"A bungled transition. It looks like performance fell off a cliff." The struggles of Georgia’s 988 Suicide & Crisis Lifeline, marked by plummeting response rates and increasing call abandonment, underscore a growing national concern about the accessibility and effectiveness of this vital mental health resource, jeopardizing lives in moments of acute crisis.
The 988 Suicide & Crisis Lifeline, established to provide immediate, accessible support for individuals experiencing mental health emergencies, is encountering significant operational hurdles in various states, with Georgia serving as a prominent case study. While the lifeline aims to connect callers with trained counselors, recent data reveals a disturbing trend of decreased in-state call answering rates and increased call abandonment, raising alarms about the system’s ability to serve those most in need. This situation is compounded by broader challenges in the mental health sector, including potential funding shifts and staffing shortages, which threaten to undermine the lifeline’s foundational mission. The experiences of individuals like Kaitlin Cooke, who found solace and support through a crisis line, highlight the profound impact these services can have, making the current operational difficulties all the more concerning.
Kaitlin Cooke’s journey, beginning in 2018 when she anonymously reached out to a statewide mental health crisis line from her car in Cartersville, Georgia, paints a vivid picture of the desperation that drives individuals to seek help. At 31, Cooke now reflects on the critical role these counselors played, offering at least 45 minutes of conversation and a message of hope: "life does get better." Her sentiment, "If it weren’t for this resource, I might have been a statistic," underscores the life-saving potential of accessible mental health support. However, the operational integrity of such resources is currently facing unprecedented strain.
Starting in March, the performance metrics for Georgia’s Crisis and Access Line, and its national successor, the 988 Suicide & Crisis Lifeline, saw a significant decline within the state. National data indicates that Georgia is among several states struggling to maintain low rates of disconnected or rerouted 988 calls. Disconnected calls, often the result of extended wait times, represent a critical failure in the system, potentially leaving individuals in imminent danger without support. The responsibility for funding and staffing these 988 systems largely rests with individual states, supplemented by federal contributions. Mental health experts emphasize that robust funding and a well-staffed response network are paramount to ensuring callers are successfully connected to local counselors rather than abandoning their calls.
The broader landscape of mental health services is currently navigating an uncertain future, influenced by significant policy shifts, including potential Medicaid cuts under the Trump administration. These changes could restrict access to care and, consequently, lead states to re-evaluate their financial commitments to crisis lines, as noted by Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF. The implications are dire for individuals experiencing severe mental health crises, where time is of the essence. Saunders highlights the urgency, stating, "Some of the callers are actively experiencing suicidal thoughts. Sometimes they actively have a suicide plan and it’s a very urgent situation."
Alarm About Call Abandonment Rate
A significant contributing factor to Georgia’s performance dip has been the operational changes within its contracted service provider, Carelon Behavioral Health, a subsidiary of Elevance Health. When Carelon terminated its contract with a subcontractor responsible for staffing the crisis lines, the system’s performance reportedly plummeted. Kevin Tanner, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, outlined this concern in a letter to Carelon, pointing to a surge in abandoned calls.
Georgia’s state requirement mandates a call abandonment rate of 3% or less. Tanner’s letter indicated that the rate had reached 18% prior to the state narrowing its definition of abandoned calls. The revised metric now focuses solely on calls disconnected after being on hold for more than 30 seconds, excluding those rerouted to backup centers.
Carelon officials have acknowledged the performance decline, attributing it to a "necessary" transition from their vendor. They assert that efforts are underway to hire additional staff to meet the demand. Hieu Nguyen, a spokesperson for Carelon, stated the company is "committed to ensuring that every Georgian in crisis can access help through 988," and that calls not answered locally are redirected to national backup centers.
With a combination of state and federal funding, Georgia allocates $17 million annually to Carelon for managing both the 988 lifeline and its predecessor, the Georgia Crisis and Access Line, which remains operational. Crisis calls are routed to the same response team regardless of the number dialed. Details regarding the allocation of these funds to the former subcontractor, Behavioral Health Link, have not been disclosed by Carelon or state officials, who cite proprietary reasons. The state retains the option to extend its contract with Carelon through 2032. Camille Taylor, a spokesperson for the state Department of Behavioral Health and Developmental Disabilities, reported in December that Carelon had shown improvement in its call response performance, though the state continues to monitor the company’s answer rates closely.
"Enormous" Staffing Challenges
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 dialing code, mirroring the familiarity of 911, is designed to facilitate immediate access to support, thereby preventing mental health crises and reducing suicide risk. The service also extends support to those reaching out on behalf of a loved one.
However, the behavioral health sector, including crisis lines, is grappling with "enormous challenges in terms of staffing," according to Margie Balfour, an Arizona-based psychiatrist and member of a national 988 advisory committee. Balfour describes the role of a crisis line counselor as "a very stressful job," given that they are "talking to people at the peak of their crisis."
Data from December revealed that Georgia ranked near the bottom among all states in the percentage of calls answered that were kept within the state, as reported by Vibrant Emotional Health, the national administrator of the 988 lifeline. A substantial number of calls originating from Georgia were routed to national call centers, according to available data.
National data also illustrates the variability in 988 call response times. In December, the average wait time for a caller in Mississippi was one second, while a caller in Virginia experienced an average wait of 74 seconds. While the unofficial industry target for answering in-state calls is 90%, more than half of the states failed to meet this benchmark in December, according to national reports. Georgia’s data showed that over 80% of crisis calls were answered within the state until March, when this rate dropped to 73%, and further declined to 62% in April. By October, the rate had recovered to 72%, reaching 79% in December.
The proximity of local counselors to the caller is crucial, as they "should be more familiar with the state infrastructure, mental health system, and resources that are available to people who live in the state," explains Saunders of KFF. Pierluigi Mancini, interim president and CEO of Mental Health America, concurs, noting that out-of-state counselors are unlikely to possess in-depth knowledge of a specific state’s mental health system and providers. This poses a particular challenge for predominantly Spanish-speaking callers who are often routed to out-of-state call centers, potentially hindering their connection to locally relevant assistance.
Since its inception, the 988 lifeline has handled over 19 million calls, texts, and chats by November, according to the Substance Abuse and Mental Health Services Administration. Research on the National Suicide Prevention Lifeline, the predecessor to 988, indicated that most suicidal callers interviewed after their call reported that it had helped them avert suicide.
The scale of the mental health crisis in the United States is significant. In 2023, over 49,000 Americans died by suicide. Preliminary data from the National Survey on Drug Use and Health suggests that in the past year, nearly 17 million Americans aged 12 and older seriously considered suicide. For Generation Z adults, who are now in their late twenties, suicide rates are higher than those of millennials at the same age a decade ago. Georgia has seen a particularly stark increase, with a 65% jump in suicide rates for this age group between 2014 and 2024, according to a Stateline analysis of federal death statistics.
Mike Hogan, a consultant with extensive experience in state mental health systems, characterized Georgia’s recent data as indicative of "a bungled transition. It looks like performance fell off a cliff." He reiterates the critical role of trained counselors in de-escalating crises and guiding individuals away from suicidal intent.
Despite these operational challenges, Balfour emphasizes that 988 enjoys bipartisan support and remains a vital resource. She views the system as a work in progress that is demonstrably helping people in crisis, stating, "988 is a success. And it’s work in progress."