VA veterans crisis line to face new investigation by congressional watchdog agency

Editor’s note: The 988 Suicide and Crisis Lifeline and the Crisis Text Line provide 24/7 support for anyone thinking about committing suicide by dialing 988. The veterans crisis line is available by dialing 1-800-273-8255 and pressing 1 or by sending a text message to 838255. The Veterans Crisis Chat is available here. 

WASHINGTON — The Government Accountability Office plans to investigate multiple whistleblower allegations of “gross mismanagement” at the Department of Veterans Affairs veterans crisis line, following a request from Kansas Republican Sen. Jerry Moran, States Newsroom has learned.

Moran, ranking member on the Senate Veterans’ Affairs Committee, sent a letter to the VA secretary this week urging the department to fully cooperate with the investigation by the congressional watchdog agency and expressing frustration with the way some veterans are being transferred after calling the crisis line.

Several whistleblowers have told Moran and his staff that veterans crisis line “responders are currently transferring veterans determined to present complex needs to an indefinite waiting list for eventual contact from a special unit,” according to the letter.

While the veterans crisis line must “be staffed by appropriately trained mental health personnel and available at all times,” the whistleblowers have alleged the unit that is supposed to address “callers with complex needs” is “severely understaffed and undertrained,” according to Moran’s letter.

“Worse yet, a break in record retention is reportedly resulting in a complete loss of communication with veterans who are disconnected while waiting on hold in this queue,” Moran wrote to VA Secretary Denis McDonough.

Moran urged the VA to fully cooperate with the Government Accountability Office investigation, but said the department shouldn’t wait until the federal agency issues a report to address concerns about the veterans crisis line.

VA secretary responds to senator in three-page letter

Republican staff on the Senate Veterans’ Affairs Committee, speaking on background to a small group of reporters, said that if a veteran calling the crisis line displays “disruptive behavior” that person may be transferred to the “callers with complex needs unit.”

Whistleblowers told the GOP committee staff that could include a veteran using swear words. But one staffer noted that “when someone is at a time of crisis, they’re not choosing their words appropriately, so we have a lot of concern about that.”

How the veteran crisis line handles ‘callers with complex needs’

McDonough wrote in his letter that he wanted to share additional information with Moran about why staff members at the veterans crisis line transfer people to the “callers with complex needs” program. That process is at the center of Moran’s concerns.

“Callers with complex needs are known callers who display inappropriately abusive behavior (e.g. cursing at responders or being racist toward responders); sexual behavior; or high-frequency calling for a purpose other than crisis support (e.g. calling VCL hundreds of times per day),” McDonough wrote.

“Oftentimes, these callers are not veterans — or those calling on behalf of veterans — and can take up resources that would normally be used to serve veterans in immediate crisis,” McDonough added.

Another staffer said, “The callers are transferred and placed on hold in an informal queue where they are left to wait for a responder on the callers with complex needs unit.”

“If they’re disconnected on their own or are disconnected for any reason, then a break in the record leads to no further contacts from the (veterans crisis line) because they haven’t retained that caller’s information,” that staffer said.

The complex needs program, McDonough wrote, was established in the spring of 2018 and consists of more than 100 staff who receive 32 hours of training on “behavior-shaping, boundary-setting and coaching.”

“In the rare situation that we come close to capacity for (callers with complex needs) callers during any shift, we will add staff to that shift, using overtime and other tools,” McDonough wrote.

Sometimes people transferred to the callers with complex needs unit will receive a “selectively delayed response,” which McDonough wrote is a “best practice” that can help those people “modify their behavior by pausing their engagement with a responder.”

“While engaged in a delay, the caller hears a caring message about why they are waiting for a response, how to shape their behavior to be removed from a hold, and what to do if in crisis,” McDonough wrote. “Crucially, there is always an option for these callers to connect to support immediately if they are experiencing an urgent crisis, and these callers are neither placed on indefinite holds nor involuntarily disconnected.”

Those callers also have “extensive records” within the veterans crisis line, meaning that even if they are disconnected from the call for any reason, there is “no break in record retention,” he wrote.

The GOP Veterans’ Affairs Committee staffers who spoke to reporters declined to provide details about the whistleblowers to protect the whistleblowers’ anonymity. But the staffers said the “multiple” whistleblowers are current and former VA employees, whom they described as “highly credible.”

Earlier problems with veteran crisis line

This isn’t the first time senators or watchdogs have expressed concerns with the veterans crisis line.

The VA Office of Inspector General released a 95-page report in mid-September after a person who used the crisis line committed suicide.

The report found that one employee of the veterans crisis line “did not complete an adequate assessment of the patient’s suicide risk factors, including the patient’s suicidal preparatory behavior and alcohol use, during the text conversation.”

That person also “failed to adequately pursue actions to address the patient’s suicidal preparatory behavior, including reducing access to immediate lethal means,” according to the Inspector General report.

The report included 14 separate recommendations for the veterans crisis line and the South Texas Veterans Health Care System.

The Senate Veterans’ Affairs Committee, chaired by Montana Democratic Sen. Jon Tester, held a hearing in late September on veterans’ mental health, including concerns from several lawmakers about the crisis line.

“Last week, a new IG report was released raising more concerns about the veterans crisis line,” Tester said during that hearing. “The veterans crisis line is a lifesaving resource for veterans and it must be a top performing entity within the VA, but as made clear by recent IG reports, it simply is not.”

Matthew Miller, executive director for suicide prevention at the Veterans Health Administration within the Department of Veterans Affairs, testified at the hearing that the agency is “better than what was depicted in that report and we have to do better than what was depicted in that report.”

Miller told senators the department had made progress on eight of the 11 recommendations in the Inspector General report that were specifically addressed to the veterans crisis line.

Louisiana Republican Sen. Bill Cassidy said during the hearing the Inspector General report was “incredibly damning.”

“I’m struck that the executive director who apparently interfered with the OIG report was not fired,” Cassidy said.

“Now we’ve passed accountability measures for people who don’t do their job, and it sounds like interfering with an investigation of a suicide, which may have been inappropriately handled on a veterans’ crisis line, is incompetence,” Cassidy added.

The Inspector General report said investigators “concluded that the director, quality and training, provided advice and information to Responder 1 prior to interviews with the OIG that potentially compromised Responder 1’s candidness.”

The Department of Veterans Affairs and Government Accountability Office didn’t return requests for comment.