When Suicidal Calls Come In, Who Answers? Georgia Crisis Line Response Rates Reveal Gaps

If you or someone you know is 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 from behind her car, where her boyfriend wouldn’t hear her.

The counselors who answered her calls were there for her when no one else was, she said. Every time she called, they talked to her for at least 45 minutes. And they told him that life “gets better.”

“Without that resource, I might have been a statistic,” said Cooke, now 31, who found a local therapist.

Starting in March, the number of responses to calls for that resource, the Georgia Crisis and Access Line, and its new 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 that Georgia is one of several states that has struggled to keep their rates of disconnected or redirected 988 calls low. Disconnected calls usually 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 coming from the federal government. Mental health experts said adequate funding for a state’s 988 system, 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 made by the Trump administration, including cuts to Medicaid that could limit access to care. The reductions could also lead states to consider reducing their allocations to crisis lines, said Heather Saunders, senior research director for the program on Medicaid and the uninsured at KFF, a nonprofit health news organization that includes KFF Health News.

The stakes couldn’t be higher for callers facing serious mental health crises.

“Some of the callers are actively having suicidal thoughts,” Saunders said. “Sometimes they actively have a suicide plan and it’s a very urgent situation.”

Call abandonment rate alarm

Georgia contracts with Carelon Behavioral Health, a unit of insurance giant Elevance Health, to manage its crisis lines. When Carelon dropped a subcontractor that managed line staff, performance plummeted. Abandoned calls increased, meaning 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, noted in a letter to Carelon.

The state requires a call abandonment rate of 3 percent or less and, Tanner wrote, the current rate is 18 percent. After sending the letter, the state narrowed its definition of abandoned calls, lowering the current rate. The state now only counts calls disconnected after being on hold for more than 30 seconds and not those redirected to backup centers.

Carelon officials acknowledged the decline in performance. They said this reflected a “necessary” transition by the company’s supplier and that they were hiring more staff to ensure crisis lines could meet 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 relief centers.

With the help of federal funding, Georgia pays Carelon $17 million a year to operate 988 and its predecessor, the Georgia Crisis and Access Line, which is still in operation. Crisis calls are sent to the same response team whether someone calls 988 or the state’s origination line. Carelon and state officials declined to disclose how much of the money was paid to the contractor, Behavioral Health Link, with Carelon saying it was proprietary information. The State can extend its contract with Carelon until 2032.

Camille Taylor, a spokeswoman for the state Department of Behavioral Health and Developmental Disabilities, said in December that Carelon had improved its call answering performance, but the state continued to monitor the company’s response rates.

“Huge” staffing challenges

Launched in 2022, the national 988 Suicide & Crisis Lifeline connects people experiencing mental health issues, emotional distress, or substance use problems to qualified counselors. This toll-free helpline, whose three-digit number reflects the ease of dialing 911, aims to help prevent mental health crises and reduce the risk of suicide. It also supports people calling someone they care about.

“All behavioral health has enormous challenges in terms of staffing,” said Margie Balfour, an Arizona psychiatrist and 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 height of their crisis.”

In December, Georgia ranked near the bottom of the 50 states in the percentage of answered calls it kept in the state, according to Vibrant Emotional Health, which administers the 988 line nationally. A large number of Georgian calls were routed to domestic call centers, the data shows.

The latest national data also showed how response times to a 988 call can vary. In December, it took an average of one second to call from Mississippi. It took a caller from Virginia 74 seconds.

While the industry’s unofficial target rate for answering calls in the state is 90%, more than half of states fell below that mark in December, according to national data. In Georgia, 988 tracking data showed that more than 80% of crisis calls were answered within the state — until March, when that number dropped to 73%. Then it fell again in April, to 62%. The rate rose to 72% in October and 79% in December.

Local counselors “should be more familiar with the state’s infrastructure, the mental health system and the resources available to people living in the state,” KFF’s Saunders said.

Pierluigi Mancini, interim president and CEO of Mental Health America, said it’s unlikely a foreign adviser would know much about the state’s mental health system and providers. The service also sends many callers, mostly Spanish-speaking, to out-of-state call centers, which can hinder their connection with local help, Mancini said.

Since the deployment of 988, the volume of calls, texts and chats to the crisis line totaled more than 19 million in November, according to the Substance Abuse and Mental Health Services Administration. One study found that with 988’s national predecessor, the National Suicide Prevention Lifeline, most suicidal callers who were subsequently surveyed said their call helped prevent them from committing suicide.