baseline. Experienced distress significantly decreased both during the baseline call (z = 23.47, P < 0.001) and at the follow-up compared with baseline (z = 9.30, P < 0.001). In the follow-up, 186 callers (84.2%, 95% CI [78.6, 88.7]) reported high satisfaction with the service. Approximately 48% (95% CI [0.410, 0.551]) (N = 98) of the subjects who were referred to other mental health services (N = 204) followed through with the suggested referrals. Conclusions: The crisis hotline was successfully implemented and well-received by callers in a developing country setting. A randomized trial is required to establish its effectiveness.