"When someone is in the throes of a mental health crisis, every second counts. A disconnect or a prolonged wait can mean the difference between life and death. Georgia’s recent struggles with its 988 Suicide & Crisis Lifeline highlight a critical vulnerability in mental healthcare access, underscoring the urgent need for robust and consistent funding to ensure these vital services reach those in peril."
The 988 Suicide & Crisis Lifeline, a national initiative designed to provide immediate, accessible support for individuals experiencing mental health crises, is facing significant operational hurdles in Georgia. A substantial decline in the state’s ability to connect callers with local counselors has raised alarms among mental health advocates and officials. This downturn, marked by a sharp increase in disconnected or rerouted calls, points to systemic issues in funding, staffing, and contractor management that jeopardize the lifeline’s core mission: to offer a direct, life-saving connection to help. The implications are profound, particularly for individuals in acute distress who rely on these services as a last resort.
The personal story of Kaitlin Cooke, a Cartersville resident who found solace and a path to recovery through Georgia’s crisis line in 2018, underscores the life-altering impact of these services. Cooke recounted clandestine calls made from behind her car to avoid her boyfriend’s awareness, finding a lifeline in counselors who dedicated at least 45 minutes to each conversation, offering hope and reassurance. "If it weren’t for this resource, I might have been a statistic," Cooke, now 31, stated, having since found a local therapist. Her experience highlights the critical role these lines play when other support systems are inaccessible or unknown.
However, the operational integrity of this vital resource has recently faltered. Beginning in March, the call response performance of both the Georgia Crisis and Access Line and its national counterpart, the 988 Suicide & Crisis Lifeline, experienced a significant decline within the state. This trend is not isolated to Georgia, as national data indicates the state is among several struggling to maintain low rates of disconnected or rerouted 988 calls. Disconnected calls often occur when callers hang up, frequently due to lengthy wait times, effectively severing their connection to potential help.
The responsibility for funding and staffing these 988 systems largely rests with individual states, supplemented by federal financial contributions. Mental health experts emphasize that adequate state funding, channeled into a well-staffed response network, is paramount. This infrastructure directly influences whether a caller successfully connects with a local counselor or opts to disconnect due to frustration or prolonged waiting. The precarious future of mental health services is further compounded by significant policy shifts under the Trump administration, including proposed Medicaid cuts that could severely restrict access to care. Such reductions might compel states to reconsider their financial allocations to crisis lines, as noted by Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit. The stakes are immeasurably high for individuals navigating severe mental health crises, where a lost connection can have fatal consequences. "Some of the callers are actively experiencing suicidal thoughts," Saunders stated. "Sometimes they actively have a suicide plan and it’s a very urgent situation."
A significant contributing factor to Georgia’s declining performance has been identified in the state’s contractual relationship with Carelon Behavioral Health, a division of the insurance conglomerate Elevance Health, which manages its crisis lines. When Carelon terminated its contract with a subcontractor responsible for staffing these lines, the service’s performance subsequently plummeted. Kevin Tanner, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, highlighted this issue in a letter to Carelon, noting a surge in abandoned calls. The state mandates an abandonment rate of 3% or less; however, Tanner reported the rate had reached 18%. In response to this critical situation, the state later revised its definition of abandoned calls, narrowing it to include only those disconnected after being on hold for more than 30 seconds, thereby excluding calls rerouted to backup centers from the official metric.
Carelon officials have acknowledged the performance dip, attributing it to a "necessary" transition from their previous vendor. They asserted that efforts are underway to hire additional staff to meet the escalating demand for crisis services. 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 redirected 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 originating from federal sources. Notably, both crisis lines direct calls to the same response team. The specifics of how much of this allocation was passed on to the subcontractor, Behavioral Health Link, have not been disclosed by Carelon or state officials, with Carelon citing proprietary reasons. The state retains the option to extend its contract with Carelon through 2032. In December, Camille Taylor, a spokesperson for the Department of Behavioral Health and Developmental Disabilities, indicated that Carelon had demonstrated improvements in call response performance, though the state continues to closely monitor the company’s answer rates.
The national 988 Suicide & Crisis Lifeline, launched in 2022, is designed to connect individuals experiencing mental health challenges, emotional distress, or substance use concerns with trained counselors. The three-digit number, mirroring the familiarity of 911, aims to prevent mental health crises and reduce suicide risk, while also providing support for those concerned about others. However, the system faces what experts describe as "enormous challenges in terms of staffing" across the behavioral health sector. Margie Balfour, an Arizona psychiatrist and a member of a national 988 advisory committee, characterized the role of a crisis line counselor as "a very stressful job," emphasizing that they interact with individuals at the "peak of their crisis."
In December, Georgia ranked near the bottom among all 50 states in the percentage of calls answered that remained within the state, according to Vibrant Emotional Health, the national administrator of the 988 Lifeline. A significant proportion of Georgia’s calls were routed to national call centers, as indicated by available data. This contrasts sharply with states like Mississippi, where the average response time for a 988 call in December was a mere one second, compared to 74 seconds for callers in Virginia.
While the unofficial industry benchmark for answering in-state calls is 90%, more than half of the states failed to meet this target in December. In Georgia, the tracking data for 988 indicated that over 80% of crisis calls were answered within the state until March, when this figure dropped to 73%. The rate declined further to 62% in April before recovering to 72% in October and reaching 79% in December. The importance of in-state connections cannot be overstated. Saunders of KFF highlighted that local counselors are "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, echoed this sentiment, noting that out-of-state counselors are unlikely to possess detailed knowledge of a state’s specific mental health system and providers. This issue is particularly concerning for predominantly Spanish-speaking callers, who may be directed to out-of-state call centers, potentially hindering their access to culturally competent and locally relevant assistance.
Since its inception, the 988 Lifeline has handled an immense volume of interactions, totaling more than 19 million calls, texts, and chats by November, according to the Substance Abuse and Mental Health Services Administration. Research has shown that with its predecessor, the National Suicide Prevention Lifeline, the majority of suicidal callers interviewed reported that their calls helped prevent them from taking their own lives.
The statistics surrounding suicide in the United States underscore the critical need for effective crisis intervention. In 2023, over 49,000 Americans died by suicide. Furthermore, approximately 17 million Americans aged 12 and older reported seriously considering suicide in the previous year, according to the National Survey on Drug Use and Health. The impact on younger generations is particularly concerning; for Generation Z adults, suicide claims more lives than it did for millennials at the same age a decade ago. A Stateline analysis of federal death statistics revealed a significant increase in suicide rates for this age group, with Georgia experiencing the largest jump—a 65% increase from 2014 to 2024.
Mike Hogan, a consultant with extensive experience managing mental health systems in three states, characterized the recent Georgia data as indicative of "a bungled transition. It looks like performance fell off a cliff." He emphasized that "counselors, with the right training, can talk people down and away from the suicidal crisis."
Despite these operational challenges, Balfour noted that 988 enjoys bipartisan support and that the system, while a work in progress, remains a crucial resource that is effectively aiding individuals in crisis. "988 is a success," Balfour stated. "And it’s work in progress." The ongoing efforts to address staffing shortages and optimize contractor performance are vital to ensuring that the 988 Lifeline can continue to fulfill its life-saving mission for all who reach out.