development, implementation, and evaluation of a psychiatric crisis hotline during the pandemic: a pilot study in a middle-income country

Background: crisis hotlines have become a popular means of providing mental health support during crises, particularly during the covid-19 pandemic. objectives: our aim was to establish and evaluate the implementation of a freely accessible psychiatric crisis hotline in iran. methods: during each call, crisis counselors conducted crisis assessments, applied behavioral techniques, provided referrals, and evaluated service satisfaction. likert scale questions were used during both the initial and follow-up calls to measure the callers' distress level. suicide risk and the degree of aggression were assessed using a modified list of questions taken from the iranian mental health survey (iranmhs). we performed the wilcoxon single-rank test and linear regression analyses to evaluate and compare changes. results: a total of 3633 calls were responded to over six months. we assessed 737 calls at baseline, of which around 30% (n = 221) were re-interviewed in the follow-up call. females constituted 71% of baseline calls (n = 523), and 53.6% of the callers (n = 395) were under 25 years old, while 63% (n = 465) were single. approximately 41.5% (95% ci [0.542, 0.615]) of the callers (n = 306) reported suicidal ideations at the baseline call, and suicidal risk was assessed as moderate-to-high in 227 callers (37.5%, 95% ci [34.1, 41.1]) at baseline. experienced distress significantly decreased both during the baseline call (z = 23.47, p < 0.001) and at the follow-up compared with baseline (z = 9.30, p < 0.001). in the follow-up, 186 callers (84.2%, 95% ci [78.6, 88.7]) reported high satisfaction with the service. approximately 48% (95% ci [0.410, 0.551]) (n = 98) of the subjects who were referred to other mental health services (n = 204) followed through with the suggested referrals. conclusions: the crisis hotline was successfully implemented and well-received by callers in a developing country setting. a randomized trial is required to establish its effectiveness.