[Senate Hearing 119-108]
[From the U.S. Government Publishing Office]
S. Hrg. 119-108
CORRECTING MISMANAGEMENT OF THE
VETERANS CRISIS LINE
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
JUNE 25, 2025
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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
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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
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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
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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
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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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