Telephone helplines play a growing role in mental healthcare. But the quality of service varies widely as the largely volunteer-run operations struggle to find funding. Now, a £5m rationalisation scheme aims to harness their potential and make them a key plank of mental health services.
Under the strategy, funded by the Department of Health, specialist helplines are working together for the first time to guarantee support for people in distress. And there are plans for a new technological infrastructure to bring the services into the 21st century.
It was 50 years ago that the charity, Samaritans, opened the first helpline, offering callers a confidential emergency service. Since then, dozens of other lines have opened to supplement and fill gaps left by statutory services. Today, they offer specialised mental health advice, support and counselling to around 800,000 callers a year.
Until recently, there has been no guarantee of service quality. In 1999, though, the government published the national service framework (NSF) for mental health, promising 24-hour access to services. With the exception of Samaritans, few, if any, mental health helplines are able to offer such round-the-clock support. The national framework exposed the need for a strategy to drive up quality, reduce unacceptable variations around the country and improve accessibility.
The project to achieve this has been masterminded by George Askoorum, a national mental health "lead" for NHS Direct [the national phone service for health advice], but leading on this work for the National Institute for Mental Health in England. He says the need for a more coherent approach became more obvious with the launch of NHS Direct in 2000 - not least because that service needed protocols for referring on and signposting callers.
By the end of 2001, NHS Direct had answered 5.4m calls, of which more than 250,000 were about mental health. To begin with, it did not have the resources to support callers with mental health problems. Although it now has a clinical assessment system and mental health training for call staff, it remains an information service.
"There is a huge range of help available, from lines supporting people with eating disorders to those for people suffering from phobias, panic attacks, or from schizophrenia," says Askoorum. "But four years ago the picture was bleak. Many helplines were operating in a climate of uncertainty and there were wildly varying standards and quality. The national service framework standards offered an opportunity to bring a uniformity of service."
A key move has been the setting up of a national partnership of mental health lines. The Mental Health Helplines Partnership Project, which is backed by the Department of Health and supported by the Telephone Helplines Association (THA), has spent the past three years setting standards covering the training of volunteers, issues of confidentiality and funding criteria.
Askoorum admits it has been a long process involving consultation with callers and some 40 lines. Major obstacles included a lack of understanding and trust among the helplines themselves, which have traditionally competed for scarce resources. The result of this work is a handbook setting out quality standards aimed at making helplines more accessible. This includes promoting the service locally and providing out-of-hours information if the helpline is not a 24-hour service. In future, callers to helplines that are closed will be re-routed to a line that can offer immediate support.
This re-routing will hopefully be achieved under a new technological infrastructure, which will also provide accredited training and support to helplines over the next three years. After this period, they will be expected to enter into contracts with primary care trusts, which are responsible for meeting the NSF standards.
Extra help is likely to be geared at smaller helplines that struggle. Groups such as the British Muslim Women's Helpline, which receives 3,000 calls a year, currently rely on individuals for contributions despite running a national service. Sarah Sharif, a spokeswoman for the service who has been involved in the partnership project, says support is vital.
"There is a national recognition of a religious dimension to mental health - yet we have huge problems getting funding," Sharif says. "We are a very small organisation with just a handful of volunteers. We fear we will have problems meeting some of the standards, but thankfully people at the [partnership project] are there to support us."
Mental health brought into focus
A model for the future development of helplines is already operating from a base in Nottingham. Focusline, set up three years ago, is a locally commissioned and highly integrated service using paid staff.
Run by mental health charity Rethink, the 24-hour service receives 20,000 calls a year from people living across the east midlands. More than 50% of the calls are from people who say they are considering harming themselves or taking their own lives. Links with local mental health crisis teams mean help is on hand in emergencies.
Five staff operate the phones at night - the busiest time for the helpline. The service's 19 employees have each received training in listening skills, self-harm awareness, data protection and confidentiality. Contracts for the service have been signed by primary care trusts in Nottingham, Leicestershire, Derbyshire, Rutland and Birmingham.
Mark Smith, operations team leader for Nottingham, says: "The service seems to work very well. We can link with NHS Direct if someone requires advice on medication, or if they are experiencing a medical crisis.
"The calls cover the broad spectrum from people who are having panic attacks to those who hear voices and those who are suicidal. I try to link in with mental health teams if a caller rings in several times and, with their permission, I will work with the community psychiatric nurse or social worker and get more information about the person to support them. A lot of time we won't get that permission. And the only time we will break confidentiality is if people threaten to hurt themselves or others."
The helpline operates from Rethink's Church House project in Nottingham, which offers face-to-face support and short-stay accommodation for people affected by mental health issues. The phone service is likely to remain exceptional in its use of paid staff, but the hope is that volunteer-run services will seek to emulate its professionalism. Linda Jackson
