"When every second counts, a dropped call can be a tragic missed connection. Georgia’s struggle to maintain low abandonment rates for its 988 Suicide & Crisis Lifeline highlights the critical need for sustained funding and robust staffing in mental health crisis response."
The 988 Suicide & Crisis Lifeline, a vital national resource designed to provide immediate support to individuals in mental health distress, is facing significant operational hurdles in Georgia. Recent data reveals a concerning surge in call abandonment rates, where callers disconnect before reaching a counselor, raising alarms about the accessibility and effectiveness of this life-saving service. This situation underscores the complex interplay between state funding, vendor performance, and the inherent challenges of staffing a highly demanding crisis response network, with potentially dire consequences for those in acute psychological distress.
Kaitlin Cooke, a Cartersville, Georgia resident, vividly recalls the pivotal role the state’s mental health crisis line played in her life in 2018. At her lowest point, contemplating suicide, she would discreetly step outside her home to call the hotline, seeking solace from her boyfriend. The counselors who answered became her lifeline, engaging with her for extended periods, often over 45 minutes, offering reassurance that "life does get better." Cooke, now 31 and having found local therapeutic support, credits this resource with potentially saving her life, stating, "If it weren’t for this resource, I might have been a statistic." Her experience underscores the profound impact that accessible and responsive crisis intervention can have.
However, starting in March, the operational metrics for the Georgia Crisis and Access Line, the state’s predecessor to the national 988 Suicide & Crisis Lifeline, and the 988 line itself, have seen a significant decline in Georgia. National data indicates that Georgia is among several states grappling with elevated rates of disconnected or rerouted 988 calls. These disconnected calls often result from lengthy wait times, leading callers to hang up before their needs can be addressed. The responsibility for funding and staffing these critical 988 systems largely falls on individual states, supplemented by federal contributions. Mental health experts emphasize that adequate state funding, translated into a well-staffed and efficient response network, is paramount in determining whether a caller successfully connects with a local counselor or abandons the call.
The broader landscape of mental health services faces uncertainty, exacerbated by potential shifts in federal policy, including proposed Medicaid cuts under the Trump administration. Such reductions could curtail access to essential care and compel states to re-evaluate their financial commitments to crisis hotlines. Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit, notes that these financial pressures could lead states to decrease allocations to crisis lines, thereby impacting their operational capacity. The stakes are exceptionally high for individuals experiencing severe mental health crises, as Saunders points out, "Some of the callers are actively experiencing suicidal thoughts. Sometimes they actively have a suicide plan and it’s a very urgent situation."
A significant concern has emerged regarding Georgia’s call abandonment rate. The state has contracted with Carelon Behavioral Health, a subsidiary of insurance giant Elevance Health, to manage its crisis lines. A substantial performance drop was observed when Carelon terminated its contract with a subcontractor responsible for staffing these lines. Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, highlighted this issue in a letter to Carelon, noting a spike in abandoned calls. The state mandates an abandonment rate of 3% or less, but at the time of Tanner’s letter, the rate had soared to 18%. Following this, the state revised its definition of an abandoned call, now excluding calls rerouted to backup centers and only counting those disconnected after being on hold for more than 30 seconds, which effectively lowered the reported rate.
Carelon officials have acknowledged the dip in performance, attributing it to a "necessary" transition from their vendor. They stated that efforts are underway to hire additional staff to meet the increasing demand. Hieu Nguyen, a spokesperson for Carelon, affirmed the company’s commitment to ensuring "that every Georgian in crisis can access help through 988," adding that calls not answered locally are directed to national backup centers. Georgia allocates $17 million annually to Carelon for managing both the 988 lifeline and its predecessor, the Georgia Crisis and Access Line. This funding, partly from federal sources, supports a unified response team for both lines. However, details regarding the specific amount paid to the former subcontractor, Behavioral Health Link, remain undisclosed by both Carelon and state officials, who cite proprietary reasons. The state holds the option to extend its contract with Carelon through 2032. Camille Taylor, a spokesperson for the state Department of Behavioral Health and Developmental Disabilities, indicated in December that Carelon had shown improvement in its call response performance, though the state continues to closely monitor the company’s answer rates.
The challenges in staffing crisis lines are "enormous," according to Margie Balfour, an Arizona psychiatrist and member of a national 988 advisory committee. Balfour explains that being a crisis line counselor is an inherently stressful role, as counselors are tasked with engaging with individuals at the "peak of their crisis." The national 988 Suicide & Crisis Lifeline, launched in 2022, aims to connect individuals experiencing mental health challenges, emotional distress, or substance use concerns with trained counselors. Its three-digit number, mirroring the familiarity of 911, is intended to facilitate access and help prevent mental health crises and reduce suicide risk, while also supporting those who call on behalf of a loved one.
Data from December revealed that Georgia ranked near the bottom among all states in the percentage of calls answered and kept within the state, as reported by Vibrant Emotional Health, the national administrator of the 988 Lifeline. A significant portion of calls originating from Georgia were routed to national call centers. National data also illustrates the stark variability in 988 call response times. In December, a caller in Mississippi experienced an average wait time of just one second, while a caller in Virginia waited an average of 74 seconds.
The unofficial industry benchmark for answering in-state calls is 90%. However, more than half of the states failed to meet this target in December, according to national data. In Georgia, the tracking data for 988 initially showed that over 80% of crisis calls were answered within the state. This figure saw a significant decline to 73% in March, further dropping to 62% in April. By October, the rate had recovered to 72%, reaching 79% in December.
The preference for in-state response is rooted in the understanding that local counselors possess a more intimate knowledge of the state’s mental health infrastructure, available resources, and service providers. Saunders of KFF emphasizes that local counselors "should be more familiar with the state infrastructure, mental health system, and resources that are available to people who live in the state." Pierluigi Mancini, interim president and CEO of Mental Health America, concurs, stating it is "unlikely that an out-of-state counselor would know much about that state’s mental health system and providers." This issue is particularly pertinent for predominantly Spanish-speaking callers, who may be routed to out-of-state call centers, potentially hindering their access to culturally competent and locally relevant assistance.
Since the inception of the 988 rollout, the crisis line has received a substantial volume of calls, texts, and chats, totaling over 19 million by November, according to the Substance Abuse and Mental Health Services Administration. Research indicates that the national predecessor to 988, the National Suicide Prevention Lifeline, proved effective in helping suicidal callers, with most interviewed individuals reporting that their calls helped prevent them from acting on suicidal impulses.
The scope of the suicide crisis in the United States remains profound. In 2023, over 49,000 Americans died by suicide. Furthermore, nearly 17 million Americans aged 12 and older reported having seriously contemplated suicide in the preceding year, according to the National Survey on Drug Use and Health. For Generation Z adults, the suicide rate is higher than that of millennials at the same age a decade ago. Notably, Georgia has experienced the largest increase in suicide rates for this age group, with a 65% jump from 2014 to 2024, according to a Stateline analysis of federal death statistics.
Mike Hogan, a consultant with extensive experience in managing mental health systems across three states, characterized Georgia’s recent data as reflective of "a bungled transition. It looks like performance fell off a cliff." He reiterated the critical role of trained counselors in de-escalating suicidal crises and preventing tragic outcomes.
Despite these operational challenges, Balfour highlights that 988 enjoys bipartisan support and emphasizes that the system, while a work in progress, remains a vital and effective resource for individuals in crisis. "988 is a success," Balfour asserts, "And it’s work in progress."