Innovations in Crisis Line Interventions

Background: Crisis lines provide evidence-based suicide prevention support that often involves active listening, safety assessment, collaborative problem solving, and sharing resources (care as usual). Many crisis lines are also innovating by providing additional interventions to support service users. Aims: We conducted a scoping review of peer-reviewed literature to understand what crisis line interventions are currently used beyond usual care and which have been evaluated. Methods: We worked with a librarian to develop a comprehensive search strategy applied across six databases (PsycInfo, MEDLINE, Embase, CINAHL, Applied Social Sciences Index and Abstracts, and Web of Science). Results were screened by pairs of analysts. Data from eligible sources were extracted using a standardized form and synthesized by type of intervention. Results: We identified 42 relevant studies describing crisis line interventions other than care as usual. Of these, seven evaluated the intervention and four found support for the evaluated intervention. There are single-study evidence in support of: applied suicide intervention skills training (ASIST); a structured safety planning intervention; artificial intelligence (AI) to support messaging; and a crisis line-specific risk assessment scale developed in Beijing. The remaining studies described a variety of interventions including triaging, managing, and de-escalating crises; structured or standardized suicide risk assessment and safety planning; care coordination; and supporting responders using AI. However, these interventions were not formally assessed. Limitations: Variability in how interventions are described, operationalized, delivered, and evaluated limits comparisons across studies. Conclusion: Crisis lines continue to explore ways to meet the needs of the people they serve. However, many approaches have not been formally evaluated. More research and evaluation are needed in real-life contexts where information can be triangulated from various data sources (e.g., crisis line data, responder feedback, user experiences) to evaluate the impact and meaning of a given intervention.