The coroner said mental health support via text messages or online chat functions were not designed to manage acute mental health or crisis situations involving significant or imminent risk. Photo: 123rf.com
A coroner has called for greater public awareness of the scope and limitations of online mental health support services.
Meenal Duggal has released her findings into the 2023 suicide of a young man in Lincoln near Christchurch.
The coroner said the man had multiple interactions with two helpline services, 1737 support services and Lifeline, sharing his suicidal thoughts before his death.
She said the man's contact with the online services raised wider concerns about the role, capacity and public understanding of them, where support is primarily provided via text messages or online chat functions.
"Such services play an important role in providing brief intervention to those suffering from mild to moderate mental distress. They are not designed to manage acute mental health or crisis situations involving significant or imminent risk," the coroner said.
Duggal said it was evident that repeated access of online services might become a substitute for or barrier to someone seeking an in-person assessment, particularly for people with severe depression or social anxiety.
"While it may be helpful to have some assistance where the distress is at a lower level, in a person with active suicidal planning or a person who is difficult to engage, it can mean that the type of assessment and treatment required is not provided," she said.
Duggal said clear public messaging was required to ensure that members of the public and referring agencies understood that services such as 1737 and Lifeline were intended to provide support to people with mild to moderate mental health issues.
She recommended that 1737 provide staff training to all staff on risk assessment and escalation policies when someone was at a high level of risk, and that Lifeline review its contact with the man.
Lifeline should examine issues with text messages and vague responses, train staff and make appropriate changes to its procedures, the coroner said.
Lifeline and Whakarongorau, which operates the 1737 line, expressed their condolences to the man's family and friends.
Whakarongorau chief operating officer Brian O'Connell said clinical leadership and 1737 frontline staff had undertaken a comprehensive review of training, policies and escalation procedures.
He said key changes include lowering the threshold for escalation, guiding kaimahi to assess thoughts, plan, means and timeframe when someone talked about suicide, and to escalate the situation early when risk was identified.
"It is important to clarify - as the coroner does - that 1737 is designed to provide brief intervention counselling and support for people experiencing mild to moderate mental distress," O'Connell said.
"While of course our counsellors support anyone who calls or texts 1737, the service is not intended to manage acute mental health crises involving imminent risk. In such cases, we help people access the urgent care they need."
Lifeline said it has also made changes as a result of the coroner's recommendations.
They included introducing a suicide prevention plan to help de-escalate risk, closer monitoring of text conversations by shift supervisors and risk management training for staff and supervisors.
"We acknowledge that there is learning for the organisation about engaging with people who communicate by text and training for our staff on exploring vague conversations," Lifeline said.
"Lifeline will continue its focus on best tele-health practices and is actively seeking government funding so we can continue to provide services to those in our community with mental health issues."
Where to get help:
- Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason
- Lifeline: 0800 543 354 or text HELP to 4357
- Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO. This is a service for people who may be thinking about suicide, or those who are concerned about family or friends
- Depression Helpline: 0800 111 757 or text 4202
- Samaritans: 0800 726 666
- Youthline: 0800 376 633 or text 234 or email talk@youthline.co.nz
- What's Up: 0800 WHATSUP / 0800 9428 787. This is free counselling for 5 to 19-year-olds
- Asian Family Services: 0800 862 342 or text 832. Languages spoken: Mandarin, Cantonese, Korean, Vietnamese, Thai, Japanese, Hindi, and English.
- Rural Support Trust Helpline: 0800 787 254
- Healthline: 0800 611 116
- Rainbow Youth: (09) 376 4155
- OUTLine: 0800 688 5463
- Aoake te Rā bereaved by suicide service: or call 0800 000 053
If it is an emergency and you feel like you or someone else is at risk, call 111.
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