VA Defends Crisis Line Amid Criticisms from Congress, Recent Reports

by U.S. Medicine

May 19, 2017

By Sandra Basu

VA officials insisted last month that the Veterans Crisis Line (VCL) “is the strongest it has been since its inception in 2007.” This VA photo shows employees fielding calls.

WASHINGTON — Despite criticism from recent government reports, VA officials insisted last month that the Veterans Crisis Line (VCL) “is the strongest it has been since its inception in 2007.”

“In the past six months, VCL has nearly doubled the capacity to ensure appropriate access to veterans,” pointed out VHA Deputy Under Secretary for Operations and Management Steve Young.

Young told lawmakers that, since January, the two VCL call centers answered an average of more than 99% of the calls received on a daily basis.

Prior to the opening of the second call center in October 2016, however, VCL saw more than 3,000 calls per week roll over to back-up call centers.

Young made his comments at a hearing held by the House Committee on Veterans’ Affairs assessing concerns about the VCL.

At the hearing, Chairman Rep. Phil Roe (R-TN) pointed out that “over the last year, VCL has been the subject of three major investigations by the VA Inspector General (IG) and by the Government Accountability Office (GAO) that have found serious management, organizational and quality deficiencies in virtually every facet of VCL’s operations.”

“There is very clearly a need for more to be done and soon, so that we can be assured that every veteran or family member who contacts the VCL gets the urgent help he or she needs every single time without fail or delay,” Roe emphasized.

IG Recommendations

VA Inspector General Michael Missal told lawmakers at the hearing that the OIG’s recommendations from 2016 and 2017 need to be addressed by VA.

“Until VHA implements fully the open 23 recommendations from our two reports they will continue to have challenges meeting VCL’s critically important mission,” Missal said.

In its February 2016 report, VA OIG identified several problems with the VCL, including crisis phone calls going to voicemail. While VHA concurred with the report and provided an action plan and timeframe to implement seven recommendations, Missal said that, “as of today, all seven of those recommendations remain open.”

The VA OIG’s March 2017 report found that VCL staff did not “respond adequately” to a veteran’s urgent needs during multiple calls to the VCL and its backup call centers. It also identified “deficiencies” in the internal review of the matter by the VCL staff.

VA IG also found continuing issues in “governance and oversight of VCL operations.” Among the problems cited was that, as of December 2016, the VCL continued to operate without a permanent director. It also found that the “lack of effective utilization of clinical decision makers at the highest level of VCL governance resulted in the failure to include fully clinical perspectives impacting the operations of the VCL.”

When asked why problems identified by VA IG have yet to be addressed, Young told lawmakers that the agency has submitted plans to the VA IG on how concerns will be addressed but that VA IG requested additional demonstration that they have sustained those changes.

“We’ve submitted now 386 documents, just recently, to demonstrated compliance with their recommendations,” he said.

VCL Director

Meanwhile, lawmakers cited concerns that the VCL lacked a permanent director.

“I’m at the point now where my major No. 1 crisis at the VA is the ability to fill leadership positions over critical agencies,” ranking member Rep. Tim Walz (D-MN) said.

Lawmakers also questioned the role that clinicians play in the VCL leadership. Roe said that, as a physician, he was “particularly upset to hear that clinical input is not being appropriately incorporated into the operations and management of the VCL.”

Melissa Bryant, director of intergovernmental affairs for the Iraq and Afghanistan Veterans of America, told lawmakers at the hearing that VA needs to reconsider the management structure of the VCL and have a dual system whereby an operations lead can oversee the functional aspects of the call line while a clinical lead oversees the clinical aspects.

“These roles must be complementary and cooperative to ensure the success and safety of those both clients of the VCL and the responders who are answering their calls,” Bryant said.

When asked by Roe about the clinical piece, Young told lawmakers that the VCL has a “PhD trained social worker that is the clinical lead.”

“In fact, the entire leadership team has 140 years, collectively, of mental health experience,” he said.

Lawmakers also questioned what VA is doing to support the responders taking the calls. The VA responded that staff has been added to take on the workload and that the VCL now has 523 responders compared to the “200 range” a year ago. In addition, the agency has wellness programs to support employees, lawmakers were told.

The VA also plans to hire clinicians that will be “available internally to our employees at any given time 24 hours a day at both campuses that will support those employees,” said VHA Office of Member Services Acting Executive Director Matthew Eitutis.

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