What we've learnt from analysing 300 calls to a mental health helpline in South Africa

By Dessy Deysel and Dr. Linda Eskell Blokland

We see the toll-free numbers on TV, read about them in magazines and newspapers, hear radio personalities encourage us to reach out. Helplines for depression, anxiety, and other psychiatric conditions are being used daily in our country, where one in three of us will likely experience a mental illness at some point in our lifetime. And yet, not much is known about this resource and the people making use of it.

Hoping to make a tangible contribution through my Master’s research rather than simply approaching it as an academic exercise, I (DD) set out to learn more about the calls received by these national NPO-run helplines, and the people making them. Why? If we better understand who the callers are, what they’re struggling with, and where they’re being directed to for further help, we would be able to make more informed decisions about much needed community mental health services and interventions.

Who is the ‘typical’ caller?

During the research process*, I sifted through call after call – hundreds per day – of people facing various life challenges and looking for help, for hope from these helplines. Volunteer lay counsellors on the other end of the line listened, tried to ease immediate worries, offered information, intervened in crisis situations, and guided callers to resources that could provide mental health treatment, or some other form of assistance with the problems expressed.

After collecting a sample of 300 call records from February to March 2017 and completing the analyses, we learned that if we were to pick up a call on one of these helplines, we’d most likely find the caller to be a woman, in her 20s, of black race, living in Gauteng, and looking for help for herself.

She’d be most likely to share a difficulty with a mental illness (particularly depression), and would be given a referral to a type of support structure, or informal counselling service. After Gauteng, the Western Cape and KwaZulu-Natal each contributed 12% to total call volumes. More calls were received during weekdays than on weekends, and early afternoons were the busiest time of the day, making up 47% of calls.

Other interesting findings

We also discovered that the reliance on NPOs to provide further assistance outweighed that on both the public and private sectors combined. This raises questions about the ability of our informal mental health care sector to cope with the demand. Does it receive enough funding, if any at all? Are the people referred there able to get the follow-up help needed, or do they become despondent and stop seeking help?

Another valuable finding was that relationship problems were the second most common theme in terms of the difficulties callers were facing. Do we pay enough attention to the role of interpersonal relationships in mental health? How can we tackle this aspect in community-based care? Could it be that people meet a need for social connection through helplines, and if so, how would this change the function or application of helplines?

Interestingly, although there is no significant difference in the prevalence of mental illness between men and women in South Africa, only a quarter of callers to the helplines were men. What is preventing men from seeking help, even when they can do so anonymously? How can we engage men more in mental health initiatives? What are we missing?

Could helplines help deliver brief interventions?

Helplines, in particular, could be used as a medium for the delivery of brief mental health interventions. They are accessible from any geographical location, can be reached immediately, are low cost or free, reduce fear of stigma and discrimination, and allow a caller to make or end a call as desired, creating a sense of empowerment. As such, could we make a shift towards using helplines for mental health screenings? What about offering a telephonic support programme in-between formal psychiatric treatment sessions?

The World Health Organisation recommends that after self-care, informal community care should be the next most commonly utilised resource, before primary care services are accessed. How do we measure up to this in South Africa? Could we alleviate some of the burden on our health care system if we shift certain basic tasks to informal community care structures? Maybe such structures already exist, and we are missing the opportunity to make better use of them. Before launching into a debate over the costs of developing more facilities, would it not be wiser to explore smarter ways to work with what we already have?

While this helpline study provided some answers, it also generated a wealth of questions that have left us with more to consider. Hopefully, the information and ideas shared will spark new ways of engaging with our informal community care resources, ways that not only help us to deliver better mental health care, but that also enable us to become more proactive rather than reactive in our approach.

Dessy Deysel is a Clinical Psychologist currently completing her community service at a government hospital in Johannesburg. She is also a Pfizer Mental Health Journalism Fellow.

Dr Linda Eskell Blokland is a Clinical Psychologist, coordinator of Itsoseng Community Clinic, and acting HOD of the Student Counselling Unit at the University of Pretoria.

*Call records used for this research were anonymised, with all personally identifying information removed.
For more details on this research project, the complete study can be found here: https://repository.up.ac.za/handle/2263/65545
[Deysel, D., & Eskell Blokland, L. M. (2017). An audit of calls to a free South African mental health call centre (Master’s mini-dissertation). University of Pretoria, Pretoria, South Africa.]