A lonely and anxious Rebecca Massie first called the Mental Health Association of San Francisco "warmline" during the 2015 winter holidays.
"It was a wonderful call," said Massie, now 38 and a mental health advocate. "I was laughing by the end, and I got in the holiday spirit."
Massie, a San Francisco resident, later used the line multiple times when she needed additional support, then began to volunteer there.
Now anyone in California who needs a little help -- or even a referral to a professional therapist -- can receive it by phone or instant message. In October, the San Francisco-based warmline expanded beyond Northern California to cover the whole state through a state budget allocation of $10.8 million for three years.
Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis -- and a more costly 911 call or ER visit. The lines are typically free, confidential peer-support services staffed by volunteers or paid employees who have experienced mental health conditions themselves.
"People pay attention when the biggest state in the union decides to say mental health services are not just for crisis," said Mark Salazar, the San Francisco association's executive director.
Such help lines aren't limited to California, though. About 30 states have some form of a warmline within their borders, including in Salt Lake City and Omaha, Neb. Still, the loose network of call lines faces no regulation or standardization. They're relatively new, so they haven't been extensively studied. And their advocates admit quantifying results can be difficult.
Better known are the suicide crisis lines for those who need help immediately. This summer, the Federal Communications Commission proposed a 988 national hotline number for those considering suicide or having a mental health crisis. Yet mental health advocates say warmlines help fill another important health care gap.
"Warmlines help people who think, 'I don't know why I'm not feeling great, or who to turn to, or where to get care, and I don't know for sure if I even need care,'" said Sarah Flinspach, a project coordinator for the National Council for Behavioral Health, which advocates for mental health care services. "It might be the call that helps someone go back to work that day."
Since the San Francisco Peer-Run Warm Line began in 2014, it has answered more than 100,000 calls and served more than 5,000 people. Approximately 85% of callers were repeat users, said Salazar, and that's just fine.