Beyond the Self-Harm Data: Answering the Crisis Hotline — Hannah Storrs and Dr. Allison Crawford

Alex:

This interview discusses suicide and self-harm. Help is available if you need it by calling 911 or your local crisis centre. As the COVID-19 pandemic is rapidly evolving, the circumstances may have changed from the time this podcast was recorded and may not reflect the current environment.

Hi, and welcome to the CHIP, the Canadian Health Information Podcast. I’m your host, Alex Maheux. This show from the Canadian Institute for Health Information will give you an in-depth look at Canada’s health systems and talk to experts you can trust. If you’re interested in health policy or health care systems, and the work being done to keep Canadians healthy, this podcast is for you.

Earlier this year, CIHI released a report on the unintended consequences of COVID-19 looking at the impact the pandemic had on the mental health of Canadians. Early data showed emergency department visits and hospitalizations for self-harm decreased at the onset of the pandemic. But we also know that mental health among Canadians declined, and people might have sought help through community organizations virtually instead. CIHI continues to collect data for a better understanding of the true impact COVID-19 has had on mental health.

In the meantime, to help us get a fuller picture of what’s happening, we’re joined by Hannah Storrs from the Distress Centre in Calgary. Hannah is a crisis team lead as well as an experienced responder. We also have Dr. Allison Crawford, the Chief Medical Officer for Canada Suicide Prevention Service. Hannah’s also a psychiatrist with the Centre for Addiction and Mental Health in Toronto. Let’s get to it.

Hi, Alison, Hannah, welcome to the CHIP. How are you both doing?

Allison:

Great. Thank you, Alex, good to be here, and hi Hannah, nice to see you.

Hannah:

Hi, I’m doing well as well.

Alex:

Let’s dive right in. It’s obviously been a very different, very difficult year. I want to ask how both of your lives personally and professionally have changed over the last year. Hannah, we’ll start with you.

Hannah:

Yeah, well, just like everyone gone remote, which was really interesting, especially at the beginning because we were a full in-centre organization. And there’s been a big change in like 2 weeks from answering calls in the centre to all of it being remote. Just because of everything, we had to go full staff rather than using our volunteers, which is our main pool, who answers our phone lines. So that was like a big change within our organization.

Yeah, it was taking some getting used to, not having that social interaction day to day and not having people to go wander to their office and see how they’re doing. So I think like on a personal level, it took some time to really get used to interactions over Zoom, over Teams and even just over email more often than just being able to see each other in person. So there’s some big changes. It’s definitely gotten easier since the year has passed. I mean, I definitely am ready to get back into the office and ready for normalcy, rather than this but we’ve definitely gotten through it. And there’s been so much change, but so much improvement as well.

Alex:

That’s wonderful. Allison, how about you?

Allison:

Oh, I can sure relate to a lot of that. It’s interesting, some of the things that I do. So I oversee virtual care in our organization, the Centre for Addiction and Mental Health, and also, the Canada Suicide Prevention Service. And so these things predated the pandemic, but boy, it’s been like, taken on a wild ride because I’ve been doing virtual care for about 10 years. Like you said, Hannah, in 2 weeks, we saw this massive growth. It’s great that we can all put some of these skills to use, but no one could have anticipated what a tumult it’s been.

And same, I travelled a lot for work prior to the pandemic. I’ve got 2 kids. I feel like they’re much happier that I’m home all the time, but trying to operate from home has taken some adjustment for me.

Alex:

There are definitely some adjustments to make but it’s great to hear as well that you’re getting some more quality family time. CIHI data and analysis that was released earlier this year show that emergency department visits and hospitalizations for self-harm decreased significantly during this portion of the pandemic. But we know that this obviously doesn’t tell the whole story. Hannah, I want to start with you. What have you seen during the pandemic? Is there a sense that the call volumes have decreased or increased? And how about the number of people in crisis? How has that been affected?

Hannah:

Yeah, so over the entire pandemic, our actual call volumes have stayed pretty normal, which is kind of interesting to hear that the decrease there. So we’ve stayed normal with our call volumes. But really, what has changed has been actually the amount of suicide calls that we’ve had. So if you actually compare our numbers from April of 2020 to April 2021, we’ve seen a 68% increase in suicide calls.

So people are reaching out a whole lot more, even though we’re seeing the same amount of calls. We’re just seeing a huge increase in those suicide-related calls, as well as the mental health calls with our top concerns being like anxiety, isolation and depressed mood. So a big thing over the pandemic that we’ve seen a big increase, is people being angry. They’ve been through so much over this time and are really struggling with these things. And sometimes they don’t have anywhere to place it.

And so sometimes it ends up being on our staff and volunteers for very valid reasons too, they’ve been through how much during this. And I know as an organization, it’s helped us learn a whole lot that we’re seeing this because we never really had this degree before. And so we’ve been able to help our volunteers get some new training in there to be able to really support the callers when they are in these states. People struggling not only there, but financially, and their social supports and those self-care things that they used to do not being effective anymore.

Allison:

We know that people are having more, what they would term negative — some of the surveys are showing negative emotions — but to be there and to be able to hear that and help people metabolize that, help people manage that is a really positive thing. And it’s like we have someone we work with who talks about stopping the emotional bleeding, helping people to make sense of — I think for all of us, I can relate to that — like making sense of this. Who would have thought we’d be in a pandemic for almost 2 years? And it’s a challenge, unlike any we’ve seen.

Alex:

So I just can’t imagine how difficult is to process this yourself. And then, in addition to that, having to help other people process this.

Hannah:

It’s definitely an interesting one. Because I mean, the pandemic, we’ve seen at the beginning, there was so much hope. The first wave, we got through that, and then summer happened and lots of great things. But then the second and third waves is when I think the real difficulty has happened, especially on the emotional level of like, OK, now this is really affecting me and now I have to figure out how to help others. And I think that’s where it really comes in with that taking care of yourself first aspect.

I mean, burnout is so relevant, and it’s way easier to be proactive, rather than reactive with it. And so if we can support our individuals who are on the lines, and by taking care of themselves first, if they need that time, take that time.

There’s no point pushing yourself to be there and do that when you aren’t truly able to be because it’s just going to affect them in the long run. And it’s not truly going to help that person on the other line. I think that’s a big thing that we’ve learned is really taking that time and how important it is to take that time for yourself and take care of yourself first.

Alex:

Of course, self-care is absolutely necessary. Allison, what have you seen from your vantage point?

Allison:

Yeah, so maybe people might be interested in how these systems fit together too. So, Hannah is at one of the very large distress centres, Calgary Distress Centre, which is part of a network of distress centres that make up the Canada Suicide Prevention Service. But the Canada Suicide Prevention Service, obviously, specializes in people who have suicidal thoughts or just related distress. I think what we’ve seen mirrors what Hannah is saying, but because we focus on suicide-related distress, our call volumes have gone up. They’ve gone up about threefold.

And mirroring the same things, again, that Hannah was saying. People expressing a lot of anxiety, worry, distress, related to the pandemic. So certainly, the content of the calls, but we haven’t necessarily seen a huge increase in the severity of the calls. It’s just the volume.

So more people wanting to connect, which I think you brought up the data around presentations to hospital and emergency departments to start with and this really shows it doesn’t tell the whole picture. So perhaps the outlets that people had to manage their distress have maybe shifted a little bit rather than more distress overall, if people aren’t presenting in emergency departments and hospitals. We certainly are seeing people connect with us who have distress.

Alex:

Right. So where people are seeking care is perhaps shifting. Hannah, I want to ask what is it like to pick up a crisis call? How do you deal with issues over the phone?

Hannah:

So, you never know what to expect when you answer that phone, especially, being on a distress line specifically, it can vary from so many different things. And so you’re kind of going into it just really open minded to kind of figure out what’s going on? What’s their story? Why are they calling in? And really when it comes to kind of trying to handle someone’s issues, really exploring those issues.

A big thing we really want to do, and is it simple as that, is just really listening. We’re trying to support them on an individual level, really trying to normalize what they’re going through. We’re all going through such difficult things right now, regardless of what it is in the pandemic. And a lot of the times people just want to know what they’re feeling and what they’re experiencing is valid. And that’s really kind of like the focus of what we have it even just for our volunteers to go into.

Of course, we do risk assessment on all our calls to assess for suicide and stuff like that, but really, at its core, it’s just being there for that person in the moment, respecting what they’re going through and really just understanding crisis is crisis, regardless of what it is. And we just want to be there for them in the moment.

Alex:

That’s great to hear. Allison, you’ve dedicated much of your career to advancing mental health services through access of digital health technologies. You touched on it a little bit earlier in that maybe this has helped expedite some of that. How has the pandemic impacted the work you do? And has this exposed any gaps or opportunities that you might not have thought of previously?

Allison:

Oh, absolutely. I mean, I won’t say that the gaps or the inequities that the pandemic has shown that we weren’t aware of them before, but I think it’s really magnified them and increased that divide for a lot of people. So, for example, now that our major health services, mental health services, a lot of that access was continued or sustained virtually during the pandemic, and if people didn’t have connectivity in their communities, access to internet data, access to technology, access to privacy, all of those things really then impacted their access to health care.

So we know that’s one way that having just larger social inequities become health inequities. We just see it live or occurring in real time during the pandemic, and that’s happened in multiple ways. So that’s virtual, it’s also communities that were more at risk of contracting COVID, people who had to do frontline work that was less safe. We’ve seen so many inequities.

I think virtual and digital health still have a lot of potential, especially now that we’re talking about population level distress. We’re seeing the number of people who are distressed, not necessarily who have a mental health disorder or a psychiatric disorder, but just are distressed, need support, and we can’t see all of those people one-on-one. So I think digital approaches still hold a lot of potential, but we have to be really aware of and start to bridge some of those inequities.

Alex:

Well, you spoke to being able to see people one-on-one, I want to bring it back to Hannah now. At CIHI, specifically, we’re always looking at things from the 10,000-foot level. What are the trends we’re seeing nationally? How are the numbers changing? But Hannah, as the team lead for this Distress Centre in Calgary, you’re seeing things on the ground. What would you want a policy-maker or health care leader to know about what’s happening?

Hannah:

I think really just knowing that people are reaching out for support and were needing support. And while we do have lots of things out there for people, the amount that we’re seeing it at, not everyone’s having access, or not getting the access in a short enough amount of time. And I think that’s a really big thing to know is that people are reaching out and we want them to reach out. But then we also need to be able to have all those things on the other end to be able to get them the help that they need.

Alex:

Absolutely. For both of you, this has been obviously a very challenging year. Allison, how do you keep your team’s morale up during such a difficult time?

Allison:

Oh yes, well, and vice versa, they really give me energy. I mean, we’ve continued to meet virtually and actually tried to have social and team building activities during these times. And just recognizing I think, our whole team, I’m very fortunate, bring a great deal of, not just commitment to the work, but a lot of compassion and collaboration. So, I feel almost like it’s easy for me, because it’s such a wonderful team of people. I feel like people have really come together.

At the same time, I think people have struggled at various times, like we all have with isolation or with feeling frustrated. I also feel like we’re working more than ever. So yeah, I think just we all try to be mindful of each other, but it’s been pretty good. Our team has stayed solid.

Alex:

That’s great to hear that there’s so much support among the team. Hannah, how about for you? How do you keep your morale up? And how do you keep your team’s morale up right now?

Hannah:

I love everything that Allison said there, especially trying to keep that connection there. I think a big thing that we’ve seen and a big thing that I found a lot of success in is really making sure that our frontline people, people that are answering those calls, even honestly, the staff as well, is really putting themselves first.

We can’t truly do this work effectively, if we aren’t taking care of ourselves first. And so I think that’s really helped individuals know when they are doing this work, that they still matter too, and what they have going on in their life still matters, too. And we need to make sure that we have focused there, just as much as we have focus for the people who we answered the lines for.

Allison:

It’s so true. Sorry, Alex, I was just going to say, it’s a sector where volunteerism is so important. It’s the kind of the lifeblood of some of these services and that’s wonderful, because it shows that the community really wants to come together and help each other. So it’s a strength, it really shows community level resilience, but I totally agree with what Hannah is saying.

And one of the things that we’ve been doing on a more educational level is talking about what are the supports that responders on distress lines need? What are the best practices? Recognizing that actually, the mental health of responders can be impacted by the work that they do, because it’s intense work, and even more intense right now. So we’re also looking organizationally at putting in education and resources and support because I agree with what Hannah was saying. Self-care is necessary to be able to care for other people.

Alex:

Well, I can’t help but notice that both of you talked about how you support your teams. What do you both do for your own self-care?

Allison:

Does work count?

Alex:

No, it does not.

Allison:

For me, what I did realize very early on is physical activity. So, I was spending so much time immobile, because of all of the virtual work and that’s made such a difference. Myself and the team, we go on walking meetings. I’ve become more involved in mindfulness and meditation practice and that has helped a lot and I read a lot.

Alex:

We’ll have to get your book recos. Hannah, how about you?

Hannah:

It’s actually kind of a new thing that actually our Executive Director, Geralynn, had brought up to our team. And it’s this whole idea of the stress cycle and really needing to finish the day, because the problem is when we get home from work, and we’re just kind of going through, making dinner, doing these things, we don’t always complete that. And I find for myself, if I don’t complete that, that’s when I’m staying up at night, I’m thinking about things, I’m ruminating.

So I have a few things that I do kind of at the end of the day to really solidify my day. And that includes things like having a cup of tea before bed, doing way too long of a self-care skincare routine to just be able to take some time for myself. Being able to read as well, just to be able to take myself away from the work, and really finish that entire day.

Of course, supports are huge. I am such a person who needs other people around on a regular basis, and that it’s really hard to do in these kinds of things. So a lot of adaptation around my social supports, and family and friends and all that stuff has had to be made during it. And I feel like I’m still trying to figure it out, but definitely is improved over the time of the pandemic.

Alex:

Well, I’m glad you’re both taking time for yourselves. I know I can’t imagine how difficult of a field this must be to be in right now.

Allison:

I’d just like to say Hannah’s like textbook, that’s like perfect. Now I’m going to try to aim for that.

Alex:

I think we can all learn a little something from each other today. As we come to the end of the third wave, people are being vaccinated, hopefully, normalcy is returning to our lives. What is something you’re both hopeful for? How are you hoping this will impact your work?

Hannah:

I really wanted to highlight how important mental health is, social interaction, social supports. Of course, we knew this before, but I think it’s become such on a higher level and we’re talking about it way more now than we ever have. And I want to keep that conversation going.

I want people to still feel comfortable once the pandemic is over to be able to reach out. Life is stressful, regardless of a pandemic and things are going to happen. And it’s always OK to reach out and get the support that you need, and I really want to keep that moving forward, as we’ve seen during this time.

Allison:

Yeah, I have to echo that. I think the conversation that’s been started about public mental health. Of course, in a pandemic, we have public health and vaccinations but mental health and thinking about that on a population level is so important. And I agree, I hope we continue the conversation and we’re speaking to CIHI today.

I’m hoping that we also pay more attention to the data because there is a great article that Paul Kurdyak and Scott Patten just published in the Canadian Journal of Psychiatry, just talking about what do we need to do that planning? Because right now what we’re doing is, “OK, well, we have more calls on the distress centres. Oh, but this article says that there’s no increase in suicide rates. And this article says, self-harm presentations in emerg changed.”

But we’re very far from being able to plan our health system fully around data and up to the moment data, not just population level surveys, but where are people presenting? How are they presenting? And is the care that they’re receiving effective? Can we really address mental health on a global or population level? And I hope that we continue to move the dial on that with good data and responsive health planning. I know that’s a bit dry, but I think it’s super important.

Alex:

Absolutely. I think it’s important to have conversations like these to help put context behind that data as well. So thank you both for your strength, your courage and helping us shed some light on such an important topic. I hope we talk to you soon.

Allison:

Thank you so much for having me.

Hannah:

Thank you.

Alex:

Thanks for listening. We hope you enjoyed this episode. Check in next time when we bring you more valuable health perspectives, and continue to chip away at health care topics that matter to you.

If you want to learn more about CIHI, visit our website, cihi.ca, that’s c-i-h-i dot ca. If you liked what you heard, subscribe where you find your podcasts and leave us a review and give us a follow on social media.

This episode was produced by Jonathan Kuehlein, with research from Amie Chant, Marissa Duncan, Shraddha Sankhe and Ramon Syyap. I’m Alex Maheux. Thanks for tuning in to the Canadian Health Information Podcast. Talk to you next time.

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