"The vital lifeline of the 988 Suicide & Crisis Lifeline is faltering in Georgia, with a significant increase in disconnected calls raising alarms for mental health advocates and those in crisis. This decline in service, exacerbated by contract issues and potential funding uncertainties, jeopardizes access to immediate, life-saving support for vulnerable individuals."
The 988 Suicide & Crisis Lifeline, designed to offer immediate, accessible mental health support across the nation, is experiencing a troubling downturn in performance within Georgia. The service, which allows individuals to connect with trained counselors by dialing or texting the three-digit number, has seen a marked increase in calls that are either disconnected or rerouted, leaving many in critical need without timely assistance. This situation is particularly concerning given the profound impact these calls can have, as exemplified by Kaitlin Cooke of Cartersville, Georgia. In 2018, Cooke found herself contemplating suicide and relied on a statewide mental health crisis line, the Georgia Crisis and Access Line, for solace. She recalls the counselors who spoke with her for at least 45 minutes, offering a message of hope that "life does get better." For Cooke, this resource was instrumental in her survival, stating, "If it weren’t for this resource, I might have been a statistic." Now 31 and having found local therapeutic support, her experience underscores the critical importance of a functioning and accessible crisis response system.
The current challenges in Georgia, which began to manifest significantly in March, are not isolated incidents. National data indicates that Georgia is among several states grappling with maintaining low rates of disconnected or rerouted 988 calls. These disconnected calls often result from prolonged wait times, leading individuals to hang up before connecting with a counselor. The responsibility for funding and staffing these 988 systems largely falls to individual states, supplemented by some federal funding. Mental health experts emphasize that adequate state-level funding, translated into a robust and well-staffed response network, is a crucial determinant of whether a caller successfully connects with a local counselor or abandons the call.
The broader landscape of mental health services is facing considerable uncertainty, influenced by significant policy shifts at the federal level. Changes initiated by the Trump administration, including proposed Medicaid cuts, could substantially limit access to essential care. These federal actions might prompt states to re-evaluate and potentially reduce their financial allocations to crisis hotlines, a concern highlighted by Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit. The implications of such reductions are dire, particularly for individuals experiencing acute mental health crises. Saunders notes, "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 point of concern in Georgia’s 988 system is its alarming call abandonment rate. The state has contracted with Carelon Behavioral Health, a division of Elevance Health, to operate 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 Georgia Department of Behavioral Health and Developmental Disabilities, pointed out in a letter to Carelon that the state’s required call abandonment rate is 3% or less, but the current rate had surged to 18%. Following this notification, the state revised its definition of an abandoned call to exclude those rerouted to backup centers, focusing only on calls disconnected after a hold of more than 30 seconds. This adjustment has led to a reported reduction in the current abandonment rate.
Carelon officials have acknowledged the dip in performance, attributing it to a "necessary" transition from a previous vendor. They have stated that efforts are underway to hire additional staff to meet the escalating demand. Hieu Nguyen, a spokesperson for Carelon, affirmed the company’s commitment to ensuring "every Georgian in crisis can access help through 988," adding that calls not answered locally are directed to national backup centers. Georgia is investing $17 million annually, with some federal support, to Carelon for managing both the 988 Lifeline and its predecessor, the Georgia Crisis and Access Line, which continues to operate concurrently. Calls to either number are handled by the same response team. However, details regarding the allocation of these funds to the former subcontractor, Behavioral Health Link, remain undisclosed by both Carelon and state officials, with Carelon citing proprietary reasons. The state holds the option to extend its contract with Carelon through 2032. Camille Taylor, a spokesperson for the Georgia Department of Behavioral Health and Developmental Disabilities, indicated in December that Carelon’s call response performance had shown improvement, though the state continues to closely monitor the company’s answer rates.
The national 988 Suicide & Crisis Lifeline, launched in 2022, serves as a crucial conduit for individuals facing mental health challenges, emotional distress, or substance use concerns, connecting them with trained counselors. The service’s three-digit number, mirroring the familiarity of 911, is designed to preempt mental health crises, mitigate suicide risk, and provide support for those concerned about others. However, the behavioral health sector is experiencing "enormous challenges in terms of staffing," according to Margie Balfour, an Arizona psychiatrist and member of a national 988 advisory committee. She describes the role of a crisis line counselor as "a very stressful job," emphasizing that counselors engage with individuals "at the peak of their crisis."
Data from December revealed that Georgia ranked near the bottom among all 50 states in the percentage of calls answered that remained within the state, as reported by Vibrant Emotional Health, the national administrator of the 988 Lifeline. A significant portion of Georgia’s calls were routed to national call centers. National data further illustrates the stark variability in 988 call response times. In December, callers in Mississippi experienced an average wait of one second, while those 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 proportion of crisis calls answered within the state remained above 80% until March, when it dropped to 73%, and further declined to 62% in April. By October, the rate had rebounded to 72%, and reached 79% in December.
The benefit of local counselors is their familiarity with the state’s specific infrastructure, mental health system, and available resources, as noted by Saunders of KFF. Pierluigi Mancini, interim president and CEO of Mental Health America, points out that out-of-state counselors are unlikely to possess detailed knowledge of a state’s mental health landscape and provider networks. This issue can be particularly acute for predominantly Spanish-speaking callers, who may be routed to out-of-state centers, potentially hindering their connection to localized support.
Since its inception, the 988 Lifeline has managed 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 with its predecessor, the National Suicide Prevention Lifeline, the majority of suicidal callers interviewed reported that their calls helped them refrain from self-harm. In 2023, over 49,000 Americans died by suicide. National Survey on Drug Use and Health data from 2024 indicates that nearly 17 million Americans aged 12 and older had seriously contemplated suicide in the preceding year.
For Generation Z adults, who are now entering their late twenties, suicide is claiming more lives than it did for millennials at the same age a decade ago. A Stateline analysis of federal death statistics reveals that suicide rates for this age group have seen the largest increase in Georgia, escalating by 65% between 2014 and 2024. Mike Hogan, a consultant with extensive experience in state mental health systems, characterized recent Georgia data as reflecting "a bungled transition. It looks like performance fell off a cliff." He stressed that with proper training, counselors are capable of de-escalating individuals from suicidal crises. Balfour, while acknowledging the system’s ongoing development, underscores that 988 enjoys bipartisan support and remains a critical, effective resource for those in distress. She concludes, "988 is a success. And it’s a work in progress."