Students Support Each Other’s Mental Health, One Text at a Time

“Are you OK?”

For undergraduate students juggling the stresses of courses, relationships, homesickness, political unrest and a seemingly never-ending pandemic, this question might take some time to answer. And that’s OK. 

Trained student coaches are on standby every night from 5 to 11 p.m., through the anonymous texting platform DukeLine, and they’ve got time to listen. 

DukeLine has been in the works for several years, operating as a pilot program. It quietly launched last fall, serving a portion of students living in on-campus housing and resulting in 70 anonymous chats where students got anonymous help from their peers. This spring, DukeLine has expanded its capacity to serve all undergraduate students.

Problems with a roommate? The volunteer coaches – all undergraduates themselves – know all about those. Social anxiety? Substance abuse? Identity questions? The more than 60 peer coaches trained for DukeLine have personal experience with these issues, too, and can guide their peers to all the right resources.

In many cases, a student seeking support simply needs someone to hear them, said Nancy Zucker, professor in psychiatry and behavioral sciences and founder of DukeLine.

“A lot of times, it’s just a good conversation. For a majority of students, that can be enough,” Zucker said. “Coaches don’t give advice – they actively listen and empower the student to figure out their next move, and part of that may be brainstorming together, or providing information about Duke resources that can help.”

A critical need

The free support line comes at a critical time, as depression has increased globally since the pandemic. In 2021, more than 60 percent of college students in a national survey of 373 college campuses met criteria for one or more mental health conditions. At the same time, the U.S. is facing a shortage of health care workers in several areas, including mental health.

Although DukeLine is not designed for mental health emergencies and is not a substitute for medical treatment, it fulfills a need for many students who need support and to know they are not alone and have options, Zucker said. 

“I have been increasingly approached by students who want alternatives,” Zucker said. “Often, they may not feel they need something as formal as psychotherapy, or perhaps they may even want to seek formal help for their mental health, but there are barriers to accessing it – perhaps they are concerned about stigma or privacy, such as a family member learning they are seeking mental health support.”  

How it works

To access DukeLine, a student simply texts (984) 230-4888. They complete a quick survey on what they need help with, then enter a chat with a peer coach who is responding through a computer-based program. The identities of the client and the coach are anonymous.

“The coaches are trained to be listeners, and through listening, to be facilitators,” Zucker said. “They help the student think about times when they have encountered similar situations in the past and what has and hasn’t worked. In some ways, they can help a student realize they already have the skills to address the problem. It’s just like the Wizard of Oz,” Zucker said, referring to the scene when Glinda, the good witch, helps Dorothy understand her own agency. “They had the tools within themselves all along.”

"Coaches don't give advice — they actively listen and empower the student to figure out their next move."

Nancy Zucker, professor in psychiatry and behavioral sciences

Although the coaches are anonymous, they have shared many details about their backgrounds on the DukeLine website so students know they are speaking to peers with diverse experiences, struggles and reasons for helping. To date, 62 students have completed a semester-long training with Zucker required to become a coach.

Coaches volunteer in pairs for three-hour shifts with Zucker on standby to guide their work or assist with an emergency. Coaches also consult an extensive database of resources and articles that may be useful to the person seeking support. The software DukeLine uses even allows coaches to schedule a follow-up chat with the student to see how they are doing while maintaining total anonymity.

Alumnus Aren Tucker, who graduated in 2022, volunteered as a coach for DukeLine when it was a pilot program. He said he felt compelled to volunteer after seeing how the pandemic exacerbated isolation and loneliness in many of his classmates.

“Peer coaches have a more personal knowledge of Duke’s campus and resources because we have also had to navigate those,” said Tucker, who studied philosophy and psychology. “It’s helpful to know the person you’re talking to has walked in your shoes.”

“A lot of these students are so stressed,” he added. “It’s a really good feeling, actively helping someone decrease the chaos in their life or in their mind. It’s satisfying.”

Monitoring success and burnout

A number of other colleges and universities have text support services for students, Zucker said, and she did a systematic review of these programs before starting DukeLine. She found varied details on how they’re staffed, how coaches are trained, how they measure effectiveness, and other details Zucker plans to publish in a research paper.

DukeLine has implemented many of the best practices of other programs, but Zucker hopes research can differentiate DukeLine from other services. Researchers at the Pratt School of Engineering plan to use artificial intelligence to measure how well DukeLine is serving students, and to diagnose or even predict burnout in coaches before it sets in, Zucker said.

“We wanted to track their mental health to make sure that this was actually a feasible thing to have students do – that the burden of hearing about their peers’ problems wasn’t going to detract from their academics, because they are students first,” Zucker said.

 

Young Kyung Kim, a Ph.D. candidate at Pratt, is leading the research. Before coming to Duke, Kim spent a year volunteering as a crisis text line counselor in South Korea, where he was raised and where suicide is a leading cause of death for young people. 

That crisis line, which has been around more than a decade, has agreed to provide Kim with deidentified data so he can use machine learning to analyze transcripts and determine models to measure the platform’s effectiveness.

In addition to evaluating efficacy and coach burnout, Kim’s research will assess how current events, such as elections or violent incidents, correlate to the type and volume of inquiries the help line is getting. The data could also offer clues on how to best match incoming requests to the skills of the coaches on duty, and to ensure difficult cases are evenly distributed among volunteers, he said.

“If we can predict who might be in need based on what is happening in the news, then perhaps that could help the program have certain counselors on standby to come in and make the system more efficient,” Kim said.

It will be a few more semesters before DukeLine has received enough inquiries for Kim to conduct his research and recommend improvements. But in the meantime, Zucker and other administrators are eager to provide another layer of support for students during a particularly stressful period.

“DukeLine is an exciting addition to the panoply of resources Duke provides to help our students manage challenging stressors,” said Gary Bennett, vice provost for undergraduate education. “We couldn't be more excited that a team of nationally recognized psychological researchers has turned its attention to our student body to create this highly innovative program. We hope to scale and iterate on DukeLine’s design in the coming years using cutting-edge research methods.”