# The 3114: a new professional helpline to swing the French suicide prevention in a new paradigm

C-E. Notredame, M. Wathelet, Margot Morgiève, P. Grandgenèvre, C. Debien, C. Mannoni, N. Pauwels, F. Ducrocq, E. Leaune, P. Binder, et al.

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## To cite this version:

C-E. Notredame, M. Wathelet, Margot Morgiève, P. Grandgenèvre, C. Debien, et al. The 3114: a new professional helpline to swing the French suicide prevention in a new paradigm. European Psychiatry, inPress, pp.1-11. 10.1192/j.eurpsy.2022.2318. hal-03940059

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# The 3114: A new professional helpline to swing the French suicide prevention in a new paradigm

C-E. Notredame<sup>1,2,3</sup>, M. Wathelet<sup>1,3,4,5</sup>, M. Morgiève<sup>3,6</sup>, P. Grandgenèvre<sup>1,2,3</sup>, C. Debien<sup>1,3</sup>, C. Mannoni<sup>4</sup>, N. Pauwels<sup>4</sup>, F. Ducrocq<sup>1,3</sup>, E. Leaune<sup>3,7</sup>, P. Binder<sup>8</sup>, S. Berrouiguet<sup>3,9,10</sup>, M. Walter<sup>3,11,12</sup>, P. Courtet<sup>12,13</sup>, G. Vaiva<sup>1,2,3,5</sup>, and P. Thomas<sup>1,2</sup>

<sup>1</sup> CHU Lille, Psychiatry Department, F-59000 Lille, France

<sup>2</sup> PSY Lab, Lille Neuroscience & Cognition Centre, INSERM U1172, Lille University, F-59000 Lille, France

<sup>3</sup> Groupement d'Étude et de Prévention du Suicide, F-86280 Saint-Benoît, France

<sup>4</sup> Fédération Régionale de Recherche en Psychiatrie et Santé Mentale des Hauts-de-France, F-59350 St-André, France

<sup>5</sup> Centre National de Ressources et Résilience pour les psychotraumatismes (Cn2r), F-75000 Paris and F-59000 Lille, France

<sup>6</sup> CERMES3, CNRS, INSERM, University of Paris, F-75006, Paris, France

<sup>7</sup> Center for Suicide Prevention, Centre Hospitalier le Vinatier, F-69500 Bron, France

<sup>8</sup> Department of general medicine, Medicine and pharmacy University of Poitiers, F-86000 Poitiers, France

<sup>9</sup> LaTIM, INSERM, UMR1101, F-29200 Brest, France

<sup>10</sup> CHU Brest, Psychiatry Department, F-29609 Brest, France

<sup>11</sup> EA 7479 SPURBO, West Brittany University, F-29238 Brest, France

<sup>12</sup> Department of Emergency Psychiatry and Acute Care, CHU Montpellier, F-34000 Montpellier, France

<sup>13</sup> IGF, University of Montpellier, CNRS, INSERM, F-34000 Montpellier, France

## Corresponding author:

Dr Charles-Edouard Notredame,
Hôpital Fontan, 2 rue André Verhaeghe, 59000 Lille, France

Email: charles-edouard.notredame@chru-lille.fr

Phone number: +33 (0) 3 20 44 67 47
Abstract

Helpline services have been identified as an important component of suicide prevention strategies. While the Covid-19 pandemic have raised major concerns about severe and longstanding mental health consequences, the French ministry of Health has recently decided to implement a national professional helpline dedicated to suicide prevention. The 3114 has been launched on the 1st of October 2021. Accessible 24/7 from any point of the national territory, it offers remote assistance to individuals in distress or worried for a close one, professionals and bereaved persons. Spread in regional call centers, medically supervised nurses and psychologists provide callers with listening, evaluation, intervention (including possible dispatch of a rescue team) and, whenever needed, referral to adapted services. At the same time, the “3114 centers” contribute to the implementation of the regional suicide prevention strategies by stimulating the development of actions, promoting resources, monitoring at-risk events, and collaborating with professional and associative stakeholders.

From a public health perspective, the inception of the 3114 has settled the conditions for a new paradigm in the French suicide prevention strategy. By dedicating specific resources to promote and organize interactions between stakeholders, it supports a major shift from the juxtaposition of efficient but segregated actions to the creation of an integrated prevention system. Embedded to the project, multidisciplinary and multilevel research will be carried out to evaluate the implementation, impact, and transferability of the 3114 model, conceived both as a helpline and territorial prevention strategy.
Despite a trend decline since the beginning of century, suicide rates in Europe remain
among the highest of WHO regions [1]. In the past ten years, France has consistently belonged
to the half of most impacted European countries [2]. In 2017, 8 214 French individuals died by
suicide [3]. Lately, strong concerns have emerged about the fact that mental health
consequences of the Covid-19 pandemic may translate into longstanding increases of suicide
rates worldwide [4], and more specifically in Europe [5]. In France, alarming indicators tend to
support this hypothesis. For instance, from 2018-2019 to 2021, admissions to the ED for
suicidal ideations and suicide attempt in 11-17 yo adolescents –especially girls – have increased
by about 130% and 30% respectively [6,7]. First figures from 2022 suggest even more
concerning patterns, with increases of suicidal behaviors rates extending to older age classes
[7].

In line with the recommendation of the European Psychiatric Association that
“unprecedented times are calling for unprecedented efforts” [5], the French government has
recently decided to complete its national strategy for suicide prevention by implementing an
universal professional helpline service. Helplines are one of the historical pillars of suicide
prevention. In the 1950’s, Samaritans have inaugurated in Great Britain a massive spread of
telephone help services across the world. Based on an important – although methodological
fragile – corpus of evidence supporting their efficacy [8], helplines are now recommended as
an important selective component of suicide prevention strategies [9].

In France, local and national suicide-prevention helplines have burgeoned since the
1960’s. Almost all consisted in trained volunteers providing distressed callers a non-directive
listening. Recently, national instances remarked the lack of a complementary professional
service able to provide distressed individuals more proactive and evidenced-based remote
evaluation and preventive interventions. More specifically, the absence of referral to mental
health professionals was identified as a missed opportunity to promote and facilitate access to
care. In addition, the only way of getting immediate help in case of acute suicidal crisis was by
calling the general emergency numbers, with non-optimal responses due to shortage of
specialized skills. Finally, numerous suicide prevention actors called for a reliable, visible, and
unified national professional helpline as a resource to promote in the community, broadcast in
the media, spread on the web, and display on hotspots.

To fulfill the gap, the 3114, French national helpline for suicide prevention, has been
launched by the French minister of health on the 1st of October 2021. Freely accessible 24
hours a day and 7 days a week from any part of the country including overseas territories, it
targets any individual needing assistance about suicidal issues, which encompasses (a)
distressed persons, ranging from emerging suicidal ideations to acute crisis, (b) persons worried
about a close one, (c) professionals needing information or advice and (d) persons bereaved by
suicide.

The development and implementation or the 3114 are coordinated by the “National
pole” of the 3114, a federative organization hosted by the University Hospital of Lille which
closely collaborates with various experts, institutions, and associations. The French ministry of
Health, which funds the project, steers its general orientation, and ensures its conformity with
the current regulatory framework.

From the operational point of view, the French national helpline has a decentralized
organization. The regional spread of “3114 centers” (1 to 2 per region) allows for proximal
responses and accurate knowledge of local resources. These centers host the “respondents” of
the 3114, i.e. nurses and psychologists placed under the supervision of a senior psychiatrist.
Respondents as well as supervisors received a specifically designed training based on an expert
consensus and evidence-grounded practices. The remote professional help they offer consists
in: (a) non-judgmental and empathic listening, with the objective of rapidly creating,
reinforcing, and maintaining an alliance with the caller; (b) a targeted clinical evaluation, which
comprises an estimation of the suicide risk, the identification of salient psychopathological
signs and symptoms and an assessment of the psychosocial context; (c) a strategical
intervention, which may include counselling, motivational reinforcement and/or problem
solving. The objective is to bring a first relief, commit the caller to the caring process and
mobilize his/her personal and external resources. (d) referral to adapted sanitary (i.e. general
practitioner, psychiatric services or emergency room), welfare, social or associative resources,
with the possibility to program a follow-up contact. A tight collaboration with emergency
services allows for dispatching a rescue team whenever the caller is estimated in immediate
danger. Also, in a global care perspective, respondents are supported by a social worker when
financial needs, housing problems, educative precarity or difficulties in accessing social rights
are identified.

Beyond this distant help activity, the 3114 regional centers also have a territorial
mission. Thanks to social workers and network managers, they contribute promoting available
suicide prevention actions, federating stakeholders, monitoring the occurrence of at-risk events
(e.g., hot spots), reducing territorial and social inequalities and stimulating the development of
innovations under the pilotage of Regional Health Agencies. The structure, missions, and
actions of the 3114 are summarized in Figure 1.

The launch of the 3114 have been supported by an intensive communication campaign
with diffusion of print and digital flyers, collaboration with journalists, organization of webinars
with local actors, promotion by national institutions and active social media publications. A
specifically designed website (www.3114.fr) have been developed to provide the general
population with various specified information, advice and resources about suicidal behaviors
and prevention.
<figure><img src="image_3.png" /><figcaption>**Figure 1.** *Structure, missions, and actions of the 3114.* A. The 3114 National Pole is composed of 8 strategic poles (horizontal light-yellow lines) and 2 transversal thematic axis (dark-yellow rings), coordinated by an operational adjudicative team (gray circle). B. Seventeen regional centers (black phones) spread over the French territory hold the 3114 missions. Each regional center is assigned an area of operation. C. The 3114 regional centers are composed of clinical, operational, and supervisory professionals. D. Each 3114 regional center has both a response and a territorial mission. As regards to territorial missions, territorial anchoring comprises articulations with healthcare and community resources, participation to health democracy organizations, cooperation with health policy makers and mapping of the sociodemographic and epidemiological indicators. Suicide prevention boost comprises contribution to surveillance of suicidal behaviors, provision of information and alerts to stakeholders and identification of prevention opportunities. Suicide prevention integration comprises operational articulation between prevention actions and systems, promotion, and facilitation of collaboration between stakeholders, mobilization of the community and resource sharing.</figcaption></figure>

The implementation of the 3114 represents a turning point for suicide prevention in France. In eight months of existence, it already received about 90,000 calls ranging from early prevention for mild distress without suicidal ideation to acute suicidal crisis needing immediate rescue. Complementary to associative services, it ensures tailored responses based on tight articulations with healthcare service, which has been pinpointed as a key condition to reduce suicide rates [10]. The implantation of the 3114 regional centers also represents a strong opportunity to put in synergy prevention actors and actions in accordance with local needs, thus helping to concretely translate the WHO recommendations for a multilevel (i.e. combining targeted, indicated and universal actions), multisectoral (i.e. base of the cooperation of the
sanitary, associative, social and community sectors), multidisciplinary (i.e. appealing to various disciplines such as biomedicine, epidemiology, sociology, etc.) and multimodal (i.e. combining modalities of actions such as communication, healthcare, training, etc.) prevention strategy. In that, the 3114 swings French prevention into a new paradigm, from animating multiple efficient but juxtaposed actions (such as the brief contact intervention system VigilanS [11]) to shaping a coherent territorialized prevention ensemble.

Importantly, the 3114 is still at an inception stage. Developments are ongoing to reach a mature, stabilized system: opening of the last call centers, consolidation of the digital and technical solutions, implementation of a continued training for responders and supervisors, improvement of work conditions, reinforcement of inter-centers collaborations, strengthening of the access for the undeserved and people living with a disability, promotion of deeper territorial anchoring, stepping-up of networking activities and leveling-up of the communication strategy for greater local and national visibility. On top of these routine developments, the National Pole and the French ministry of Solidarity and Heath have already anticipated major evolutions for the 3114. Among those, the opening of a 24/7 online chat is intended to broaden the spectrum of reached populations both in terms of socio-demographic (especially towards youth) and clinical characteristics. In a further effort to support the development of a national digital prevention strategy, the 3114 may also open a social network channel, so as people can contact respondents directly from their daily communication apps. Because such innovation is highly sensitive from a technological, regulatory, and ethical point of view, the National Pole will rely on insights from the Elios project, a national randomized control trial assessing the efficacy of allowing suicidal young adults to get a direct contact with web-clinicians through Instagram and Messenger [12].

Given its key role in the French public health strategy for suicide prevention, it is crucial to evaluate the relevance and effectiveness of the 3114, both as a hotline and a territorial
prevention actor. As respect to distal indicators, the national all-at-once implementation
represents both an opportunity and a hurdle to impute observed changes to the service: on the
one hand, it allows for observing the time trends of suicidal behaviors precisely before and after
the launching date, on the other hand, it prevents any comparison with equivalent non-covered
territory. However, as noticed by Hoffberg et al., evaluation of crisis lines is a multi-faceted
area covering much more than the reduction of suicidal behavior [8]. To meet this challenge,
the National Pole intends to broaden its research interest and implement several studies based
on collected data and metadata. The following protocols are already planned: (1) description of
calls and callers' characteristics producing follow-up indicators, (2) medico-economic
evaluation of the cost of suicidal behavior and comparison to the period preceding the opening
of the service, (3) embedded monitoring of the respondents' mental health – the final aim being
the production of recommendations to promote better quality of life for the professionals, (4)
sociological observations that will help drawing lessons from the 3114 about the socio-cultural
determinants, political constrains and contextual leverages or obstacles to be taken in account
when implementing such a broad and complex prevention project, (5) assessment of the opinion
and representations of the service users as well as upstream and downstream partners in order
to improve the acceptability of the 3114. Of note, systematically collected data will be also
made available to external research teams upon application. Overall, the idea is to shed light on
the relevance of the 3114 model, but also on the transferability of this model to other contexts
and countries.
**Key words:** suicide, suicide prevention, helpline

**Acknowledgements.** We thank all the national team members that allowed for designing and implementing the 3114, but also the ground professionals that contribute daily to the helpline and are committed to suicide prevention.

**Financial support.** The implementation and functioning of the 3114 is fully funded by the French Ministry of Solidarity and Health.

**Conflicts of Interest.** The authors have no conflict of interest to declare.

**Data availability.** The data about the number of calls received by the 3114 are available upon request to recherche@3114.fr

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