"When seconds count, disconnected calls can mean lost lives. Georgia’s 988 Suicide & Crisis Lifeline is experiencing a significant surge in abandoned calls, a critical failure that leaves individuals in the throes of despair without immediate support, potentially turning a moment of hope into a tragic statistic."
The 988 Suicide & Crisis Lifeline, a vital national network designed to provide immediate, free, and confidential support to individuals experiencing mental health crises, is facing a critical juncture in Georgia. Recent data reveals a substantial decline in the state’s call response performance, marked by a sharp increase in disconnected or rerouted calls. This alarming trend threatens the lifeline’s core mission: to connect those in urgent need with trained counselors, potentially leading to devastating consequences for vulnerable individuals. The issue is compounded by broader challenges in mental health funding and staffing, casting a shadow of uncertainty over the future accessibility of essential crisis services.
Kaitlin Cooke’s experience in 2018 serves as a poignant reminder of the life-saving impact of these crisis lines. Contemplating suicide, Cooke found solace and support through clandestine calls to Georgia’s statewide mental health crisis line. She recalls sneaking outside her home to make these calls, ensuring her boyfriend wouldn’t overhear, a testament to the desperation and isolation she felt. The counselors who answered not only listened for extended periods, often exceeding 45 minutes, but also offered a crucial message of hope: "life does get better." This lifeline, she states, was instrumental in preventing her from becoming another statistic. Now 31 and having found a local therapist, Cooke’s testimony underscores the profound importance of readily accessible, responsive crisis intervention services.
However, the very resource that offered Cooke a path to recovery has recently seen a significant downturn in its performance. Starting in March, the call response record for the Georgia Crisis and Access Line, and its national counterpart, the 988 Suicide & Crisis Lifeline, plummeted within the state. The 988 line, established during President Donald Trump’s first term, was intended to simplify access to mental health support, mirroring the ease of dialing 911. Yet, national data indicates Georgia is among several states struggling to maintain low rates of disconnected or rerouted 988 calls. Disconnected calls, often a consequence of prolonged wait times, represent a direct failure to connect a caller in distress with immediate assistance.
The responsibility for funding and staffing these critical 988 systems largely falls on individual states, supplemented by some federal funding. Mental health experts emphasize that adequate funding, leading to a well-staffed response network, is paramount. This directly influences whether a caller successfully connects with a local counselor or, discouraged by delays, chooses to hang up. The future of mental health services in states like Georgia is further complicated by significant policy shifts from the Trump administration, including potential Medicaid cuts. Such reductions could drastically limit access to care and, consequently, compel states to reconsider their financial commitments 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 for individuals experiencing severe mental health crises cannot be overstated. Saunders highlights the urgency of these situations, stating, "Some of the callers are actively experiencing suicidal thoughts. Sometimes they actively have a suicide plan and it’s a very urgent situation." In these critical moments, a delayed or disconnected call can have fatal consequences.
Alarm About Call Abandonment Rate
Georgia has contracted with Carelon Behavioral Health, a subsidiary of insurance giant Elevance Health, to manage its crisis lines. A significant performance decline occurred when Carelon terminated its contract with a subcontractor responsible for staffing these lines. This led to a dramatic spike in abandoned calls, meaning more individuals are hanging up or disconnecting before a counselor can answer. Kevin Tanner, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, brought this issue to Carelon’s attention in a formal letter.
The state mandates an abandonment rate of 3% or less. Tanner’s letter indicated that the rate had soared to 18%. Following this correspondence, the state revised its definition of an abandoned call, consequently lowering the reported rate. The new definition now only considers calls disconnected after being on hold for more than 30 seconds, excluding those that are rerouted to backup centers.
Carelon officials have acknowledged the performance dip, attributing it to a "necessary" transition from their vendor. They assert that efforts are underway to hire additional staff to meet the growing demand. Hieu Nguyen, a spokesperson for Carelon, stated the company’s commitment to ensuring "every Georgian in crisis can access help through 988," adding that calls not answered locally are routed to national backup centers.
Georgia allocates $17 million annually to Carelon for managing both 988 and its predecessor, the Georgia Crisis and Access Line, with a portion of this funding coming from federal sources. Crisis calls are directed to the same response team regardless of whether the 988 number or the original state line is dialed. Neither Carelon nor state officials disclosed the specific amount paid to the former subcontractor, Behavioral Health Link, with Carelon citing proprietary reasons. The state holds the option to extend its contract with Carelon through 2032.
In December, Camille Taylor, a spokesperson for the Georgia Department of Behavioral Health and Developmental Disabilities, indicated that Carelon had shown improvement in call response performance, though the state continues to closely monitor the company’s answer rates.
"Enormous" Staffing Challenges
The national 988 Suicide & Crisis Lifeline, launched in 2022, aims to connect individuals facing mental health challenges, emotional distress, or substance use concerns with trained counselors. The service provides free, confidential support and is designed to prevent mental health crises, reduce suicide risk, and assist those calling on behalf of a loved one.
Margie Balfour, a psychiatrist in Arizona and a member of a national 988 advisory committee, points to widespread difficulties in the behavioral health sector. "All behavioral health is having enormous challenges in terms of staffing," she stated. Balfour further described the role of a crisis line counselor as "a very stressful job," emphasizing that they engage with individuals "at the peak of their crisis."
Data from Vibrant Emotional Health, the national administrator of the 988 Lifeline, revealed that in December, Georgia ranked among the lowest states in terms of the percentage of calls answered and kept within the state. A significant number of Georgia’s calls were being routed to national call centers.
National data illustrates the stark variation in 988 call response times. In December, a caller in Mississippi experienced an average wait of just one second, while a caller in Virginia faced an average wait of 74 seconds. The unofficial industry benchmark for answering in-state calls is 90%. However, more than half of the states fell below this threshold in December, according to national reports. In Georgia, the rate of crisis calls answered within the state remained above 80% until March, when it dropped to 73%. This rate continued to decline, falling to 62% in April, before recovering to 72% in October and reaching 79% in December.
Saunders of KFF emphasizes the importance of local counselors, stating they "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, echoed this sentiment, suggesting that out-of-state counselors are unlikely to possess in-depth knowledge of a specific state’s mental health system and available providers. This issue is particularly concerning for predominantly Spanish-speaking callers, who may be routed to out-of-state call centers, potentially hindering their access to localized support.
Since the 988 rollout, the crisis line 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 predecessor to 988, the National Suicide Prevention Lifeline, indicated that a majority of suicidal callers interviewed after their calls reported that the conversation helped prevent them from acting on their suicidal impulses.
The urgency of these services is underscored by national statistics. In 2023, over 49,000 Americans died by suicide. Furthermore, nearly 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. For Generation Z adults, suicide is claiming more lives than it did for millennials at the same age a decade ago. A Stateline analysis of federal death statistics revealed that Georgia experienced the largest increase in suicide rates for this age group, with a 65% jump between 2014 and 2024.
Mike Hogan, a consultant with 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 reiterated that "counselors, with the right training, can talk people down and away from the suicidal crisis."
Balfour, however, noted that 988 enjoys bipartisan support and stressed that while the system is a work in progress, it remains a crucial and effective resource for individuals in crisis. "988 is a success," Balfour concluded, "And it’s work in progress."
Healthbeat is a nonprofit newsroom covering public health, published by Civic News Company and KFF Health News. Sign up for its newsletters here.