A mental-health hotline saw a 116% increase in texts during coronavirus lockdowns and expects COVID-19 to take a psychological toll for years to come

• The coronavirus pandemic and ensuing stay-at-home measures have without question impacted people's mental health.
• Business Insider recently spoke to Ashley Womble, head of communications at Crisis Text Line, a free mental health hotline that works in the US, Canada, UK, and Ireland.
• Womble said the number of suicide interventions actually went down in the past three months, when most countries were under some form of lockdown.
• More middle-aged people have been using the service, and the predominant complaint among users has been anxiety.
• While text volume is returning to pre-coronavirus levels, Womble said she believes the outbreak will have a long-term impact on mental health.

The high-profile suicides of two New York City medical workers has raised questions about how much the coronavirus outbreak is impacting people's mental health.

In early May, President Donald Trump suggested there would be a spike in suicides if lockdowns continued, but the truth appears to be more complicated.

Earlier this week Business Insider spoke to Ashley Womble, head of communications at Crisis Text Line, a free mental health hotline that operates solely by text, to understand the outbreak's impact on its service.

The group operates in the US, Canada, UK, and Ireland, and exchanges a million messages a month with texters, according to its website.

Womble said traffic shot up 116% in late March and early April when those countries started imposing lockdown measures, and that the type of texter and their issues changed — but suicide interventions actually decreased.

While Crisis Text Line's crisis counselors are able to deescalate 99% situations, Womble says they hear from a few people a day that express clear plans to kill themselves, leading counselors to get law enforcement involved.

But these kinds of calls have gone down during the pandemic.

Back in February, there was an average of 28 calls a day that required intervention. As of May, that number had decreased to 23.8.

Womble declined to speculate on the reasoning behind the drop, saying "it would be dangerous to make assumptions."

Suicides in Japan also dropped 20% year-on-year in April 2020, during the country's coronavirus state of emergency, according to Reuters. But an expert told the agency it was just "the quiet before the storm."

A growing crisis among the middle-aged

One of the most surprising changes Crisis Text Line experienced during the early stages of the pandemic, Womble said, were the age groups seeking help.

Normally, 75% of the people who text the line are young people below the age of 25. But when coronavirus lockdowns started in March, Womble said they started seeing a large uptick in texts from people between 35 and 44.

As a member of this age group, Womble said she can see why this may be, since many her age are balancing both working from home and home-schooling their children.

Some in this age category may also be on the front lines of the outbreak.

"We've also seen a lot of text message conversations from people who are essential workers. The word 'essential' has been one of our trending topics," Womble said.

"We did a deep dive into this and found that 48% of our texters either are themselves or have an immediate family member on the front lines."

'Three waves' of anxiety

Their concerns were different as well.

Depression is usually the biggest issue that people text Crisis Text Line looking for help with, followed by relationship issues and anxiety. But after the outbreak, anxiety became the chief concern.

Womble says they noticed "three waves" when it came to the things triggering anxiety, which they determined from an analysis of keywords used during text conversations.

In the early days, it was clear people were worried about getting sick themselves, with the words "cough" and "asthma" coming up a lot, Womble said.

People were also worried about their grandparents getting the disease, since older people have a harder time overcoming the coronavirus.

But after weeks of lockdown, the complaints shifted to issues about quarantine, such as living with an abusive partner or substance abuse.

The graphs below show the number of conversations per week about substance abuse, sexual abuse, and domestic violence. All have edged upward between March and May 2020.

Now they're experiencing a third wave of issues having to do with grief and job loss.

Preparing for a long-term impact on mental health

Womble says that text traffic now has recently returned to pre-coronavirus levels, but she doesn't think that's because mental health is improving.

"Our volume is not higher right now, but I don't think that speaks to resilience. I think that speaks to people maybe not reaching out," Womble said.

"Clearly people are in pain and I think more people need to know that this resource is available."

In fact, Womble says Crisis Text Line is "preparing for the mental health impact to last for years."

To meet the coming need, they recently expanded their service to nearly 10,000 crisis counselors, all of whom work remotely.

They've also bumped up plans to expand to four other languages — Arabic, Spanish, French, and Portuguese — that will allow them to operate in more countries. The original plan was to expand to these languages by 2025, but now they're aiming for 2022.