Community Mental Health Service Crisis Line Staffing Ratios and Call Abandonment Among Rural Kenyan Callers: An Interrupted Time-Series Estimation of Queue Exposure

Crisis line abandonment among rural Kenyan callers is typically attributed to demand surges or caller reluctance, yet the structural determinant may be the staffing ratio that governs queue exposure. The framework distinguishes between staffing levels and staffing ratios, shows that abandonment responds non-linearly to ratio changes because queue exposure accumulates over waiting time, and identifies the identification assumptions under which a ratio shift can be treated as a natural experiment. A worked illustration using the DHS Program indicator 'Knowledge of any method of contraception among married women' (N = 162 country-survey observations, 38 African countries, 1986–2025; mean = 91.776, SD = 11.342) demonstrates the descriptive and distributional reporting conventions that the proposed design requires. The contribution is a testable specification linking staffing ratios to abandonment through queue exposure, together with the estimation strategy and reporting standards needed to evaluate it in rural Kenyan crisis line settings.