The Effectiveness of Volunteering for Crisis Support Hotlines
For some people, volunteering with a crisis support hotline may be a particularly effective way to make a positive difference.
After a few weeks of training, volunteers provide one-off crisis support over the phone to people in distress. Volunteers may be required to make a modest financial contribution towards the cost of the training.
Some crisis support services do not have enough volunteers to answer all calls, meaning that new volunteers would not just be answering calls which would have been answered anyway, but will be helping the organization to answer more calls.
Typically, crisis support services will require a minimum time commitment from their volunteers, for example a few hours per fortnight or 100 hours per year, which can be proportionately reduced during any period in which the volunteer cannot do shifts because of their personal circumstances.
During those 100 hours, a volunteer may answer calls from 100 – 200 people, allowing time for breaks between calls where needed. The problems which prompt callers to seek help from the hotline will depend on the exact type of service the hotline provides. If it is a general-purpose crisis support hotline, the demographic of callers will be experiencing a wide range of problems and issues.
Assisting distressed callers is worthwhile even if their difficulties are not life-threatening. A small percentage of callers may be suicidal and a smaller still percentage imminently suicidal.
A volunteer might answer calls from, say, three imminently suicidal callers in a year. Being imminently suicidal does not necessarily signify a certainty of attempting suicide in the absence of effective intervention, but rather that there is an imminent risk of an attempt, such as a risk of an attempt within the next few hours.
Out of those three callers, it may be that one is at high risk of completing suicide within a few hours without effective intervention.
If the volunteer continues their efforts for ten years, they may therefore save, perhaps, 10 lives. Probably, they will never know with certainty whether their efforts are successful in an individual case, although it is likely that some callers will express profound gratitude to them.
If the volunteer is highly skilled in demonstrating empathy, instilling hope or helping callers identify reasons to live or sources of support, it might be that suicidal callers they speak to, or at least some of them, may never again be at imminent risk of suicide, or live for many more years before being at imminent risk again.
Losing a family member or friend is a risk factor for suicide, so if a volunteer prevents 10 suicides, they may also prevent other suicides, as well as preventing all the other adverse ripple effects which result from suicide.
A volunteer who maintains their efforts for 10 years will also reduce the distress, at least temporarily, of over 1,000 other people. They may have a significant ongoing positive impact in dozens or possibly hundreds of lives, either because of a direct practical impact – perhaps a timely referral to an effective source of support – or because the caller remembers that their call was answered by a volunteer who cared.
In addition, by volunteering with the hotline a person could gain skills and knowledge which will be useful to them in their paid work, or which will help them to obtain more highly paid work to enable them to give more to charities, or work which has a greater positive impact.
Volunteers may also learn things which will enable them to help their friends, family, or work colleagues to deal with distress, or to help themselves.
100 hours of volunteer work per year is a significant commitment, particularly when it consists of answering calls from distressed people. On top of that, volunteers may need to do a few hours of training each year to maintain their skills or accreditation. Volunteers should practice self-care to reduce to the risk of burnout.
Some employers provide their workers with a small amount of paid leave to engage in volunteering, so it is possible that some of their “volunteer” shifts will be, in effect, paid.
Some crisis support organizations provide occasional social activities for volunteers to help reduce the rate of attrition of volunteers, either due to the demanding nature of the work or to competing priorities in the own lives of volunteers.
A crisis support volunteer who answers calls for more than a year or two is therefore of great value to a crisis support organization.
Some volunteers may go on to train, supervise or support other volunteers and therefore have other positive impacts. If engaging in these other activities means less hours of answering calls their overall positive impact may or may not increase, depending on their supervisory skill compared with their skill at directly assisting distressed callers.
Nice post. It reminds me that I want to consider this option. By the way, someone once tried to very roughly estimate the cost-effectiveness of volunteering at a suicide hotline here.
I’m the author of that post. Here is an edit I just added:
I don’t have better numbers than what I came up with here, but the overall rationale seems very similar to that of vegan leafletting, and I just don’t believe their numbers. I think people are in general likely to overestimate the effect of conversations they just had.
None of this means volunteering can’t be effective, or is worse than a given volunteer’s best alternative, but I don’t think “I felt helpful” is strong data.
Thank you, and for including the link to the other post.
Thanks for writing this up! I think mental health is a really important cause area, and I am always eager to think about ways to reduce the burden of suffering it causes. I also think more EAs should try to find volunteering opportunities that can help them reconnect with their values and have an immediate impact on their community, and this seems like a great opportunity for that.
That being said, if your estimates are correct (100 hours of volunteer work leading to one life saved), and if crisis lines could be staffed at normal call center wages (~$15/hr in the US, implying $1,500/life saved), that would suggest this is more cost-effective than the most effective interventions that Givewell has identified, and many orders of magnitude more effective than most governments’ current healthcare spending. Because of this, I think we should probably have very low confidence in crisis hotlines being this effective at saving lives, at least until more research is done that suggests otherwise.
Still plenty of good reasons to consider this opportunity, though. Especially the point you mention about reducing the immediate distress of callers. In my mind, that is probably the most important benefit that these services provide!
I don’t think a median call center worker would do well at a suicide hotline (source: I’m a former volunteer). I leave most call center interactions feeling vaguely bad, and handling returns is emotionally easier than helping suicidal people.
Separately, you need a lot of people, because It’s hard enough to find people who are good at it for 4 hours/week and almost no one can do it full time.
A quick google suggests the average hourly wage of a social worker in the US is $29/hr — would they be better prepared/trained to do well at this work?
I think this point holds as long as we grant that the estimated cost to staff a hotline is anywhere within this order of magnitude, suggesting that this is one of the most cost-effective mental healthcare + life-saving interventions we’ve ever identified, particularly in wealthy countries.
Of course, the specifics of implementation would be way more challenging than just writing a check. It would only be if the cost of staffing a hotline with competent employees came out to be 10x or 100x more than the $15-30 range that I think this argument wouldn’t apply.
Thanks for your comment (and the link)! I agree that more research is needed. My estimates are just estimates. They’re based on my experience taking calls and supervising other crisis supporters for nine years at one organization taking calls from people with any sort of crisis, and about 18 months of volunteering at a second organization which was not directly focused on mental health but still received calls from very distressed people. Helping non-suicidal domestic violence victims increase their safety is another area where there is potential for life-saving interventions by crisis supporters. But again, more research is needed.
I agree with your analysis, but would use the total cost of hiring an employee for one hour’s productive work including taxes, overhead, training time, benefits if any, etc. I think you may have used a nominal hourly wage.
Thanks for your comment.