Launch HN: Koko (YC W22 Nonprofit) – Online Suicide Prevention Kit
Today, we are launching our Online Suicide Prevention Kit (https://www.kokocares.org/suicide-prevention-toolkit). The goal is to help social networks and online communities better support at-risk individuals on their platforms.
Many social platforms have built-in lists of keywords that detect mental health-related search terms (e.g., “self-harm” or “depression”). There is already an established practice to suppress content or surface disclaimers for such searches. Search “suicide” on most platforms and you’ll at least get shown a 1-800 number.
But there are a few problems with this. The keyword lists always have glaring omissions. Millions of young adults can still easily find dangerous content, such as tips on how to self-harm or kill themselves. And while some platforms redirect users to “emotional support” pages, the resources provided are often underwhelming and lack evidence-base. The most common approach is to provide an overwhelming list of crisis lines (which isn’t particularly helpful to someone who may already be overwhelmed themselves).
Here’s our solution: We have a privacy-first native library designed for social networks, streaming services, online communities, forums, etc. It catches common search terms like “kill myself”, “depressed” or “thinspiration”, as well as a huge long-tail of slang terms and evasive language (e.g., “sewerslide” or “an0rex1a”).
The library is written in Rust and matches in under a microsecond. It has language bindings to Python, Go, and Ruby, and all other major runtimes are coming soon. Our keywords are sourced from over 12k known crisis posts and are hand-curated by social and clinical psychologists on our team. We also use text generators like GPT-3 to expand these lists with other keywords beyond our user-generated corpus. The terms are updated regularly based on new patterns that emerge on our support platform, as well as co-listed terms on large social platforms.
We also provide evidence-based mental health interventions and resources, to help supplement what online platforms might already provide (though, frankly, many do essentially nothing). Our interventions can be accessed online, for free, without having to download an app. We provide users with online peer support, self-guided mini courses, crisis triage, etc. We have published seven reviewed papers on these interventions and we have two more in prep now. In a randomized controlled trial with Harvard, our services increased the conversion rate to crisis lines by 23%.*
This combination —search detection + evidence-based online interventions — enables us to reach users where they are, right at the moment they are reaching out for help. Instead of showing a user an ad or, at worst, harmful content, we can display resources that are actually helpful. We have seen young people search for “proanorexia” content, then click our banner, then engage with our courses, and then show marked improvement in body image perception and a greater motivation to get help offline.
Our library collects no data and our interventions are anonymous (we do not collect emails, usernames, IP addresses, phone numbers, etc).
Online platforms are heavily (and rightly) criticized for contributing to the youth mental health crisis. But what’s missing from the discussion is how these platforms are uniquely positioned to do something about it. Everyday, millions of people are crying out for help and the most anyone does is throw up a 1-800 number or offer suggestions to “go take a walk” or “reach out to a friend.”
Fortunately, we have partnered with a fe...
62 comments
[ 2.5 ms ] story [ 121 ms ] threadDo you have any numbers for outcomes or harm reduction?
TL;DR At a high level, for people who complete our interventions, we see 71% feel more hopeful, 42% feel better about their bodies, and 67% feel less self-hatred. Completion rates range from 25-55%. Outcomes would most likely be lower for those who dropout prematurely.
More specifically:
We track multiple outcomes, depending on what the user may be presenting. If they are experiencing suicidal thoughts, we track conversion to crisis lines.
See here: https://psycnet.apa.org/record/2019-14424-004
We follow-up 5hrs later and ask general questions about their experience with the life line.
If they are experiencing self harm, in addition to crisis lines, we offer them a single-session online intervention on managing sh. For that, we see significant improvements pre vs post on measures like “self-hatred”, and “desire to stop selfharm”, with medium effect sizes (.4-.8 cohen’s d). Very hard to show enduring effects for this, however. This research, as well as our work on disordered eating, is still in prep.
For peer support, we have previously published data here: https://pubmed.ncbi.nlm.nih.gov/25835472/
And here: https://pubmed.ncbi.nlm.nih.gov/28903637/
For our interventions on mood and stress regulation, we’ve adapted single session interventions, alongside some wonderful collaborators at Stony Brook. They have published their work here: https://www.nature.com/articles/s41562-021-01235-0
> If they are experiencing self harm, in addition to crisis lines, we offer them a single-session online intervention on managing sh. For that, we see significant improvements pre vs post on measures like “self-hatred”, and “desire to stop selfharm”, with medium effect sizes (.4-.8 cohen’s d). Very hard to show enduring effects for this, however.
Are you measuring in such a way that you can realistically determine which effects are due to the online intervention and which are due to the SH itself? I ask because after SH, especially a few hours later, I consistently have increased "desire to stop selfharm", and lessened "self-hatred". SH has that effect on me, hence its unfortunate use as a coping mechanism.
Scroll to the bottom to try the "managing self-harm" mini course. It only takes 7-8min and there is a spot for feedback at the end.
When I click on the "managing self-harm" course, I only see a "form.typeform.com refused to connect" error. Seems this is because I'm using tor, which is the only way I'd feel comfortable legitimately using the service. Would be nice if there were a way to use the service via tor.
I did complete the course. All the negativity coupled with "it's easy!!" made me feel worse, but sounds like I'm an outlier. Is there a reason there are no positive statements in the course, like "I think I'm a good person"?
We run a free tutoring service for low income students and this is something we deal with pretty regularly so def gonna look into this more and may reach out directly.
Love the intent though.
As for publishing the lists, it's definitely something we're thinking of. for now, it's easy to get them if you sign up with us. we don't charge for use
> "Reddit has partnered with Crisis Text Line to provide redditors who may be considering suicide or seriously hurting themselves with support from trained Crisis Counselors. If you’re worried about someone, you can let us know by reporting the specific post or comment that worried you and selecting, Someone is considering suicide or serious self-harm. After you let us know, we’ll reach out (confidentially) to put them in touch with Crisis Text Line’s trained Crisis Counselors."
However, many people on Reddit seem to view this as an opportunity for harrassment of those they disagree with, by generating bogus reports. Any thoughts on how to avoid those kind of outcomes?
Our system gently recommends our service to users right when they search and so the cost of a false positive is low (they can just ignore it or it might just seem like an unrelated PSA). Search is also great because we can vary the intensity of the keywords. For one of our partners, we’re now surfacing resources (in subtle ways) for lower risk searches like “depression.” It is super important to us to think about how we might help people upstream, before they reach a state of crisis.
For users flagged, we work well as a layer on top of CTL as our ux works for people across the entire spectrum of severity.
Even in the few subreddits dedicated to it, you have to be real careful about what you post if you don't want a ban.
Out of sight out of mind... yeah, I guess it works. Reddit doesn't need suicidal people posting about this problem, it hurts the platform and they can't do anything about it anyway, to be fair.
Source: me and 4 people I've talked about it, all were previously banned. Not much, I know, but I'm confident enough they do it on the regular. Again, not really blaming Reddit here, they're a business not a charity.
It's like if I had a chronic back condition, and instead of finding from people wanting to listen I get the equivalent of a flyer in the mail about back issues.
The person that was trying to ends the potentially uncomfortable conversation and gets to wash their hands of the situation, thinking they helped.
If you're suicidal and posting on social media, of course you know about the hotlines. Getting spammed with it is so discouraging though.
And, for what it's work, I live in the US, and have tried calling the major hotlines in two different episodes only to get a busy signal. A person to talk to what would have helped me most in that situation.
(And btw, I'm not saying people are obligated to help suicidal people. it's just if someone actually wants to help, a canned text response is not effective.)
I often do know how to help people deal with non suicidal depression but I dont always have time and energy to help…and I definitely cannot program a computer to do what I know how to do.
I don’t have any clue how to help someone reduce suicidal intent.
I don't mean "fix the problem that made them suicidal."
I mean physically pick them up and take them somewhere else (a safe place preferably, but there's something to be said for a sudden shock of actual danger). I mean send them a thousand bucks. I mean pay off their car loan, pay their rent for a year, something that eliminates that primary stressor.
Suicide is very often a single/recurrent practical situation that gets catastrophized into sheer despair, yes often with other mental health concerns confounding. But you can't fix those immediately. You can bring force to rehab (not great, many downsides). You can take them for coffee.
Talking might help, in fact it's necessary, but it's not enough.
Banning people who express suicidal intentions from online platforms, which often are the last community they belong to, is unbelievably harmful.
Advertising dollars be damned: companies don't get to put toxic materials in our foods, and social media companies don't get to clandestinely use "crisis support" buttons to figure out who to "clean up".
You may also wish to write a letter to your attorney general.
Still, in retrospect - definitely a bad naming choice for a service like this.
https://news.ycombinator.com/newsguidelines.html
"When disagreeing, please reply to the argument instead of calling names. 'That is idiotic; 1 + 1 is 2, not 3' can be shortened to '1 + 1 is 2, not 3."
"Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something."
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
https://news.ycombinator.com/newsguidelines.html
Also I think combining self harm with suicide resources might actually have a negative effect. If someone is searching something like hiding self harm marks from cutting and gets resources on suicide, it could trigger suicidal ideation when it wasn’t actually the issue they were seeking help with.
It is very true that self-injury is not the same as suicidal ideation, though they can certainly overlap. A common thought is that asking about suicide or presenting resources could be harmful or ‘trigger’ more ideation. The evidence to date suggests, on the contrary, that asking about suicide can actually reduce risks. https://pubmed.ncbi.nlm.nih.gov/24998511/ https://www.cambridge.org/core/journals/the-british-journal-...
This is an incredibly condescending worldview. If a person's going to commit suicide, allowing them to find methods that aren't likely to fail or cause extreme amounts of pain is incredibly important. By interrupting their access to information, you're likely to end up pushing suicidal people into making attempts using what little information they already know, which can often lead to excruciatingly painful medical consequences for the rest of their lives, whether lasting minutes or decades.
Intervention is good, but pushing for the elimination of the ability to find that content is almost impossible to see as anything but harmful.
By the way, are you related to the chain of Robert Morrisi that worked on UNIX, wrote the first computer worm, and wrote the language this site is written in?
https://en.wikipedia.org/wiki/Robert_Morris_(cryptographer)
https://en.wikipedia.org/wiki/Robert_Tappan_Morris
What motivated you personally to be in this space?
We regularly consult clinical advisors (listed here: https://www.kokocares.org/our-team)
I made some comments on outcome measures in another comment you can find here, but you can also see some of our papers here: https://www.kokocares.org/research
Good luck.
And maybe you could open up your API documentation not behind a registration. I understand you are operating a non profit, and signup is free, but somebody like me does not have a social platform that needs this integration right now, don't like to pretend to be a customer/user in order to read a doc. Maybe after seeing the doc, I can have some idea what is the capabilities and can be used on future project.
Anyway, I like your intent working on helping vulnerable.
I have two perspectives on suicide.
First, 'Informed Suicide' where a person rationally determines that there's no point in continuing their life after exhausting all other options. Deliberate hurdles to prevent that person from ending their life through social stigma, criminal action(laws against suicide), unavailability of euthanasia just feels like taking away their right, treating them as a commodity and leading them to painful death or disability through botched suicides.
Second, 'Hasty Suicide' where a person haven't exhausted all options, they like living but they don't like their current life. I think the intervention methods are very useful for preventing such suicides. I hope Koko library comes handy to make this process more efficient to saves more lives 'which want to be saved'.
I see the social and practical reasons for why suicides aren't categorized, I just wish it was.
Affordable housing and education, livable wage, universal healthcare etc. are suicide prevention. This is what people should be focusing on more.
Next question, whos is the team behind that non-profit? no faces, it feels almost like a VC scam..
> Use our library of support and referral links (provided as single pages or div blocks)
What do you mean by referral links?