If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”
Kaitlin Cooke of Cartersville, Georgia, was contemplating suicide when she started calling a statewide mental health crisis line in 2018. She said she would sneak outside and call the hotline behind her car, where her boyfriend would not hear her.
The counselors who answered her calls were there for her when no one else was, she said. Each time she called, they spoke to her for at least 45 minutes. And they told her that life “does get better.”
“If it weren’t for this resource, I might have been a statistic,” said Cooke, now 31, who found a local therapist.
Starting in March, the call response record for that resource, the Georgia Crisis and Access Line, and its newer national counterpart, the 988 Suicide & Crisis Lifeline, plummeted in the state. The 988 line was created during President Donald Trump’s first term.
National data shows Georgia is one of several states that have struggled to keep their rates of disconnected or rerouted 988 calls low. Disconnected calls typically involve the caller hanging up, possibly after a long wait time. States are largely responsible for funding and staffing their 988 systems, with some money from the federal government. 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.
The future of mental health services appears uncertain amid massive changes from the Trump administration, including Medicaid cuts that could limit access to care. The cuts could also lead states to consider reducing their allocations to crisis lines, said Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News.
The stakes couldn’t be higher for callers experiencing severe mental health crises.
“Some of the callers are actively experiencing suicidal thoughts,” Saunders said. “Sometimes they actively have a suicide plan and it’s a very urgent situation.”
Alarm About Call Abandonment Rate
Georgia has contracted with Carelon Behavioral Health, a unit of insurance giant Elevance Health, to run its crisis lines. When Carelon dropped a subcontractor that managed staffing the lines, performance plunged. Abandoned calls spiked, which means more callers were hanging up or disconnecting before a counselor answered the phone, Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, pointed out in a letter to Carelon.
The state requires a call abandonment rate of 3% or less, and, Tanner wrote, the current rate was 18%. After sending the letter, the state narrowed its definition of abandoned calls, lowering the current rate. The state now counts only calls disconnected after being on hold for more than 30 seconds and not those rerouted to backup centers.
Carelon officials have acknowledged the dip in performance. They said it reflected a “necessary” transition from the company’s vendor and that they were hiring more staff to ensure the crisis lines could handle the demand. Carelon spokesperson Hieu Nguyen said the company is “committed to ensuring that every Georgian in crisis can access help through 988,” noting that calls not answered locally are routed to national backup centers.
With the help of some federal funding, Georgia is paying Carelon $17 million annually to manage 988 and its predecessor, the Georgia Crisis and Access Line, which is still operating. Crisis calls go to the same response team, whether someone calls 988 or the original state line. Carelon and state officials declined to disclose how much of the money went to the subcontractor, Behavioral Health Link, with Carelon saying it is proprietary information. The state can extend its contract with Carelon to 2032.
Camille Taylor, a spokesperson for the state Department of Behavioral Health and Developmental Disabilities, said in December that Carelon had improved its call response performance but that the state continues to monitor the company’s answer rates.
‘Enormous’ Staffing Challenges
Launched in 2022, the national 988 Suicide & Crisis Lifeline connects people experiencing mental health problems, emotional distress, or alcohol or drug use concerns to trained counselors. The free hotline, with the three-digit number mirroring the ease of dialing 911, aims to help avert mental health crises and reduce suicide risk. It also supports people who call for someone they care about.
“All behavioral health is having enormous challenges in terms of staffing,” said Margie Balfour, an Arizona psychiatrist and a member of a national 988 advisory committee. Being a crisis line counselor “is a very stressful job,” she said. “You’re talking to people at the peak of their crisis.”
In December, Georgia ranked near the bottom of the 50 states in percentage of calls answered that it kept in state, according to Vibrant Emotional Health, which administers the 988 line nationally. A high number of Georgia calls were routed to national call centers, data showed.
The latest national data also showed how different the response times to a 988 call can be. In December, it took one second on average if someone called from Mississippi. It took 74 seconds for a caller from Virginia.
While the unofficial industry target rate for answering in-state calls is 90%, more than half the states fell below that mark in December, according to the national data. In Georgia, the tracking data for 988 showed that more than 80% of crisis calls were answered within the state — until March, when the number dropped to 73%. Then it fell again in April, to 62%. The rate rose to 72% in October and reached 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,” said Saunders of KFF.
Pierluigi Mancini, interim president and CEO of Mental Health America, said it’s unlikely that an out-of-state counselor would know much about that state’s mental health system and providers. The service also sends many predominantly Spanish-speaking callers to out-of-state call centers, possibly hindering their connection to local help, Mancini said.
Since the 988 rollout, the volume of calls, texts, and chats to the crisis line totaled more than 19 million by November, according to the Substance Abuse and Mental Health Services Administration. A study found that with the national predecessor to 988, the National Suicide Prevention Lifeline, most suicidal callers who were later interviewed said their call helped stop them from killing themselves.
More than 49,000 Americans died by suicide in 2023. Nearly 17 million Americans ages 12 and older said in 2024 they had seriously thought about suicide in the previous year, according to the National Survey on Drug Use and Health.
For Generation Z adults, the oldest of whom are now reaching their late 20s, suicide is taking more lives than a decade ago when millennials were the same age, according to a Stateline analysis of federal death statistics. The largest increase in suicide rates for the age group was in Georgia, which jumped 65% from 2014 to 2024.
Mike Hogan, a consultant who ran mental health systems in three states, said recent Georgia data reflects “a bungled transition. It looks like performance fell off a cliff.”
For people calling a crisis line, he said, “counselors, with the right training, can talk people down and away from the suicidal crisis.”
Balfour noted that 988 has bipartisan support. The system can be improved, she said, emphasizing that it’s still an important resource that’s effectively helping people in crisis.
“988 is a success,” Balfour said. “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.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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