Introduction: Previous studies have found that helplines are effective in reducing suicidality, but effects are small, non-response is common and the evidence for chat-based helplines is scarce, although such services are already being offered to people with suicidal thoughts and behaviors worldwide.
Aims: To examine whether the outcomes of a chat-based suicide prevention helpline can be improved by training counselors in Motivational Interviewing (MI).
Methods: Visitors of a chat-based suicide prevention helpline received either TAU or MI and completed a pre- and post-chat questionnaire on suicidal ideation and several other risk factors for suicide. Linear mixed modeling was used to estimate the effect of condition. Treatment proficiency was assessed using the MI-Scope by two independent raters.
Results: A total of 756 visitors and 55 counselors participated in the study. The visitors improved on all suicide risk factors during the chat, but there were no significant differences between the MI and TAU conditions (? = 0.03, 95% CI [?0.23–0.30], p = 0.80). Although the fidelity indices showed that the counselors mostly used MI-consistent techniques, their proficiency in evoking change talk was not sufficient.
Conclusion: MI was not superior to TAU in changing suicide-related outcomes. However, fidelity indices showed counselors' proficiency in the proces of evoking was insufficient. This proces has previously been identified as a crucial component of MI. Outcomes might therefore be improved by improving counselors' training in this proces. Possible strategies to achieve this within a helpline will be discussed.