"When the call response record for Georgia’s crisis line plummeted, it meant more individuals in desperate need were being disconnected, potentially turning hope into tragedy. This decline highlights a critical vulnerability in the state’s mental health safety net, raising serious questions about the future of accessible crisis support."
The vital 988 Suicide & Crisis Lifeline, designed to be a readily accessible lifeline for individuals experiencing mental health emergencies, is facing significant operational challenges in Georgia. A stark decline in call response performance, marked by an alarming increase in disconnected and rerouted calls, has raised serious concerns about the state’s ability to effectively support its most vulnerable residents. This situation underscores the complex interplay of funding, staffing, and subcontractor management in maintaining a robust crisis response system, with potentially life-or-death consequences for those in need.
Kaitlin Cooke’s experience in 2018 serves as a poignant reminder of the profound impact these crisis lines can have. Contemplating suicide, she found solace and support by secretly calling a statewide mental health crisis line. The counselors who answered her calls provided a sustained connection, speaking with her for at least 45 minutes each time and offering the crucial message that "life does get better." For Cooke, now 31 and having found local therapeutic support, this resource was instrumental in preventing her from becoming another statistic. Her story underscores the human element at the heart of these services – the direct, empathetic connection that can make the difference between despair and hope.
However, the operational landscape for such critical services is increasingly precarious. Since March, the performance metrics for both the Georgia Crisis and Access Line and its national counterpart, the 988 Suicide & Crisis Lifeline, have seen a significant downturn in Georgia. National data indicates that Georgia is among several states grappling with an inability to maintain low rates of disconnected or rerouted 988 calls. Disconnected calls, often a result of prolonged wait times, represent a critical failure in the system, leaving individuals in acute distress without immediate support. The responsibility for funding and staffing these 988 systems largely falls on the states, with supplementary federal funding. Mental health experts emphasize that adequate state funding, channeled into a well-staffed response network, is paramount in determining whether a caller reaches a local counselor or abandons the call out of frustration or escalating crisis.
The broader context of mental health service provision is further complicated by potential shifts in federal policy. The future of mental health services appears uncertain amid significant changes proposed by the Trump administration, including potential Medicaid cuts. These cuts could curtail access to essential care for many individuals, and consequently, may prompt states to re-evaluate their financial commitments to crisis lines. Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit, cautions that such reductions in state allocations could have a devastating impact on the accessibility and effectiveness of crisis hotlines. For individuals experiencing severe mental health crises, the stakes are exceptionally high. Saunders highlights that many callers are actively suicidal, some with detailed plans, necessitating an immediate and effective response.
The recent downturn in Georgia’s crisis line performance has been largely attributed to issues stemming from its contracted provider, Carelon Behavioral Health, a unit of Elevance Health. Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, expressed alarm in a letter to Carelon, noting a significant spike in abandoned calls after Carelon terminated its contract with a subcontractor responsible for staffing the lines. The state mandates a call abandonment rate of 3% or less; however, the reported rate surged to 18%. In response to this alarming figure, the state subsequently narrowed its definition of abandoned calls, now only counting those disconnected after more than 30 seconds on hold, excluding calls rerouted to backup centers.
Officials at Carelon have acknowledged the performance decline, characterizing it as a "necessary" transition period following the change in vendors. They assert that efforts are underway to hire additional staff to meet the demand for crisis line services. Hieu Nguyen, a spokesperson for Carelon, stated 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, with a portion of this funding derived from federal sources. The specific amount disbursed to the former subcontractor, Behavioral Health Link, remains undisclosed, with Carelon citing 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 metrics, though the state continues to closely monitor the company’s answer rates.
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 rapid access to support, thereby preventing mental health crises and reducing suicide risk. The service also extends its support to individuals reaching out on behalf of loved ones.
However, the broader behavioral health sector is encountering "enormous challenges in terms of staffing," according to Dr. Margie Balfour, an Arizona psychiatrist and member of a national 988 advisory committee. She describes the role of a crisis line counselor as exceptionally stressful, as they are tasked with engaging with individuals at the "peak of their crisis."
Data from Vibrant Emotional Health, the national administrator of the 988 Lifeline, revealed in December that Georgia ranked near the bottom among the 50 states in the percentage of calls answered within the state. A substantial number of calls originating from Georgia were rerouted to national call centers. This redirection can have significant implications for the quality and effectiveness of the support provided. National data also illustrates the wide disparity in response times. In December, a caller in Mississippi experienced an average wait time of just one second, while a caller in Virginia faced an average of 74 seconds.
The unofficial industry benchmark for answering in-state calls is 90%. However, in December, more than half of the states fell below this target. Georgia’s performance exhibited a notable decline, with over 80% of crisis calls initially answered within the state. This figure dropped to 73% in March and further declined to 62% in April. While rates saw some recovery, reaching 72% in October and 79% in December, the earlier dips are cause for concern. Saunders of KFF emphasizes that local counselors are better equipped to understand the state’s specific infrastructure, mental health system, and available resources, which is crucial for effective client care.
Pierluigi Mancini, interim president and CEO of Mental Health America, points out that out-of-state counselors are unlikely to possess in-depth knowledge of a state’s mental health landscape and providers. This is particularly problematic for predominantly Spanish-speaking callers who may be routed to out-of-state call centers, potentially hindering their access to culturally competent and geographically relevant assistance.
Since its inception, the 988 Lifeline has handled a substantial volume of interactions. By November, the Substance Abuse and Mental Health Services Administration reported that calls, texts, and chats to the crisis line had collectively exceeded 19 million. Research on the national predecessor to 988, the National Suicide Prevention Lifeline, indicated that the majority of suicidal callers interviewed after their calls reported that the interaction helped them refrain from self-harm.
The urgency of these services is underscored by alarming national suicide statistics. In 2023, over 49,000 Americans died by suicide. Furthermore, according to the National Survey on Drug Use and Health, nearly 17 million Americans aged 12 and older reported having seriously contemplated suicide in the previous year. For Generation Z adults, suicide is now claiming more lives than it did for millennials at the same age a decade ago. A Stateline analysis of federal death statistics revealed a particularly steep increase in suicide rates for this age group in Georgia, which saw a 65% jump between 2014 and 2024.
Mike Hogan, a consultant with extensive experience in state mental health systems, characterized the recent Georgia data as indicative of "a bungled transition," stating, "It looks like performance fell off a cliff." He reiterates that well-trained counselors possess the critical ability to de-escalate individuals and guide them away from suicidal crises.
Despite these challenges, Dr. Balfour maintains that 988 enjoys bipartisan support and represents a vital, evolving resource that is demonstrably helping people in crisis. She concludes that "988 is a success. And it’s a work in progress."