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Reducing treatment delay for early intervention: evaluation of a community based crisis helpline

Amresh K Shrivastava110*, Megan E Johnston2, Larry Stitt3, Meghana Thakar4, Gopa Sakel5, Sunita Iyer6, Nilesh Shah7 and Yves Bureau89

Author Affiliations

1 Department of Psychiatry, Silver Mind Hospital and Mental Health Foundation of India, (PRERANA Charitable Trust) Mumbai, University of Western Ontario, London, Canada

2 Department of Psychology, University of Toronto, Toronto, ON, Canada

3 Department of Epidemiology & Biostatistics, Biostatistical Support Unit, The University of Western Ontario, London, Ontario, Canada

4 Silver mind Hospital, Mumbai, Child and Adolescent Mental Health Practitioner, Lambeth CAMHS Early Intervention Team, South London and Maudsley NHS Trust, London, UK

5 PRERANA, suicide prevention services, Mental Health Foundation of India, (PRERANA Charitable Trust), Mumbai, India

6 PRERANA, suicide prevention services, Mental Health Foundation of India, (PRERANA Charitable Trust), Mumbai, India

7 LTMG hospital, University of Mumbai, Mumbai, India

8 University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3 K7, Canada

9 Research Scientist Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4 V2, Canada

10 Regional Mental Health Care, 467, Sunset Drive, St.Thomas, Ontario, N5H 3 V9, Canada

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Annals of General Psychiatry 2012, 11:20  doi:10.1186/1744-859X-11-20

Published: 24 July 2012



A limited number of studies have assessed the pathways to care of patients experiencing psychosis for the first time. Helpline/clinic programs may offer patients who are still functional but have potential for crisis an alternative that is free from judgment.


In this study we report on patient calling a round-the-clock crisis helpline for suicide prevention supported by psychiatric facilities in Mumbai, India. Chi-square and test of mean differences were used to compare outcomes between first-episode patients and those with a previous history.


Within five years, the helpline received 15,169 calls. Of those callers, 2341 (15.4%) experienced suicidal ideation. Two hundred and thirty four patients opting for counseling lasting 12 months agreed to a psychiatric assessment. Of those, 32 were fist time psychosis sufferers, whereas, 54 had previously been psychotic. Of all psychiatric assessments, the clinic received 94 patients with ‘first-episode psychosis’. We found that the duration of illness was significantly shorter (17 vs. 28 months) and suicide attempts were fewer (16 vs. 21) in first-time psychosis sufferers compared to those with a treatment history.


We conclude that some first-episode patients of schizophrenia and other disorders do access services by using helplines. We also argue that helplines may be somewhat immune to stigma, allowing patients a safe alternative when finding help.

Helpline; Stigma; Psychosis; Early intervention; Duration of treatment