TXT4Life brings crisis counseling into the digital age

It can make a guy feel like a Stan Roper fogey to be surprised that there really is a digital service for everything. Yes, it’s a magical world when you can use Uber to get a cab in 5 minutes to meet a person you Tinder-swiped 10 minutes ago. But crisis texting? Doesn’t counseling at that level require a personal touch, something face to face, or at least voice to voice?
No. In fact the very impersonal nature of crisis texting is one of its greatest strengths. And it has advocates using smiley-face emojis to describe its potential.
Last month the Minnesota Legislature authorized $46 million in funding for mental health services, and tucked inside the allocation was $1 million for TXT4Life, which is operated by Canvas Health, a non-profit human services provider in Richfield. Canvas staffs the TXT4Life center with trained counselors and equips it with software that allows for up to 500 text conversations at a time. The service is up from noon to 3 a.m., seven days a week, 365 days a year. Last year it responded to more than 5,500 individuals who texted “LIFE” to the number 61222. That number is expected to double this year.

Mark Kuppe is a licensed psychologist who serves as Canvas Health’s CEO. He has the calm, soothing voice of a therapist and the distinguished appearance of David Ogden Stiers. He’s not an animated fellow. But he gets animated talking about crisis texting, especially in terms of its impact on young people.
“They’re reaching out to us in big numbers, which makes sense, as texting is how they communicate,” he says. “Before TXT4Life we had a hotline, and we would get only 15 to 18 calls a month from young people, for the whole state. That just didn’t seem representative of the population. We wanted to try something new.”

Operating in 7 counties

It rolled out TXT4Life in 2012 in seven counties in northeast Minnesota, chosen in response to a string of suicides in the region. The traffic was hot pretty much from the jump. “By the end of the first year we were averaging 400 text messages a month, just for those seven counties,” Kuppe says.
There are a few dynamics at play that suggest why texting provides a comfort level to people in distress. One is the anonymity. People feel less self-conscious texting for help than asking for help. It also helps texters get right to the point. “With phone counseling you’d often need to spend five to 10 minutes building rapport,” Kuppe says,  “but texters will tell us they’re suicidal and need help in the first couple exchanges in texting.”
In 2013 Canvas Health received $1.25 million in state funding to expand the service to 30 counties. And now with another $1 million it plans to be in 49 counties by the end of the year. It also wants to expand its hours of operation to 24-7 and have a presence on Indian reservations.
Private funding is following as well. In April of this year, HealthPartners announced it had given $200,000 to Canvas to promote the service throughout the state.
"HealthPartners supports TXT4Life because most mental illnesses often start early in life, and early intervention and treatment increases the chances for full recovery,” says Karen Lloyd, HealthPartners' senior director for behavioral health strategies. “It’s an excellent example of evidence-based intervention.”

Billboards in Northern Minnesota

Canvas Health is already putting the HealthPartners contribution to use by putting billboards on major highways in Northern Minnesota and planning to do more around the state, according to Kuppe.

Courtesy of Mark Kuppe

Mark Kuppe

This is all part of a national trend. Crisis Text Line in New York has raised millions to promote its service nationwide, thanks in part to a powerful New Yorker article that ran in February. And the veteran community has rolled out the Veteran Crisis Line to provide soldier-specific text support.
Yet text counseling isn’t a curative for the whole question of suicide, of course. And not all demographics are equally being lifted by it. It’s still mostly used by young people. And the service is in too early a stage to make long-term assessments on efficacy.
“The only way we’ll know definitely how we’re doing is when we’re able to gather data from the state Department of Health from every county and compare to the baseline for the previous two years and see if we’re either maintaining or reducing those numbers,” Kuppe says.

Optimistic about reversing a bad trend

One thing is for certain: Suicide prevention has an urgency in Minnesota. From 2003 to 2011 Minnesota’s suicide rate jumped 29 percent, more than double the national rate of increase. In 2013, 683 Minnesotans died by suicide, which was up from 496 in 2003. For people in the 15-to-34 age range, suicide is the second leading cause of death.
Still, Kuppe believes texting gives the community reason to be optimistic about reversing that trend.