"The future of mental health services appears uncertain amid massive changes… mental health experts said proper funding for the 988 system in a state, through a well-staffed response network, can influence whether a caller is connected to a local counselor – or chooses to hang up."
This critical takeaway underscores the precarious state of mental health crisis support in Georgia and potentially across the nation. The 988 Suicide & Crisis Lifeline, a vital resource designed to connect individuals in distress with immediate help, is experiencing significant challenges in maintaining its operational efficiency, particularly concerning call abandonment rates. The article delves into the systemic issues, including funding disparities and staffing shortages, that are impacting the lifeline’s ability to serve its intended purpose, potentially leaving vulnerable individuals without timely and effective support during their most desperate moments.
Georgia’s 988 Lifeline Struggles Amidst Operational Setbacks and Funding Concerns
Georgia is confronting a significant decline in its ability to connect individuals in mental health crises with counselors through the 988 Suicide & Crisis Lifeline. Data reveals a sharp increase in call abandonment rates, a critical issue that compromises the effectiveness of this essential public health service. The situation in Georgia mirrors broader national challenges in adequately funding and staffing crisis intervention networks, raising serious concerns about the accessibility and reliability of mental health support for those in urgent need.
Kaitlin Cooke, a 31-year-old resident of Cartersville, Georgia, recounted her personal experience with the state’s crisis line in 2018, a time when she was contemplating suicide. She described seeking privacy to make calls to the Georgia Crisis and Access Line, often from behind her car to conceal her distress from her boyfriend. The counselors who answered her calls provided crucial support, engaging with her for at least 45 minutes during each interaction and offering words of hope, such as "life does get better." Cooke attributes her survival to this resource, stating, "If it weren’t for this resource, I might have been a statistic," before eventually finding a local therapist.
However, starting in March, the performance of the Georgia Crisis and Access Line, and its national counterpart, the 988 Suicide & Crisis Lifeline, has seen a marked deterioration in the state. This decline is reflected in plummeting call response records. The 988 line, established during President Donald Trump’s first term, was intended to streamline access to mental health support. Yet, national data indicates that Georgia is among several states struggling to keep their rates of disconnected or rerouted 988 calls to a minimum. Disconnected calls often result from lengthy wait times, leading callers to hang up before receiving assistance. The responsibility for funding and staffing these critical 988 systems largely falls on individual states, supplemented by federal funding. Mental health experts emphasize that adequate state-level investment in a robust, well-staffed response network is paramount to ensuring callers are successfully connected to local counselors rather than abandoning their calls.
The broader landscape of mental health services faces an uncertain future, exacerbated by significant policy shifts under the Trump administration, including proposed Medicaid cuts that could curtail access to care. These potential reductions in federal funding could compel states to re-evaluate their financial allocations 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 measures could have dire consequences. The stakes are exceptionally high for individuals experiencing severe mental health crises. "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."
Alarming Call Abandonment Rates and Contractual Disruptions
Georgia has contracted with Carelon Behavioral Health, a division of the insurance giant Elevance Health, to manage its crisis lines. A significant performance plunge occurred when Carelon terminated its contract with a subcontractor responsible for staffing these lines. This action led to a surge in abandoned calls, meaning a greater number of individuals are disconnecting or hanging up before a counselor can answer. Kevin Tanner, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, highlighted this issue in a letter to Carelon, noting that the state’s required call abandonment rate is 3% or less, while the current rate had escalated to 18%.
Following Tanner’s letter, the state revised its definition of abandoned calls, thereby lowering the reported rate. The current measurement now exclusively includes 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 previous vendor. They stated that efforts are underway to hire additional staff to meet the increasing demand for crisis services. Hieu Nguyen, a spokesperson for Carelon, affirmed the company’s commitment: "We are committed to ensuring that every Georgian in crisis can access help through 988," adding that calls not answered locally are redirected to national backup centers.
With the support of federal funding, Georgia allocates $17 million annually to Carelon for the management of both the 988 Lifeline and its predecessor, the Georgia Crisis and Access Line, which remains operational. Individuals calling either the 988 number or the original state line are directed to the same response team. Both Carelon and state officials declined to disclose the specific amount paid to the former subcontractor, Behavioral Health Link, citing proprietary reasons. The state retains 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 improved its call response performance, but the state continues to closely monitor the company’s answer rates.
The "Enormous" Staffing Challenges Facing Crisis Hotlines
Launched nationwide in 2022, the 988 Suicide & Crisis Lifeline provides immediate connection for individuals experiencing mental health challenges, emotional distress, or substance use concerns to trained counselors. The ease of dialing the three-digit number, mirroring 911, aims to prevent mental health crises, reduce suicide risk, and support those calling on behalf of a loved one.
However, the behavioral health sector is grappling with "enormous challenges in terms of staffing," according to Margie Balfour, an Arizona psychiatrist and member of a national 988 advisory committee. Balfour described the role of a crisis line counselor as "a very stressful job" due to the nature of speaking with individuals at the peak of their distress.
Data from Vibrant Emotional Health, the national administrator of the 988 Lifeline, revealed in December that Georgia ranked near the bottom among all 50 states in the percentage of calls answered within the state. A significant number of calls originating from Georgia were routed to national call centers. This routing pattern has implications for the quality and relevance of the support provided.
National data also illustrates considerable variation in 988 call response times. In December, callers in Mississippi experienced an average wait time of one second, while those in Virginia waited an average of 74 seconds. While the generally accepted industry target for answering in-state calls is 90%, more than half of the states fell below this benchmark in December, according to national data. In Georgia, the tracking data for 988 showed that over 80% of crisis calls were answered within the state until March, when the rate dropped to 73%. This figure further declined to 62% in April before rising to 72% in October and reaching 79% in December.
"Local counselors should be more familiar with the state infrastructure, mental health system, and resources that are available to people who live in the state," commented Saunders of KFF. Pierluigi Mancini, interim president and CEO of Mental Health America, echoed this sentiment, noting the unlikelihood of an out-of-state counselor possessing in-depth knowledge of a specific state’s 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 localized 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 indicates that with the National Suicide Prevention Lifeline, the predecessor to 988, a majority of suicidal callers interviewed reported that their calls helped prevent them from taking their lives.
The urgency of these services is underscored by stark statistics. In 2023, over 49,000 Americans died by suicide. Nearly 17 million Americans aged 12 and older reported having seriously considered 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. Stateline’s analysis of federal death statistics shows the largest increase in suicide rates for this age group occurred in Georgia, with a 65% jump between 2014 and 2024.
Mike Hogan, a consultant with extensive experience managing mental health systems in three states, characterized recent Georgia data as reflective of "a bungled transition. It looks like performance fell off a cliff." He emphasized the critical role of counselors with appropriate training in de-escalating suicidal crises.
Despite these challenges, Balfour maintained that 988 enjoys bipartisan support and that the system, while a work in progress, is a crucial and effective resource. "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.