The phone lines at Georgia’s crisis call center lit up for days after comedian Robin Williams took his own life in 2014. And the call volume spiked again when celebrity chef and popular TV show host Anthony Bourdain committed suicide in 2018.
These celebrity suicides left callers struggling to reconcile the happy and confident on-screen personas they had known for years with the tragic way their lives came to an end.
“I think it’s really hard for people to get their arms around it when someone did not appear the way that they ended up feeling,” said Andrea Corley, who is the director of the state’s call center and a licensed professional counselor.
And then along came the pandemic in 2020, upending life as many knew it. People suddenly found themselves isolated, cut off from the social interactions and outings that once filled their day, and were left fearful of catching a little-understood virus and spreading it to loved ones.
Call volume at the crisis center jumped again, ultimately growing by 24% at the height of the pandemic. The higher call volume and workforce shortages hamstrung the state’s call center, causing average wait times of more than three minutes and resulting in a third of callers hanging up.
As of last month, callers were only waiting about 30 seconds on average for someone to answer, but the higher call volume has not gone away.
“Now that we’re coming out of the worst of the pandemic, people are really starting to kind of get back to ‘normal life’ and are realizing they’ve got anxiety, they’ve got depression, they’ve got things that maybe they weren’t even aware of during the (pandemic) because everyone was in somewhat of a just survival mood, getting through day by day,” Corley said.
Now, state behavioral health officials are bracing for another sustained surge in calls and texts expected through the new National Suicide Prevention Lifeline that officially launches Saturday. For the first time, there will be a simple three-digit national calling code – 988 – created to make it easier than ever for someone in crisis to pick up a phone and ask for help.
The number of calls and texts coming into Georgia’s call center could as much as double by next year, although right now it is really anyone’s guess as to how quickly the call volume will grow and by how much.
‘We’re asking folks to be patient with us’
Since Georgia already has a long-established crisis call center, the state had an advantage over states that were starting from scratch when the federal law creating 988 was passed in 2020.
The state’s call center, known as the Georgia Crisis and Access Line, grew out of the need for a go-to number for Hurricane Katrina transplants after the devastating 2005 storm.
But the folks who answer the hundreds of calls and texts that come in each day are meant to be more than a compassionate voice on the other end of the line.
Their job is to also help connect people with services and assistance if needed, whether it’s sending out a mobile crisis team to deescalate a situation or identifying care options. And this is where the rollout of 988 becomes more complicated for Georgia.
Judy Fitzgerald, commissioner of the state Department of Behavioral Health and Developmental Disabilities, has called the multiyear rollout of 988 “the largest transformation in behavioral health crisis response our state has ever seen.”
It will take time and an infusion of new, not-yet-identified funding, though, to get there. The state agency is projected to need an additional $283 million annually, as well as about $150 million for one-time construction costs for projects like additional and modernized crisis units around the state.
“The good news is there’s awareness that there’s a place to call, but we are hustling right alongside of that to build the infrastructure to respond,” Fitzgerald said in an interview this month.
Fitzgerald has raised the issue of funding with state lawmakers, but she also vowed to bring them the data needed to justify new spending. She expects the increased call volume through 988 to provide more insights soon about which services are most in demand here.
This year, state lawmakers added about $1.5 million to the agency’s budget to help increase the call center’s staffing, as well as about $7 million to add bed spaces at crisis centers in Augusta and Columbus.
The federal law that created 988 – which was signed into law by former Republican President Donald Trump in 2020 – allows states to pass a telecommunication fee to help pay for the buildout. In Georgia, there is a $1.50 fee on phone bills to help pay for 911, which raises about $20 million every month to support emergency services.
The state’s revenues also continue to grow, with last fiscal year’s total collections up by $6 billion over the previous year.
The rollout of 988 comes on the heels of a legislative session where mental health and substance abuse concerns generated overwhelming bipartisan support for a bill meant to be a first major step toward improving access in Georgia.
Kaleb McMichen, spokesman for Republican House Speaker David Ralston, who put all his political might behind this year’s bill, said Thursday they are expecting a “long ramp-up process” with 988.
“As it continues we will have continuing dialog with DBHDD both about the rollout process and any additional resources which may be needed,” McMichen said.
For now, Fitzgerald’s agency is taking steps to prioritize groups considered at high-risk for suicide and self-harm in hopes of helping the state’s most vulnerable residents without overwhelming the system. That targeted outreach has centered on young people, veterans, older adults and members of the LGBTQ community.
“Every state in the country is doing what we are, which is walking this fine line with how do we get ready but also, how do we not over promise anything we can’t deliver right now?” Fitzgerald said.
The federal government has decided to hold off on marketing 988 to give states more time to adapt.
“The infrastructure that we think will be in place in five years, it’s going to take time to build that and we’re asking folks to be patient with us as we go along in that process,” Fitzgerald said.
Somewhere to go
Already, the majority of Georgia Crisis and Access Line’s referrals go to local community service boards across the state. So, if call volume increases as expected, Georgia’s 22 CSBs will likely see an uptick in people turning to them for help.
These local organizations play a key role in providing behavioral health services to uninsured Georgians, people with limited means to pay and those covered by Medicaid. Those administrators are watching closely to see how quickly the public embraces 988.
“We really just don’t know. We don’t know how big this is going to be and how quickly we’ll be impacted by it,” said David Kidd, who is a board member for both the Athens-based Advantage Behavioral Health Systems and the Georgia Association of Community Service Boards.
The 988 rollout begins as these local providers continue to grapple with staffing shortages even as the pandemic has brought more people through their doors. Many people who reached the state’s call center were referred to the local organizations’ crisis stabilization units and behavioral health crisis centers.
Melanie Dallas, the chief executive officer of the Highland Rivers Behavioral Health in northwest Georgia, says she believes 988 will help improve access to care in Georgia. But it is by no means a panacea for the state’s challenges, she said.
“We really have to still have a systemic view of what’s available and how people access care at the local level within our communities and that those partnerships are going to be really critical and really important to how Georgia responds to potentially greater access, greater numbers of people calling in to seek mental health services,” said Dallas, who is also a board member for the Georgia Association of Community Service Boards.
Dallas says she will leave it to state elected officials to figure out how best to pay for the services, whether it’s through a fee or another method. But she and Kidd say they believe the public will support chipping in after likely being personally affected in some way by mental health and substance abuse issues in recent years.
“I truly believe that people see the need and feel like something needs to be done,” Dallas said. “Whether they’re going to agree with what this is, I don’t really know. But I think that people, when they understand it, see the need.
“Because I think there’s too many people who have experienced the frustration of trying to help a loved one gain access to a system that is not really easy to access,” she said. “And I think that that is becoming a universal experience that people are sharing.”
‘It’s not going to be a silver bullet’
Advocates are also cautioning against viewing 988 as a fix for longstanding problems that have been building for decades.
They argue it will take time to improve behavioral health care in Georgia, which ranks near last place for access to care according to Mental Health America.
And even if funding quickly materializes for behavioral health services to serve 988 callers, the realities of ongoing workforce shortages will likely continue to undermine efforts to provide timely care.
“It’s not going to be a silver bullet,” said Kim Jones, executive director of the National Alliance on Mental Health’s Georgia chapter. “It took us a long time to get in this situation here in Georgia, and it’s going to take us a long time to clean it up.
“And I think that’s the most important thing for people to understand and not have unrealistic expectations for either the work that we’re doing at the (state) Capitol or 988 or anything. This is a very complex, complicated system that is going to take years to fix,” Jones said.
More needs to be done, Jones said, to prevent people from reaching a crisis state. “How do we turn off the faucet?” she said.
But when people do need services during and after a crisis, where are they going to find it and how will it be funded, asks Roland Behm, who serves on the board for the Georgia chapter of the American Foundation for Suicide Prevention.
Georgia may be well situated to receive the increased calls through 988, but the state’s downstream crisis care resources are already stretched thin, Behm said. It can be especially challenging for Georgians to access care in a crisis situation close to home, he said.
But Behm said he believes the initiative can be transformative if funding is dedicated to fully implement Congress’ vision for 988 and increase community-based behavioral health services.
“This isn’t just an issue of a phone number and a phone number working. This is a commitment to care for behavioral health crises in Georgia,” he said.
This story was written by Jill Nolin, State Government Reporter at the Georgia Recorder, where this story first appeared.