Can Mental Health Helplines Help People in Crisis?

Mental health counseling, from people who’ve been there themselves, provides unique empathy. Here’s what you should know.

Peer counseling has been around for decades: From hotlines for LGBTQ assistance to veteran- and teen-focused hotlines, peers helping peers is a time-honored model for providing assistance to those in need.

But one program put a different spin on the classic model. In San Francisco, a call-in “Warm Line” — a step down from a hotline — is staffed by those who’ve experienced mental health issues themselves.

“Hotlines are traditionally for people when they’re in crisis level,” says Rachel Del Rossi, executive director of the Mental Health Association of San Francisco (MHASF), which runs the line. “We don’t need people to be in absolute crisis before they access services.”

The name is also a bit of a play on words. “We really prioritize being warm and friendly,” Del Rossi says. “We believe in personal connection as a primary tool of recovery.”

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There are very few warm lines in existence in the United States, and peer-run warm lines are even less common. Many operate only with limited hours. The MHASF line, funded by a California state mental health grant, operates every day of the week, 24 hours a day.  

The line, which has the potential to help reduce institutionalization and forced treatment, provides referrals as well as a listening ear for those looking for mental health services and treatment.

“It’s meant to be a peer-to-peer support so you can get that person-to-person real contact instead of a kind of hierarchical, patient-subject mentality,” Del Rossi says.

Since its beginnings in August 2014, the peer-run Warm Line has taken more than 185,000 calls. There are no limits on how often a caller can use the service, so repeat callers are common.

“We find people with mental health issues tend to be incredibly isolated, which tends to have very negative effects on their mental health and well-being,” Del Rossi explains. “So having that point of connection where they can call, they know somebody’s going to be respectful on the other end of the phone, and they know somebody’s going to understand what they’re going through is important — we’ve gotten so many responses that this has prevented them from going on a downward spiral.”

While counselors are carefully trained not to give medical advice, they are encouraged to serve as a peer support system, to listen empathetically, and to share their own experience if it seems appropriate.

“We are not a professional mental health resource. We are a social resource,” Del Rossi says. “We will help people figure out how they want to address their issues and encourage people to seek treatment when they want, but we also really honor the person’s experience and choice.”

Traditionally, mental health treatment providers avoid talking about themselves or their own personal challenges when working with a client, even if those challenges include mental health issues. Most therapeutic models discourage this practice. But the MHASF believes such disclosure can help callers feel more comfortable and carefully trains staff about when and how to offer it.

Melodee Jarvis, former manager of the Warm Line, says this difference can provide unique opportunities for those who call in. “When you call the Warm Line, you’re not calling somebody who’s keeping you, the potential caller, at a distance. What they’re really doing is inviting the caller to share what they’re going through and hold space for them, but also be part of the conversation and engage in dialogue and bring up their own experience. It’s a more natural conversation than the clinical relationship.”

It’s not necessary to have had the same experience as another person to feel empathy for their situation, says Carl Tishler, PhD, an adjunct associate professor of psychology and psychiatry at The Ohio State University. But, he says, “it can be extremely helpful to have that sense of empathy with a person who’s calling in.”

In another innovation, counselors are paid — they’re not volunteers. “Part of our mission is to offer folks with lived experiences of mental health challenges the chance to work and be employed,” Jarvis says. “This is a stepping stone back into the workforce and a way for people to feel empowered themselves in being able to help others.”

The program provides opportunities for both callers and staff alike. “Participating in a help center like this and getting this kind of training is a very rewarding thing for the helper,” Tishler notes.

The Warm Line now takes calls across the United States (and internationally) and offers a link so those in need can send an instant message to the Warm Line.

Says Del Rossi: “It’s been really amazing to see the line be embraced by the whole community. We really believe that this is a wonderful service that we would love to see grow throughout the country and the world.”

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