Veterans Crisis Line:
Further Efforts Needed to Improve Service
GAO-17-545T: Published: Apr 4, 2017. Publicly Released: Apr 4, 2017.
The Department of Veterans Affairs started the Veterans Crisis Line to help support veterans in emotional crisis. From 2007 to 2015, call volume increased almost 700%. As VA tried to handle the volume, some veterans were dissatisfied with the service.
This statement for the record summarizes our 2016 report on VA oversight of the crisis line. Three of the 4 recommendations in that report have not been implemented. VA has not specified targets or timeframes for assessing its call center. Also, VA has not worked with its partners to identify or address why veterans reach the National Suicide Prevention Lifeline rather than the crisis line.
Veterans Crisis Line (VCL) Milestones, Call Volume, and Funding Obligations, Fiscal Years 2007 through 2015
Bar chart showing that call volume increases have corresponded with funding increases.
What GAO Found
In May 2016, GAO found that the Department of Veterans Affairs (VA) did not meet its call response-time goals for the Veterans Crisis Line (VCL), although extended call wait times were not common; issues with text messages were also found. VA's goal was to answer 90 percent of VCL calls at the VCL primary center within 30 seconds in the period GAO studied. Calls not answered within 30 seconds were to route to VCL backup call centers; however, for 5 months of fiscal year 2015, calls were routed to VCL backup call centers after 60 seconds. According to VA officials about 65 to 75 percent of VCL calls were answered at the VCL primary center in fiscal year 2015 within either 30 or 60 seconds. GAO's covert testing in July and August 2015 confirmed this. Specifically, 119 covert test calls showed that an estimated 73 percent of calls made during this period were answered within 30 seconds. GAO also covertly tested the VCL's text messaging services and found that 4 of 14 GAO test text messages did not receive responses. GAO recommended that VA regularly test the VCL's text messaging system to identify issues and correct them promptly. In response, VA developed and implemented procedures to regularly test the VCL's text messaging system, as well as its telephone and online chat systems.
In May 2016, GAO found that VA had taken a number of steps to improve its monitoring of the VCL primary center operations. For example, VA had established a permanent VCL call center evaluation team and created a mechanism for tracking complaints about the performance of the VCL primary center from VCL callers or external parties. However, GAO found that VA had not specified quantifiable or otherwise measurable targets and had not included dates for when it would expect the VCL to complete actions covered by each key performance indicator. This was inconsistent with guidance provided by the Office of Management and Budget. GAO recommended that VA document clearly stated and measurable targets and time frames for key performance indicators needed to assess VCL performance. Although VA agreed, as of March 2017, this recommendation remains open.
GAO also found that VA had established an interagency agreement with its service partner, the Department of Health and Human Services' (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA), to manage the shared operations of the VCL and Lifeline (a public-private network that provides free and confidential support to people in suicidal crisis or emotional distress). Despite these efforts to coordinate, VA and SAMHSA did not collect information needed to assess how often and why callers intending to reach the VCL do not follow voice prompts and instead reach Lifeline local crisis centers. As a result, VA and SAMHSA did not know the extent to which this occurred and could not determine the underlying causes that may need to be addressed. GAO recommended that VA and SAMHSA (1) collect information on how often and why callers intending to reach the VCL instead reach Lifeline local crisis centers and (2) review the information collected and, if necessary, develop plans to address the underlying causes. Although VA and SAMHSA agreed, as of March 2017, these recommendations remain open.
Why GAO Did This Study
VA established the VCL in July 2007 to provide support to veterans in emotional crisis. Between fiscal years 2008, its first full year of operation, and 2015, the number of calls received by the VCL increased almost 700 percent, exceeding VA's expectations. As VA began to address increasing numbers of requests for assistance, reports of dissatisfaction with VCL's service periodically appeared in the media.
This statement summarizes GAO's May 2016 report on VA's oversight of the VCL. Specifically, the statement describes (1) the extent to which VA met response-time goals for VCL calls and text messages, (2) how VA monitored VCL primary center call center operations, and (3) how VA worked with VCL service partners to help ensure veterans receive high-quality service. For the May 2016 report, GAO visited the VCL's primary center and two backup call centers; tested VCL response time through a generalizable sample of covert telephone calls and a nongeneralizable sample of text messages in July and August 2015; reviewed internal reports and policies and plans; and interviewed VA officials. GAO contacted VA and SAMHSA for an update on actions taken in response to the report's recommendations.
What GAO Recommends
In its May 2016 report, GAO made four recommendations to VA and HHS to improve the VCL. VA and HHS concurred with the recommendations and while action has been taken on one, three remain open as of March 2017.