VA should offer more support for Veterans Crisis Line personnel, watchdog says

The Veterans Crisis Line was able to successfully implement the National Suicide Prevention Hotline’s “988 then press 1 option” for retired servicemembers in need of help but should do more to oversee and assist its responders, according to an audit released on Thursday by the Department of Veterans Affairs’ Office of Inspector General.

The 988 dialing code was designated as the nationwide phone number for connecting with crisis counselors in 2020, following action by the Federal Communications Commission and passage of the National Suicide Hotline Designation Act that codified the three-digit number. The 988 plus 1 option, which connects veterans directly with the Veterans Crisis Line, went live in July 2022.

OIG’s report found that crisis line officials successfully collaborated with the Substance Abuse and Mental Health Services Administration and “applied an external contractor’s forecasting model to predict the increase in calls” prior to the rollout of the more direct phone option. 

The anticipated increase in calls — which was forecasted to be between 122% to 154% — allowed VA to hire additional personnel, although the report found that the crisis line did not subsequently increase the number of supervisors needed to effectively oversee the new staffers. 

VA said last month that it has seen a 22.7% increase in calls to its crisis line since the dial 988 then press 1 option was launched two years ago — a “substantially lower” growth than had been predicted, the report found.

“The OIG learned that prior to the implementation of 988 press 1, the ratio of supervisor to responders was 1 to approximately 10,” the audit said. “At the time of the review, the ratio had increased to 1 supervisor responsible for approximately 20 responders.”

Crisis line officials told the watchdog that the number of personnel in need of retraining subsequently increased, which affected supervisors’ “ability to complete other responsibilities” and “may have led to difficulties in providing guidance and oversight to responders.”

Officials also expressed concern about the staff training process. The number of new personnel brought on led to training being conducted virtually, which drastically increased the amount of staffers in each session. The report said that previously 20 staffers would typically receive training at once; the number jumped to roughly 100 during implementation of the 988 then press 1 option.

OIG also found that crisis line staffers were in need of more postvention support — an intervention for those who have recently been exposed to a suicide to help with the traumatic experience. 

While both the Veterans Health Administration and the Veterans Crisis Line outline postvention standards and procedures, a survey conducted by the watchdog found that 72% of staffers were aware of these services. Another 72% of personnel “responded feeling supported by their supervisors to access postvention resources.”

The watchdog said it was concerned that both of these numbers were not closer to 100% and said that postvention resources should receive more visibility. 

OIG recommended that crisis line officials work to ensure an appropriate ratio of staffers to supervisors and enhance awareness of postvention resources. VA concurred with both recommendations and said that, as of last month, it was maintaining a ratio of less than 10 responders to every supervisor.

Beyond the use of the crisis line, VA has also been looking into leveraging artificial intelligence capabilities to identify veterans who are at a high risk of suicide. Some of these use cases include using AI to analyze clinical notes for signs of self harm, as well as using AI to parse signs of mental distress from surveys emailed to veterans.