988 call responses plummet in Georgia after insurer cutbacks

Since the 988 crisis hotline launched in July 2022, it has become a lifesaving resource for millions of Americans. It routes calls to local operators in each state who help people in crisis and can connect them to local resources, like therapy, to help them get well.

Kaitlin Cooke credits Georgia’s crisis hotline, which predates the national one, with saving her life. “If it weren’t for this resource, I might have been a statistic,” she told KFF Health News,  

Starting last March, Georgia’s response rate to mental health crisis calls “fell off a cliff” following a decision by Carelon Behavioral Health, who runs the lines, to drop a subcontractor that handled staffing.

Carelon is a subsidiary of Elevance Health, an insurance agency, and its response teams answer calls to Georgia’s local line and the national number. If a local center can’t answer 988 call they are routed to a national backup network.

At issue is the sharp rise in abandoned calls – when callers hang up before they’re connected to a counselor.

Georgia requires a call abandonment rate of 3% or less, but had one at 18%, according to a letter sent to Carelon by Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities.

Since that letter went out, state officials have changed what qualifies as an abandoned call – excluding those abandoned after less than 30 seconds, and those routed to national backup centers – making the rate artificially lower.

In April, only 62% of calls were answered within the state – the industry’s unofficial target is 90%. While it has recovered in the months since, people in severe mental health crises needed help throughout, and still do. 

“Some of the callers are actively experiencing suicidal thoughts,” said Heather Saunders, a senior research manager at KFF. “Sometimes they actively have a suicide plan and it’s a very urgent situation.”

As suicides rise among young adults – with the largest such rise recorded in Georgia – the urgency to ensure they’re connected to help couldn’t be higher. Yet its future looks tenuous as federal cuts to Medicaid threaten funds for state crisis lines, many of which are already under-resourced, she said.

“All behavioral health is having enormous challenges in terms of staffing,” said psychiatrist Margie Balfour, 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.”