October 11, 2010 was a day a therapist hopes she never will have.For a therapist in San Francisco, this day started with the discovery of distressed text messages on her phone sent by one of her young clients, a teenager named Alex. He was desperate and thinking of ending his life. He wanted to connect with her and needed her support. But she didn't provide overnight text-messaging services. The help he needed didn't reach him in time and he chose to end his life by suicide.
You can find more about this heartbreaking story at the website his family created, The Alex Project.
Thankfully, San Francisco-based crisis text services have been created as a result of this tragedy to prevent further teen suicides.
In fact, text messaging services are popping up all over the country in response to our growing recognition as parents, advocates, mental health professionals, systems planners and funders, that in-person and phone-based services don't work for the majority of youth in crisis. In Minnesota, Nevada, and San Francisco, text services have been created and are doing phenomenal work to serve as a lifeline for youth who prefer to communicate via text messaging. For a complete list of text-messaging services in the USA and abroad (luckily there are many) visit the unsuicide wiki, maintained by Canadian mental health advocate Sandra Kiume.
A national service has also been formed. Mental Health Advocate Nancy Lublin of DoSomething.org has worked tirelessly to create a new national service, the Crisis Text Line, which just launched in August 2013 and eventually will reach all youth in crisis in any part of the country. This is a life-saving service that will be relied on by hundreds of thousands of young people every year.
But, as Alex's situation poignantly illustrates, these anonymous texting services are not enough. People want to connect with people they know and trust when they are in crisis. Alex wanted to text his therapist but she did not provide mental health support via text-messaging.
In fact, many clients want to communicate with their therapists via text messaging and email. Texting communications can be used for support as well as other general communications such as scheduling appointments.
Clients want to text their therapists because its just how we communicate. With 72% of adults and 95% of teens using their phones for text messaging every day, according to a Pew Internet study, it is becoming as ubiquitous as the telephone.
And for many people, especially teens, who find verbal communication uncomfortable, texting offers a sense of safety, creating an environment that facilitates communication about sensitive subjects and difficult emotions. Thinking about how to reach teens by text-messaging to prevent suicide seems paramount.
The mental health profession is scrambling to catch up. The majority of therapists and mental health centers do not offer text-messaging services.
But now is the time to move and adopt this service. There are many software solutions already available and tried and tested to fill this gap.
Applications such as Hipaa Chat allow for two way text-messaging and video conferencing from an iPhone, with capacities for an Android system coming soon. This application immediately destroys all information transmitted on it, so that no personal health information is stored on the phone where it can be harvested by applications and stored outside of a secure clinical record.
But this is not the only software solution available. Mosio, Educational Messaging Services, and iCarol also provide industry-standard encryption to provide secure text-messaging. Each platform offers slightly different features. Mosio combines email, chat and text messaging options together, EMS's Prevention Pays platform provides robust outgoing messaging as well as one-on-one texting, and iCarol offers chat and texting on one platform with substantial reporting capacities.
And models for keeping these services sustainable and staffed also need to be explored. A partnership with a local crisis center is the most cost effective and secure way to ensure your clients have 24/7 access to someone who can respond immediately and then communicate with the therapist if needed in an emergency.
Therapists can help their clients feel comfortable contacting the crisis center, explaining that they work together and the center can contact the anytime therapist if there truly is an emergency. In this way the crisis center works effectively as an extension of the therapist-client relationship to facilitate help-seeking in a time of crisis.
I encourage mental health professionals to start exploring these options actively and now! People in crisis are trying to reach out for help every day via text messaging and we currently are unable to respond.
We are behind the curve, not meeting people where they are and this has resulted in lives lost. Let's create real, responsive and accessible mental health services for all people.
I know that text-messaging services can be a big part of that solution.
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