Community Mental Health Service Crisis Line Call-Back Interval and Repeat Self-Harm Presentation in South African Catchments: An Instrumental-Variable Estimation of Follow-Up Exposure
Year: 2026
Type: article
Abstract: Crisis line call-back intervals vary widely across South African community mental health catchments, yet the causal effect of follow-up exposure on repeat self-harm presentation remains poorly identified because call-back timing is allocated in response to clinical need. The design is presented as a methodological proposal rather than an executed empirical analysis: no primary data were collected for the present analysis. The paper formalises the exposure, defines the complier subpopulation, states the exclusion and monotonicity assumptions, and derives the Wald estimand for the catchment-stratified setting. It then examines the principal threats to identification, including differential crisis line utilisation, competing routes to care, and the possibility that staffing instruments operate through pathways other than call-back timing. A sensitivity framework is proposed to bound the estimand under plausible violations. The contribution is a transparent, falsifiable template for estimating follow-up exposure effects in low-resource community mental health systems, together with an explicit statement of what such a design can and cannot establish.
Institution: University of Cape Town
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7223222648