I didn't even care to see what helpline it was, I just found the number and kept on dialing,
kept on calling them. But they were not picking up, so I went back to read what was written in
the description. It said it was Monday to Saturday, and I remember it was Sunday,
9 pm-ish. So I was like what the fuck, are you kidding me? Can I not be suicidal on a Sunday?
And I didn't know about this before --- I thought all the helplines are 24/7.
Hi, my name is Sachin. Today I'll be presenting our work from CHI 2021 --- Can I Not Be Suicidal
on a Sunday?: Understanding Technology-Mediated Pathways to Mental Health Support.
For context, I'll begin with a brief overview of our work from CHI 2020.
In this work, we interviewed Indian mental health helpline volunteers to better understand how they
use their lived experiences and leverage their cultural backgrounds and their local
context to better serve the diverse needs of callers. We found that callers form really
deep and therapeutic bonds with volunteers, to the point where callers even do update
calls with volunteers to let them know when they're feeling better. However there's a
common understanding in India (as shown in our introduction) that helplines "just don't work."
To better understand how helplines don't work, and who they don't work for, in this work we
ask the question: how does the design of the indian mental health helpline system
interact with societal factors to marginalize caller's individual identity-based needs?
In this work, we leverage the Pathway to Care model to better understand how helplines play into
participants' broader engagements with care. We also leverage Sen's delineation of institutional
justice and justice as experienced to envision what a more just helpline might look like.
In Sen's view, lived experience should be used to evaluate whether justice is done,
and not solely be based on abstract laws or institutions.
Finally, we leverage a design justice framework to better understand how technical factors interact
with structural factors to marginalize people's individual, identity-based needs.
To do so, we did interviews with 18 different participants
whom we characterized as helpline stakeholders, which included both people who called helplines,
and people who consciously decided not to call (out of a belief that helplines don't work).
Moving on to the first part of our findings, we found that helplines were a place for people to
go in crisis, particularly given a lack of support in everyday life, as the quote from Mitali shows.
Participants often found helplines via friends or via Google, including recommendations after
they searched like a means of suicide. Trust was also really important and many
intentionally searched for helplines and used helplines that they felt looked trustworthy,
such as those that explicitly said that they were queer affirmative. However, as the quote from Juhi
shows, people didn't really know what to expect before calling, and were concerned about active
(non-consensual) rescue, in which the helplines would call people (in theory) without the consent
of the caller. However, from our past work, we know that Indian helplines do not call anyone
without the consent of the caller. However, this was not effectively communicated to callers.
Moving on to the second section of our findings, looking to when people actually called the number,
we found that the number recommended by Google (at time of fieldwork) as
well as the numbers that they would find online often did not work. People would
engage in a trial and error process, sometimes leveraging multiple phones,
trying as many numbers as possible, until one of them actually worked. articipants
who had poor experiences and had little ability because of this to leave any kind of feedback,
and were concerned about their confidentiality being violated if they gave bad feedback.
There were different ideas of what a successful interaction could look like but one participant
summed it up the best when they said that a great interaction was when they felt safe.
Identity was also very important with regards to how people used the helpline.
As the quotes from Juhi and Donna show, class and caste both had an influence on how people
understood and used, or explicitly decided not to use the helplines.
Participants related helplines as another form of mental health care that didn't work for them,
and drew parallels between their experiences in therapy
and their experiences with helpline volunteers and what they expected out of helpline volunteers.
I'll move on now to our recommendations. We make several different recommendations in
our paper --- some important ones are signaling the wait time that corresponds to being actually
connected, call routing that routes scholars to whichever helpline is most free, enabling
volunteers to connect callers to different and diverse sources of care, and having mechanisms for
feedback. Other structural recommendations include more information about the calling experience,
including what happens after a call, and boundaries, such as making sure that callers
know that the police won't be called and external parties will not be called without their consent.
Additionally we recommend that helpline administrators integrate
volunteer backgrounds and their diversity into how helplines are administered,
especially those who come from underserved and underrepresented backgrounds.
Thank you so much for watching this presentation, and I look forward to your questions!