Vol. 76, No. 1External submissions

Real-time response to suicidal tweets

Toronto police Cst. Scott Mills and Toronto street nurse Anne Marie Batten work together using Twitter in an innovative suicide intervention strategy. Credit: Kevin Masterman, TPS


"Sitting on the tracks, waiting for the next train, ready to end it all. Goodbye World."

If someone tweeted this to you or this came in on your Facebook feed in your personal life or on a professional social media twitter account, would you know what to do? A grassroots effort called Real Time Crisis Intervention is underway to provide social service and police solutions 24/7.

In the case of the suicidal tweet above, the vision is that the partners of Real Time Crisis would have the capability to obtain assistance from police and communicate with the transit safety officers to get any trains stopped that may be travelling into the affected area.

All of this communication occurs via social media in real-time. A crisis nurse or social worker will be dealing confidentially with the person in crisis while preventing a railway fatality.

Real Time Crisis Intervention is a not-for-profit corporation in the process of start up with the goal of saving and improving lives. Social media is a key tool used in the solution.

Founded and led by Toronto street nurse Anne Marie Batten, it's run in collaboration with Internet safety specialist Jesse Miller of Mediated Reality in Vancouver, B.C., USA health care, well-known international community builder Scott Abrams of Crime Stoppers USA and law enforcement social media strategist Lauri Stevens of Laws Communications.

The Toronto Police Service (TPS) works collaboratively with Batten. This team uses social media tools in a similar way to street level nurse/police collaborations often called Mobile Crisis Intervention Teams (MCIT).

Real Time Crisis Intervention has the expertise to assist persons in acute distress. While maintaining a focus on prevention, the nurse and police officer are currently intervening in real time through social media involving persons posting suicidal intent and during other real-time crisis situations.

An engaging approach

There's a unique difference between this program and similar support programs that are currently operating in social media. Real Time Crisis involves the use of trained professionals including those from the nursing profession and social services who work with police officers to engage directly with the person in crisis.

Sandra Dawson operates a Twitter account with close to 15,000 followers called @Unsuicide. She shares links to resources, coping tips, peer knowledge and e-health services.

"There are more than 500 Twitter users that I've collected in a list, and others who work on other sites such as Tumblr, Reddit and YouTube, who also have the initiative to reach out to peers in need and offer a compassionate tweet full of hope," says Dawson.

However, those users are limited in bridging the gap between virtual support and offline help in a crisis, such as when someone posts a suicide attempt. Social media networks don't allow users access to another user's IP (Internet Protocol) and offline location information, if they even collect that information. Without personally knowing the other user and their street address, they can't phone police or an ambulance.

Real Time Crisis has proved useful in incidents where a follower has had an emergency and a crisis nurse has stepped in for counselling, and prevented escalation. With law enforcement ties to Twitter's support team, police will be able to locate users with IP data in life-and-death emergencies where imminent medical intervention is required.

Growing demand

Anne Marie Batten and Cst. Mills were introduced on Twitter by Los Angeles-based homeless advocate Mark Horvath. The Real Time Crisis concept started in November 2012 when they concluded that the volume of mental health-related issues in social media were increasing, and that a collaborative, real-time 24/7 response was needed.

The first joint effort was in assisting a homeless man who was struggling with mental illness and falling through the gaps in the traditional health care system.

Having a police officer and nurse working together providing outreach with real-time communication made a difference. The man known as #HomelessJoe on Twitter is now housed, on medication, has income and is managing well with community support.

Following this positive outcome, the team discussed how to help people in distress who were reaching out for assistance through Twitter and Facebook.

TPS was seeing a high volume of requests for assistance from persons at risk of suicide and the information was being communicated through social media. Batten believed that having a mental health professional available to assist with these calls could result in a clinically based mental health and risk assessment being conducted and possibly diverting police intervention.

Jointly, they committed to creating a virtual structure by developing a program based on community collaboration. A focus group was formed that included leaders in policing, nursing, education, law, community mental health, probation, emergency management, youth engagement and transit safety officers.

A number of community members with lived experience, including advocate Andrew Stewart, added the essential perspective from those for whom this service is designed. It became apparent that listening more and talking less was the key.

Through direct real-time engagement and assessment, they've been successful in meeting the needs of people at risk and building trusted relationships.

Early diversion

In the majority of cases, the people who were reaching out for assistance didn't require emergency care. Their needs were safely managed with support and community follow-up.

As the team continued to intervene online, they noticed that people who had been previously assisted by them were now reaching out directly in times of distress. This prevented cries for help that would otherwise have gone to TPS's corporate social media accounts, thus avoiding public displays of very private issues.

Developing these online relationships is a proactive way to manage mental health crises. By reaching out in real time and conducting a comprehensive mental health and risk assessment, the needs of those who are in distress are being met.

Reducing 911 calls for people experiencing mental health crises and decreasing visits to the hospital emergency room is what every police service and hospital in the world strives for. This has been achieved by Real Time Crisis Intervention.

Statistics collected show that there were more than 100 interventions during a four-month period. Of those interventions, 12 were deemed to be of high risk. Police and emergency response were activated on only three of these occasions.

The vision for Real Time Crisis includes 24/7 operations with the ability to respond immediately when someone is in need of assistance. If the concern is tweeted to police, for example, Real Time Crisis can be consulted.

How it works

While the initial contact for help may be communicated directly to Real Time Crisis, it's usually brought to the attention of police or social services by third parties who've identified a risk, and request assistance. A consultation then takes place and the crisis nurse or social worker engages directly with the person in distress. This may include a tweet as simple as "Can I help?"

The person is then switched to private messaging for confidentiality. During this discussion, the nurse will conduct a mental health and risk assessment and may take a health history including diagnosis, medications being taken and community supports.

A response will be arranged that's appropriate for the level of risk involved. Ongoing communication is maintained with police during situations of high acuity to ensure a safe intervention. During events of lesser risk, Real Time Crisis manages the assessment, response, safety planning and follow-up support.

If someone is transferred for emergency care, the professional from Real Time Crisis is able to communicate directly with the receiving personnel so that essential information is reported. Safety for the person at risk and for all service providers involved is a priority.

Although not fully operational, Real Time Crisis has a presence on social media with established sites on Twitter, Facebook, Instagram, Tumblr, Google+ and YouTube.

"I have been a crisis nurse for seventeen years and have watched as persons in distress fell through the gaps within our system," says Batten. "By incorporating direct engagement using social media tools into my practice, I've experienced an innovative way to provide seamless care."

Real Time Crisis Intervention doesn't aim to re-invent the wheel, just to add spokes in a wheel of crisis response that often has people falling through the cracks who are calling for help. Wouldn't it be great if the police weren't dispatched to assist someone in crisis because the crisis was averted due to professional help available 24/7 in social media? Better to invest in this type of prevention than testify at an inquest for a police shooting.