100 Million Texts from People in Crisis: What Have We Learned?

By Lindsey Weedston 05/08/19

On Election Night 2016, Crisis Text Line received four times their average volume. The biggest surge came from people concerned about issues including LGBTQ+, sexual assault, and immigration.

Cartoon from Crisis Text Line: volunteer helping a person who is not okay, and "text hello to 741741"
The Crisis Text Line is a free 24-hour texting service powered by volunteers who are trained to help texters process and get through any personal psychological crisis.

Crisis Text Line, which is like the Suicide Hotline but with texting, recently processed its 100 millionth text. All the data they’ve recorded from the texting sessions since launching in 2013 has now been compiled into what they’re calling the biggest mental health data set ever collected. There are different ways of accessing the data including a visualization tool that allows users to see which issues are the biggest in which state (plus Puerto Rico), which issues co-occur with others, and when they occur (day of week and time of day). Plus, they made word clouds for each key issue such as anxiety, eating disorders, and self-harm, and paired them with example texts.

I'm so nervous it's making me nauseous

The Crisis Text Line is a free 24-hour texting service powered by volunteers who are trained to help texters process and get through any personal psychological crisis. It’s about much more than suicide; people are encouraged to text when they feel at a loss about their relationships, school problems, substance use, LGBTQ+ issues, or “health concerns.” To access the service, you just send a text to 741741 from anywhere in the U.S.A.

It’s no secret that younger generations prefer texting to talking on the phone. Sending a text, as opposed to making a call and actually speaking to someone, can take a lot of pressure off of someone who is already upset, so it’s not surprising that Crisis Text Line has grown so rapidly, especially among young people who make up the majority of the texters (75 percent are under age 25). In addition to providing a much-needed service, the company is dedicated to collecting and reporting data from the texts in order to help communities across the country better understand mental health and hopefully aid in the prevention of future crises and suicides.

The Data

There’s a lot of data to pore through with the Crisis Trends tool alone, but there are some key trends that stand out. The most common issue people contact the Crisis Text Line about is depression/sadness, followed by relationships. The number one state for depression is Montana. Looking at the timeline, you can see that depression/sadness calls weren’t always the most common, but there was a big jump in December 2017. It was certainly a volatile month, but it’s unclear why this trend has continued — depression calls peaked at over 35 percent in February 2019.

I've got recurring feelings of worthlessness, despair, and overwhelming sense of I can't stop was [sic] going on in my head... Why can't I be happy?!

For most issues, texters are more likely to contact the line at night. Which day of the week people reach out depends on the issue. Not surprisingly, depression calls dip on Friday and Saturday, increase on Sunday, and peak on Monday.

Substance use-related texts most often come from North Dakota. States like New York and California, where you might expect more drug use due to having large metropolitan areas, are low on the list. However, this type of text is also one of the least common to Crisis Text Line, hovering between 1.5 and 2 percent.

Ashley Womble, Head of Communications at Crisis Text Line, was able to offer more insight into drug use-related texts:

  • People are more likely to text about substance use between 4-10 a.m. than texters with other issues.
  • Mondays are the most common days for conversations about substance misuse.
  • We see an increase in texters about substance misuse during the summer, from June to September.
  • For all ages, the most common additional issues mentioned in conversations about substance abuse are, in order: Depression/sadness, relationships, suicide, anxiety/stress, and isolation/loneliness.
  • For texters 24 and under, the most common issues mentioned in conversations about substance abuse are, in order: Depression/sadness, suicide, relationships, anxiety/stress, and school.
  • Within the last seven days, Xanax and Ativan are on our trending topics list, meaning that many more people are using that word in texts than on average.

The word clouds provide some interesting insights as well. One of the most commonly used words across the board is “people,” which makes sense since the most common topic that comes up in addition to any of the main conversation topics is “relationships.” Some words you would expect to come up in substance use-related conversations are in there, such as “drugs” and “need” and “take” and “hard.” The word “cut” is also present, suggesting possible overlap between substance abuse and self-harm, though "cut" could also refer to cutting the dose of a drug or mixing in other ingredients.

I feel like going to buy them...just need anyone to talk to.

“Mom” is also a very common word across the word clouds, but not “dad.”

Crisis Text Line also published their own list of “100 Things We Learned From Our First 100M Messages,” which is full of fascinating tidbits. The season with the most texts about suicidal ideation? Surprisingly, spring. Others are a bit more expected, such as the fact that texters over 65 are the most likely group to contact the line about bereavement.

What Have We Learned?

Looking at the data brings up more questions than answers. Why is bullying such a big problem in the Dakotas? Why is Hawaii at the top of the list for every type of abuse? Why is there so much self-harm in the northern states and not in the southern?

It’s important to keep in mind that the data only keeps track of how many people are contacting Crisis Text Line about each issue, not necessarily how many people are actually experiencing it. Therefore, each bit of data warrants the question: “Is this a big problem in this state, or are people just more willing to reach out for help about the problem here?” Looking at additional statistics from other sources, we can make some educated guesses.

For example, Crisis Trends shows that they get the most texts about suicide from Montana. In 2016, suicide rates were highest in the country in Montana. We can therefore conclude that an aggressive campaign addressing suicide in this state is a good idea.

I don't want to live anymore…

It’s also understandable that anxiety and stress texts went up across the nation shortly before November 2016 and have stayed up. Looking at data from Election Day, it’s pretty clear what happened there.

“During the November 2016 election night, we were swamped with 4X our average volume,” says Crisis Text Line. “The biggest surge we saw came from issues including LGBTQ+, sexual assault, and immigration.”

Turning Information Into Action

Through its Open Data Collaboration program, Crisis Text Line provided data to researchers at MIT, Purdue University, Yale, Columbia University, and elsewhere. Analyses have been published in the Journal of Medical Internet Research, PubMed, and the MIT Media Lab.

After analysis comes action. The great thing about the map function of Crisis Trends is that it shows exactly where specific targeted mental health campaigns should be directed. We need anxiety/stress relief in the Northeast. We need addiction treatment programs all down the Rocky Mountain area, plus Vermont and New Hampshire. Send bullying intervention advocates to the Dakotas and West Virginia. Figure out what’s up with the abuse problem in Hawaii. People are lonely in Florida and Puerto Rico, send them friends.

Also, while texters access the service from every part of the country, statistics show that a significant number are poor and from rural areas. Nineteen percent of texters are from the ten percent lowest-income zip codes; Fourteen percent are Latinx. And though only 1.6 percent of the U.S. population is Native American, they make up six percent of texters to the crisis line. Mental health resources are usually concentrated in big cities and services are more available to people with money or good insurance. More than anything, we need more and easier access to mental health services in rural and low-income areas and marginalized communities.

Hopefully, the big number of 100 million texts in six years combined with the visualization of the data will help inspire both individuals and governments to take action. Mental health in the U.S. has been declining, with rates of suicide, addiction, and PTSD reaching new highs. Part of the blame lies in our society continuing to treat mental health conditions as less important than physical health. Having a comfortable way to talk to a trained person is a good start, but it’s up to our leaders to fund the additional resources that we need, and it’s up to the rest of us to motivate them to do so.

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Lindsey Weedston is a Seattle area writer focused on mental health and addiction, politics, human rights, and various social issues. Her work has appeared in The Establishment, Ravishly, ThinkProgress, Little Things, Yes! Magazine, and others. You can find her daily writings at NotSorryFeminism.com. Twitter: https://twitter.com/LindseyWeedston