The Veterans Crisis Line's process for handling abusive or disruptive callers may be harming both veterans and the employees who answer the phones at the suicide helpline, according to a recently released government watchdog investigation.
In an effort to reduce wait times for callers, more calls meant for the so-called "Customers with Complex Needs" unit began being redirected to the main phone line last year, but most responders on the main line don't have the proper training for complex callers, the Government Accountability Office, or GAO, found in a report released last week.
"This creates a risk to the quality of service provided to the caller and causes increased stress and burnout for responders," Alyssa Hundrup, director of the GAO's health care team, testified at a Senate hearing last week unveiling the findings of the investigation.
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The GAO's finding came in an investigation that was requested by Senate Veterans Affairs Committee Chairman Jerry Moran, R-Kan., after whistleblowers came forward to his office to allege that difficult callers to the Veterans Crisis Line, or VCL, were being passed off to an understaffed and undertrained complex needs unit.
After Moran first publicized the allegations and requested the GAO investigation in November 2023, the Department of Veterans Affairs defended the existence of the unit as a common, evidence-based practice at crisis call centers and maintained that more than 120 responders were fully trained for the unit.
In response to the GAO findings, the VA promised to assess the outcomes of calls to the complex unit compared to the main line and make changes to staffing and procedures based on the assessment.
"VA is committed to preventing veteran suicides and providing critical support in moments of crisis," Thomas O'Toole, the VA's deputy assistant under secretary for health for clinical services, said at last week's hearing. "As we confront an ever-increasing volume of contacts, we remain focused on ensuring that every veteran receives the immediate and effective support they need."
The complex needs unit was created in 2017 to handle VCL callers who are abusive, exhibit sexually inappropriate behavior, threaten violence against responders, or call at a particularly high frequency, according to the GAO report. The training for the unit includes 32 hours of specialized classroom instruction and shadowing more experienced members of the unit.
Prior to March 2024, if callers being directed to the complex needs unit were on hold for more than three minutes, they would be sent back to the main phone line. But that month, the policy changed, and complex callers are being sent to the main phone line if a member of the special unit isn't immediately available, according to the report.
The change was made despite the fact that more than 84% of main phone line responders don't have the specialized complex needs training, the report said.
The change did result in wait times dropping, but also caused a spike in calls meant for the complex needs unit being handled by main line responders without proper training, according to the report. More than 6,000 calls meant for the complex needs unit were handled by the main line from March 2024 through September, compared to less than 14,000 in the three years before that.
Marcia Blane, a former responder at the VCL who testified at last week's hearing, described handling complex callers who would call 30 to 40 times a day with the intention of crashing the VCL and were "calling us every racial epithet they know and suggesting someone sexually assault us."
"Can you imagine what those words do to the nervous system of someone who has no recourse, no defense?" Blane, who left the VCL in May, said at the hearing. The callers with the complex needs team are "constantly understaffed, and the calls are still often handled by main line responders, which again, taxes the broader system, defeating the purpose of the specialized team."
VA officials told the GAO they chose to redirect more calls to the main line rather than increasing staff for the specialized line because they "assume" main line responders can handle the complex calls by following established protocols, the report said.
"However, in our survey, main phone line responders indicated that they faced problems interacting with difficult or abusive CWCNs," the GAO report said, using an abbreviation for customers with complex needs. "At the same time, about half of the responders who answered our survey reported feeling burnt out from their work at the VCL."
Whistleblowers came forward to Moran's office after a Senate Veterans Affairs Committee hearing in 2023 about a VA inspector general investigation that detailed the failure of the VCL to help a veteran who texted the hotline and died by suicide minutes after cutting off contact. The inspector general investigation found systemic issues at the VCL in addition to its failure in the specific veteran's case.
Brad Combs, former lead auditor at the VCL from 2019 to 2023, was the first whistleblower to approach Moran's office and also testified at last week's hearing. Illustrating the issues he saw while working at the VCL, Combs said a call that was meant for the complex needs unit was once transferred to him.
Callers with complex needs have been pushed "into a deep dark hole," he said, adding that "as indifference to these callers [has] continued, several clinicians have left VCL in protest."
-- If you are a service member or veteran who needs help, it is available 24/7 at the Veterans and Military Crisis Line, call 988, Press 1; text 988; or use the online chat function at www.veteranscrisisline.net.
