    [Senate Hearing 119-108]
    [From the U.S. Government Publishing Office]

                                                          S. Hrg. 119-108

                        CORRECTING MISMANAGEMENT OF THE
                              VETERANS CRISIS LINE

    =======================================================================

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 JUNE 25, 2025

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    60-891 PDF                  WASHINGTON : 2025

    -----------------------------------------------------------------------------------

                     SENATE COMMITTEE ON VETERANS' AFFAIRS

                         Jerry Moran, Kansas, Chairman
    John Boozman, Arkansas               Richard Blumenthal, Connecticut,
    Bill Cassidy, Louisiana                  Ranking Member
    Thom Tillis, North Carolina          Patty Murray, Washington
    Dan Sullivan, Alaska                 Bernard Sanders, Vermont
    Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii
    Kevin Cramer, North Dakota           Margaret Wood Hassan, New
    Tommy Tuberville, Alabama                Hampshire
    Jim Banks, Indiana                   Angus S. King, Jr., Maine
    Tim Sheehy, Montana                  Tammy Duckworth, Illinois
                                         Ruben Gallego, Arizona
                                         Elissa Slotkin, Michigan

                         David Shearman, Staff Director
                    Tony McClain, Democratic Staff Director

                                C O N T E N T S

                                  ----------

                                 June 25, 2025

                                    SENATORS

                                                                       Page
    Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     1
    Hon. Richard Blumenthal, Ranking Member, U.S. Senator from
      Connecticut....................................................     2
    Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    11
    Hon. Angus S. King, Jr., U.S. Senator from Maine.................    13
    Hon. Jim Banks, U.S. Senator from Indiana........................    16
    Hon. Tammy Duckworth, U.S. Senator from Illinois.................    18
    Hon. Mazie K. Hirono, U.S. Senator from Hawaii...................    32

                                   WITNESSES
                                    Panel I

    Brad Combs, Former Lead Auditor, Veterans Crisis Line, Veterans
      Health Administration, U.S. Department of Veterans Affairs.....     4

    Marcia Blane, Former Responder, Veterans Crisis Line, Veterans
      Health Administration, U.S. Department of Veterans Affairs.....     6

                                    Panel II

    Alyssa Hundrup, Director, Health Care, U.S. Government
      Accountability Office..........................................    22

    Dr. Thomas O'Toole, Deputy Assistant Under Secretary for Health
      for Clinical Services, Veterans Health Administration, U.S.
      Department of Veterans Affairs accompanied by Dr. Christopher
      Watson, Executive Director, Veterans Crisis Line, Veterans
      Health Administration, U.S. Department of Veterans Affairs.....    24

                                    APPENDIX
                              Prepared Statements

    Brad Combs, Former Lead Auditor, Veterans Crisis Line, Veterans
      Health Administration, U.S. Department of Veterans Affairs.....    41

    Marcia Blane, Former Responder, Veterans Crisis Line, Veterans
      Health Administration, U.S. Department of Veterans Affairs.....    49

    Alyssa Hundrup, Director, Health Care, U.S. Government
      Accountability Office..........................................    53

    Dr. Thomas O'Toole, Deputy Assistant Under Secretary for Health
      for Clinical Services, Veterans Health Administration, U.S.
      Department of Veterans Affairs.................................    65

                           Submissions for the Record

    Information requested during the hearing by Senator King from
      former
      Veterans Crisis Line employees:

      Brad Combs.....................................................    71

      Marcia Blane...................................................    76

                        CORRECTING MISMANAGEMENT OF THE
                              VETERANS CRISIS LINE

                                  ----------

                            WEDNESDAY, JUNE 25, 2025

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 3:57 p.m., in
    Room SR-418, Russell Senate Office Building, Hon. Jerry Moran,
    Chairman of the Committee, presiding.

        Present: Senators Moran, Banks, Sheehy, Blumenthal, Hirono,
    Hassan, King, and Duckworth.

                 OPENING STATEMENT OF HON. JERRY MORAN,
                   CHAIRMAN, U.S. SENATOR FROM KANSAS

        Chairman Moran. The Senate Committee on Veterans' Affairs
    will come to order. Senator Blumenthal is en route. I'm going
    to go ahead and make my only statement. We are trying to work
    our way around votes at 4:15 p.m., so we're going to see if we
    can figure out a way to make this all work, and make sure we
    hear the testimony of both panels.
        So, good afternoon, and welcome. Nearly two years ago,
    during another oversight hearing this Committee held, examining
    the VA's Mental Health and Suicide Prevention efforts. My
    office received a phone call. That phone call was from a
    whistleblower reaching out as he listened in real time to VA
    witnesses answering questions about a tragic veteran suicide
    and the VA's potential cover-up of serious issues at the
    Veterans Crisis Line.
        The oversight hearing with VA previous leadership left us
    with more questions than answers, and my office had multiple
    conversations with this whistleblower. Those meetings led to
    several other VA employees coming forward to speak with my
    staff about their firsthand experiences, sharing troubling
    details about mismanagement at the Veterans Crisis Line. They
    spoke of policies and practices that may be leaving veterans in
    critical need of support at an increased risk for harm to self
    or others.
        I would like to thank every individual who bravely stepped
    forward and contacted our office to share those concerning
    accounts. I would especially like to thank, express my
    gratitude to Mr. Brad Combs, a whistleblower, and the Veterans
    Crisis Line's former lead internal auditor, who placed the
    original call and who is here with us this afternoon.
        Without his sacrifice, his courage to do the right thing
    for veterans that he and us serve, we would not be in this
    position today to have this hearing.
        After we held multiple meetings and calls with
    whistleblowers on November 6, 2023, I sent a request to the
    Comptroller General, Gene Dodaro, to call for a thorough audit
    of the Veterans Crisis Line. I would like to extend my
    gratitude to him and his team at the Government Accountability
    Office, for their thorough and informative work on this matter.
        Throughout the past 21 months, my office has worked through
    hundreds of pages of disclosures, countless hours of
    interviews, and I am holding this hearing today to release the
    findings of the GAO investigation, and to hear directly from
    the initial whistleblower, the program's former lead internal
    auditor.
        It is my intent that this hearing serve to force action.
    Real change and improvements require transparency and
    accountability. Based upon information provided by the Office
    of the Inspector General, it is my understanding that 21 months
    later, the Veterans Crisis Line still has not completed an
    internal investigation, nor held anyone accountable, for the
    inadequate and problematic leader and staff actions before and
    after a veteran died by suicide.
        My expectation is Secretary Collins will hold accountable
    the individuals, with the department who were responsible for
    both the mismanagement of the Veterans Crisis Line, and any
    attempted cover-up of these troubling issues.
        The Veterans Crisis Line is a critical tool for veterans at
    immediate risk of suicide. Members of this Committee, as well
    as VA leadership, must make certain America's veterans and
    their family members can depend upon this valuable resource.
    And I'm going to now pause the hearing in anticipation of the
    arrival of Senator Blumenthal. Which if things worked as they
    should, he would appear right now.
        [Laughter.]
        Senator Blumenthal. And lo and behold.
        Chairman Moran. Senator Blumenthal, thank you for joining
    us. You were kind enough to allow me to begin. With the
    critical circumstance with our votes, the interruptions that we
    will have, I wanted to get started, and I've completed my
    opening statement. And I now recognize you for yours.

             OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,
             RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT

        Senator Blumenthal. Thank you, Mr. Chairman. Thank you to
    Chairman Moran, as well as to our witnesses on this really
    critically important topic, which is, as you may gather,
    bipartisan, and it should be, because the Veterans Crisis Line
    is a critical resource in our fight to eliminate veteran
    suicide.
        That fight has been ongoing since I came to the United
    States Senate. One of my very first bills was with Senator John
    McCain on this topic. It passed the United States Congress, and
    one of the proudest moments of my life, as the United States
    Senator, was to go to the White House with John McCain, to the
    East Room, where President Obama signed our legislation into
    law, with myself on one side and John McCain on the other.
        I don't need to remind any of you that John McCain and
    President Obama actually ran against each other, but they came
    together in this cause, and I think we have a similar
    obligation today.
        The Veterans Crisis Line is at the forefront of combating
    veterans' suicide, as you all know, as trained responders
    available to any veteran service member or family member, 24
    hours a day. This hearing demonstrates that the VA's ability to
    improve its resource and operation relies on independent bodies
    like the Inspector General and the Government Accountability
    Office, as well as, unbreakable protections for whistleblowers,
    to enable VA employees to sound the alarm on waste, fraud, and
    abuse.
        I want to express my personal regret that VA Inspector
    General Mike Missal, is not here as a witness. He was fired
    along with 18 other Inspectors General after performing with
    huge distinction and honor over different Presidents,
    Republican and Democratic, and saving taxpayers billions of
    dollars.
        The Trump administration, unfortunately, has also attacked
    the nonpartisan Government Accountability Office and is working
    full-time to demoralize and frighten whistleblowers by
    invalidating collective bargaining agreements, requiring senior
    leaders to sign NDAs, politicizing independent watchdogs and
    overhauling hiring requirements to force public servants to
    declare loyalty to President Trump, not to the Constitution.
        These actions, along with a lack of transparency and
    accountability from this VA and this Administration, make
    meaningful oversight of VA programs like the Veterans Crisis
    Line, extremely challenging. The GAO and IG reports that we are
    discussing today, show that the Veterans Crisis Line needs more
    resources, more staffing, more investment into technology.
        These recommendations demonstrably conflict with the
    ongoing mismanagement of the department by Secretary Collins
    and this Administration. There is a practical relevance and
    importance to the GAO report that we have today that is
    indisputable.
        In the first phase of illegal firings, the Veterans Crisis
    Line employees, including those who conduct advanced training
    for responders, were fired without warning. Secretary Collins
    also fired at least nine staff at one Veterans Crisis Line call
    center, who were responsible for locating veterans actively in
    crisis, and coordinating in-person emergency response and
    coordination with Veterans Crisis Line responders.
        Secretary Collins reversed these findings, but not before
    weeks passed, and the Administration has provided zero answers,
    none, regarding the Veterans Crisis Line and other suicide
    prevention efforts that will be impacted by Secretary Collins'
    goal of terminating an additional 83,000 VA employees in the
    coming months. That is his plan. We've had testimony about it,
    but we have no specifics, no facts, especially as concerned the
    Veterans Crisis Line.
        My office, regrettably and tragically, sometimes continues
    to hear from Veterans Crisis Line and VHA staff, that these
    reduction-in-force plans have led to significant increases in
    call volumes to the Veterans Crisis Line, from veterans who
    fear they're going to be fired.
        And the reason is quite simply, that of those 83,000
    employees that Secretary Collins is going to fire, a quarter to
    a third of them are veterans, whose lives are about to be
    decimated. And so, of course, they're calling the Veterans
    Crisis Line at a time when it is about to be potentially
    decimated as well. Secretary Collins ordered in February that
    all Veterans Crisis Line employees return to office, ``return
    to office'' as part of the mandate set by President Trump.
        Employees were brought to offices that they never
    previously occupied. The offices were ill-equipped. They lacked
    the necessary privacy for calls of this kind of sensitivity.
    Some Veterans Crisis Line employees simply left. They figured
    they had no future there, and they lacked the resources to do
    their jobs in a way they thought necessary.
        And then, Secretary Collins reversed the return to office
    decision for Veterans Crisis Line employees as well. So, I
    think we can do better. I think we must do better. Veterans
    Crisis Lines save lives. They literally save lives. And to ping
    pong these employees is, in my view, disgraceful and a
    disservice to all our veterans.
        Part of the trash and slash strategy that was originated
    and implemented by the DOGE tech bros, they're still around
    even though Elon Musk has left, and the effects have been
    catastrophic for the Veterans Crisis Line. Thank you, Mr.
    Chairman.
        Chairman Moran. Senator Blumenthal, thank you and I will
    join you in expressing my gratitude to Inspector General Missal
    for his efforts during his time as the Inspector General at the
    Department of Veterans Affairs, and his work to bring
    information such as this to us for our use in trying to improve
    the circumstances that veterans face across the country.
        Testifying today on our first panel is Mr. Brad Combs,
    whistleblower and former VCL Lead Internal Auditor, Department
    of Veterans Affairs, and Ms. Marcia Blane, former VCL
    Responder, Department of Veterans Affairs. And as I indicated
    in my opening statement, we're very grateful for your presence
    here today, and thank you for your willingness to tell us
    things you think we should know for the benefit of those you
    have served and I assume will continue to serve. So, Mr. Combs,
    you're now recognized.

                                PANEL I

                                  ----------

     STATEMENT OF BRAD COMBS, FORMER LEAD AUDITOR, VETERANS CRISIS
       LINE, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF
                            VETERANS AFFAIRS

        Mr. Combs. Chairman Moran, Ranking Member Blumenthal, and
    distinguished Members of the Committee, thank you for the
    opportunity to speak with you today. My name is Brad Combs.
    From 2019 to 2023, I worked as a lead auditor for the Veterans
    Crisis Line. My work theory gave me a deep insight into its
    operations.
        I was directly involved in the Inspector General's
    investigation that was discussed with this Committee in the
    September 2023 hearing. I called this Committee after that
    hearing because I believed you were being misled. I testify now
    for all the whistleblowers who had the courage to step forward.
        I presented four areas of concern. Number one, Callers with
    Complex Needs or CWCN. CWCN are callers who display disruptive
    behaviors such as incessant calling, hate speech or abusive
    language, but also historically include a small number of
    misunderstood callers in acute crisis. A small clinical team
    engages these callers, but due to staffing and demand
    mismatches, excess demand is re-queued and handled by specially
    trained responders.
        Just before leaving the VA, I received a transferred CWCN
    call due to a system-controlled gap. This bypasses cues and
    tracking and risks and indefinite holds and dropped calls, that
    was a known tactic to avoid returning callers to the call
    center with no one being the wiser.
        The leadership was aware of these issues since 2018, but
    took no action. Further, in 2022, the cross-functional team
    that provided oversight of the clinical team's intervention
    decisions was dissolved and replaced by one reporting to the
    clinical team, further pushing CWCN into a deep dark hole. As
    indifference to these callers has continued, several clinicians
    have left VCL in protest.
        Number two, quality assurance. From 2022 into 2023, testing
    of the reliability for measuring responder adherence to
    interaction standards, repeatedly showed significant and
    unacceptable variances. This would include such standards as
    suicide risk, and lethal means. This would be the equivalent of
    teachers grading students without fully understanding the
    subject material themselves. VCL had little actual
    understanding of how well responders were performing and there
    was no plan to fix it.
        Number three, electronic media management. Chat and text
    responders are required to handle multiple interactions at a
    time, when necessary. Responders have continually expressed
    concerns about this, which has centered on such problems as
    trying to maintain focus on two interactions while one is at
    acute risk of self-harm or harming another.
        Despite the concerns and accredited recommendations,
    leadership has made no changes. In fact, when I began to survey
    for industry standards, the VCL Executive Director ordered me
    to stop, despite the IG using similar methods in prior reports.
        Number four, disclosure of sentinel events. The Suicide
    Prevention Program Executive Director had known since 2018 of
    the need to determine when or how to perform a disclosure when
    something went wrong during or after a VCL interaction. After
    three years, he still had to be told by his boss to make these
    disclosures as a result of an Inspector General investigation.
        The following year, when the VCL Executive Director learned
    of VCL's culpability for a veteran suicide that happened one
    year prior, she did not make a disclosure despite the standard
    operating procedure she signed now requiring it.
        In management's comments to the Inspector General's 2023
    report recommendations, even the Veterans Health Administration
    Under Secretary was clear that he wanted a disclosure
    completed. But as soon as the report was published, the Suicide
    Prevention Program Executive Director stopped it from
    occurring. GAO confirmed that VCL is now back to 2018 on
    disclosures.
        The many Inspectors General investigations have not changed
    VCL's culture. Managers have exploited accountability gaps,
    rather than mitigating against the risks these gaps created,
    and have been doing this since before my time. The Suicide
    Prevention Program Executive Director has been leading the VCL
    since 2017. This is the culture he built.
        The VCL Executive Director was moved to the Secretary's
    office, but months later was still a tasking me through her
    former boss. Now she works with VHA Under Secretary, even more
    directly affecting VCL's operations. All of these leaders that
    made these decisions and took these actions that led us to
    where we are today, have been kept in roles to still directly
    affect veterans in the VCL. VCL cannot change or improve until
    they and their influence are being completely removed.
        Thank you for your time and attention. This oral testimony
    is just the tip of the iceberg, and I thank you for allowing me
    to also submit written testimony to flesh these items out. I
    welcome your questions.

        [The prepared statement of Mr. Combs appears on page 41 of
    the Appendix.]

        Chairman Moran. Mr. Combs. Thank you very much. Now, Ms.
    Blane.

     STATEMENT OF MARCIA BLANE, FORMER RESPONDER, VETERANS CRISIS
       LINE, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF
                            VETERANS AFFAIRS

        Ms. Blane. Chairman Moran, Ranking Member Blumenthal, and
    Members of the Veterans' Affairs Committee; thank you for the
    opportunity to give a voice to Federal employees. I am Marcia
    Blane, a Licensed Professional Counselor, a Certified
    Professional Counselor Supervisor, and a Certified
    Hypnotherapist.
        I'm a proud retired employee of the Federal Government
    where I worked for 28 and a half years, spending 19 years at
    the Department of Treasury and Internal Revenue Service, and
    the last nine and a half years at the Veterans Crisis Line at
    the VA.
        As the daughter and mother of Marine combat veterans,
    watching and living through the impact of post-traumatic stress
    after combat, my father and my son were greatly impacted. I
    found it imperative to give back to a community that has given
    so much of themselves.
        When the Atlanta site opened in 2016, future employees were
    required to have a master's degree in an area of mental health.
    Our level of education mattered. During our training we were
    repeatedly told your degrees don't matter. However, for the
    work that we do to save lives, our degrees certainly mattered.
    The professionalism we brought to the staff was relevant,
    because we were trained to deal with crisis differently.
        There is a staff of highly trained individuals who are
    often told, this is not a clinical position, so don't use that
    skill set. The Veterans Crisis Line is filled with caring
    professionals who are frequently encouraged to dim their lights
    and just answer the call. Prioritizing quantity over quality.
    Responders also faced racially, misogynistic, abusive, and
    sexually inappropriate interactions with the callers.
        I, along with a couple of other responders, worked
    tirelessly to meet with the leadership staff with the hope of
    establishing protocols regarding abusive callers. After
    initially being rebuffed and dismissed by leadership, told that
    being called the ``N'' word, repeatedly by callers not in
    crisis was essentially a ``me'' problem.
        I was later asked to put a team together and offer
    suggestions to help reduce the impact of racially and sexually
    charged interactions internally and externally. After our team
    created robust educational materials and assessments, the
    process was shut down by those in charge, in the main VCL
    office. And I was told the leaders are apprehensive to be
    taught DEI by a responder.
        While they coined it DEI, it was actually an effort to
    educate the masses regarding abusive callers and the impact it
    has on workers. Unfortunately, this was the continued stance of
    the leadership at the VCL. Unless you were at the top, any way
    that you could contribute to making it a better workplace and
    more effective service for veterans was shunned. Responders
    continue to face a daily barrage of callers that have been
    identified as Callers with Complex Needs, CWCNs, who are
    supposed to be assigned to a team with specialized training to
    free up the main line.
        These callers are aggressive, abusive, disrespectful, and
    burden the VCL platform. They would intentionally call 30 to 40
    times a day, in a hope to interrupt the functioning of the
    line. They also text and chat about that much. And the outreach
    volume from CWCNs has only increased in the recent months. Now
    they are regularly crashing the chat and text platforms, and
    blocking up the main crisis line for veterans who actually need
    our help.
        We encounter situations where, on one call we have just
    talked to a person into unloading their firearm that they were
    planning to use to complete their life, to the next call with
    an abuser who is calling us every racial epithet they know and
    suggesting someone sexually assaults us. Can you imagine what
    those words do to the nervous system of someone who has no
    recourse, no defense?
        The CWCN trained team is constantly understaffed and the
    calls are still often handled by mainline responders, which
    again, taxes the broader system, defeating the purpose of the
    specialized team. The VCL does not have a reprieve from abuse.
    Attempts to deescalate or redirect can be deemed inappropriate
    by quality insurance, and you are threatened to be taken off
    the phone. In those instances, we are reminded that others
    outside of the VCL, had been hired to become quality monitors
    and often failed to have the experience of being a crisis
    responder.
        On May 8, 2025, I submitted my final email to the VCL, as
    it was my last working day before retirement. I shared with
    leadership that it's important that they gain experience by
    observing live calls, since most of the leadership has not been
    a responder. Rules on call handling are being made by people
    who have not had the experience of talking down a caller or
    hearing the completion of life and doing all that you can to
    prevent it.
        We are consistently attacked because of the underlying myth
    that responders aren't working since we are working from home,
    by individuals who have no direct experience with what we do.
    People who insist that we need to come into the office full
    time, meanwhile, the employees working from home statistically
    have less call outs, handle more calls, and provide the same
    quality of service as the reports from the Inspector General
    show that.
        Leaders are trying to manage and supervise when their
    skills lack ability, insight, and often experience. A recent
    example of the lack of insight, was the termination earlier in
    the year of vital VCL employees such as the Social Science
    Assistants, who are our right hands.
        When we are in the throes of a crisis call, they become the
    investigators to find the locations of callers who won't reveal
    their locations. They are the voice behind the calls to police
    departments when rescues are activated. They are the follow up
    to ensure a veteran or civilian has arrived at a facility.
    Terminating those employees created a delay in service, reduced
    employee morale, and made all of us more vulnerable to misses.
    That's missed opportunities for those with suicidal thoughts.
        In closing, the VCL could be a much better place to work if
    VA utilized the skills and experiences of their employees to
    create a healthy environment for the employees and those that
    we serve. There's more to the people working from home for the
    VCL than what I've shared here. They are professionals that
    keep individuals who are ready to end their life, to change
    direction based on hope and the love for what we do. And VA has
    to do better for them, so they can continue to provide the best
    possible support for veterans in crisis. Thank you for your
    time, and I look forward to your questions.

        [The prepared statement of Ms. Blane appears on page 49 of
    the Appendix.]

        Chairman Moran. Thank you, Ms. Blane. Mr. Combs, thank you
    again for bringing these serious matters to our attention, for
    working with me and our team and the Government Accountability
    Office, and for being here today.
        I know your motivation is to help improve the circumstances
    that the Veteran Crisis Line and to protect the well-being of
    those in need of services. Would you describe for me, for the
    Committee, the interaction between the veteran caller and the
    responder that led to the September 23 OIG report?
        Mr. Combs. Yes, sir. If I could really quick--I would like
    to thank you for listening. It's been really important that you
    listen and for John and Emily and your staff for everything
    they did for these past couple years. It was really important.
        Chairman Moran. Thank you.
        Mr. Combs. The interaction that took place, a veteran was
    in the act of accomplishing a suicide. He contacted the crisis
    line, via text message. The responder missed multiple cues,
    multiple cues that the veteran had a belt around his neck, that
    he was losing consciousness, that he was actually attempting
    suicide as he was texting her. She reported that the call ended
    normally. Ten minutes later the veteran was dead, and in fact,
    died in his garage behind his house, mere feet from his entire
    family.
        Chairman Moran. My understanding based upon what my staff
    tells me, that an interaction like that should trigger a root
    cause analysis. Tell me what that is and tell me if one
    occurred. Why or why not?
        Mr. Combs. Yes, sir. Root cause analysis within the VA,
    they use it on a clinical basis, but it's a very common thing
    that frankly everyone does to get down to what was the root
    cause of the issue that led to the event. It's used in business
    as well. A root cause analysis in the VCL's terminology is to
    identify what the actual root cause of the event was that led
    to the suicide after VA was last touched, after VA was
    involved, or VCL was involved, or could be involved in a
    suicide.
        The root cause analysis was not performed in 2021 when we
    were first informed of the veteran, because we didn't have a
    transcript and no one was actually all that concerned about it.
    It was kind of business as usual. But when the IG said they
    were coming in, we were very concerned about what the IG might
    identify, so we wanted to dig into what the IG might find out
    and try to get ahead of the train.
        But frankly to be able to put a point on this, the
    Executive Director determined that a root cause analysis would
    not be performed in 2021, and in 2022 decided that root cause
    analysis was appropriate to perform.
        Chairman Moran. My takeaway from your testimony, Mr. Combs,
    and perhaps you too Ms. Blane, is that there's this culture of
    turning a blind eye, outright covering up of deficiencies. And
    what it seems is that it may be really common at the Veterans
    Crisis Line, and none of this makes sense to me.
        I don't think I know people who would not take those
    circumstances seriously. Whether you're the responder, whether
    you're the person on the line, or whether you're the that
    person's supervisor, I don't think I understand how anyone
    could not see the importance and take every step necessary to
    protect the life of the caller. What's missing? How does this
    take place? I wrote down training, attitude, leadership. I
    don't know what supervision--what's missing here that would
    cause somebody to do something that seems to me to be so
    inhumane?
        Mr. Combs. Sir, it is an attitude or a culture of
    permissiveness. It starts from the top. It's the Executive
    Director of Suicide Prevention Program that, again, has been
    running the program as well as the VCL since 2017, who's
    created the culture of permissiveness and his management team,
    outside the call center. Because I want to be very clear, call
    center people are rock stars. But the management team overall,
    the cultural permissiveness has led to this environment where
    they chase metrics and not lives.
        Chairman Moran. And what do they benefit by having better
    metrics? Is there an incentive for better metrics?
        Mr. Combs. Mr. Chairman, I can't answer that because it's
    completely foreign to me from a service point of view, all I
    know is to serve.
        Chairman Moran. Senator Blumenthal, I wish he was here. He
    and I on a different committee, the Senate Committee on
    Commerce, conducted a long investigation into the sexual abuse
    of gymnasts in the Olympics. And I remember the Olympian, at
    least one of them saying what stuck with me from the very
    beginning is--and it was a series of women who were harmed. And
    it was, why was there more than one?
        And it strikes me as something very similar here about if
    there's an error, a poor performance, disregard for human life,
    it happened once, but then it was taken care of. And so, while
    I would condemn the bad behavior of any employee, I don't
    understand how it wouldn't be corrected so that it never
    happened again.
        Ms. Blane let me ask you, I also thank you for being here
    and your courage and explaining and sharing your experience.
    Describe the VCL leadership. What's the story there?
        Ms. Blane. Thank you so much for that question. I have to
    start with the fact that I have a lot of leadership experience
    coming from IRS. So, coming into the VCL, notable things such
    as no active standard operation procedures were written, there
    was elevation of positions by clicks, not by experience. There
    was an ignorance to what was in the union contract, what was
    right, what was wrong, what was indifferent. And I think that
    because of a lack of leadership skills, trained individuals on
    running departments from that manner, trickled down to what was
    happening at the bottom line with the crisis responder and all
    of the teams.
        When we onboarded in 2016, the management staff were new
    hires off the street. They had not been Federal employees
    before. They knew nothing about union contracts. They knew
    nothing about managerial principles. In fact, I went to the
    then director and said, listen, I know I'm not in management,
    but I can guarantee you with all the years that I've been
    training managers at IRS, I can help get your people on their
    feet. They said, ``no, thank you.''
        So, at that point, I had to begin looking at how could I be
    a voice on behalf of the responders and the employees, because
    I knew that the management staff, their abilities, even in
    projecting staffing, was not that great, because they just
    didn't have the experience.
        Chairman Moran. I need to wrap up my questions quickly for
    the benefit of my colleagues. I want to ask two more and then
    we'll move on. Are the people you are describing here today,
    are they still employed at the VA? Has there been any
    consequences? One or both of you, either of you?
        Mr. Combs. Ms. Chairman, I think Marcia is most--She just
    left the VCL, so she's probably better situated to answer.
        Ms. Blane. Several of them are still employed. Some have
    left, but yes, the answer to your question.
        Chairman Moran. And finally, and it kind of fits with what
    Mr. Combs just said when he deferred to you. So, if you were
    still an employee at the VA and you were here in front of us,
    is that something that you would be honored for or something
    you'd be punished for?
        Ms. Blane. More than likely punished. There is an
    atmosphere of be quiet, keep your head down or face the
    consequences.
        Chairman Moran. Strikes me so sadly, because we're dealing
    with people who served our country, who had no option of
    keeping their head down.
        Ms. Blane. Correct.
        Chairman Moran. Senator Hassan.

                       HON. MARGARET WOOD HASSAN,
                    U.S. SENATOR FROM NEW HAMPSHIRE

        Senator Hassan. Well, thank you Mr. Chair, and thanks for
    this very important hearing, and thank you Mr. Combs and Ms.
    Blane for being here today and for your care for our veterans
    and your service to our veterans. And Ms. Blane, like you, my
    dad was a veteran, so I know this is personal for so many of us
    in this country, as it should be.
        Mr. Combs, I also want to just, before I ask you my first
    question, I want to say thank you for your service, not just to
    our veterans, but for your service as a veteran yourself. In
    your written testimony, you discuss the fact that callers to
    the Veterans Crisis Line with complex needs often exhibit
    disruptive behavior, but that many of these callers are also in
    a heightened state, and they're unable to control their
    emotions because they're in a very vulnerable position.
        You also noted that supporting these callers can take a
    toll on the responders who answer the calls, which is also
    really understandable. In your experience as the former Lead
    Auditor at the Veterans Crisis Line, what do you believe are
    the most important policy changes that can be made to ensure
    that veterans who have complex needs, get the help that they
    need while we're also making sure that crisis line workers are
    supported?
        Mr. Combs. Yes, ma'am. As far as these complex callers,
    there was a team that was stood up in 2017. This was their
    purpose. They developed multi-tiered interventions and then
    also, based on the callers, because these callers are repeated,
    based on the callers, they provided training or tools to the
    responders who might encounter them, how to work with each one
    of these callers, to run it down to mitigate the concerns. That
    team has been decimated. And the people who stood it up, the
    clinician who stood it up, have left in protest over the way
    the callers have been treated.
        Senator Hassan. So, reconstituting that kind of team would
    be an important first step?
        Mr. Combs. Yes, ma'am.
        Senator Hassan. Okay. Another question for you, Mr. Combs.
    You've also mentioned that the Veterans Crisis Line had a
    standard practice of having call responders simultaneously
    handle multiple chat or text interactions with veterans in
    crisis. I understand wanting to help as many veterans as
    possible and trying to reduce wait times, but our veterans also
    deserve to be given individual attention by crisis line
    responders. We can and we should accomplish both of those
    goals.
        Our veterans deserve to get prompt support when they reach
    out to the Veterans Crisis Line, and our responders shouldn't
    be asked to divide their attention between multiple veterans in
    crisis at once. So, can you please discuss some of the risks
    involved with having responders treat multiple veterans at
    once, and what the crisis line can do to avoid this issue while
    also ensuring that veterans get prompt help?
        Mr. Combs. Yes, ma'am. As far as the risk, I can talk on a
    very high level. Marcia is extremely well qualified to answer
    that question very specifically. But I will tell you, anytime
    you divert attention from someone who is in crisis, who is an
    acute risk of actually committing a suicide or a homicide, you
    do not want your attention diverted. But I would defer to
    Marcia for answering that.
        Senator Hassan. And Ms. Blane, please.
        Ms. Blane. Thank you so much for that question. In bringing
    light to what's happening in the digital media part of what we
    do at the Veterans Crisis Line. Even as early as yesterday, our
    responders were still taking two, sometimes three texts or
    chats from veterans. That puts us in a situation where there
    are gaps.
        Because if you're dealing with someone that's in a crisis
    and someone, it could be a kid, because we get a lot of
    children chatting to the Veterans Crisis Line, you are having
    to divide your attention and something could very well go
    through the gap and we could miss opportunities.
        We need to identify a better way to handle those chats,
    individualize them so that, one, we don't burn out the
    responders themselves, and then they're now having to react
    from anxiety. What did I miss? How did I miss it? And things of
    that nature.
        Senator Hassan. And when you said, we get a lot of kids,
    who are the kids? why are they reaching out digitally, texting,
    chatting?
        Ms. Blane. So, every time an entertainer mentions 988 or
    chat or text there, we see an abundance of interactions from
    young people. We see it through the calls when they're on
    spring break or summer break because they're bored and their
    parents need to get something for them to do.
        And then they also get on the chat, we do have some serious
    chatters that are that young, that may be feeling some anxiety
    and things of that nature, but our line is for veterans. And so
    that taxes our system as well.
        Senator Hassan. Right. Are they ever children of veterans?
        Ms. Blane. No, these are kids that are in the middle of
    their classroom.
        Senator Hassan. I hear you. Alright. Well, we're waiting
    for the Ranking Member to return. So, I do have one more
    question for Mr. Combs. So, I think it is important to
    acknowledge, like you do in your written testimony, sir, that
    Veterans Crisis Line and staff are dedicated, hardworking
    people who want to help veterans and that's been very clear
    from both of you.
        When you have staff who want to do the right thing and who
    are working under difficult circumstances, it's really
    important to provide them with the tools and resources
    necessary to help them do their jobs the best way possible,
    including effective, consistent feedback and oversight to help
    them improve.
        So based on your experience as an auditor, and Ms. Blane,
    I'll welcome you to comment as well. Could you please describe
    some ways in which the crisis line can improve its feedback and
    quality assurance so that responders can continuously improve
    and provide veterans with the best care possible.
        And I remember that in response to Senator Moran, you said,
    there's too much chasing of metrics rather than saving lives.
    But how do we assess what we're doing? How do we tackle the
    chats that are distracting and disruptive, but how do we get
    this kind of continuous improvement in this operation?
        Mr. Combs. Yes, ma'am. Continuous improvement at this
    point, you change the leadership and the top management that
    has created this culture of permissiveness. After that, you
    need continued oversight. And in Congress, this Committee has
    done a wonderful job and I do appreciate every bit of what you
    all have done in bringing this to light and seeing this through
    with me.
        But you need oversight from the auditors, the Inspector
    General. I'm just going to say the Inspector General community
    needs to provide continued, repeated, ongoing oversight of the
    VCL to help them achieve the cultural change they need to
    achieve, to meet this. The call center is, as Ms. Blane is
    saying, is not the challenge. It's the managers and leaders
    outside the call center who are telling them, this is how
    you're going to do it. We're talking at you, not with you.
    That's the challenge.
        Senator Hassan. And Ms. Blane, if you have something to
    add, I'd love to hear it, and then I'll turn it over to Senator
    King.
        Ms. Blane. Actually, he said it all, it really does need to
    just have a change in how they present the information and in
    management.
        Senator King. Can you get closer to your microphone?
        Ms. Blane. Yes, sure. Thank you for that. I absolutely
    agree with Mr. Combs that there needs to be a change in
    leadership structure. When we went from serving to
    productivity, we lost the essence of what needed to be done.
    That's when the metrics came into play. I shared with them
    then, having been an analyst at Delta Airlines, you cannot use
    a productive model in human services. It doesn't work. And
    that's where the problem has been, is that they tried to create
    numbers instead of quality.
        Senator Hassan. Well, thank you very much. Thank you both
    again for being here. And now we have our Ranking Member arrive
    back. Senator Blumenthal, would you like to go next or would
    you like Senator King to go ahead?
        Senator Blumenthal. I'll yield to Senator King.
        Senator King. That's a rare occurrence around here.
        [Laughter.]
        Senator Blumenthal. But it should be more common.

                        HON. ANGUS S. KING, JR.,
                        U.S. SENATOR FROM MAINE

        Senator King. I want to follow up on that question, Ms.
    Blane, about productivity. Were the people in the call centers
    under pressure to do so many calls a day or not have calls be
    longer than a certain number of minutes? Describe to me the
    metrics that were being applied.
        Ms. Blane. Sure. Thank you for that question. So, the
    metrics that were being applied was the amount of time that you
    were staying on a call. What a lot of people fail to realize is
    that veterans that are getting help from the responders at the
    crisis line, they call back.
        For example, even though we're told it's not a clinical
    role, a lot of us that are licensed, we will literally de-
    escalate, give them suggestions on home works, walk them
    through deep breathing. But those things can be easily frowned
    upon because it takes a call longer to be completed. I am not
    willing to leave anyone behind that needs my assistance. So,
    the idea of production didn't work for me, because human
    services and human life was more valuable than the numbers.
        Senator King. Well, I fully understand that. I'm amazed
    that there would be such--the last thing you want to do if
    you're talking with someone in crisis is to say, I'm sorry, but
    our time is up. I mean, maybe if you're a cable services call
    center that's different. I'm surprised that anyone would even
    think of applying that metric.
        Ms. Blane. Well, we would frequently receive direct
    messages in TEAMS saying, ``hey, I noticed that you've been on
    this call for a long time. Do you need any help?'' Well, what
    kind of help are you going to help me with if I'm the one de-
    escalating someone, you can't come in and take over the call.
    You don't know what's going on within the call. So, you are
    literally distracting me from completing the call and paying
    attention to the veteran.
        Senator King. When did this metric system come into place?
        Ms. Blane. In, I believe it was 2018 when we had a
    director, and then he hired a new person and that person had
    come from a background in a call center that was more
    production guided versus being able to be human guided.
        Senator King. Now, I noticed that you left in May, so you
    went through at least several months of the new Administration
    at the agency. It's no secret that there were firings, hiring
    freezes, threats of more firings, reorganization. Did that
    affect the operation of the call center in terms of people,
    morale and dedication, people wanting to stay or go? Talk to me
    about whether the difficulties at the agency level affected the
    call center.
        Ms. Blane. Thank you so much for that question and bringing
    the humanism back into it. It absolutely affected the morale.
    One of the things that happens when you are a crisis responder
    is you can develop vicarious trauma by listening to the
    repeated situations that individuals are going through.
        However, when you're concerned if you're going to be able
    to pay your bills, if you're going to be able to keep your
    healthcare, if you're going to be able to function, that is
    going to impact your ability to stay focused.
        Now, I have to admit, my peers at the Veterans Crisis Line,
    as Mr. Combs said, are rock stars. They stayed focused. We all
    came together in TEAMS, and I would say, ``hey, here's my phone
    number if anybody needs me, text me.'' We had to create
    situations outside of TEAMS to offer support to each other
    because it was so overwhelming. Every week, having to write----
        Senator King. The chaos.
        Ms. Blane. The chaos was overwhelming, and it was
    distracting. Every week you're having to write, what did I do
    next week or last week letters to send off to an invisible
    email that you----
        Senator King. That was the famous five things you
    accomplished.
        Ms. Blane. Yes, the 14 roles.
        Senator King. I sent one of those in myself to Mr. Musk. I
    never heard back.
        Ms. Blane. Yes, because the mailbox at one point got
    completely full and nobody was answering it.
        Senator King. Let me ask another question, and this is not
    about this subject, but what are the issues that are there--
    there must be a pattern to issues. Are they financial? Are
    they, you mentioned healthcare. Can you give us a summary of
    what are the most likely calls are about?
        Ms. Blane. So, most of the calls that we received are
    usually individuals that have faced levels of trauma from
    military sexual trauma, remembrance of their time in combat,
    individuals that may have not gone to combat but may have been
    on a ship and felt like they were in a sleeping coffin, marital
    issues. We became notorious for being marriage counselors.
    Sometimes having to break up arguments over the phone between
    spouses.
        And so, it just varied between that individuals that were
    homeless or individuals that specifically just felt unseen,
    unheard, and easily forgotten.
        Senator King. And did you have the capacity to refer them
    to VA PTSD programs, for example? I mean, in other words, did
    your duties go beyond listening?
        Ms. Blane. So, the referral processes, the first referral
    process is to the suicide prevention coordinators. And those
    individuals are usually housed at the VA medical centers, a
    social work department that takes those referrals and then
    tries to disseminate them to the appropriate areas.
        Directly referrals, we will send individuals that are
    facing homelessness, we send them over to the to the national
    call center for homeless veterans. When it comes to things like
    needing appointments, I was a little different from what the
    SOP said. If I have a veteran on the phone and they needed to
    get through to make an appointment, I'm going to make the call
    to get them through to make that appointment. The SOP says,
    transfer them blindly. Let them pick up on that end.
        To me, I believe that we needed to be more of a one-stop
    shop, so that we would not--can you imagine a 90-year-old
    veteran calling in and the call just keeps circling because he
    doesn't know what button to push. I'm not going to send them
    over blindly. And those are some of the things, some of the
    stressors for our elderly veterans, because everyone was
    wanting to force them to use a computer, go and navigate a
    phone system. They can't, it's not a part of their generation.
    And why would we want to do that? So, I mean----
        Senator King. The most frustrating thing in the world is to
    be on some kind of call like this, tell your story, and then
    have somebody say, well, I'll move you over to this other
    department.
        Ms. Blane. Exactly.
        Senator King. And then you're on hold listening to music.
    Well, your testimony has been very important and impressive. I
    hope you can, I'd like to assign some homework. Could you
    supply to the Committee further thoughts about how this system
    can be improved, because that's the business we're in here, and
    both of you have firsthand experience to the extent you can
    make suggestions about the standard operating procedure or the
    productivity metrics, those kinds of things, that would be very
    helpful to us.
        Ms. Blane. Absolutely. Thank you.
        Senator King. Thank you, Ranking Member.

        [The information requested begins on page 71 of the
    Appendix.]

        Senator Blumenthal [presiding]. Thanks, Senator King.
    Senator Banks.

                            HON. JIM BANKS,
                       U.S. SENATOR FROM INDIANA

        Senator Banks. Thank you, Mr. Chairman. Mr. Combs, one of
    the frequent criticisms I hear about the crisis line is that
    management often sweeps problems under the rug. And I wonder,
    is that your experience, what you saw when you were the former
    auditor?
        Mr. Combs. Thank you for your question, Senator. Yes.
        Senator Banks. Can you expand on that? I mean, why is that
    not a technical term, but often a description that I hear from
    people who are criticizing the Veterans Crisis Line and the
    management?
        Mr. Combs. As far as the----
        Senator Banks. What is that? Sweeping big problems under
    the rug?
        Mr. Combs. Okay. Well, Senator, a common definition for us
    to work off of would-be sweeping problems under the rug would
    be to not address the problem, not learn from it, not resolve
    it, and not improve from it, but rather ignore the problem,
    believe it somehow, make it such that it did not occur, and no
    one's going to find out about it.
        Senator Banks. And you agree that, you know, sort of
    something that you saw widespread?
        Mr. Combs. Yes, sir. During my time at the VCL, I brought
    up many challenges that, what we would call in the audit world
    lack of conformance to regulations, to VA policy, to even
    statutes. And I was told, well, there's more context to that or
    it doesn't apply to us or we're VCL and . . . no, we work for
    the government. We're part of the government. We need to comply
    with the government rules.
        Senator Banks. What would you say that the Veteran Crisis
    Line needs to be more effective? Is it technology, better
    training? What is it going to take to make it work better?
        Mr. Combs. Senator it is about leadership. VCL--I can't
    talk for right this moment as far as staffing goes. I can't
    talk right this moment for budgeting. I can't talk about those
    things. All I can tell you is during my time at the VCL, and I
    know it's ongoing because I hear and I listen to what this
    Committee has talked to VCL about and the VA about, as far as
    the VCL operations. If they needed something, they were getting
    it.
        So, from my perspective, the technology that we lacked,
    which we did lack technology, was the decisions of leadership.
    How we staffed the call center when we had people to staff, as
    the GAO was about to inform you. Chat and text were staffed by
    historical standards, historical staffing patterns, not by
    demand, which meant we were going to have to double up because
    we weren't looking at what was demand going to be for chat and
    text for this time period.
        Instead, you know, we're going to staff it at this level,
    if it gets overwhelming, double up, triple up if you need to.
    We don't have a backup. So, make sure you answer the call. It's
    about leadership and it's about the leadership culture. And as
    long as we can make problems go away, you are my friend.
        Senator Banks. We heard from crisis line employees who told
    us that they were regularly texting and web chatting with 2, 3,
    4 veterans at the same time. How does that happen?
        Mr. Combs. For the technical aspect of that, you must ask
    Ms. Blane. I'm not aware of that. I can tell you that within
    the short little period of time I had to dig into industry
    standards, that's not the industry standard that I was coming
    up with. Before I was told to cease my activity by the
    Executive Director of the VCL. Industry standard is that when
    you definitely have someone in crisis, you're not handling any
    more multiple interactions. You're handling that one. You stay
    focused on that one because that life is at risk.
        Now, as far as the technical aspects of how you can handle
    or how you can end up with multiple interactions, Ms. Blane
    would have to answer.
        Senator Banks. Ms. Blane, is that an accurate?
        Ms. Blane. It is accurate that there were possibilities to
    have to handle two, three, and four chats. One, understaffing
    was an issue at one point when we first came on board, they
    kept chat and text in New York only. And so, it wasn't spread
    around and you didn't have enough staffing trained. So, they
    began the training.
        The problem is now the equipment, the software, the
    platforms that is on that causes crashing and things of that
    nature. They've beefed up the training for the number of
    individuals that are going to be doing chat and textbook. As of
    yesterday, speaking with some current responders, they are
    still being assigned a minimum of two texts or chats at a time.
        Senator Banks. I've been in Congress for eight and a half
    years, and we've increased the budget for the Veteran Crisis
    Line repeatedly. So, is it surprising to you that we would be
    understaffed and lack training and technology or to Mr. Combs
    point, is it that really the leadership issue that you're
    talking about? I mean, I find that shocking.
        Ms. Blane. I think it's a combination of a couple of
    things. I think it's leadership, and I think that the revolving
    door of new hires coming in, them not being adequately prepared
    for abuse from callers, not knowing how to move along. They
    want to stay, but everybody doesn't have--this'll be funny, my
    Generation X skin, that we can take tough stuff, right? And
    keep going. Some of the younger generations, they just cannot
    handle that level of pressure.
        You ask the question about how does it happen when things
    don't get done, or they're pushed to the side, because they
    don't want to confront the truth of situations.
        You have to confront abuse, because it's burning your
    people out. It's causing that revolving door. That's a
    leadership call. You have to want to train and re-train and
    continuously train.
        I came from an environment at IRS where every year, even as
    Congress is on the floor changing tax laws, we were doing
    training. There is no up-to-date annual training. You get
    things in TMS, which is the training block, but it is not the
    same of going in the classroom and being focused on what
    changes we need.
        The Veterans Crisis Line needs to evolve with what things
    are going on. We cannot continue to operate from a place, from
    the origin vision of what the Veteran Crisis Line is. We've
    moved into the adult stage, now we need to grow up.
        Senator Banks. Thank you very much. My time has expired.
        Senator Blumenthal. Thank you, Senator Banks. I'm going to
    hold my questions and yield to Senator Duckworth.

                         HON. TAMMY DUCKWORTH,
                       U.S. SENATOR FROM ILLINOIS

        Senator Duckworth. Thank you, Mr. Ranking Member. Mr.
    Combs, during your tenure as lead auditor for the Veterans
    Crisis Line, was it your experience that responders were the
    only employees to answer the phones, and could you elaborate on
    that? Did anybody else answer the Veterans Crisis Line phones
    other than trained responders?
        Mr. Combs. Thank you for the question, Senator. So trained
    personnel, yes. Responders that worked every day, all day as
    responders? No. They did bring in people to work during
    overtime periods.
        Senator Duckworth. So, these were other VA employees?
        Mr. Combs. Other, no, I'm sorry, ma'am. I should clarify.
    Other VCL employees who had at some point in time gone through
    responder training and had qualified as a responder and had
    been approved to work as a responder in times of need, for
    demand. They could come in when the call was put out, come in
    and work as responders.
        Senator Duckworth. Okay. So, these are folks who had been
    trained as responders, but maybe are now doing some other job
    that's not responder training?
        Mr. Combs. Yes, ma'am.
        Senator Duckworth. And they were given the opportunity to
    work overtime to help answer the calls?
        Mr. Combs. Yes, ma'am.
        Senator Duckworth. Okay. Did they receive any guidance or
    training or currency refreshers to assist them in doing that
    overtime on the hotline? These non-responders, even though
    they--it's like saying that somebody got the training once upon
    a time. Now they're off doing something else. Now they, hey,
    you can pick up a little bit of overtime answering the VCL. Did
    they get additional training? Did they get the same level of
    training as the people currently in the responder position?
        Mr. Combs. Well, so again, thank you for the question. The
    2023 IG report that, the Inspector General reflects that that
    practice stopped because of that incident that's described in
    the report. And in fact, how do I say this--the Deputy Director
    of the Crisis Clinical Operations, he made the decision that
    that practice would stop as of that event. And you had to be a
    full-time responder or work in the call center as that call
    center team to take a call from any veteran going forward. So
    that was about February 2022, going forward, you had to be a
    full-time responder or the supervisor team operation
    coordinator, assistant deputy director to take a call.
        Senator Duckworth. Okay. Thank you. Ms. Blane, can you
    please confirm whether as recently as May 2025, so just last
    month, responders were not the only employees to answer the
    phones?
        Ms. Blane. As of May 2025, it was only responders that were
    answering the phones.
        Senator Duckworth. It was. Okay. Because my understanding
    is we've got that 160 hours of training, and I think it's
    really important that people who are answering the phones are
    the most up-to-date. You had mentioned Ms. Blane earlier that
    the VCL terminations caused delays in services to veterans. Can
    you please elaborate? I mean, what guidance did you receive
    from leadership to mitigate these delays following the wrongful
    terminations?
        Ms. Blane. With the--thank you so much Senator Duckworth
    for the question. With the wrongful terminations, we didn't get
    a lot of communication. That's one of the concerns with the
    Veterans Crisis Line, is there was not an evolving door on
    communication. It was pretty much like, here's where it is.
    Oops, we've changed directions and going from there, just, you
    know, keep working as normal.
        Senator Duckworth. I had a couple people that I knew
    through my service in the National Guard reach out to myself
    and some folks within my organization who knew us personally
    through the Guard who were working the VCL. And some of them
    received termination notices, and their supervisors didn't even
    know they just got the email. Did that happen?
        Ms. Blane. That is a failure of leadership. Because that
    has been the bane of my existence at the Veterans Crisis Line.
    Again, part of my responsibility at the Department of Treasury,
    was to train supervisors. And I would often share with them;
    you all are literally just a grade up with no power. You are
    getting information at the same time that the responders are.
    There's no way that you could adequately prepare to funnel
    information down to us because your leadership fails to trust
    you with information, in how it's delivered. That is poor
    leadership.
        One of the issues, or one of the things I often say is
    leaders lead, managers manage. But if you have a leader trying
    to manage, you've already missed the mark on what you're
    supposed to be doing.
        Senator Duckworth. Thank you. I'm over time. Mr. Chairman.
        Senator Blumenthal. Just a few questions. Ms. Blane, I have
    to tell you, I was really profoundly moved by your testimony,
    coming from the daughter of a Marine and the mother of a
    Marine, both combat veterans, both having gone through trauma.
    You know in your heart how deep and dire the danger can be to
    somebody going through crisis. But you also know that more is
    required than just a good heart.
        Empathy goes a long way, but professionalism is required.
    And you are a consummate professional, a Licensed Professional
    Counselor, Certified Professional Counselor Supervisor, and a
    Certified Hypnotherapist. You've worked for 28.5 years as a
    Federal employee, 19 of those years at the Department of
    Treasury in the Internal Revenue Service. But you pursued your
    dream, which was to help veterans.
        And so, I think your testimony comes from someone who has
    seen this problem, not only in a personal way, not only in
    emotional way, but in an analytical way that is very, very
    important. And I thought one of the most important observations
    you made was the effect of terminating the Social Science
    Assistants.
        Now, the temptation is to say, oh, I'm doing it on my own.
    I can do it all as the crisis line counselor. But these Social
    Science Assistants who were terminated are important to the
    work you do. I'd like you to expound a little bit on why that
    termination was so shortsighted.
        Ms. Blane. The Social Science Assistants are on the same
    level as 911 operators. They are our eyes, our ears, and our
    fingers when we are handling a crisis call. We send a message
    saying, hey, I need to find this person. They are actively
    suicidal, and all of that information. I can focus on the
    veteran when I have a Social Science Assistant who is
    diligently working, tracing calls, working to get locations,
    full name, date of birth, so I don't have to be bothered in the
    sense of redirecting my attention. I can stay with this
    veteran.
        When those SSAs were terminated, averagely on the shift
    after their termination, you're talking 45 to 50 people to two
    SSAs. My heart broke because I had so many years in criminal
    investigations at IRS, I know how to do a lot of research,
    right? But my heart was breaking for them because for every
    crisis that was coming in, they're juggling so many different
    calls.
        It was a slap in the face of the SSAs and the responders,
    because you're telling us to give our best, but you take our
    best from us, our best support, our best voice, our best
    fingers, and you leave all of us, including that veteran in
    crisis, in a gap, and possibly harmed.
        Senator Blumenthal. And often these SSAs, the Social
    Science Assistants, help you locate the voice behind the call
    when they don't want to be located. Because they're about to
    take their own lives. And this is a desperate act on their part
    to call you, and you need to find out where they are so you can
    reach out to them.
        Ms. Blane. Absolutely.
        Senator Blumenthal. You remarked in your testimony about
    how there are a lot of very well-meaning professionals working
    on the crisis line, who are ``frequently encouraged to dim
    their lights and just answer the call.'' Could you explain what
    you meant by that?
        Ms. Blane. Yes. In 2018, I believe that's the correct year.
    We had a clinical operations person that came into the Veterans
    Crisis Line with a production model, answer the call, answer
    the call. In fact, when we began questioning that, his response
    in one meeting was, if you don't like the way we do things,
    find another job.
        Not taking into consideration the lives that we were
    changing, which was always a detriment to me, simply because if
    you don't know what we do, making a blatant statement like that
    shows that you have ill concern. Trying to operate, and I
    shared this earlier, trying to operate a production mentality
    for human services will never be a win. We're not selling
    products, we're saving lives.
        Senator Blumenthal. Yes. I think that's really important.
    You know, we all have called the lines, you know, like I don't
    know, for Amazon or whatever, we want to return a product.
    We're put on hold. It's maddening, but it's not about taking
    our lives. It's about sending something back and getting a
    refund. You have to demonstrate a responsiveness and empathy
    that is very different.
        When we talk about a crisis line, you know, some
    merchandiser who says, we have great service on our call-in
    lines, because you don't have to wait for more than 30 minutes
    or whatever it is. A caller to your line is not going to wait
    for 30 minutes.
        Ms. Blane. Not at all.
        Senator Blumenthal. They need help right away. I just want
    to ask you one more question. Would you say that employees
    during the period January to May, you left in May--January
    there was a new Administration, feel more or less confident in
    reporting waste or fraud or abuse without fear of retaliation,
    compared to the previous nine years that you were in the VA?
        Ms. Blane. So honestly, it began in November once the
    election results came in. People immediately became afraid of
    just understanding what the previous four years were like with
    this Administration, and not really having an idea of where we
    were going.
        So, in response to your question, they are less likely to
    report the fraud and abuse, because as long as we have the ugly
    umbrella of potential firing, that is going to stop people from
    fully engaging in sharing the information. We see that every
    year with those employee survey responses. It never gets a
    hundred percent of participation.
        Senator Blumenthal. I want to thank you and Mr. Combs for
    your testimony today. It's been extremely important and
    enlightening, and I want to thank the Chairman, Chairman Moran,
    for having this hearing which has given us an opportunity to
    explore the issues that you have raised. It really is I think
    extraordinarily important that we hear from you and have this
    hearing. So, I thank the Chairman.
        Chairman Moran [presiding]. Senator Blumenthal, thank you
    for taking care of the Committee in my absence. I suppose you
    still need to vote?
        Senator Blumenthal. On the second one?
        Chairman Moran. On the second one, it's been called. Okay.
    Mr. Combs, the whistleblower protections, do they work? Too
    early to tell?
        [Laughter.]
        Mr. Combs. Yes. Thank you, sir. Well, some things you do
    because it's the right thing to do. You let the chips fall
    where they may. Within the VA, right before I left, one Deputy
    Director, he had a direct report hire his wife; Ms. Blane knows
    who I'm talking about. His wife was hired by his direct report.
    I received the report to submit to the IG or a hotline
    complaint. The report--I'm messing this up, sorry.
        The report I received was from the Office of Accountability
    and Whistleblower Protection--in fact, that was the response I
    saw published regarding the Secretary's response to your letter
    asking for the GAO to do an audit on the VCL, was that I could
    have gone to the Office of Accountability and Whistleblower
    Protection--I had the report that said nepotism did not occur.
        The Deputy Director's wife got hired by his direct report
    to work for the Deputy Director and Office of Accountability
    and Whistleblower Protection said that did not happen--that's
    not nepotism. So, I don't think Office of Accountability and
    Whistleblower Protection should be trusted, if it still exists,
    but it should not be trusted. No, whistleblower protections did
    not work in the VA.
        Chairman Moran. Thank you for your testimony. Not
    necessarily pleased by the answer, but thank you for your
    testimony very much. It's my practice and it's certainly, I
    hope in this case of value. Is there anything either one of you
    would want to say that you didn't say in your testimony or that
    we didn't ask questions about that you think we should know?
        Ms. Blane. No, I think all of the questions that were asked
    and answered gave a better insight to the Veterans Crisis Line
    from the responders' perspective. So, thank you for today and
    this opportunity.
        Chairman Moran. You're welcome. Thank you.
        Mr. Combs. Yes, sir. And I know there were multiple
    whistleblowers that came forward. I really thank you and your
    staff, John and Emily, again for keeping us anonymous. None of
    us wanted to be identified. We were protected for two years as
    this proceeded. I thank you for the ear and for hearing us and
    going after this, and for John and Emily for doing everything
    they did for all of us.
        Chairman Moran. Thank you for highlighting the role of John
    and Emily, and our staff generally, are hugely valuable to us
    and valuable to veterans in the country. I thank you for your
    testimony, and will now call to the witness table the second
    panel.
        Testifying today on the second panel is Ms. Alyssa Hundrup,
    Director Health Care Team, U.S. Government Accountability
    Office, and Dr. Thomas O'Toole, the Deputy Assistant Under
    Secretary for Health for Clinical Services, Veterans Health
    Administration, accompanied by Dr. Christopher Watson,
    Executive Director, Veterans Crisis Line.
        Ms. Hundrup, Doctor, Doctor, thank you for your presence.
    Ms. Hundrup, we'll start with you, and you're welcome to
    provide your testimony.

                                PANEL II

                                  ----------

       STATEMENT OF ALYSSA HUNDRUP, DIRECTOR, HEALTH CARE, U.S.
                    GOVERNMENT ACCOUNTABILITY OFFICE

        Ms. Hundrup. Thank you. Chairman Moran, Ranking Member
    Blumenthal, and Members of the Committee, thank you for the
    opportunity to discuss our work on VA's management of its
    Veterans Crisis Line or VCL. My testimony covers findings and
    recommendations we made in a report we are publicly releasing
    today.
        The suicide rate for veterans remains tragically high, with
    more than 17 veterans losing their lives to suicide every day.
    The VCL is a vital resource to assist veterans or their loved
    ones in crisis. The use of the crisis line continues to grow,
    with customer interactions across call, text, and chat
    platforms, increasing nearly 40 percent from fiscal years 2021
    through 2024.
        In total, VCL responded to about 3.8 million interactions
    over that time and by 2024, it responded to over 2,500 calls
    every day. The VCL's goal is to answer 95 percent of calls
    within 20 seconds, which it has been able to achieve. As of
    this March, VCL has more than 1000 crisis responders on staff
    to answer calls.
        A subset of responders are trained to work in the Customers
    With Complex Needs unit. This unit handles callers assigned as
    having complex needs such as abusive, sexually inappropriate,
    or high frequency callers.
        However, we found problems with how the VCL is managing
    this unit. Specifically, it made a procedural change so that if
    there is no responder available in the unit, callers are
    immediately redirected to the main line. Previously, this
    redirection occurred after 3 minutes. VCL made this change to
    reduce wait times for complex callers and reduce the number of
    abandoned calls.
        Yet this change has resulted in many more complex calls
    being answered by mainline phone responders who have not had
    complex needs training, and therefore may not be well equipped
    to handle the interactions. This creates a risk to the quality
    of service provided to the caller and causes increased stress
    and burnout for responders.
        Therefore, we are recommending that the VCL assess the risk
    of adverse effects associated with this procedure change. VA
    agreed with our recommendation stating that it would perform
    such an assessment by this October. We also identified workload
    challenges for the VCL's digital services unit for texts and
    chats.
        For example, responders are expected to handle up to two
    interactions concurrently as demand requires, and we found this
    has commonly occurred. Text and chat responders are also
    expected to document their interactions at the same time as
    they handle live interactions. This is unlike for calls where
    responders are given time after the call for documentation.
    Having to do both at the same time can create workload
    challenges and can distract responders from ongoing
    interactions, especially if the responder is handling two
    interactions concurrently. Such challenges can make it
    difficult to be fully attuned to customer needs, creating a
    risk to safety and increasing responder burnout.
        The VCL has not assessed how these challenges may be
    affecting the quality of its digital services. So, we are
    recommending that it do so. VA agreed stating that it would
    assess its digital services unit by this October.
        Finally, we found that the VCL conducts quality assurance
    reviews, such as using silent monitors to evaluate interactions
    against a set of standards. The VCL also reviews its
    involvement in critical incidents such as a related suicide, to
    identify areas for improvement and provide coaching to
    responders. An important aspect of addressing critical
    incidents is also disclosing VCL involvement with certain
    incidents to customers or their representatives.
        However, due to a recent policy change, the VCL now has no
    procedure for disclosing incidents to customers. The VCL
    recently withdrew its procedure because it determined the
    policy applied only to clinical services, whereas the crisis
    line provides non-clinical services. The lack of disclosure
    procedures could result in missed opportunities for the VCL to
    hold itself accountable to customers or their families, in the
    event that a VCL action or inaction contributed to a customer's
    harm.
        Accordingly, we are recommending that VA establish a
    procedure for the VCL to identify the types of incidents that
    warrant disclosure and a process for doing so. VA agreed
    stating that it would take action to implement it by next
    January. Doing so will better ensure that VA meets its goal of
    building trust with stakeholders through transparency and
    accountability.
        This concludes my prepared statement. I'd be happy to
    answer any questions you may have. Thank you.

        [The prepared statement of Ms. Hundrup appears on page 53
    of the Appendix.]

        Chairman Moran. Thank you very much. Dr. O'Toole.

        STATEMENT OF DR. THOMAS O'TOOLE, DEPUTY ASSISTANT UNDER
      SECRETARY FOR HEALTH FOR CLINICAL SERVICES, VETERANS HEALTH
    ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS ACCOMPANIED
    BY DR. CHRISTOPHER WATSON, EXECUTIVE DIRECTOR, VETERANS CRISIS
       LINE, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF
                            VETERANS AFFAIRS

        Dr. O'Toole. Chairman Moran, Ranking Member Blumenthal, and
    distinguished Members of the Committee, thank you for the
    opportunity to provide an update on the Department of Veterans
    Affairs efforts to enhance the Veteran Crisis Line and our
    continuing commitment to support our veterans in crisis.
        My name is Dr. Thomas O'Toole, and I'm the Deputy Assistant
    Under Secretary for Health for Clinical Services. And joining
    me today is Dr. Christopher Watson, Executive Director of the
    Veteran Crisis Line.
        VCL continues to encounter a significant and growing demand
    for its service. In fiscal year 2025, up through this last May,
    VCL managed nearly 787,000 contacts, including chats and texts.
    VCL is the only crisis line in the United States that is
    integrated into a complete healthcare system, offering a direct
    bridge between immediate crisis intervention and ongoing care.
    Our dedicated team of crisis responders is trained to provide
    immediate assistance ensuring that no veterans call for help
    goes unanswered.
        Informed by work of both OIG and GAO, VA is significantly
    enhanced its capacity to assist veterans in crisis. A September
    2023, OIG report identified critical deficiencies within VCL
    operations and oversight. As of June 25, of this year, VA has
    implemented and closed 12 of the 14 OIG recommendations, and we
    are working diligently to close the final two recommendations,
    by the end of fiscal year 2025.
        These actions include: a comprehensive review of staff
    performance, enhanced training programs, and establishment of
    more robust oversight mechanisms. Our commitment to these
    improvements has already bolstered VCL's ability to deliver
    safer and more effective services. We have reinforced training
    and guidance for all VCL leaders and staff to ensure full and
    transparent cooperation with oversight reviews.
        Furthermore, we have formalized written standard operating
    procedures for call escalation, to enhance the consistency and
    oversight of complex or high-risk calls. One critical area of
    focus has been the management of calls from Callers with
    Complex Needs, or CWCN. We are assessing the outcomes of CWCN
    calls managed by both mainline crisis responders and CWCN
    trained crisis responders.
        This assessment will inform any necessary adjustments to
    our procedures and staffing to ensure we provide the highest
    standard of care. To address concerns about our digital
    services procedures, we have conducted an in-depth review to
    analyze crisis responder documentation practices.
        We are also enhancing processes to better capture and
    analyze crisis responder workload. Our goal is to enable crisis
    responders on digital service platforms to manage the growing
    volume of texts and chats without compromising service quality.
    We have implemented a technological solution to mitigate the
    issue of chats being abandoned due to crisis responder
    unavailability. This update includes real-time notification to
    crisis responder supervisors who can reassign chats promptly,
    ensuring continuous support for veterans.
        Recognizing the need for transparency, VA is convening a
    multidisciplinary work group to establish a standardized
    process for disclosure procedures. We anticipate the review to
    be complete in January 2026. The aim is to foster trust and
    accountability in our services.
        In conclusion, VA is committed to preventing veteran
    suicides and providing critical support in moments of crisis.
    VA's dedication to implementing OIG and GAO recommendations
    demonstrates our commitment to continuous improvement in
    excellence in service delivery.
        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. So, thank you
    Chairman Moran, Ranking Member Blumenthal and the Committee for
    your oversight, guidance, and steadfast commitment to the
    health and safety of our veterans.
        I also want to thank our first panel, the GAO and the OIG
    for their oversight and input. We need to be doing a better
    job. We need to be more accountable, and we need to be holding
    ourselves more accountable. I look forward to your questions
    and to continued collaboration in our shared mission to support
    the well-being of our Nation's heroes.

        [The prepared statement of Dr. O'Toole appears on page 65
    of the Appendix.]

        Chairman Moran. Thank you. Dr. Watson, do you have
    testimony? You do, Dr. Watson?
        Dr. Watson. No, sir.
        [Laughter.]
        Chairman Moran. Well, first of all, Dr. O'Toole, you heard
    the description of what was described as prevalent or certainly
    ongoing culture at the Veterans Crisis Line, and you outlined
    you have these tasks to undertake due to IG and GAO reports,
    some of which you indicate have been completed, and some which
    you're still working on. Do you disagree that the culture or
    the circumstances that were described by the first panel
    existed?
        Dr. O'Toole. So, thank you, Senator, and let me just start
    by saying, you know, I'm deeply disturbed by what I heard. It's
    unacceptable. I want to thank our first panel for their honesty
    and for their courage in coming forward with that. We need to
    be holding ourselves more accountable.
        I want to also personally apologize. It's not acceptable
    that these behaviors and these actions were taking place. So, I
    have no reasons to dispute it or definitely no interest in
    disregarding it. This office has been reporting to me among
    others for about the past six months. And so, I clearly look
    forward to our opportunity to address these issues most
    directly.
        Chairman Moran. Do you know the Department of Veterans
    Affairs well enough to explain to me why those circumstances
    were there? What you call actions and behavior, and that they
    were there for a long period of time, but no one seemed to
    report or change or insist that the behavior changed? Why does
    it take a GAO report or an Inspector General's report to get
    someone's attention to do something?
        Dr. O'Toole. I have been in the VA a long time and
    unfortunately, you know, we have not always been the best we
    can be and should be in this regard. I can't speak to the
    specifics of this. I can't speak to behaviors of individuals of
    past leadership. I will convey though our commitment to really
    trying to get this right.
        Chairman Moran. Dr. Watson. I don't know your history and
    how long you've been at the VA, but do you have an answer to
    the question of how can this go on? And it continued until some
    whistleblower decides they've had enough and it needs to be
    reported.
        Dr. Watson. Similar to Dr. O'Toole, I have been in my role
    since April 2024. I'm a psychologist. I've been with the VA SSA
    psychologist since 1993, so I'll be 32 years in September. So,
    I cannot really explain what has happened prior to my time with
    the Veterans Crisis Line.
        Chairman Moran. Well sadly, it seems that this circumstance
    is not limited to the Veterans Crisis Line. This is not the
    first time we've had reports of this behavior, or the first
    time we've had a GAO or Inspector General's report. It seems
    like it's there in a persistent and widespread, but way too far
    spread circumstance at the VA.
        And I don't understand why it is that an entity and
    organization that's its purpose is to care for those who served
    our country would have challenges like the Department of
    Veterans Affairs has. Any opportunity to explain this to me?
        Dr. O'Toole. I don't have any specific answer to this. I
    will say, however, that work in the Veterans Crisis Line has
    got to be one of the most difficult jobs in the VA. Literally,
    they are trying to save lives hour by hour, 24/7, 365 days.
    It's a tremendous stress, and we need to be doing a better job
    of protecting our employees and taking care of our employees
    because they are the ones who are taking care of our veterans.
        Chairman Moran. What prohibits or prevents the firing, the
    discharge of an employee in these circumstances? As I
    understand, they are still working. My experience in so many
    instances at the Department of Veterans Affairs in which
    there's been wrongdoing, is that the individual who committed
    the wrongdoing remains at the VA, sometimes transferred to a
    different department, a different hospital. This is not a one-
    time circumstance in my experience.
        Why is it so difficult to discharge an employee for
    misbehavior?
        Dr. O'Toole. Well, sir, I mean, you're absolutely right.
    And looking at the time from this GAO report and OIG report to
    where we are now, it's very frustrating. Part of the dynamic
    for the VA is we need to follow a due process for employees who
    have been accused, and allow the investigatory process to
    proceed and adhere to the recommendations for what disciplinary
    action is appropriate. It can be very frustrating, particularly
    from the outside looking in at that process. But it is a due
    process that our employees are entitled to.
        I will say from a management perspective, if there is an
    employee that is not performing to the standards that we would
    expect, our first and foremost goal is to make sure that our
    veterans are protected from that bad behavior. And oftentimes
    that requires moving that employee to a different place to work
    while the investigation is underway. And I just want to point
    that out within the process, not trying to justify the larger
    picture.
        Chairman Moran. Did that happen here?
        Dr. O'Toole. In some instances, yes. I mean, there were 18
    employees that were ultimately investigated in this process.
        Chairman Moran. Senator Blumenthal.
        Senator Blumenthal [presiding]. [Inaudible.] I'd defer to
    him if he hasn't.
        Senator King. First, I want to thank Ms. Hundrup for the
    thorough report. That's really helpful. And I hope that the
    Committee can pour through it and act on some of those
    recommendations. My personal aversion is to reports that don't
    get acted upon, so we're certainly going to try to do that.
        One of the issues seems to be, and this is for any of you,
    responders answering, dealing with multiple contacts at the
    same time. You're on the phone and you've got a text. I can't
    understand how that would ever be a good practice. I mean, it
    just, it's bound to divert your focus from one or the other of
    the contacts. Ms. Hundrup, is that a problem?
        Ms. Hundrup. Yes, the concurrent texts and chats, just to
    build on our concern a little bit, are happening coupled with
    the documentation requirements. So not only may a responder be
    required to handle two chats, sometimes up to three
    concurrently, but they're also required to document that at the
    same time. Couple that with some uneven algorithms for how
    responders are assigned the chats and then finally, historical
    staffing that has not kept up with the demand.
        For texts alone, we have seen an 80 percent increase over
    the four-year period that we looked at----
        Senator King. 80 percent over four years?
        Ms. Hundrup. For texting. So, I think, maybe just talking
    about concurrent texts or chats alone, one could understand the
    VCL's policy, and VCL officials told us that that's industry
    standard.
        When we looked and spoke with SAMHSA, they said that on the
    988 lines, there are some call centers that do allow concurrent
    texting and chatting, however others don't. But I think our
    concern is that it's not only this concurrent text and
    chatting, but all of the other responder tasks combined that
    are resulting in serious workload challenges.
        Senator King. Are people expected to handle chats and text
    as well as being on a call?
        Ms. Hundrup. No. So, they are all separate. If you work a
    phone line shift, you would be on the phone line strictly. I
    think we do understand that when a responder is assigned to
    answer chats or texts, if the phone lines are needing extra
    staff, they might get shifted over, but then they would shift
    completely over to the phone lines.
        Senator King. But they still might be dealing with multiple
    chats and texts at the same time?
        Ms. Hundrup. Correct.
        Senator King. And that's a challenge, correct?
        Ms. Hundrup. Correct. Absolutely.
        Senator King. Dr. O'Toole, you've probably heard Ms.
    Blane's testimony about productivity requirements like the time
    of calls. That strikes me as not consistent with what we're
    trying to do here. Nobody's going to stay on one of these calls
    just for fun. They're on the calls because it's important. Give
    me some thoughts about the standards that are being applied.
        Dr. O'Toole. I'd like to defer to Dr. Watson on that, who
    would know much more about it than I.
        Senator King. Dr. Watson, your thoughts on a time pressure
    on a person that's on a call.
        Dr. Watson. Yes. Thank you for that question. And that is
    also a concern. So, what we have with the Veterans Crisis Line
    is having to strike the best balance that we can to serve and
    meet the mission of answering as many calls or texts or chats
    as possible, and making sure that every one of those is at the
    highest quality. So the feedback----
        Senator King. It strikes me that a time limit of some--if
    I'm on a call and I get a message that says, you've been on
    this call too long, I don't understand why that's ever
    appropriate.
        Dr. Watson. And what is your question for me?
        Senator King. My question is, is that the practice and
    can't we change it?
        Dr. Watson. We do have some productivity targets that we're
    being asked to look at, and that is something that we can
    review and make changes as needed. We do thank the GAO for the
    recommendations, and we'll definitely follow up on that.
        Senator King. Great. Thank you, Mr. Ranking Member.
        Senator Blumenthal. Thanks, Senator King. For whoever can
    ask it Dr. O'Toole or Dr. Watson, what is the budget request
    for the Veterans Crisis Line for fiscal year 2026?
        Dr. Watson. It's approximately $312 million.
        Senator Blumenthal. $312 million. How does that compare to
    the current fiscal year 2025?
        Dr. Watson. This year is approximately $306 million.
        Senator Blumenthal. 306. So that's really a marginal
    increase, around $6 million requested increase, correct?
        Dr. Watson. Correct.
        Senator Blumenthal. Could you tell me whether the budget
    documents reflecting that number have been submitted to
    Congress, as yet?
        Dr. Watson. Thank you for that question, and I do not have
    the definitive answer of whether that has been submitted and
    approved, and we can get information for follow up.
        Senator Blumenthal. If you would, I'd appreciate it. We've
    received reports directly to the Committee from VA employees
    who say that the Veterans Crisis Line is experiencing an
    increase, in fact, a massive uptick in the outreach volume
    since the beginning of this year, which happens to coincide
    with the beginning of the Trump administration. Both overall
    for 2025 and regularly daily breaking outreach records. Is that
    report to us in accord with your experience?
        Dr. Watson. Thank you for that question. Yes, we have seen
    an appreciable increase in our call volume and our chat volume
    and our text volume.

    ------------------------------------------------------------------------

    -------------------------------------------------------------------------
    VA Response: The 2026 President's budget requested $312.8 million to
     support the Veterans Crisis Line (VCL), which represents an increase of
     22.2 million (7.7%) above the FY 2025 current estimate.
    ------------------------------------------------------------------------

        Senator Blumenthal. Do you have any predictions or early
    data on why this volume is higher than it has been in recent
    past? You have a theory or a view as to what the cause is?
        Dr. Watson. Thank you for that question and some initial
    thoughts about the increase in our volume overall. Some of that
    is related to multiple customers that call or text or chat
    multiple times. Some of those callers or customers fall in the
    customers with complex needs unit. So that accounts for some of
    the increase.
        Some of the increase, I think is certainly a good thing, in
    that there are more veterans and service members in those that
    support each group that are wanting to utilize the Veterans
    Crisis Line.
        Senator Blumenthal. I don't have more than a layman's view
    on this topic, but my working theory would be there's more
    anxiety and worry and depression than in the past. If the
    numbers are up, my conclusion would be, there are more mental
    health challenges. Correct?
        Dr. Watson. That is certainly possible.
        Senator Blumenthal. And I would hypothesize that a lot of
    veterans are really upset about the fact they're going to be
    fired. Does that make sense?
        Dr. Watson. I understand what you're saying and that's
    possible as well.
        Senator Blumenthal. Okay. I mean, if you're about to lose
    your job you're likely to be anxious and depressed. Senator
    King, did you have question?
        Senator King. I just wanted follow up on your question
    about increasing call volumes, increasing chat. You said 80
    percent in the last 4 years. I didn't do the math, but a $6
    million increase on a $300 million budget is not a lot. If the
    demand is, I think your word, Dr. Watson, was appreciably
    increasing.
        I hope that's something that Dr. O'Toole, you can take
    back, because there are very few, I can't think of any more
    important functions in the United States Government than this
    one. And if demand is increasing, we don't want to be putting
    pressure on people to try to shorten their calls or otherwise
    meet artificial productivity goals. We want to be sure these
    calls are responded to.
        So, I hope that there might be a hard look at the budget.
    There ought to be a ratio between calls received and the
    budget. That's a pretty straightforward proposition. Thank you,
    Richard.
        Senator Blumenthal. I think that's a really important
    point. And that's where I was going with my questioning. Do you
    have numbers on the increase in calls?
        Dr. Watson. We do track that information. Please specify
    more with your question of the period that you are looking for,
    and we can make sure that we provide that information for you.
        Senator Blumenthal. Well, you don't have that information
    now? The numbers of calls this year compared to last year?
        Dr. Watson. Yes. So, we thank you for that question,
    Senator. And we receive with our calls between 80 and 90,000
    per month.
        Senator Blumenthal. 80 to 90,000 now?
        Dr. Watson. Per month. So, each month of the fiscal year,
    starting in October.
        Senator Blumenthal. And what was it for the previous year?
        Dr. Watson. I do not have that information in front of me,
    but we do track that. I can provide that for you.
        Senator Blumenthal. Because that really goes to Senator
    King's point and the point that I was driving at. I'm going to
    also hypothesize that the numbers were inadequate last year and
    are even more inadequate this year in terms of the resources
    provided to you. Is that a reasonable hypothesis?
        Dr. Watson. I think that's a reasonable hypothesis and
    we'll be able to check the math to confirm.

    ------------------------------------------------------------------------

    -------------------------------------------------------------------------
    VA Response: When compared to the baseline levels of demand set when 988
     launched, VCL volume has increased across all services. The table below
     shows the number of calls each year following the implementation of
     988, press 1. While the number of calls has increased, our staff has
     too. We are continuing to hire as needed.
    ------------------------------------------------------------------------

    ----------------------------------------------------------------------------------------------------------------
                                              7/1/2022-6/30/2023       7/1/2023-6/30/2024       7/1/2024-6/30/2025
    ----------------------------------------------------------------------------------------------------------------
    Number of Calls                                        797,519                  893,654                1,044,461
    Percent Year Over Year                                     N/A                    12.05                    16.88
    ----------------------------------------------------------------------------------------------------------------

        Senator Blumenthal. I don't mean to be cute about it. Your
    department or agency saves lives. You save lives.
        Dr. Watson. Yes.
        Senator Blumenthal. And I can't think of anything more
    impactful and the VA does a lot of really impactful and
    important work, saving lives in surgery, in all kinds of other
    activities. It's a great agency. It should be preserved, not
    decimated as the current Administration seems bent on doing.
        But I can think of no more important area to provide
    sufficient resources so you meet the increasing demand, than
    your agency. So, I hope that you will be a partner in this
    effort, Dr. Watson, because I know you're committed to the
    cause and I'm so glad we are having this hearing because it
    enables us to shine a light on the importance of adequately
    resourcing this area of the work that the VA does.
        Dr. Watson. Thank you, Senator, for your support.
        Senator Blumenthal. Well, it is support. Senator King.
        Senator King. Just a quick comment. I should have started
    my questioning by saying, would you please convey our profound
    appreciation and thanks to the people that are doing this very
    difficult work, that they're recognized here and we realize how
    hard it is and that it's challenging and also how important it
    is.
        And I suspect that many of these people are there because
    of a sense of mission, and please take back our appreciation
    for what they're doing. We're not trying to be critics; we're
    just trying to make it work better. And I do want hopefully to
    take the message back to the people that are on the front lines
    doing such good work. I just wanted to add that.
        Dr. O'Toole. Thank you, Senator. And we appreciate that.
        Senator Blumenthal. Yes. I'm so glad, again, Senator King.
    Thank you. Please express our gratitude to these folks because
    they do a really hard job. There are other people in the VA who
    have hard jobs, this one is particularly challenging. And I
    want to go to the question that I asked Ms. Blane about the
    SSAs.
        I'd like to get from you as well, whether there has been an
    increase or decrease in the number of the Social Science
    Assistants, because as you've heard, and you know better than I
    do, but I was struck by how important these personnel are;
    locating the caller, phoning the police, providing records.
    It's almost like a nurse in a surgery, providing the scalpel
    and the this and that. So, if you could provide that
    information. How many are currently employed, if you know?
        Dr. Watson. Thank you for that question. And again, the
    support of our staff who do a critical role to serve the
    mission. I do not have the specific numbers for the SSAs on me
    at this time. We do track that information and we're able to
    provide that.
        Senator Blumenthal. Yes, if you could get me information
    about numbers of all your personnel, I would appreciate it.

    ------------------------------------------------------------------------

    -------------------------------------------------------------------------
    VA Response: Please see below staffing for Social Science Assistants
     (SSA) staff, Crisis Responders (CRs) and all Veterans Crisis Line (VCL)
     as of July 10, 2025:
    ------------------------------------------------------------------------

    ----------------------------------------------------------------------------------------------------------------
                            Position                            Current FTEE        FY 24 FTEE          Increase
    ----------------------------------------------------------------------------------------------------------------
    Crisis Responders                                                    1,096              1,066                 30
    Social Services Assistants                                             173                154                 19
    ----------------------------------------------------------------------------------------------------------------

    ------------------------------------------------------------------------
                          Department                          Current FTEE
    ------------------------------------------------------------------------
    Directors Office                                                      11
    Business                                                              98
    Data & Information                                                    61
    Technology & Innovation                                               59
    Crisis Operations                                                   1576
    Quality, Training & Risk Management                                  123
    National Care & Peer Support                                          92
    ------------------------------------------------------------------------
        Total............................................               2020
    ------------------------------------------------------------------------

        Dr. O'Toole. I would just add, and I don't want to speak
    for Dr. Watson, but we have added, what is it, 187 crisis
    responders this fiscal year to the Veteran Crisis Line. So, it
    is a workforce that we are actively recruiting and growing.
        Senator Blumenthal. Let me ask you, LGBTQ+ veterans and
    children of veterans, young people who are LGBTQ+ are you aware
    of discrimination against them?
        Dr. O'Toole. No, sir. I'm not.
        Senator Blumenthal. It would be against the law, wouldn't
    it?
        Dr. O'Toole. Yes, it would.
        Senator Blumenthal. And does the VA have policies to
    prevent responders on the VCL line from discriminating against
    LGBTQ+ callers?
        Dr. O'Toole. I will defer to Dr. Watson on that specific
    question, but the VA by policy cannot, should not, be
    discriminating against anyone.
        Senator Blumenthal. And one last question before we go to
    Senator Hirono. Do you have policies, Dr. O'Toole, to protect
    against retaliation for whistleblowers?
        Dr. O'Toole. We do, and it is something we take very
    seriously. It is essential and clearly, we have the policies,
    but if your office or others hear of that occurring, we need to
    know and investigate and respond aggressively.
        Senator Blumenthal. Thank you. I will turn to Senator
    Hirono if she's ready. Otherwise, I can stall a little while.

                         HON. MAZIE K. HIRONO,
                        U.S. SENATOR FROM HAWAII

        Senator Hirono. I know that we're all committed to
    providing the services that the veterans need, and there are a
    lot of changes happening in the VA and the word chaos and
    confusion I think are apt. But I do have one question for
    either Dr. O'Toole or Dr. Watson.
        My staff spoke with a veteran in Hawaii whose mental health
    care providers recently left VA. When the veteran asked how he
    should continue to access mental health care, he and others,
    they like similar situations, were directed to call the VCL.
    Can you confirm whether this was a one-off mistake or whether
    the VA is directing veterans to utilize the VCL for their
    everyday mental health needs? Either one of you?
        Dr. O'Toole. Well, I will take a first stab at it and then
    defer to Dr. Watson. That should not be the approach by any
    means. And I certainly would hope and expect that it is a one-
    off. And if your office could follow up with us on that
    specific veteran, we are more than happy to reach out and make
    sure that here he----
        Senator Hirono. So, what was supposed to happen?
        Dr. O'Toole. We should have been able to, and we should by
    all means, transfer that individual to another mental health
    provider within the VA system. And if we aren't able to provide
    care within the VA system, to be able to refer that patient to
    the community. But it is absolutely unacceptable for any
    veteran to fall through the cracks.
        Senator Hirono. Do you have something to add?
        Dr. Watson. I concur with Dr. O'Toole. The Veterans Crisis
    Line is for crisis care of veteran service members, and those
    that support each group, for the treatment that is needed for
    mental health, that is to occur either at the facility or
    healthcare system that's closest to that veteran or service
    member or in the community as Dr. O'Toole has mentioned.
        Senator Hirono. So, who is this veteran supposed to call to
    pursue a line of inquiry? This person, this veteran is supposed
    to get another treatment person to assign to him or her. Is
    that right? How do we make that happen?
        Dr. O'Toole. Yes. Obviously, the system did not work for
    this veteran as it is intended to. And we should have in the
    context of care for this veteran, without the veteran asking
    for it, been able to transfer that veteran's care to another
    mental health provider or make sure we are getting care for
    that veteran in the community.
        And again, we own that we need to address it. So, we are
    more than happy to follow up with your office to reach out to
    that veteran to make sure we can fix it.
        Senator Hirono. So, you would like us to provide you with
    the name of this veteran so someone can contact him with the
    name of a new treatment person?
        Dr. O'Toole. Yes, ma'am.
        Senator Hirono. Okay. Has the VCL seen any spikes in
    outreach following Administration actions that
    disproportionately impact the veteran community, such as the
    announcement of probationary firings or RIFs?
        Dr. Watson. Thank you for that question. We do track that
    information and we have received some increases of course, from
    the veterans or service members who contact the Veterans Crisis
    Line. Sometimes they share that information specifically with
    specific information. Other times they choose not to. But we
    are looking and tracking that carefully.
        Senator Hirono. So, my understanding of the Veteran Crisis
    Line is that, veterans call the crisis line with a variety of
    requests and questions. What kind of training do they--and by
    the way, how many people do you have nationwide on the crisis
    line who are taking all these calls?
        Dr. Watson. Are you asking for the specific number of
    crisis responders?
        Senator Hirono. The people who are taking these calls? How
    many people does the VA have, manning the crisis lines?
        Dr. Watson. Yes, for the crisis responders, I can give you
    an exact account. We do track that.
        Senator Hirono. No, gimme ballpark.
        Dr. Watson. I would say, let's say ballpark 1500. We have
    currently 2,049 employees within the Veterans Crisis Line.
        Senator Hirono. And is that an increase from say, I don't
    know what is another timeframe when you added more people to--
    --
        Dr. Watson. We had an exponential increase when we moved to
    988 press 1 option, in July 2022. So, we had to increase our
    staffing significantly at that time to manage that change.
        Senator Hirono. Okay. What is a significant increase?
        Dr. Watson. I would have to give you maybe a ballpark, so
    not an exact number. Because that occurred prior to my time
    with the Veterans Crisis Line. I started in April 2024. So, we
    can get that information for you. I would say we had to
    increase, I've heard at least by close to a thousand employees
    to manage that initiative.

    ------------------------------------------------------------------------

    -------------------------------------------------------------------------
    VA Response: To prepare for 988 Press 1 implementation, VCL added 1,073
     new positions in January 2022.
    ------------------------------------------------------------------------

        Senator Hirono. That is very significant. And the reason
    that you did that was, that what, more veterans were accessing
    the crisis line?
        Dr. Watson. Correct. We had a 1-800 number prior to July
    2022. Then when we connected with our 988 partners, we are
    press 1, so you call 988 and press 1. So, we need to increase
    our staff significantly with that change.
        Senator Hirono. So, would you say that the crisis line is
    one of the first numbers that a veteran might call for
    information and assistance? It could be the first encounter
    that a veteran may be having, accessing potential services that
    the VA provides?
        Dr. Watson. That's a great question and yes, I would. That
    is our hope as we are an integrated service crisis line for
    veterans and service members.
        Senator Hirono. So, since we have asked questions about the
    potential for another 80,000 people from VA being let go, at a
    time when there are all these needs in terms of providing
    veterans with services. Is there a plan to eliminate
    significantly this 1500 people that you have currently on the
    crisis lines?
        Dr. Watson. That's a great question and no plan that I'm
    aware of.
        Senator Hirono. I would like a great answer.
        [Laughter.]
        Dr. Watson. Yes, no plan that I'm aware of to eliminate our
    staff.
        Senator Hirono. And what did you say, that as far as, you
    know, that these people are going to stay there?
        Dr. Watson. As far as I know at this moment, that is
    correct.
        Senator Hirono. I think if, can you double check that?
    Because we don't want the first line of encounters for veterans
    to be among the 80,000 or so that potentially can be cut.

    ------------------------------------------------------------------------

    -------------------------------------------------------------------------
    VA Response: VCL was granted an exemption from the current federal
     hiring freeze and has continued to conduct hiring as needed. VA has no
     plans to reduce the number of VCL staff. Furthermore, on July 7, 2025,
     VA announced that we are on pace to reduce total VA staff by nearly
     30,000 employees by the end of fiscal year 2025, eliminating the need
     for a large-scale reduction-in-force.
    ------------------------------------------------------------------------

        Dr. O'Toole. Senator, I would just add to that. So, there
    are other phone access points for veterans trying to establish
    care and access care. So, the crisis line is clearly intended
    for those veterans who are in crisis and who need emergency
    crisis response. But ending veteran suicides is a priority of
    this Administration. And, you know, the expectation of that
    with those positions being exempted for many hiring freezes,
    through reversal of the return to office provisions for that
    group. You know, this is a committed group and we have grown
    that labor force within the crisis line by 187 individuals for
    this fiscal year.
        Senator Hirono. I am over my time. Alright. Can I go on? So
    is there a specific line for suicide situations that people can
    call?
        Dr. O'Toole. That would be the Veteran Crisis Line, ma'am.
        Senator Hirono. Okay. That would be the VCL? So then my
    next question is what kind of training do all your people have
    in order to deal with these kinds of very critical situations?
        Dr. Watson. Thank you for that question. They have very
    specific training to help them provide the best support and
    meet the mission. They often go through many, many hours of
    training and review. Then they have a precepting program. So,
    all of these things occur before they're actually allowed on
    the line to answer a call.
        Senator Hirono. There are some concerns that have been
    raised about what kind of training your crisis center people
    have. And so, if you have a description of the kind of training
    that people have and I don't know what kind of turnover you
    have, I would imagine that these jobs can be very--it's high
    pressure. Anyway, can you send me a description of what kind of
    training your crisis center people get?
        Dr. Watson. Yes. We have very specific training and we can
    send you that information for follow up.
        Senator Hirono. And what the retention is for your people?
        Dr. Watson. Certainly. Thank you.
        Senator Hirono. Thank you.

    ------------------------------------------------------------------------

    -------------------------------------------------------------------------
    VA Response: Office of Suicide Prevention (OSP) Veterans Crisis Line
     (VCL) has an extensive and robust training program providing crisis
     intervention focus subjects highlighting veteran specific experience
     including but not limited to modules on Military Culture, Post
     Traumatic Stress Disorder, Military Sexual Trauma, Engagement,
     Motivational Interviewing, Lethal Means Safety, Substance Use and
     Overdose Risk, Risk Assessment, Violence Risk Assessment, Crisis
     Intervention, and technical application use. All training is tracked
     through Veterans Affairs' (VA) Talent Management System (TMS). Each
     module has individual post-test requirements. New Employee Orientation
     (NEO) training is evaluated through the completion of a pre- and post-
     test knowledge checks. All trainees are expected to demonstrate
     competency at the end of classroom period by scoring 80% or higher on
     the post-test assessment.

    The VCL's turnover rate for Fiscal Year 2025 (October 1, 2024, through
     June 2025) to date is 7.9%.
    ------------------------------------------------------------------------

        Senator Blumenthal. Thank you, Senator Hirono. Thank you to
    our witnesses. And I think there are no further questions. I
    want to thank members of the audience as well as our witnesses.
    And please convey to your colleagues, not only at the Veterans
    Crisis Line, but throughout the VA, our profound thanks for
    their service.
        As harsh as I may have sounded in some of my criticism of
    the top leadership, I have profound admiration and gratitude
    for the service of the VA workforce, including present company,
    because your job is doubly difficult because of the cutbacks
    that are occurring and the slashing of programs. So, I'm not
    asking you to comment, but please convey my thanks to your
    colleagues and with that----
        Senator Hirono. I join in that by the way.
        Senator Blumenthal. Thank you, thanks Senator Hirono. And I
    think by the way, that comment reflects the vast majority of
    United States Senators, if not everyone.
        The hearing record will remain open for five legislative
    days should any Committee members want to submit additional
    statements or questions for the record. And I ask our
    witnesses, both from this panel and the previous one, to
    respond to any questions that may be submitted in a timely
    manner.
        And with that, the hearing is adjourned.
        [Whereupon, at 5:57 p.m., the hearing was adjourned.]

                                A P P E N D I X

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