Hearings to examine correcting mismanagement of the veterans crisis line.

1[Senate Hearing 119-108]2[From the U.S. Government Publishing Office]34                                                      S. Hrg. 119-10856                    CORRECTING MISMANAGEMENT OF THE7                          VETERANS CRISIS LINE89=======================================================================1011                                HEARING1213                               BEFORE THE1415                     COMMITTEE ON VETERANS' AFFAIRS16                          UNITED STATES SENATE1718                    ONE HUNDRED NINETEENTH CONGRESS1920                             FIRST SESSION2122                               __________2324                             JUNE 25, 20252526                               __________2728       Printed for the use of the Committee on Veterans' Affairs2930[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3132        Available via the World Wide Web: http://www.govinfo.gov3334                                __________3536                   U.S. GOVERNMENT PUBLISHING OFFICE3760-891 PDF                  WASHINGTON : 20253839-----------------------------------------------------------------------------------4041                 SENATE COMMITTEE ON VETERANS' AFFAIRS4243                     Jerry Moran, Kansas, Chairman44John Boozman, Arkansas               Richard Blumenthal, Connecticut,45Bill Cassidy, Louisiana                  Ranking Member46Thom Tillis, North Carolina          Patty Murray, Washington47Dan Sullivan, Alaska                 Bernard Sanders, Vermont48Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii49Kevin Cramer, North Dakota           Margaret Wood Hassan, New50Tommy Tuberville, Alabama                Hampshire51Jim Banks, Indiana                   Angus S. King, Jr., Maine52Tim Sheehy, Montana                  Tammy Duckworth, Illinois53                                     Ruben Gallego, Arizona54                                     Elissa Slotkin, Michigan5556                     David Shearman, Staff Director57                Tony McClain, Democratic Staff Director5859                            C O N T E N T S6061                              ----------6263                             June 25, 20256465                                SENATORS6667                                                                   Page68Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     169Hon. Richard Blumenthal, Ranking Member, U.S. Senator from70  Connecticut....................................................     271Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    1172Hon. Angus S. King, Jr., U.S. Senator from Maine.................    1373Hon. Jim Banks, U.S. Senator from Indiana........................    1674Hon. Tammy Duckworth, U.S. Senator from Illinois.................    1875Hon. Mazie K. Hirono, U.S. Senator from Hawaii...................    327677                               WITNESSES78                                Panel I7980Brad Combs, Former Lead Auditor, Veterans Crisis Line, Veterans81  Health Administration, U.S. Department of Veterans Affairs.....     48283Marcia Blane, Former Responder, Veterans Crisis Line, Veterans84  Health Administration, U.S. Department of Veterans Affairs.....     68586                                Panel II8788Alyssa Hundrup, Director, Health Care, U.S. Government89  Accountability Office..........................................    229091Dr. Thomas O'Toole, Deputy Assistant Under Secretary for Health92  for Clinical Services, Veterans Health Administration, U.S.93  Department of Veterans Affairs accompanied by Dr. Christopher94  Watson, Executive Director, Veterans Crisis Line, Veterans95  Health Administration, U.S. Department of Veterans Affairs.....    249697                                APPENDIX98                          Prepared Statements99100Brad Combs, Former Lead Auditor, Veterans Crisis Line, Veterans101  Health Administration, U.S. Department of Veterans Affairs.....    41102103Marcia Blane, Former Responder, Veterans Crisis Line, Veterans104  Health Administration, U.S. Department of Veterans Affairs.....    49105106Alyssa Hundrup, Director, Health Care, U.S. Government107  Accountability Office..........................................    53108109Dr. Thomas O'Toole, Deputy Assistant Under Secretary for Health110  for Clinical Services, Veterans Health Administration, U.S.111  Department of Veterans Affairs.................................    65112113                       Submissions for the Record114115Information requested during the hearing by Senator King from116  former117  Veterans Crisis Line employees:118119  Brad Combs.....................................................    71120121  Marcia Blane...................................................    76122123                    CORRECTING MISMANAGEMENT OF THE124                          VETERANS CRISIS LINE125126                              ----------127128                        WEDNESDAY, JUNE 25, 2025129130                                       U.S. Senate,131                            Committee on Veterans' Affairs,132                                                    Washington, DC.133    The Committee met, pursuant to notice, at 3:57 p.m., in134Room SR-418, Russell Senate Office Building, Hon. Jerry Moran,135Chairman of the Committee, presiding.136137    Present: Senators Moran, Banks, Sheehy, Blumenthal, Hirono,138Hassan, King, and Duckworth.139140             OPENING STATEMENT OF HON. JERRY MORAN,141               CHAIRMAN, U.S. SENATOR FROM KANSAS142143    Chairman Moran. The Senate Committee on Veterans' Affairs144will come to order. Senator Blumenthal is en route. I'm going145to go ahead and make my only statement. We are trying to work146our way around votes at 4:15 p.m., so we're going to see if we147can figure out a way to make this all work, and make sure we148hear the testimony of both panels.149    So, good afternoon, and welcome. Nearly two years ago,150during another oversight hearing this Committee held, examining151the VA's Mental Health and Suicide Prevention efforts. My152office received a phone call. That phone call was from a153whistleblower reaching out as he listened in real time to VA154witnesses answering questions about a tragic veteran suicide155and the VA's potential cover-up of serious issues at the156Veterans Crisis Line.157    The oversight hearing with VA previous leadership left us158with more questions than answers, and my office had multiple159conversations with this whistleblower. Those meetings led to160several other VA employees coming forward to speak with my161staff about their firsthand experiences, sharing troubling162details about mismanagement at the Veterans Crisis Line. They163spoke of policies and practices that may be leaving veterans in164critical need of support at an increased risk for harm to self165or others.166    I would like to thank every individual who bravely stepped167forward and contacted our office to share those concerning168accounts. I would especially like to thank, express my169gratitude to Mr. Brad Combs, a whistleblower, and the Veterans170Crisis Line's former lead internal auditor, who placed the171original call and who is here with us this afternoon.172    Without his sacrifice, his courage to do the right thing173for veterans that he and us serve, we would not be in this174position today to have this hearing.175    After we held multiple meetings and calls with176whistleblowers on November 6, 2023, I sent a request to the177Comptroller General, Gene Dodaro, to call for a thorough audit178of the Veterans Crisis Line. I would like to extend my179gratitude to him and his team at the Government Accountability180Office, for their thorough and informative work on this matter.181    Throughout the past 21 months, my office has worked through182hundreds of pages of disclosures, countless hours of183interviews, and I am holding this hearing today to release the184findings of the GAO investigation, and to hear directly from185the initial whistleblower, the program's former lead internal186auditor.187    It is my intent that this hearing serve to force action.188Real change and improvements require transparency and189accountability. Based upon information provided by the Office190of the Inspector General, it is my understanding that 21 months191later, the Veterans Crisis Line still has not completed an192internal investigation, nor held anyone accountable, for the193inadequate and problematic leader and staff actions before and194after a veteran died by suicide.195    My expectation is Secretary Collins will hold accountable196the individuals, with the department who were responsible for197both the mismanagement of the Veterans Crisis Line, and any198attempted cover-up of these troubling issues.199    The Veterans Crisis Line is a critical tool for veterans at200immediate risk of suicide. Members of this Committee, as well201as VA leadership, must make certain America's veterans and202their family members can depend upon this valuable resource.203And I'm going to now pause the hearing in anticipation of the204arrival of Senator Blumenthal. Which if things worked as they205should, he would appear right now.206    [Laughter.]207    Senator Blumenthal. And lo and behold.208    Chairman Moran. Senator Blumenthal, thank you for joining209us. You were kind enough to allow me to begin. With the210critical circumstance with our votes, the interruptions that we211will have, I wanted to get started, and I've completed my212opening statement. And I now recognize you for yours.213214         OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,215         RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT216217    Senator Blumenthal. Thank you, Mr. Chairman. Thank you to218Chairman Moran, as well as to our witnesses on this really219critically important topic, which is, as you may gather,220bipartisan, and it should be, because the Veterans Crisis Line221is a critical resource in our fight to eliminate veteran222suicide.223    That fight has been ongoing since I came to the United224States Senate. One of my very first bills was with Senator John225McCain on this topic. It passed the United States Congress, and226one of the proudest moments of my life, as the United States227Senator, was to go to the White House with John McCain, to the228East Room, where President Obama signed our legislation into229law, with myself on one side and John McCain on the other.230    I don't need to remind any of you that John McCain and231President Obama actually ran against each other, but they came232together in this cause, and I think we have a similar233obligation today.234    The Veterans Crisis Line is at the forefront of combating235veterans' suicide, as you all know, as trained responders236available to any veteran service member or family member, 24237hours a day. This hearing demonstrates that the VA's ability to238improve its resource and operation relies on independent bodies239like the Inspector General and the Government Accountability240Office, as well as, unbreakable protections for whistleblowers,241to enable VA employees to sound the alarm on waste, fraud, and242abuse.243    I want to express my personal regret that VA Inspector244General Mike Missal, is not here as a witness. He was fired245along with 18 other Inspectors General after performing with246huge distinction and honor over different Presidents,247Republican and Democratic, and saving taxpayers billions of248dollars.249    The Trump administration, unfortunately, has also attacked250the nonpartisan Government Accountability Office and is working251full-time to demoralize and frighten whistleblowers by252invalidating collective bargaining agreements, requiring senior253leaders to sign NDAs, politicizing independent watchdogs and254overhauling hiring requirements to force public servants to255declare loyalty to President Trump, not to the Constitution.256    These actions, along with a lack of transparency and257accountability from this VA and this Administration, make258meaningful oversight of VA programs like the Veterans Crisis259Line, extremely challenging. The GAO and IG reports that we are260discussing today, show that the Veterans Crisis Line needs more261resources, more staffing, more investment into technology.262    These recommendations demonstrably conflict with the263ongoing mismanagement of the department by Secretary Collins264and this Administration. There is a practical relevance and265importance to the GAO report that we have today that is266indisputable.267    In the first phase of illegal firings, the Veterans Crisis268Line employees, including those who conduct advanced training269for responders, were fired without warning. Secretary Collins270also fired at least nine staff at one Veterans Crisis Line call271center, who were responsible for locating veterans actively in272crisis, and coordinating in-person emergency response and273coordination with Veterans Crisis Line responders.274    Secretary Collins reversed these findings, but not before275weeks passed, and the Administration has provided zero answers,276none, regarding the Veterans Crisis Line and other suicide277prevention efforts that will be impacted by Secretary Collins'278goal of terminating an additional 83,000 VA employees in the279coming months. That is his plan. We've had testimony about it,280but we have no specifics, no facts, especially as concerned the281Veterans Crisis Line.282    My office, regrettably and tragically, sometimes continues283to hear from Veterans Crisis Line and VHA staff, that these284reduction-in-force plans have led to significant increases in285call volumes to the Veterans Crisis Line, from veterans who286fear they're going to be fired.287    And the reason is quite simply, that of those 83,000288employees that Secretary Collins is going to fire, a quarter to289a third of them are veterans, whose lives are about to be290decimated. And so, of course, they're calling the Veterans291Crisis Line at a time when it is about to be potentially292decimated as well. Secretary Collins ordered in February that293all Veterans Crisis Line employees return to office, ``return294to office'' as part of the mandate set by President Trump.295    Employees were brought to offices that they never296previously occupied. The offices were ill-equipped. They lacked297the necessary privacy for calls of this kind of sensitivity.298Some Veterans Crisis Line employees simply left. They figured299they had no future there, and they lacked the resources to do300their jobs in a way they thought necessary.301    And then, Secretary Collins reversed the return to office302decision for Veterans Crisis Line employees as well. So, I303think we can do better. I think we must do better. Veterans304Crisis Lines save lives. They literally save lives. And to ping305pong these employees is, in my view, disgraceful and a306disservice to all our veterans.307    Part of the trash and slash strategy that was originated308and implemented by the DOGE tech bros, they're still around309even though Elon Musk has left, and the effects have been310catastrophic for the Veterans Crisis Line. Thank you, Mr.311Chairman.312    Chairman Moran. Senator Blumenthal, thank you and I will313join you in expressing my gratitude to Inspector General Missal314for his efforts during his time as the Inspector General at the315Department of Veterans Affairs, and his work to bring316information such as this to us for our use in trying to improve317the circumstances that veterans face across the country.318    Testifying today on our first panel is Mr. Brad Combs,319whistleblower and former VCL Lead Internal Auditor, Department320of Veterans Affairs, and Ms. Marcia Blane, former VCL321Responder, Department of Veterans Affairs. And as I indicated322in my opening statement, we're very grateful for your presence323here today, and thank you for your willingness to tell us324things you think we should know for the benefit of those you325have served and I assume will continue to serve. So, Mr. Combs,326you're now recognized.327328                            PANEL I329330                              ----------331332 STATEMENT OF BRAD COMBS, FORMER LEAD AUDITOR, VETERANS CRISIS333   LINE, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF334                        VETERANS AFFAIRS335336    Mr. Combs. Chairman Moran, Ranking Member Blumenthal, and337distinguished Members of the Committee, thank you for the338opportunity to speak with you today. My name is Brad Combs.339From 2019 to 2023, I worked as a lead auditor for the Veterans340Crisis Line. My work theory gave me a deep insight into its341operations.342    I was directly involved in the Inspector General's343investigation that was discussed with this Committee in the344September 2023 hearing. I called this Committee after that345hearing because I believed you were being misled. I testify now346for all the whistleblowers who had the courage to step forward.347    I presented four areas of concern. Number one, Callers with348Complex Needs or CWCN. CWCN are callers who display disruptive349behaviors such as incessant calling, hate speech or abusive350language, but also historically include a small number of351misunderstood callers in acute crisis. A small clinical team352engages these callers, but due to staffing and demand353mismatches, excess demand is re-queued and handled by specially354trained responders.355    Just before leaving the VA, I received a transferred CWCN356call due to a system-controlled gap. This bypasses cues and357tracking and risks and indefinite holds and dropped calls, that358was a known tactic to avoid returning callers to the call359center with no one being the wiser.360    The leadership was aware of these issues since 2018, but361took no action. Further, in 2022, the cross-functional team362that provided oversight of the clinical team's intervention363decisions was dissolved and replaced by one reporting to the364clinical team, further pushing CWCN into a deep dark hole. As365indifference to these callers has continued, several clinicians366have left VCL in protest.367    Number two, quality assurance. From 2022 into 2023, testing368of the reliability for measuring responder adherence to369interaction standards, repeatedly showed significant and370unacceptable variances. This would include such standards as371suicide risk, and lethal means. This would be the equivalent of372teachers grading students without fully understanding the373subject material themselves. VCL had little actual374understanding of how well responders were performing and there375was no plan to fix it.376    Number three, electronic media management. Chat and text377responders are required to handle multiple interactions at a378time, when necessary. Responders have continually expressed379concerns about this, which has centered on such problems as380trying to maintain focus on two interactions while one is at381acute risk of self-harm or harming another.382    Despite the concerns and accredited recommendations,383leadership has made no changes. In fact, when I began to survey384for industry standards, the VCL Executive Director ordered me385to stop, despite the IG using similar methods in prior reports.386    Number four, disclosure of sentinel events. The Suicide387Prevention Program Executive Director had known since 2018 of388the need to determine when or how to perform a disclosure when389something went wrong during or after a VCL interaction. After390three years, he still had to be told by his boss to make these391disclosures as a result of an Inspector General investigation.392    The following year, when the VCL Executive Director learned393of VCL's culpability for a veteran suicide that happened one394year prior, she did not make a disclosure despite the standard395operating procedure she signed now requiring it.396    In management's comments to the Inspector General's 2023397report recommendations, even the Veterans Health Administration398Under Secretary was clear that he wanted a disclosure399completed. But as soon as the report was published, the Suicide400Prevention Program Executive Director stopped it from401occurring. GAO confirmed that VCL is now back to 2018 on402disclosures.403    The many Inspectors General investigations have not changed404VCL's culture. Managers have exploited accountability gaps,405rather than mitigating against the risks these gaps created,406and have been doing this since before my time. The Suicide407Prevention Program Executive Director has been leading the VCL408since 2017. This is the culture he built.409    The VCL Executive Director was moved to the Secretary's410office, but months later was still a tasking me through her411former boss. Now she works with VHA Under Secretary, even more412directly affecting VCL's operations. All of these leaders that413made these decisions and took these actions that led us to414where we are today, have been kept in roles to still directly415affect veterans in the VCL. VCL cannot change or improve until416they and their influence are being completely removed.417    Thank you for your time and attention. This oral testimony418is just the tip of the iceberg, and I thank you for allowing me419to also submit written testimony to flesh these items out. I420welcome your questions.421422    [The prepared statement of Mr. Combs appears on page 41 of423the Appendix.]424425    Chairman Moran. Mr. Combs. Thank you very much. Now, Ms.426Blane.427428 STATEMENT OF MARCIA BLANE, FORMER RESPONDER, VETERANS CRISIS429   LINE, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF430                        VETERANS AFFAIRS431432    Ms. Blane. Chairman Moran, Ranking Member Blumenthal, and433Members of the Veterans' Affairs Committee; thank you for the434opportunity to give a voice to Federal employees. I am Marcia435Blane, a Licensed Professional Counselor, a Certified436Professional Counselor Supervisor, and a Certified437Hypnotherapist.438    I'm a proud retired employee of the Federal Government439where I worked for 28 and a half years, spending 19 years at440the Department of Treasury and Internal Revenue Service, and441the last nine and a half years at the Veterans Crisis Line at442the VA.443    As the daughter and mother of Marine combat veterans,444watching and living through the impact of post-traumatic stress445after combat, my father and my son were greatly impacted. I446found it imperative to give back to a community that has given447so much of themselves.448    When the Atlanta site opened in 2016, future employees were449required to have a master's degree in an area of mental health.450Our level of education mattered. During our training we were451repeatedly told your degrees don't matter. However, for the452work that we do to save lives, our degrees certainly mattered.453The professionalism we brought to the staff was relevant,454because we were trained to deal with crisis differently.455    There is a staff of highly trained individuals who are456often told, this is not a clinical position, so don't use that457skill set. The Veterans Crisis Line is filled with caring458professionals who are frequently encouraged to dim their lights459and just answer the call. Prioritizing quantity over quality.460Responders also faced racially, misogynistic, abusive, and461sexually inappropriate interactions with the callers.462    I, along with a couple of other responders, worked463tirelessly to meet with the leadership staff with the hope of464establishing protocols regarding abusive callers. After465initially being rebuffed and dismissed by leadership, told that466being called the ``N'' word, repeatedly by callers not in467crisis was essentially a ``me'' problem.468    I was later asked to put a team together and offer469suggestions to help reduce the impact of racially and sexually470charged interactions internally and externally. After our team471created robust educational materials and assessments, the472process was shut down by those in charge, in the main VCL473office. And I was told the leaders are apprehensive to be474taught DEI by a responder.475    While they coined it DEI, it was actually an effort to476educate the masses regarding abusive callers and the impact it477has on workers. Unfortunately, this was the continued stance of478the leadership at the VCL. Unless you were at the top, any way479that you could contribute to making it a better workplace and480more effective service for veterans was shunned. Responders481continue to face a daily barrage of callers that have been482identified as Callers with Complex Needs, CWCNs, who are483supposed to be assigned to a team with specialized training to484free up the main line.485    These callers are aggressive, abusive, disrespectful, and486burden the VCL platform. They would intentionally call 30 to 40487times a day, in a hope to interrupt the functioning of the488line. They also text and chat about that much. And the outreach489volume from CWCNs has only increased in the recent months. Now490they are regularly crashing the chat and text platforms, and491blocking up the main crisis line for veterans who actually need492our help.493    We encounter situations where, on one call we have just494talked to a person into unloading their firearm that they were495planning to use to complete their life, to the next call with496an abuser who is calling us every racial epithet they know and497suggesting someone sexually assaults us. Can you imagine what498those words do to the nervous system of someone who has no499recourse, no defense?500    The CWCN trained team is constantly understaffed and the501calls are still often handled by mainline responders, which502again, taxes the broader system, defeating the purpose of the503specialized team. The VCL does not have a reprieve from abuse.504Attempts to deescalate or redirect can be deemed inappropriate505by quality insurance, and you are threatened to be taken off506the phone. In those instances, we are reminded that others507outside of the VCL, had been hired to become quality monitors508and often failed to have the experience of being a crisis509responder.510    On May 8, 2025, I submitted my final email to the VCL, as511it was my last working day before retirement. I shared with512leadership that it's important that they gain experience by513observing live calls, since most of the leadership has not been514a responder. Rules on call handling are being made by people515who have not had the experience of talking down a caller or516hearing the completion of life and doing all that you can to517prevent it.518    We are consistently attacked because of the underlying myth519that responders aren't working since we are working from home,520by individuals who have no direct experience with what we do.521People who insist that we need to come into the office full522time, meanwhile, the employees working from home statistically523have less call outs, handle more calls, and provide the same524quality of service as the reports from the Inspector General525show that.526    Leaders are trying to manage and supervise when their527skills lack ability, insight, and often experience. A recent528example of the lack of insight, was the termination earlier in529the year of vital VCL employees such as the Social Science530Assistants, who are our right hands.531    When we are in the throes of a crisis call, they become the532investigators to find the locations of callers who won't reveal533their locations. They are the voice behind the calls to police534departments when rescues are activated. They are the follow up535to ensure a veteran or civilian has arrived at a facility.536Terminating those employees created a delay in service, reduced537employee morale, and made all of us more vulnerable to misses.538That's missed opportunities for those with suicidal thoughts.539    In closing, the VCL could be a much better place to work if540VA utilized the skills and experiences of their employees to541create a healthy environment for the employees and those that542we serve. There's more to the people working from home for the543VCL than what I've shared here. They are professionals that544keep individuals who are ready to end their life, to change545direction based on hope and the love for what we do. And VA has546to do better for them, so they can continue to provide the best547possible support for veterans in crisis. Thank you for your548time, and I look forward to your questions.549550    [The prepared statement of Ms. Blane appears on page 49 of551the Appendix.]552553    Chairman Moran. Thank you, Ms. Blane. Mr. Combs, thank you554again for bringing these serious matters to our attention, for555working with me and our team and the Government Accountability556Office, and for being here today.557    I know your motivation is to help improve the circumstances558that the Veteran Crisis Line and to protect the well-being of559those in need of services. Would you describe for me, for the560Committee, the interaction between the veteran caller and the561responder that led to the September 23 OIG report?562    Mr. Combs. Yes, sir. If I could really quick--I would like563to thank you for listening. It's been really important that you564listen and for John and Emily and your staff for everything565they did for these past couple years. It was really important.566    Chairman Moran. Thank you.567    Mr. Combs. The interaction that took place, a veteran was568in the act of accomplishing a suicide. He contacted the crisis569line, via text message. The responder missed multiple cues,570multiple cues that the veteran had a belt around his neck, that571he was losing consciousness, that he was actually attempting572suicide as he was texting her. She reported that the call ended573normally. Ten minutes later the veteran was dead, and in fact,574died in his garage behind his house, mere feet from his entire575family.576    Chairman Moran. My understanding based upon what my staff577tells me, that an interaction like that should trigger a root578cause analysis. Tell me what that is and tell me if one579occurred. Why or why not?580    Mr. Combs. Yes, sir. Root cause analysis within the VA,581they use it on a clinical basis, but it's a very common thing582that frankly everyone does to get down to what was the root583cause of the issue that led to the event. It's used in business584as well. A root cause analysis in the VCL's terminology is to585identify what the actual root cause of the event was that led586to the suicide after VA was last touched, after VA was587involved, or VCL was involved, or could be involved in a588suicide.589    The root cause analysis was not performed in 2021 when we590were first informed of the veteran, because we didn't have a591transcript and no one was actually all that concerned about it.592It was kind of business as usual. But when the IG said they593were coming in, we were very concerned about what the IG might594identify, so we wanted to dig into what the IG might find out595and try to get ahead of the train.596    But frankly to be able to put a point on this, the597Executive Director determined that a root cause analysis would598not be performed in 2021, and in 2022 decided that root cause599analysis was appropriate to perform.600    Chairman Moran. My takeaway from your testimony, Mr. Combs,601and perhaps you too Ms. Blane, is that there's this culture of602turning a blind eye, outright covering up of deficiencies. And603what it seems is that it may be really common at the Veterans604Crisis Line, and none of this makes sense to me.605    I don't think I know people who would not take those606circumstances seriously. Whether you're the responder, whether607you're the person on the line, or whether you're the that608person's supervisor, I don't think I understand how anyone609could not see the importance and take every step necessary to610protect the life of the caller. What's missing? How does this611take place? I wrote down training, attitude, leadership. I612don't know what supervision--what's missing here that would613cause somebody to do something that seems to me to be so614inhumane?615    Mr. Combs. Sir, it is an attitude or a culture of616permissiveness. It starts from the top. It's the Executive617Director of Suicide Prevention Program that, again, has been618running the program as well as the VCL since 2017, who's619created the culture of permissiveness and his management team,620outside the call center. Because I want to be very clear, call621center people are rock stars. But the management team overall,622the cultural permissiveness has led to this environment where623they chase metrics and not lives.624    Chairman Moran. And what do they benefit by having better625metrics? Is there an incentive for better metrics?626    Mr. Combs. Mr. Chairman, I can't answer that because it's627completely foreign to me from a service point of view, all I628know is to serve.629    Chairman Moran. Senator Blumenthal, I wish he was here. He630and I on a different committee, the Senate Committee on631Commerce, conducted a long investigation into the sexual abuse632of gymnasts in the Olympics. And I remember the Olympian, at633least one of them saying what stuck with me from the very634beginning is--and it was a series of women who were harmed. And635it was, why was there more than one?636    And it strikes me as something very similar here about if637there's an error, a poor performance, disregard for human life,638it happened once, but then it was taken care of. And so, while639I would condemn the bad behavior of any employee, I don't640understand how it wouldn't be corrected so that it never641happened again.642    Ms. Blane let me ask you, I also thank you for being here643and your courage and explaining and sharing your experience.644Describe the VCL leadership. What's the story there?645    Ms. Blane. Thank you so much for that question. I have to646start with the fact that I have a lot of leadership experience647coming from IRS. So, coming into the VCL, notable things such648as no active standard operation procedures were written, there649was elevation of positions by clicks, not by experience. There650was an ignorance to what was in the union contract, what was651right, what was wrong, what was indifferent. And I think that652because of a lack of leadership skills, trained individuals on653running departments from that manner, trickled down to what was654happening at the bottom line with the crisis responder and all655of the teams.656    When we onboarded in 2016, the management staff were new657hires off the street. They had not been Federal employees658before. They knew nothing about union contracts. They knew659nothing about managerial principles. In fact, I went to the660then director and said, listen, I know I'm not in management,661but I can guarantee you with all the years that I've been662training managers at IRS, I can help get your people on their663feet. They said, ``no, thank you.''664    So, at that point, I had to begin looking at how could I be665a voice on behalf of the responders and the employees, because666I knew that the management staff, their abilities, even in667projecting staffing, was not that great, because they just668didn't have the experience.669    Chairman Moran. I need to wrap up my questions quickly for670the benefit of my colleagues. I want to ask two more and then671we'll move on. Are the people you are describing here today,672are they still employed at the VA? Has there been any673consequences? One or both of you, either of you?674    Mr. Combs. Ms. Chairman, I think Marcia is most--She just675left the VCL, so she's probably better situated to answer.676    Ms. Blane. Several of them are still employed. Some have677left, but yes, the answer to your question.678    Chairman Moran. And finally, and it kind of fits with what679Mr. Combs just said when he deferred to you. So, if you were680still an employee at the VA and you were here in front of us,681is that something that you would be honored for or something682you'd be punished for?683    Ms. Blane. More than likely punished. There is an684atmosphere of be quiet, keep your head down or face the685consequences.686    Chairman Moran. Strikes me so sadly, because we're dealing687with people who served our country, who had no option of688keeping their head down.689    Ms. Blane. Correct.690    Chairman Moran. Senator Hassan.691692                   HON. MARGARET WOOD HASSAN,693                U.S. SENATOR FROM NEW HAMPSHIRE694695    Senator Hassan. Well, thank you Mr. Chair, and thanks for696this very important hearing, and thank you Mr. Combs and Ms.697Blane for being here today and for your care for our veterans698and your service to our veterans. And Ms. Blane, like you, my699dad was a veteran, so I know this is personal for so many of us700in this country, as it should be.701    Mr. Combs, I also want to just, before I ask you my first702question, I want to say thank you for your service, not just to703our veterans, but for your service as a veteran yourself. In704your written testimony, you discuss the fact that callers to705the Veterans Crisis Line with complex needs often exhibit706disruptive behavior, but that many of these callers are also in707a heightened state, and they're unable to control their708emotions because they're in a very vulnerable position.709    You also noted that supporting these callers can take a710toll on the responders who answer the calls, which is also711really understandable. In your experience as the former Lead712Auditor at the Veterans Crisis Line, what do you believe are713the most important policy changes that can be made to ensure714that veterans who have complex needs, get the help that they715need while we're also making sure that crisis line workers are716supported?717    Mr. Combs. Yes, ma'am. As far as these complex callers,718there was a team that was stood up in 2017. This was their719purpose. They developed multi-tiered interventions and then720also, based on the callers, because these callers are repeated,721based on the callers, they provided training or tools to the722responders who might encounter them, how to work with each one723of these callers, to run it down to mitigate the concerns. That724team has been decimated. And the people who stood it up, the725clinician who stood it up, have left in protest over the way726the callers have been treated.727    Senator Hassan. So, reconstituting that kind of team would728be an important first step?729    Mr. Combs. Yes, ma'am.730    Senator Hassan. Okay. Another question for you, Mr. Combs.731You've also mentioned that the Veterans Crisis Line had a732standard practice of having call responders simultaneously733handle multiple chat or text interactions with veterans in734crisis. I understand wanting to help as many veterans as735possible and trying to reduce wait times, but our veterans also736deserve to be given individual attention by crisis line737responders. We can and we should accomplish both of those738goals.739    Our veterans deserve to get prompt support when they reach740out to the Veterans Crisis Line, and our responders shouldn't741be asked to divide their attention between multiple veterans in742crisis at once. So, can you please discuss some of the risks743involved with having responders treat multiple veterans at744once, and what the crisis line can do to avoid this issue while745also ensuring that veterans get prompt help?746    Mr. Combs. Yes, ma'am. As far as the risk, I can talk on a747very high level. Marcia is extremely well qualified to answer748that question very specifically. But I will tell you, anytime749you divert attention from someone who is in crisis, who is an750acute risk of actually committing a suicide or a homicide, you751do not want your attention diverted. But I would defer to752Marcia for answering that.753    Senator Hassan. And Ms. Blane, please.754    Ms. Blane. Thank you so much for that question. In bringing755light to what's happening in the digital media part of what we756do at the Veterans Crisis Line. Even as early as yesterday, our757responders were still taking two, sometimes three texts or758chats from veterans. That puts us in a situation where there759are gaps.760    Because if you're dealing with someone that's in a crisis761and someone, it could be a kid, because we get a lot of762children chatting to the Veterans Crisis Line, you are having763to divide your attention and something could very well go764through the gap and we could miss opportunities.765    We need to identify a better way to handle those chats,766individualize them so that, one, we don't burn out the767responders themselves, and then they're now having to react768from anxiety. What did I miss? How did I miss it? And things of769that nature.770    Senator Hassan. And when you said, we get a lot of kids,771who are the kids? why are they reaching out digitally, texting,772chatting?773    Ms. Blane. So, every time an entertainer mentions 988 or774chat or text there, we see an abundance of interactions from775young people. We see it through the calls when they're on776spring break or summer break because they're bored and their777parents need to get something for them to do.778    And then they also get on the chat, we do have some serious779chatters that are that young, that may be feeling some anxiety780and things of that nature, but our line is for veterans. And so781that taxes our system as well.782    Senator Hassan. Right. Are they ever children of veterans?783    Ms. Blane. No, these are kids that are in the middle of784their classroom.785    Senator Hassan. I hear you. Alright. Well, we're waiting786for the Ranking Member to return. So, I do have one more787question for Mr. Combs. So, I think it is important to788acknowledge, like you do in your written testimony, sir, that789Veterans Crisis Line and staff are dedicated, hardworking790people who want to help veterans and that's been very clear791from both of you.792    When you have staff who want to do the right thing and who793are working under difficult circumstances, it's really794important to provide them with the tools and resources795necessary to help them do their jobs the best way possible,796including effective, consistent feedback and oversight to help797them improve.798    So based on your experience as an auditor, and Ms. Blane,799I'll welcome you to comment as well. Could you please describe800some ways in which the crisis line can improve its feedback and801quality assurance so that responders can continuously improve802and provide veterans with the best care possible.803    And I remember that in response to Senator Moran, you said,804there's too much chasing of metrics rather than saving lives.805But how do we assess what we're doing? How do we tackle the806chats that are distracting and disruptive, but how do we get807this kind of continuous improvement in this operation?808    Mr. Combs. Yes, ma'am. Continuous improvement at this809point, you change the leadership and the top management that810has created this culture of permissiveness. After that, you811need continued oversight. And in Congress, this Committee has812done a wonderful job and I do appreciate every bit of what you813all have done in bringing this to light and seeing this through814with me.815    But you need oversight from the auditors, the Inspector816General. I'm just going to say the Inspector General community817needs to provide continued, repeated, ongoing oversight of the818VCL to help them achieve the cultural change they need to819achieve, to meet this. The call center is, as Ms. Blane is820saying, is not the challenge. It's the managers and leaders821outside the call center who are telling them, this is how822you're going to do it. We're talking at you, not with you.823That's the challenge.824    Senator Hassan. And Ms. Blane, if you have something to825add, I'd love to hear it, and then I'll turn it over to Senator826King.827    Ms. Blane. Actually, he said it all, it really does need to828just have a change in how they present the information and in829management.830    Senator King. Can you get closer to your microphone?831    Ms. Blane. Yes, sure. Thank you for that. I absolutely832agree with Mr. Combs that there needs to be a change in833leadership structure. When we went from serving to834productivity, we lost the essence of what needed to be done.835That's when the metrics came into play. I shared with them836then, having been an analyst at Delta Airlines, you cannot use837a productive model in human services. It doesn't work. And838that's where the problem has been, is that they tried to create839numbers instead of quality.840    Senator Hassan. Well, thank you very much. Thank you both841again for being here. And now we have our Ranking Member arrive842back. Senator Blumenthal, would you like to go next or would843you like Senator King to go ahead?844    Senator Blumenthal. I'll yield to Senator King.845    Senator King. That's a rare occurrence around here.846    [Laughter.]847    Senator Blumenthal. But it should be more common.848849                    HON. ANGUS S. KING, JR.,850                    U.S. SENATOR FROM MAINE851852    Senator King. I want to follow up on that question, Ms.853Blane, about productivity. Were the people in the call centers854under pressure to do so many calls a day or not have calls be855longer than a certain number of minutes? Describe to me the856metrics that were being applied.857    Ms. Blane. Sure. Thank you for that question. So, the858metrics that were being applied was the amount of time that you859were staying on a call. What a lot of people fail to realize is860that veterans that are getting help from the responders at the861crisis line, they call back.862    For example, even though we're told it's not a clinical863role, a lot of us that are licensed, we will literally de-864escalate, give them suggestions on home works, walk them865through deep breathing. But those things can be easily frowned866upon because it takes a call longer to be completed. I am not867willing to leave anyone behind that needs my assistance. So,868the idea of production didn't work for me, because human869services and human life was more valuable than the numbers.870    Senator King. Well, I fully understand that. I'm amazed871that there would be such--the last thing you want to do if872you're talking with someone in crisis is to say, I'm sorry, but873our time is up. I mean, maybe if you're a cable services call874center that's different. I'm surprised that anyone would even875think of applying that metric.876    Ms. Blane. Well, we would frequently receive direct877messages in TEAMS saying, ``hey, I noticed that you've been on878this call for a long time. Do you need any help?'' Well, what879kind of help are you going to help me with if I'm the one de-880escalating someone, you can't come in and take over the call.881You don't know what's going on within the call. So, you are882literally distracting me from completing the call and paying883attention to the veteran.884    Senator King. When did this metric system come into place?885    Ms. Blane. In, I believe it was 2018 when we had a886director, and then he hired a new person and that person had887come from a background in a call center that was more888production guided versus being able to be human guided.889    Senator King. Now, I noticed that you left in May, so you890went through at least several months of the new Administration891at the agency. It's no secret that there were firings, hiring892freezes, threats of more firings, reorganization. Did that893affect the operation of the call center in terms of people,894morale and dedication, people wanting to stay or go? Talk to me895about whether the difficulties at the agency level affected the896call center.897    Ms. Blane. Thank you so much for that question and bringing898the humanism back into it. It absolutely affected the morale.899One of the things that happens when you are a crisis responder900is you can develop vicarious trauma by listening to the901repeated situations that individuals are going through.902    However, when you're concerned if you're going to be able903to pay your bills, if you're going to be able to keep your904healthcare, if you're going to be able to function, that is905going to impact your ability to stay focused.906    Now, I have to admit, my peers at the Veterans Crisis Line,907as Mr. Combs said, are rock stars. They stayed focused. We all908came together in TEAMS, and I would say, ``hey, here's my phone909number if anybody needs me, text me.'' We had to create910situations outside of TEAMS to offer support to each other911because it was so overwhelming. Every week, having to write----912    Senator King. The chaos.913    Ms. Blane. The chaos was overwhelming, and it was914distracting. Every week you're having to write, what did I do915next week or last week letters to send off to an invisible916email that you----917    Senator King. That was the famous five things you918accomplished.919    Ms. Blane. Yes, the 14 roles.920    Senator King. I sent one of those in myself to Mr. Musk. I921never heard back.922    Ms. Blane. Yes, because the mailbox at one point got923completely full and nobody was answering it.924    Senator King. Let me ask another question, and this is not925about this subject, but what are the issues that are there--926there must be a pattern to issues. Are they financial? Are927they, you mentioned healthcare. Can you give us a summary of928what are the most likely calls are about?929    Ms. Blane. So, most of the calls that we received are930usually individuals that have faced levels of trauma from931military sexual trauma, remembrance of their time in combat,932individuals that may have not gone to combat but may have been933on a ship and felt like they were in a sleeping coffin, marital934issues. We became notorious for being marriage counselors.935Sometimes having to break up arguments over the phone between936spouses.937    And so, it just varied between that individuals that were938homeless or individuals that specifically just felt unseen,939unheard, and easily forgotten.940    Senator King. And did you have the capacity to refer them941to VA PTSD programs, for example? I mean, in other words, did942your duties go beyond listening?943    Ms. Blane. So, the referral processes, the first referral944process is to the suicide prevention coordinators. And those945individuals are usually housed at the VA medical centers, a946social work department that takes those referrals and then947tries to disseminate them to the appropriate areas.948    Directly referrals, we will send individuals that are949facing homelessness, we send them over to the to the national950call center for homeless veterans. When it comes to things like951needing appointments, I was a little different from what the952SOP said. If I have a veteran on the phone and they needed to953get through to make an appointment, I'm going to make the call954to get them through to make that appointment. The SOP says,955transfer them blindly. Let them pick up on that end.956    To me, I believe that we needed to be more of a one-stop957shop, so that we would not--can you imagine a 90-year-old958veteran calling in and the call just keeps circling because he959doesn't know what button to push. I'm not going to send them960over blindly. And those are some of the things, some of the961stressors for our elderly veterans, because everyone was962wanting to force them to use a computer, go and navigate a963phone system. They can't, it's not a part of their generation.964And why would we want to do that? So, I mean----965    Senator King. The most frustrating thing in the world is to966be on some kind of call like this, tell your story, and then967have somebody say, well, I'll move you over to this other968department.969    Ms. Blane. Exactly.970    Senator King. And then you're on hold listening to music.971Well, your testimony has been very important and impressive. I972hope you can, I'd like to assign some homework. Could you973supply to the Committee further thoughts about how this system974can be improved, because that's the business we're in here, and975both of you have firsthand experience to the extent you can976make suggestions about the standard operating procedure or the977productivity metrics, those kinds of things, that would be very978helpful to us.979    Ms. Blane. Absolutely. Thank you.980    Senator King. Thank you, Ranking Member.981982    [The information requested begins on page 71 of the983Appendix.]984985    Senator Blumenthal [presiding]. Thanks, Senator King.986Senator Banks.987988                        HON. JIM BANKS,989                   U.S. SENATOR FROM INDIANA990991    Senator Banks. Thank you, Mr. Chairman. Mr. Combs, one of992the frequent criticisms I hear about the crisis line is that993management often sweeps problems under the rug. And I wonder,994is that your experience, what you saw when you were the former995auditor?996    Mr. Combs. Thank you for your question, Senator. Yes.997    Senator Banks. Can you expand on that? I mean, why is that998not a technical term, but often a description that I hear from999people who are criticizing the Veterans Crisis Line and the1000management?1001    Mr. Combs. As far as the----1002    Senator Banks. What is that? Sweeping big problems under1003the rug?1004    Mr. Combs. Okay. Well, Senator, a common definition for us1005to work off of would-be sweeping problems under the rug would1006be to not address the problem, not learn from it, not resolve1007it, and not improve from it, but rather ignore the problem,1008believe it somehow, make it such that it did not occur, and no1009one's going to find out about it.1010    Senator Banks. And you agree that, you know, sort of1011something that you saw widespread?1012    Mr. Combs. Yes, sir. During my time at the VCL, I brought1013up many challenges that, what we would call in the audit world1014lack of conformance to regulations, to VA policy, to even1015statutes. And I was told, well, there's more context to that or1016it doesn't apply to us or we're VCL and . . . no, we work for1017the government. We're part of the government. We need to comply1018with the government rules.1019    Senator Banks. What would you say that the Veteran Crisis1020Line needs to be more effective? Is it technology, better1021training? What is it going to take to make it work better?1022    Mr. Combs. Senator it is about leadership. VCL--I can't1023talk for right this moment as far as staffing goes. I can't1024talk right this moment for budgeting. I can't talk about those1025things. All I can tell you is during my time at the VCL, and I1026know it's ongoing because I hear and I listen to what this1027Committee has talked to VCL about and the VA about, as far as1028the VCL operations. If they needed something, they were getting1029it.1030    So, from my perspective, the technology that we lacked,1031which we did lack technology, was the decisions of leadership.1032How we staffed the call center when we had people to staff, as1033the GAO was about to inform you. Chat and text were staffed by1034historical standards, historical staffing patterns, not by1035demand, which meant we were going to have to double up because1036we weren't looking at what was demand going to be for chat and1037text for this time period.1038    Instead, you know, we're going to staff it at this level,1039if it gets overwhelming, double up, triple up if you need to.1040We don't have a backup. So, make sure you answer the call. It's1041about leadership and it's about the leadership culture. And as1042long as we can make problems go away, you are my friend.1043    Senator Banks. We heard from crisis line employees who told1044us that they were regularly texting and web chatting with 2, 3,10454 veterans at the same time. How does that happen?1046    Mr. Combs. For the technical aspect of that, you must ask1047Ms. Blane. I'm not aware of that. I can tell you that within1048the short little period of time I had to dig into industry1049standards, that's not the industry standard that I was coming1050up with. Before I was told to cease my activity by the1051Executive Director of the VCL. Industry standard is that when1052you definitely have someone in crisis, you're not handling any1053more multiple interactions. You're handling that one. You stay1054focused on that one because that life is at risk.1055    Now, as far as the technical aspects of how you can handle1056or how you can end up with multiple interactions, Ms. Blane1057would have to answer.1058    Senator Banks. Ms. Blane, is that an accurate?1059    Ms. Blane. It is accurate that there were possibilities to1060have to handle two, three, and four chats. One, understaffing1061was an issue at one point when we first came on board, they1062kept chat and text in New York only. And so, it wasn't spread1063around and you didn't have enough staffing trained. So, they1064began the training.1065    The problem is now the equipment, the software, the1066platforms that is on that causes crashing and things of that1067nature. They've beefed up the training for the number of1068individuals that are going to be doing chat and textbook. As of1069yesterday, speaking with some current responders, they are1070still being assigned a minimum of two texts or chats at a time.1071    Senator Banks. I've been in Congress for eight and a half1072years, and we've increased the budget for the Veteran Crisis1073Line repeatedly. So, is it surprising to you that we would be1074understaffed and lack training and technology or to Mr. Combs1075point, is it that really the leadership issue that you're1076talking about? I mean, I find that shocking.1077    Ms. Blane. I think it's a combination of a couple of1078things. I think it's leadership, and I think that the revolving1079door of new hires coming in, them not being adequately prepared1080for abuse from callers, not knowing how to move along. They1081want to stay, but everybody doesn't have--this'll be funny, my1082Generation X skin, that we can take tough stuff, right? And1083keep going. Some of the younger generations, they just cannot1084handle that level of pressure.1085    You ask the question about how does it happen when things1086don't get done, or they're pushed to the side, because they1087don't want to confront the truth of situations.1088    You have to confront abuse, because it's burning your1089people out. It's causing that revolving door. That's a1090leadership call. You have to want to train and re-train and1091continuously train.1092    I came from an environment at IRS where every year, even as1093Congress is on the floor changing tax laws, we were doing1094training. There is no up-to-date annual training. You get1095things in TMS, which is the training block, but it is not the1096same of going in the classroom and being focused on what1097changes we need.1098    The Veterans Crisis Line needs to evolve with what things1099are going on. We cannot continue to operate from a place, from1100the origin vision of what the Veteran Crisis Line is. We've1101moved into the adult stage, now we need to grow up.1102    Senator Banks. Thank you very much. My time has expired.1103    Senator Blumenthal. Thank you, Senator Banks. I'm going to1104hold my questions and yield to Senator Duckworth.11051106                     HON. TAMMY DUCKWORTH,1107                   U.S. SENATOR FROM ILLINOIS11081109    Senator Duckworth. Thank you, Mr. Ranking Member. Mr.1110Combs, during your tenure as lead auditor for the Veterans1111Crisis Line, was it your experience that responders were the1112only employees to answer the phones, and could you elaborate on1113that? Did anybody else answer the Veterans Crisis Line phones1114other than trained responders?1115    Mr. Combs. Thank you for the question, Senator. So trained1116personnel, yes. Responders that worked every day, all day as1117responders? No. They did bring in people to work during1118overtime periods.1119    Senator Duckworth. So, these were other VA employees?1120    Mr. Combs. Other, no, I'm sorry, ma'am. I should clarify.1121Other VCL employees who had at some point in time gone through1122responder training and had qualified as a responder and had1123been approved to work as a responder in times of need, for1124demand. They could come in when the call was put out, come in1125and work as responders.1126    Senator Duckworth. Okay. So, these are folks who had been1127trained as responders, but maybe are now doing some other job1128that's not responder training?1129    Mr. Combs. Yes, ma'am.1130    Senator Duckworth. And they were given the opportunity to1131work overtime to help answer the calls?1132    Mr. Combs. Yes, ma'am.1133    Senator Duckworth. Okay. Did they receive any guidance or1134training or currency refreshers to assist them in doing that1135overtime on the hotline? These non-responders, even though1136they--it's like saying that somebody got the training once upon1137a time. Now they're off doing something else. Now they, hey,1138you can pick up a little bit of overtime answering the VCL. Did1139they get additional training? Did they get the same level of1140training as the people currently in the responder position?1141    Mr. Combs. Well, so again, thank you for the question. The11422023 IG report that, the Inspector General reflects that that1143practice stopped because of that incident that's described in1144the report. And in fact, how do I say this--the Deputy Director1145of the Crisis Clinical Operations, he made the decision that1146that practice would stop as of that event. And you had to be a1147full-time responder or work in the call center as that call1148center team to take a call from any veteran going forward. So1149that was about February 2022, going forward, you had to be a1150full-time responder or the supervisor team operation1151coordinator, assistant deputy director to take a call.1152    Senator Duckworth. Okay. Thank you. Ms. Blane, can you1153please confirm whether as recently as May 2025, so just last1154month, responders were not the only employees to answer the1155phones?1156    Ms. Blane. As of May 2025, it was only responders that were1157answering the phones.1158    Senator Duckworth. It was. Okay. Because my understanding1159is we've got that 160 hours of training, and I think it's1160really important that people who are answering the phones are1161the most up-to-date. You had mentioned Ms. Blane earlier that1162the VCL terminations caused delays in services to veterans. Can1163you please elaborate? I mean, what guidance did you receive1164from leadership to mitigate these delays following the wrongful1165terminations?1166    Ms. Blane. With the--thank you so much Senator Duckworth1167for the question. With the wrongful terminations, we didn't get1168a lot of communication. That's one of the concerns with the1169Veterans Crisis Line, is there was not an evolving door on1170communication. It was pretty much like, here's where it is.1171Oops, we've changed directions and going from there, just, you1172know, keep working as normal.1173    Senator Duckworth. I had a couple people that I knew1174through my service in the National Guard reach out to myself1175and some folks within my organization who knew us personally1176through the Guard who were working the VCL. And some of them1177received termination notices, and their supervisors didn't even1178know they just got the email. Did that happen?1179    Ms. Blane. That is a failure of leadership. Because that1180has been the bane of my existence at the Veterans Crisis Line.1181Again, part of my responsibility at the Department of Treasury,1182was to train supervisors. And I would often share with them;1183you all are literally just a grade up with no power. You are1184getting information at the same time that the responders are.1185There's no way that you could adequately prepare to funnel1186information down to us because your leadership fails to trust1187you with information, in how it's delivered. That is poor1188leadership.1189    One of the issues, or one of the things I often say is1190leaders lead, managers manage. But if you have a leader trying1191to manage, you've already missed the mark on what you're1192supposed to be doing.1193    Senator Duckworth. Thank you. I'm over time. Mr. Chairman.1194    Senator Blumenthal. Just a few questions. Ms. Blane, I have1195to tell you, I was really profoundly moved by your testimony,1196coming from the daughter of a Marine and the mother of a1197Marine, both combat veterans, both having gone through trauma.1198You know in your heart how deep and dire the danger can be to1199somebody going through crisis. But you also know that more is1200required than just a good heart.1201    Empathy goes a long way, but professionalism is required.1202And you are a consummate professional, a Licensed Professional1203Counselor, Certified Professional Counselor Supervisor, and a1204Certified Hypnotherapist. You've worked for 28.5 years as a1205Federal employee, 19 of those years at the Department of1206Treasury in the Internal Revenue Service. But you pursued your1207dream, which was to help veterans.1208    And so, I think your testimony comes from someone who has1209seen this problem, not only in a personal way, not only in1210emotional way, but in an analytical way that is very, very1211important. And I thought one of the most important observations1212you made was the effect of terminating the Social Science1213Assistants.1214    Now, the temptation is to say, oh, I'm doing it on my own.1215I can do it all as the crisis line counselor. But these Social1216Science Assistants who were terminated are important to the1217work you do. I'd like you to expound a little bit on why that1218termination was so shortsighted.1219    Ms. Blane. The Social Science Assistants are on the same1220level as 911 operators. They are our eyes, our ears, and our1221fingers when we are handling a crisis call. We send a message1222saying, hey, I need to find this person. They are actively1223suicidal, and all of that information. I can focus on the1224veteran when I have a Social Science Assistant who is1225diligently working, tracing calls, working to get locations,1226full name, date of birth, so I don't have to be bothered in the1227sense of redirecting my attention. I can stay with this1228veteran.1229    When those SSAs were terminated, averagely on the shift1230after their termination, you're talking 45 to 50 people to two1231SSAs. My heart broke because I had so many years in criminal1232investigations at IRS, I know how to do a lot of research,1233right? But my heart was breaking for them because for every1234crisis that was coming in, they're juggling so many different1235calls.1236    It was a slap in the face of the SSAs and the responders,1237because you're telling us to give our best, but you take our1238best from us, our best support, our best voice, our best1239fingers, and you leave all of us, including that veteran in1240crisis, in a gap, and possibly harmed.1241    Senator Blumenthal. And often these SSAs, the Social1242Science Assistants, help you locate the voice behind the call1243when they don't want to be located. Because they're about to1244take their own lives. And this is a desperate act on their part1245to call you, and you need to find out where they are so you can1246reach out to them.1247    Ms. Blane. Absolutely.1248    Senator Blumenthal. You remarked in your testimony about1249how there are a lot of very well-meaning professionals working1250on the crisis line, who are ``frequently encouraged to dim1251their lights and just answer the call.'' Could you explain what1252you meant by that?1253    Ms. Blane. Yes. In 2018, I believe that's the correct year.1254We had a clinical operations person that came into the Veterans1255Crisis Line with a production model, answer the call, answer1256the call. In fact, when we began questioning that, his response1257in one meeting was, if you don't like the way we do things,1258find another job.1259    Not taking into consideration the lives that we were1260changing, which was always a detriment to me, simply because if1261you don't know what we do, making a blatant statement like that1262shows that you have ill concern. Trying to operate, and I1263shared this earlier, trying to operate a production mentality1264for human services will never be a win. We're not selling1265products, we're saving lives.1266    Senator Blumenthal. Yes. I think that's really important.1267You know, we all have called the lines, you know, like I don't1268know, for Amazon or whatever, we want to return a product.1269We're put on hold. It's maddening, but it's not about taking1270our lives. It's about sending something back and getting a1271refund. You have to demonstrate a responsiveness and empathy1272that is very different.1273    When we talk about a crisis line, you know, some1274merchandiser who says, we have great service on our call-in1275lines, because you don't have to wait for more than 30 minutes1276or whatever it is. A caller to your line is not going to wait1277for 30 minutes.1278    Ms. Blane. Not at all.1279    Senator Blumenthal. They need help right away. I just want1280to ask you one more question. Would you say that employees1281during the period January to May, you left in May--January1282there was a new Administration, feel more or less confident in1283reporting waste or fraud or abuse without fear of retaliation,1284compared to the previous nine years that you were in the VA?1285    Ms. Blane. So honestly, it began in November once the1286election results came in. People immediately became afraid of1287just understanding what the previous four years were like with1288this Administration, and not really having an idea of where we1289were going.1290    So, in response to your question, they are less likely to1291report the fraud and abuse, because as long as we have the ugly1292umbrella of potential firing, that is going to stop people from1293fully engaging in sharing the information. We see that every1294year with those employee survey responses. It never gets a1295hundred percent of participation.1296    Senator Blumenthal. I want to thank you and Mr. Combs for1297your testimony today. It's been extremely important and1298enlightening, and I want to thank the Chairman, Chairman Moran,1299for having this hearing which has given us an opportunity to1300explore the issues that you have raised. It really is I think1301extraordinarily important that we hear from you and have this1302hearing. So, I thank the Chairman.1303    Chairman Moran [presiding]. Senator Blumenthal, thank you1304for taking care of the Committee in my absence. I suppose you1305still need to vote?1306    Senator Blumenthal. On the second one?1307    Chairman Moran. On the second one, it's been called. Okay.1308Mr. Combs, the whistleblower protections, do they work? Too1309early to tell?1310    [Laughter.]1311    Mr. Combs. Yes. Thank you, sir. Well, some things you do1312because it's the right thing to do. You let the chips fall1313where they may. Within the VA, right before I left, one Deputy1314Director, he had a direct report hire his wife; Ms. Blane knows1315who I'm talking about. His wife was hired by his direct report.1316I received the report to submit to the IG or a hotline1317complaint. The report--I'm messing this up, sorry.1318    The report I received was from the Office of Accountability1319and Whistleblower Protection--in fact, that was the response I1320saw published regarding the Secretary's response to your letter1321asking for the GAO to do an audit on the VCL, was that I could1322have gone to the Office of Accountability and Whistleblower1323Protection--I had the report that said nepotism did not occur.1324    The Deputy Director's wife got hired by his direct report1325to work for the Deputy Director and Office of Accountability1326and Whistleblower Protection said that did not happen--that's1327not nepotism. So, I don't think Office of Accountability and1328Whistleblower Protection should be trusted, if it still exists,1329but it should not be trusted. No, whistleblower protections did1330not work in the VA.1331    Chairman Moran. Thank you for your testimony. Not1332necessarily pleased by the answer, but thank you for your1333testimony very much. It's my practice and it's certainly, I1334hope in this case of value. Is there anything either one of you1335would want to say that you didn't say in your testimony or that1336we didn't ask questions about that you think we should know?1337    Ms. Blane. No, I think all of the questions that were asked1338and answered gave a better insight to the Veterans Crisis Line1339from the responders' perspective. So, thank you for today and1340this opportunity.1341    Chairman Moran. You're welcome. Thank you.1342    Mr. Combs. Yes, sir. And I know there were multiple1343whistleblowers that came forward. I really thank you and your1344staff, John and Emily, again for keeping us anonymous. None of1345us wanted to be identified. We were protected for two years as1346this proceeded. I thank you for the ear and for hearing us and1347going after this, and for John and Emily for doing everything1348they did for all of us.1349    Chairman Moran. Thank you for highlighting the role of John1350and Emily, and our staff generally, are hugely valuable to us1351and valuable to veterans in the country. I thank you for your1352testimony, and will now call to the witness table the second1353panel.1354    Testifying today on the second panel is Ms. Alyssa Hundrup,1355Director Health Care Team, U.S. Government Accountability1356Office, and Dr. Thomas O'Toole, the Deputy Assistant Under1357Secretary for Health for Clinical Services, Veterans Health1358Administration, accompanied by Dr. Christopher Watson,1359Executive Director, Veterans Crisis Line.1360    Ms. Hundrup, Doctor, Doctor, thank you for your presence.1361Ms. Hundrup, we'll start with you, and you're welcome to1362provide your testimony.13631364                            PANEL II13651366                              ----------13671368   STATEMENT OF ALYSSA HUNDRUP, DIRECTOR, HEALTH CARE, U.S.1369                GOVERNMENT ACCOUNTABILITY OFFICE13701371    Ms. Hundrup. Thank you. Chairman Moran, Ranking Member1372Blumenthal, and Members of the Committee, thank you for the1373opportunity to discuss our work on VA's management of its1374Veterans Crisis Line or VCL. My testimony covers findings and1375recommendations we made in a report we are publicly releasing1376today.1377    The suicide rate for veterans remains tragically high, with1378more than 17 veterans losing their lives to suicide every day.1379The VCL is a vital resource to assist veterans or their loved1380ones in crisis. The use of the crisis line continues to grow,1381with customer interactions across call, text, and chat1382platforms, increasing nearly 40 percent from fiscal years 20211383through 2024.1384    In total, VCL responded to about 3.8 million interactions1385over that time and by 2024, it responded to over 2,500 calls1386every day. The VCL's goal is to answer 95 percent of calls1387within 20 seconds, which it has been able to achieve. As of1388this March, VCL has more than 1000 crisis responders on staff1389to answer calls.1390    A subset of responders are trained to work in the Customers1391With Complex Needs unit. This unit handles callers assigned as1392having complex needs such as abusive, sexually inappropriate,1393or high frequency callers.1394    However, we found problems with how the VCL is managing1395this unit. Specifically, it made a procedural change so that if1396there is no responder available in the unit, callers are1397immediately redirected to the main line. Previously, this1398redirection occurred after 3 minutes. VCL made this change to1399reduce wait times for complex callers and reduce the number of1400abandoned calls.1401    Yet this change has resulted in many more complex calls1402being answered by mainline phone responders who have not had1403complex needs training, and therefore may not be well equipped1404to handle the interactions. This creates a risk to the quality1405of service provided to the caller and causes increased stress1406and burnout for responders.1407    Therefore, we are recommending that the VCL assess the risk1408of adverse effects associated with this procedure change. VA1409agreed with our recommendation stating that it would perform1410such an assessment by this October. We also identified workload1411challenges for the VCL's digital services unit for texts and1412chats.1413    For example, responders are expected to handle up to two1414interactions concurrently as demand requires, and we found this1415has commonly occurred. Text and chat responders are also1416expected to document their interactions at the same time as1417they handle live interactions. This is unlike for calls where1418responders are given time after the call for documentation.1419Having to do both at the same time can create workload1420challenges and can distract responders from ongoing1421interactions, especially if the responder is handling two1422interactions concurrently. Such challenges can make it1423difficult to be fully attuned to customer needs, creating a1424risk to safety and increasing responder burnout.1425    The VCL has not assessed how these challenges may be1426affecting the quality of its digital services. So, we are1427recommending that it do so. VA agreed stating that it would1428assess its digital services unit by this October.1429    Finally, we found that the VCL conducts quality assurance1430reviews, such as using silent monitors to evaluate interactions1431against a set of standards. The VCL also reviews its1432involvement in critical incidents such as a related suicide, to1433identify areas for improvement and provide coaching to1434responders. An important aspect of addressing critical1435incidents is also disclosing VCL involvement with certain1436incidents to customers or their representatives.1437    However, due to a recent policy change, the VCL now has no1438procedure for disclosing incidents to customers. The VCL1439recently withdrew its procedure because it determined the1440policy applied only to clinical services, whereas the crisis1441line provides non-clinical services. The lack of disclosure1442procedures could result in missed opportunities for the VCL to1443hold itself accountable to customers or their families, in the1444event that a VCL action or inaction contributed to a customer's1445harm.1446    Accordingly, we are recommending that VA establish a1447procedure for the VCL to identify the types of incidents that1448warrant disclosure and a process for doing so. VA agreed1449stating that it would take action to implement it by next1450January. Doing so will better ensure that VA meets its goal of1451building trust with stakeholders through transparency and1452accountability.1453    This concludes my prepared statement. I'd be happy to1454answer any questions you may have. Thank you.14551456    [The prepared statement of Ms. Hundrup appears on page 531457of the Appendix.]14581459    Chairman Moran. Thank you very much. Dr. O'Toole.14601461    STATEMENT OF DR. THOMAS O'TOOLE, DEPUTY ASSISTANT UNDER1462  SECRETARY FOR HEALTH FOR CLINICAL SERVICES, VETERANS HEALTH1463ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS ACCOMPANIED1464BY DR. CHRISTOPHER WATSON, EXECUTIVE DIRECTOR, VETERANS CRISIS1465   LINE, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF1466                        VETERANS AFFAIRS14671468    Dr. O'Toole. Chairman Moran, Ranking Member Blumenthal, and1469distinguished Members of the Committee, thank you for the1470opportunity to provide an update on the Department of Veterans1471Affairs efforts to enhance the Veteran Crisis Line and our1472continuing commitment to support our veterans in crisis.1473    My name is Dr. Thomas O'Toole, and I'm the Deputy Assistant1474Under Secretary for Health for Clinical Services. And joining1475me today is Dr. Christopher Watson, Executive Director of the1476Veteran Crisis Line.1477    VCL continues to encounter a significant and growing demand1478for its service. In fiscal year 2025, up through this last May,1479VCL managed nearly 787,000 contacts, including chats and texts.1480VCL is the only crisis line in the United States that is1481integrated into a complete healthcare system, offering a direct1482bridge between immediate crisis intervention and ongoing care.1483Our dedicated team of crisis responders is trained to provide1484immediate assistance ensuring that no veterans call for help1485goes unanswered.1486    Informed by work of both OIG and GAO, VA is significantly1487enhanced its capacity to assist veterans in crisis. A September14882023, OIG report identified critical deficiencies within VCL1489operations and oversight. As of June 25, of this year, VA has1490implemented and closed 12 of the 14 OIG recommendations, and we1491are working diligently to close the final two recommendations,1492by the end of fiscal year 2025.1493    These actions include: a comprehensive review of staff1494performance, enhanced training programs, and establishment of1495more robust oversight mechanisms. Our commitment to these1496improvements has already bolstered VCL's ability to deliver1497safer and more effective services. We have reinforced training1498and guidance for all VCL leaders and staff to ensure full and1499transparent cooperation with oversight reviews.1500    Furthermore, we have formalized written standard operating1501procedures for call escalation, to enhance the consistency and1502oversight of complex or high-risk calls. One critical area of1503focus has been the management of calls from Callers with1504Complex Needs, or CWCN. We are assessing the outcomes of CWCN1505calls managed by both mainline crisis responders and CWCN1506trained crisis responders.1507    This assessment will inform any necessary adjustments to1508our procedures and staffing to ensure we provide the highest1509standard of care. To address concerns about our digital1510services procedures, we have conducted an in-depth review to1511analyze crisis responder documentation practices.1512    We are also enhancing processes to better capture and1513analyze crisis responder workload. Our goal is to enable crisis1514responders on digital service platforms to manage the growing1515volume of texts and chats without compromising service quality.1516We have implemented a technological solution to mitigate the1517issue of chats being abandoned due to crisis responder1518unavailability. This update includes real-time notification to1519crisis responder supervisors who can reassign chats promptly,1520ensuring continuous support for veterans.1521    Recognizing the need for transparency, VA is convening a1522multidisciplinary work group to establish a standardized1523process for disclosure procedures. We anticipate the review to1524be complete in January 2026. The aim is to foster trust and1525accountability in our services.1526    In conclusion, VA is committed to preventing veteran1527suicides and providing critical support in moments of crisis.1528VA's dedication to implementing OIG and GAO recommendations1529demonstrates our commitment to continuous improvement in1530excellence in service delivery.1531    As we confront an ever-increasing volume of contacts, we1532remain focused on ensuring that every veteran receives the1533immediate and effective support they need. So, thank you1534Chairman Moran, Ranking Member Blumenthal and the Committee for1535your oversight, guidance, and steadfast commitment to the1536health and safety of our veterans.1537    I also want to thank our first panel, the GAO and the OIG1538for their oversight and input. We need to be doing a better1539job. We need to be more accountable, and we need to be holding1540ourselves more accountable. I look forward to your questions1541and to continued collaboration in our shared mission to support1542the well-being of our Nation's heroes.15431544    [The prepared statement of Dr. O'Toole appears on page 651545of the Appendix.]15461547    Chairman Moran. Thank you. Dr. Watson, do you have1548testimony? You do, Dr. Watson?1549    Dr. Watson. No, sir.1550    [Laughter.]1551    Chairman Moran. Well, first of all, Dr. O'Toole, you heard1552the description of what was described as prevalent or certainly1553ongoing culture at the Veterans Crisis Line, and you outlined1554you have these tasks to undertake due to IG and GAO reports,1555some of which you indicate have been completed, and some which1556you're still working on. Do you disagree that the culture or1557the circumstances that were described by the first panel1558existed?1559    Dr. O'Toole. So, thank you, Senator, and let me just start1560by saying, you know, I'm deeply disturbed by what I heard. It's1561unacceptable. I want to thank our first panel for their honesty1562and for their courage in coming forward with that. We need to1563be holding ourselves more accountable.1564    I want to also personally apologize. It's not acceptable1565that these behaviors and these actions were taking place. So, I1566have no reasons to dispute it or definitely no interest in1567disregarding it. This office has been reporting to me among1568others for about the past six months. And so, I clearly look1569forward to our opportunity to address these issues most1570directly.1571    Chairman Moran. Do you know the Department of Veterans1572Affairs well enough to explain to me why those circumstances1573were there? What you call actions and behavior, and that they1574were there for a long period of time, but no one seemed to1575report or change or insist that the behavior changed? Why does1576it take a GAO report or an Inspector General's report to get1577someone's attention to do something?1578    Dr. O'Toole. I have been in the VA a long time and1579unfortunately, you know, we have not always been the best we1580can be and should be in this regard. I can't speak to the1581specifics of this. I can't speak to behaviors of individuals of1582past leadership. I will convey though our commitment to really1583trying to get this right.1584    Chairman Moran. Dr. Watson. I don't know your history and1585how long you've been at the VA, but do you have an answer to1586the question of how can this go on? And it continued until some1587whistleblower decides they've had enough and it needs to be1588reported.1589    Dr. Watson. Similar to Dr. O'Toole, I have been in my role1590since April 2024. I'm a psychologist. I've been with the VA SSA1591psychologist since 1993, so I'll be 32 years in September. So,1592I cannot really explain what has happened prior to my time with1593the Veterans Crisis Line.1594    Chairman Moran. Well sadly, it seems that this circumstance1595is not limited to the Veterans Crisis Line. This is not the1596first time we've had reports of this behavior, or the first1597time we've had a GAO or Inspector General's report. It seems1598like it's there in a persistent and widespread, but way too far1599spread circumstance at the VA.1600    And I don't understand why it is that an entity and1601organization that's its purpose is to care for those who served1602our country would have challenges like the Department of1603Veterans Affairs has. Any opportunity to explain this to me?1604    Dr. O'Toole. I don't have any specific answer to this. I1605will say, however, that work in the Veterans Crisis Line has1606got to be one of the most difficult jobs in the VA. Literally,1607they are trying to save lives hour by hour, 24/7, 365 days.1608It's a tremendous stress, and we need to be doing a better job1609of protecting our employees and taking care of our employees1610because they are the ones who are taking care of our veterans.1611    Chairman Moran. What prohibits or prevents the firing, the1612discharge of an employee in these circumstances? As I1613understand, they are still working. My experience in so many1614instances at the Department of Veterans Affairs in which1615there's been wrongdoing, is that the individual who committed1616the wrongdoing remains at the VA, sometimes transferred to a1617different department, a different hospital. This is not a one-1618time circumstance in my experience.1619    Why is it so difficult to discharge an employee for1620misbehavior?1621    Dr. O'Toole. Well, sir, I mean, you're absolutely right.1622And looking at the time from this GAO report and OIG report to1623where we are now, it's very frustrating. Part of the dynamic1624for the VA is we need to follow a due process for employees who1625have been accused, and allow the investigatory process to1626proceed and adhere to the recommendations for what disciplinary1627action is appropriate. It can be very frustrating, particularly1628from the outside looking in at that process. But it is a due1629process that our employees are entitled to.1630    I will say from a management perspective, if there is an1631employee that is not performing to the standards that we would1632expect, our first and foremost goal is to make sure that our1633veterans are protected from that bad behavior. And oftentimes1634that requires moving that employee to a different place to work1635while the investigation is underway. And I just want to point1636that out within the process, not trying to justify the larger1637picture.1638    Chairman Moran. Did that happen here?1639    Dr. O'Toole. In some instances, yes. I mean, there were 181640employees that were ultimately investigated in this process.1641    Chairman Moran. Senator Blumenthal.1642    Senator Blumenthal [presiding]. [Inaudible.] I'd defer to1643him if he hasn't.1644    Senator King. First, I want to thank Ms. Hundrup for the1645thorough report. That's really helpful. And I hope that the1646Committee can pour through it and act on some of those1647recommendations. My personal aversion is to reports that don't1648get acted upon, so we're certainly going to try to do that.1649    One of the issues seems to be, and this is for any of you,1650responders answering, dealing with multiple contacts at the1651same time. You're on the phone and you've got a text. I can't1652understand how that would ever be a good practice. I mean, it1653just, it's bound to divert your focus from one or the other of1654the contacts. Ms. Hundrup, is that a problem?1655    Ms. Hundrup. Yes, the concurrent texts and chats, just to1656build on our concern a little bit, are happening coupled with1657the documentation requirements. So not only may a responder be1658required to handle two chats, sometimes up to three1659concurrently, but they're also required to document that at the1660same time. Couple that with some uneven algorithms for how1661responders are assigned the chats and then finally, historical1662staffing that has not kept up with the demand.1663    For texts alone, we have seen an 80 percent increase over1664the four-year period that we looked at----1665    Senator King. 80 percent over four years?1666    Ms. Hundrup. For texting. So, I think, maybe just talking1667about concurrent texts or chats alone, one could understand the1668VCL's policy, and VCL officials told us that that's industry1669standard.1670    When we looked and spoke with SAMHSA, they said that on the1671988 lines, there are some call centers that do allow concurrent1672texting and chatting, however others don't. But I think our1673concern is that it's not only this concurrent text and1674chatting, but all of the other responder tasks combined that1675are resulting in serious workload challenges.1676    Senator King. Are people expected to handle chats and text1677as well as being on a call?1678    Ms. Hundrup. No. So, they are all separate. If you work a1679phone line shift, you would be on the phone line strictly. I1680think we do understand that when a responder is assigned to1681answer chats or texts, if the phone lines are needing extra1682staff, they might get shifted over, but then they would shift1683completely over to the phone lines.1684    Senator King. But they still might be dealing with multiple1685chats and texts at the same time?1686    Ms. Hundrup. Correct.1687    Senator King. And that's a challenge, correct?1688    Ms. Hundrup. Correct. Absolutely.1689    Senator King. Dr. O'Toole, you've probably heard Ms.1690Blane's testimony about productivity requirements like the time1691of calls. That strikes me as not consistent with what we're1692trying to do here. Nobody's going to stay on one of these calls1693just for fun. They're on the calls because it's important. Give1694me some thoughts about the standards that are being applied.1695    Dr. O'Toole. I'd like to defer to Dr. Watson on that, who1696would know much more about it than I.1697    Senator King. Dr. Watson, your thoughts on a time pressure1698on a person that's on a call.1699    Dr. Watson. Yes. Thank you for that question. And that is1700also a concern. So, what we have with the Veterans Crisis Line1701is having to strike the best balance that we can to serve and1702meet the mission of answering as many calls or texts or chats1703as possible, and making sure that every one of those is at the1704highest quality. So the feedback----1705    Senator King. It strikes me that a time limit of some--if1706I'm on a call and I get a message that says, you've been on1707this call too long, I don't understand why that's ever1708appropriate.1709    Dr. Watson. And what is your question for me?1710    Senator King. My question is, is that the practice and1711can't we change it?1712    Dr. Watson. We do have some productivity targets that we're1713being asked to look at, and that is something that we can1714review and make changes as needed. We do thank the GAO for the1715recommendations, and we'll definitely follow up on that.1716    Senator King. Great. Thank you, Mr. Ranking Member.1717    Senator Blumenthal. Thanks, Senator King. For whoever can1718ask it Dr. O'Toole or Dr. Watson, what is the budget request1719for the Veterans Crisis Line for fiscal year 2026?1720    Dr. Watson. It's approximately $312 million.1721    Senator Blumenthal. $312 million. How does that compare to1722the current fiscal year 2025?1723    Dr. Watson. This year is approximately $306 million.1724    Senator Blumenthal. 306. So that's really a marginal1725increase, around $6 million requested increase, correct?1726    Dr. Watson. Correct.1727    Senator Blumenthal. Could you tell me whether the budget1728documents reflecting that number have been submitted to1729Congress, as yet?1730    Dr. Watson. Thank you for that question, and I do not have1731the definitive answer of whether that has been submitted and1732approved, and we can get information for follow up.1733    Senator Blumenthal. If you would, I'd appreciate it. We've1734received reports directly to the Committee from VA employees1735who say that the Veterans Crisis Line is experiencing an1736increase, in fact, a massive uptick in the outreach volume1737since the beginning of this year, which happens to coincide1738with the beginning of the Trump administration. Both overall1739for 2025 and regularly daily breaking outreach records. Is that1740report to us in accord with your experience?1741    Dr. Watson. Thank you for that question. Yes, we have seen1742an appreciable increase in our call volume and our chat volume1743and our text volume.17441745------------------------------------------------------------------------17461747-------------------------------------------------------------------------1748VA Response: The 2026 President's budget requested $312.8 million to1749 support the Veterans Crisis Line (VCL), which represents an increase of1750 22.2 million (7.7%) above the FY 2025 current estimate.1751------------------------------------------------------------------------17521753    Senator Blumenthal. Do you have any predictions or early1754data on why this volume is higher than it has been in recent1755past? You have a theory or a view as to what the cause is?1756    Dr. Watson. Thank you for that question and some initial1757thoughts about the increase in our volume overall. Some of that1758is related to multiple customers that call or text or chat1759multiple times. Some of those callers or customers fall in the1760customers with complex needs unit. So that accounts for some of1761the increase.1762    Some of the increase, I think is certainly a good thing, in1763that there are more veterans and service members in those that1764support each group that are wanting to utilize the Veterans1765Crisis Line.1766    Senator Blumenthal. I don't have more than a layman's view1767on this topic, but my working theory would be there's more1768anxiety and worry and depression than in the past. If the1769numbers are up, my conclusion would be, there are more mental1770health challenges. Correct?1771    Dr. Watson. That is certainly possible.1772    Senator Blumenthal. And I would hypothesize that a lot of1773veterans are really upset about the fact they're going to be1774fired. Does that make sense?1775    Dr. Watson. I understand what you're saying and that's1776possible as well.1777    Senator Blumenthal. Okay. I mean, if you're about to lose1778your job you're likely to be anxious and depressed. Senator1779King, did you have question?1780    Senator King. I just wanted follow up on your question1781about increasing call volumes, increasing chat. You said 801782percent in the last 4 years. I didn't do the math, but a $61783million increase on a $300 million budget is not a lot. If the1784demand is, I think your word, Dr. Watson, was appreciably1785increasing.1786    I hope that's something that Dr. O'Toole, you can take1787back, because there are very few, I can't think of any more1788important functions in the United States Government than this1789one. And if demand is increasing, we don't want to be putting1790pressure on people to try to shorten their calls or otherwise1791meet artificial productivity goals. We want to be sure these1792calls are responded to.1793    So, I hope that there might be a hard look at the budget.1794There ought to be a ratio between calls received and the1795budget. That's a pretty straightforward proposition. Thank you,1796Richard.1797    Senator Blumenthal. I think that's a really important1798point. And that's where I was going with my questioning. Do you1799have numbers on the increase in calls?1800    Dr. Watson. We do track that information. Please specify1801more with your question of the period that you are looking for,1802and we can make sure that we provide that information for you.1803    Senator Blumenthal. Well, you don't have that information1804now? The numbers of calls this year compared to last year?1805    Dr. Watson. Yes. So, we thank you for that question,1806Senator. And we receive with our calls between 80 and 90,0001807per month.1808    Senator Blumenthal. 80 to 90,000 now?1809    Dr. Watson. Per month. So, each month of the fiscal year,1810starting in October.1811    Senator Blumenthal. And what was it for the previous year?1812    Dr. Watson. I do not have that information in front of me,1813but we do track that. I can provide that for you.1814    Senator Blumenthal. Because that really goes to Senator1815King's point and the point that I was driving at. I'm going to1816also hypothesize that the numbers were inadequate last year and1817are even more inadequate this year in terms of the resources1818provided to you. Is that a reasonable hypothesis?1819    Dr. Watson. I think that's a reasonable hypothesis and1820we'll be able to check the math to confirm.18211822------------------------------------------------------------------------18231824-------------------------------------------------------------------------1825VA Response: When compared to the baseline levels of demand set when 9881826 launched, VCL volume has increased across all services. The table below1827 shows the number of calls each year following the implementation of1828 988, press 1. While the number of calls has increased, our staff has1829 too. We are continuing to hire as needed.1830------------------------------------------------------------------------18311832----------------------------------------------------------------------------------------------------------------1833                                          7/1/2022-6/30/2023       7/1/2023-6/30/2024       7/1/2024-6/30/20251834----------------------------------------------------------------------------------------------------------------1835Number of Calls                                        797,519                  893,654                1,044,4611836Percent Year Over Year                                     N/A                    12.05                    16.881837----------------------------------------------------------------------------------------------------------------18381839    Senator Blumenthal. I don't mean to be cute about it. Your1840department or agency saves lives. You save lives.1841    Dr. Watson. Yes.1842    Senator Blumenthal. And I can't think of anything more1843impactful and the VA does a lot of really impactful and1844important work, saving lives in surgery, in all kinds of other1845activities. It's a great agency. It should be preserved, not1846decimated as the current Administration seems bent on doing.1847    But I can think of no more important area to provide1848sufficient resources so you meet the increasing demand, than1849your agency. So, I hope that you will be a partner in this1850effort, Dr. Watson, because I know you're committed to the1851cause and I'm so glad we are having this hearing because it1852enables us to shine a light on the importance of adequately1853resourcing this area of the work that the VA does.1854    Dr. Watson. Thank you, Senator, for your support.1855    Senator Blumenthal. Well, it is support. Senator King.1856    Senator King. Just a quick comment. I should have started1857my questioning by saying, would you please convey our profound1858appreciation and thanks to the people that are doing this very1859difficult work, that they're recognized here and we realize how1860hard it is and that it's challenging and also how important it1861is.1862    And I suspect that many of these people are there because1863of a sense of mission, and please take back our appreciation1864for what they're doing. We're not trying to be critics; we're1865just trying to make it work better. And I do want hopefully to1866take the message back to the people that are on the front lines1867doing such good work. I just wanted to add that.1868    Dr. O'Toole. Thank you, Senator. And we appreciate that.1869    Senator Blumenthal. Yes. I'm so glad, again, Senator King.1870Thank you. Please express our gratitude to these folks because1871they do a really hard job. There are other people in the VA who1872have hard jobs, this one is particularly challenging. And I1873want to go to the question that I asked Ms. Blane about the1874SSAs.1875    I'd like to get from you as well, whether there has been an1876increase or decrease in the number of the Social Science1877Assistants, because as you've heard, and you know better than I1878do, but I was struck by how important these personnel are;1879locating the caller, phoning the police, providing records.1880It's almost like a nurse in a surgery, providing the scalpel1881and the this and that. So, if you could provide that1882information. How many are currently employed, if you know?1883    Dr. Watson. Thank you for that question. And again, the1884support of our staff who do a critical role to serve the1885mission. I do not have the specific numbers for the SSAs on me1886at this time. We do track that information and we're able to1887provide that.1888    Senator Blumenthal. Yes, if you could get me information1889about numbers of all your personnel, I would appreciate it.18901891------------------------------------------------------------------------18921893-------------------------------------------------------------------------1894VA Response: Please see below staffing for Social Science Assistants1895 (SSA) staff, Crisis Responders (CRs) and all Veterans Crisis Line (VCL)1896 as of July 10, 2025:1897------------------------------------------------------------------------18981899----------------------------------------------------------------------------------------------------------------1900                        Position                            Current FTEE        FY 24 FTEE          Increase1901----------------------------------------------------------------------------------------------------------------1902Crisis Responders                                                    1,096              1,066                 301903Social Services Assistants                                             173                154                 191904----------------------------------------------------------------------------------------------------------------19051906------------------------------------------------------------------------1907                      Department                          Current FTEE1908------------------------------------------------------------------------1909Directors Office                                                      111910Business                                                              981911Data & Information                                                    611912Technology & Innovation                                               591913Crisis Operations                                                   15761914Quality, Training & Risk Management                                  1231915National Care & Peer Support                                          921916------------------------------------------------------------------------1917    Total............................................               20201918------------------------------------------------------------------------19191920    Dr. O'Toole. I would just add, and I don't want to speak1921for Dr. Watson, but we have added, what is it, 187 crisis1922responders this fiscal year to the Veteran Crisis Line. So, it1923is a workforce that we are actively recruiting and growing.1924    Senator Blumenthal. Let me ask you, LGBTQ+ veterans and1925children of veterans, young people who are LGBTQ+ are you aware1926of discrimination against them?1927    Dr. O'Toole. No, sir. I'm not.1928    Senator Blumenthal. It would be against the law, wouldn't1929it?1930    Dr. O'Toole. Yes, it would.1931    Senator Blumenthal. And does the VA have policies to1932prevent responders on the VCL line from discriminating against1933LGBTQ+ callers?1934    Dr. O'Toole. I will defer to Dr. Watson on that specific1935question, but the VA by policy cannot, should not, be1936discriminating against anyone.1937    Senator Blumenthal. And one last question before we go to1938Senator Hirono. Do you have policies, Dr. O'Toole, to protect1939against retaliation for whistleblowers?1940    Dr. O'Toole. We do, and it is something we take very1941seriously. It is essential and clearly, we have the policies,1942but if your office or others hear of that occurring, we need to1943know and investigate and respond aggressively.1944    Senator Blumenthal. Thank you. I will turn to Senator1945Hirono if she's ready. Otherwise, I can stall a little while.19461947                     HON. MAZIE K. HIRONO,1948                    U.S. SENATOR FROM HAWAII19491950    Senator Hirono. I know that we're all committed to1951providing the services that the veterans need, and there are a1952lot of changes happening in the VA and the word chaos and1953confusion I think are apt. But I do have one question for1954either Dr. O'Toole or Dr. Watson.1955    My staff spoke with a veteran in Hawaii whose mental health1956care providers recently left VA. When the veteran asked how he1957should continue to access mental health care, he and others,1958they like similar situations, were directed to call the VCL.1959Can you confirm whether this was a one-off mistake or whether1960the VA is directing veterans to utilize the VCL for their1961everyday mental health needs? Either one of you?1962    Dr. O'Toole. Well, I will take a first stab at it and then1963defer to Dr. Watson. That should not be the approach by any1964means. And I certainly would hope and expect that it is a one-1965off. And if your office could follow up with us on that1966specific veteran, we are more than happy to reach out and make1967sure that here he----1968    Senator Hirono. So, what was supposed to happen?1969    Dr. O'Toole. We should have been able to, and we should by1970all means, transfer that individual to another mental health1971provider within the VA system. And if we aren't able to provide1972care within the VA system, to be able to refer that patient to1973the community. But it is absolutely unacceptable for any1974veteran to fall through the cracks.1975    Senator Hirono. Do you have something to add?1976    Dr. Watson. I concur with Dr. O'Toole. The Veterans Crisis1977Line is for crisis care of veteran service members, and those1978that support each group, for the treatment that is needed for1979mental health, that is to occur either at the facility or1980healthcare system that's closest to that veteran or service1981member or in the community as Dr. O'Toole has mentioned.1982    Senator Hirono. So, who is this veteran supposed to call to1983pursue a line of inquiry? This person, this veteran is supposed1984to get another treatment person to assign to him or her. Is1985that right? How do we make that happen?1986    Dr. O'Toole. Yes. Obviously, the system did not work for1987this veteran as it is intended to. And we should have in the1988context of care for this veteran, without the veteran asking1989for it, been able to transfer that veteran's care to another1990mental health provider or make sure we are getting care for1991that veteran in the community.1992    And again, we own that we need to address it. So, we are1993more than happy to follow up with your office to reach out to1994that veteran to make sure we can fix it.1995    Senator Hirono. So, you would like us to provide you with1996the name of this veteran so someone can contact him with the1997name of a new treatment person?1998    Dr. O'Toole. Yes, ma'am.1999    Senator Hirono. Okay. Has the VCL seen any spikes in2000outreach following Administration actions that2001disproportionately impact the veteran community, such as the2002announcement of probationary firings or RIFs?2003    Dr. Watson. Thank you for that question. We do track that2004information and we have received some increases of course, from2005the veterans or service members who contact the Veterans Crisis2006Line. Sometimes they share that information specifically with2007specific information. Other times they choose not to. But we2008are looking and tracking that carefully.2009    Senator Hirono. So, my understanding of the Veteran Crisis2010Line is that, veterans call the crisis line with a variety of2011requests and questions. What kind of training do they--and by2012the way, how many people do you have nationwide on the crisis2013line who are taking all these calls?2014    Dr. Watson. Are you asking for the specific number of2015crisis responders?2016    Senator Hirono. The people who are taking these calls? How2017many people does the VA have, manning the crisis lines?2018    Dr. Watson. Yes, for the crisis responders, I can give you2019an exact account. We do track that.2020    Senator Hirono. No, gimme ballpark.2021    Dr. Watson. I would say, let's say ballpark 1500. We have2022currently 2,049 employees within the Veterans Crisis Line.2023    Senator Hirono. And is that an increase from say, I don't2024know what is another timeframe when you added more people to--2025--2026    Dr. Watson. We had an exponential increase when we moved to2027988 press 1 option, in July 2022. So, we had to increase our2028staffing significantly at that time to manage that change.2029    Senator Hirono. Okay. What is a significant increase?2030    Dr. Watson. I would have to give you maybe a ballpark, so2031not an exact number. Because that occurred prior to my time2032with the Veterans Crisis Line. I started in April 2024. So, we2033can get that information for you. I would say we had to2034increase, I've heard at least by close to a thousand employees2035to manage that initiative.20362037------------------------------------------------------------------------20382039-------------------------------------------------------------------------2040VA Response: To prepare for 988 Press 1 implementation, VCL added 1,0732041 new positions in January 2022.2042------------------------------------------------------------------------20432044    Senator Hirono. That is very significant. And the reason2045that you did that was, that what, more veterans were accessing2046the crisis line?2047    Dr. Watson. Correct. We had a 1-800 number prior to July20482022. Then when we connected with our 988 partners, we are2049press 1, so you call 988 and press 1. So, we need to increase2050our staff significantly with that change.2051    Senator Hirono. So, would you say that the crisis line is2052one of the first numbers that a veteran might call for2053information and assistance? It could be the first encounter2054that a veteran may be having, accessing potential services that2055the VA provides?2056    Dr. Watson. That's a great question and yes, I would. That2057is our hope as we are an integrated service crisis line for2058veterans and service members.2059    Senator Hirono. So, since we have asked questions about the2060potential for another 80,000 people from VA being let go, at a2061time when there are all these needs in terms of providing2062veterans with services. Is there a plan to eliminate2063significantly this 1500 people that you have currently on the2064crisis lines?2065    Dr. Watson. That's a great question and no plan that I'm2066aware of.2067    Senator Hirono. I would like a great answer.2068    [Laughter.]2069    Dr. Watson. Yes, no plan that I'm aware of to eliminate our2070staff.2071    Senator Hirono. And what did you say, that as far as, you2072know, that these people are going to stay there?2073    Dr. Watson. As far as I know at this moment, that is2074correct.2075    Senator Hirono. I think if, can you double check that?2076Because we don't want the first line of encounters for veterans2077to be among the 80,000 or so that potentially can be cut.20782079------------------------------------------------------------------------20802081-------------------------------------------------------------------------2082VA Response: VCL was granted an exemption from the current federal2083 hiring freeze and has continued to conduct hiring as needed. VA has no2084 plans to reduce the number of VCL staff. Furthermore, on July 7, 2025,2085 VA announced that we are on pace to reduce total VA staff by nearly2086 30,000 employees by the end of fiscal year 2025, eliminating the need2087 for a large-scale reduction-in-force.2088------------------------------------------------------------------------20892090    Dr. O'Toole. Senator, I would just add to that. So, there2091are other phone access points for veterans trying to establish2092care and access care. So, the crisis line is clearly intended2093for those veterans who are in crisis and who need emergency2094crisis response. But ending veteran suicides is a priority of2095this Administration. And, you know, the expectation of that2096with those positions being exempted for many hiring freezes,2097through reversal of the return to office provisions for that2098group. You know, this is a committed group and we have grown2099that labor force within the crisis line by 187 individuals for2100this fiscal year.2101    Senator Hirono. I am over my time. Alright. Can I go on? So2102is there a specific line for suicide situations that people can2103call?2104    Dr. O'Toole. That would be the Veteran Crisis Line, ma'am.2105    Senator Hirono. Okay. That would be the VCL? So then my2106next question is what kind of training do all your people have2107in order to deal with these kinds of very critical situations?2108    Dr. Watson. Thank you for that question. They have very2109specific training to help them provide the best support and2110meet the mission. They often go through many, many hours of2111training and review. Then they have a precepting program. So,2112all of these things occur before they're actually allowed on2113the line to answer a call.2114    Senator Hirono. There are some concerns that have been2115raised about what kind of training your crisis center people2116have. And so, if you have a description of the kind of training2117that people have and I don't know what kind of turnover you2118have, I would imagine that these jobs can be very--it's high2119pressure. Anyway, can you send me a description of what kind of2120training your crisis center people get?2121    Dr. Watson. Yes. We have very specific training and we can2122send you that information for follow up.2123    Senator Hirono. And what the retention is for your people?2124    Dr. Watson. Certainly. Thank you.2125    Senator Hirono. Thank you.21262127------------------------------------------------------------------------21282129-------------------------------------------------------------------------2130VA Response: Office of Suicide Prevention (OSP) Veterans Crisis Line2131 (VCL) has an extensive and robust training program providing crisis2132 intervention focus subjects highlighting veteran specific experience2133 including but not limited to modules on Military Culture, Post2134 Traumatic Stress Disorder, Military Sexual Trauma, Engagement,2135 Motivational Interviewing, Lethal Means Safety, Substance Use and2136 Overdose Risk, Risk Assessment, Violence Risk Assessment, Crisis2137 Intervention, and technical application use. All training is tracked2138 through Veterans Affairs' (VA) Talent Management System (TMS). Each2139 module has individual post-test requirements. New Employee Orientation2140 (NEO) training is evaluated through the completion of a pre- and post-2141 test knowledge checks. All trainees are expected to demonstrate2142 competency at the end of classroom period by scoring 80% or higher on2143 the post-test assessment.21442145The VCL's turnover rate for Fiscal Year 2025 (October 1, 2024, through2146 June 2025) to date is 7.9%.2147------------------------------------------------------------------------21482149    Senator Blumenthal. Thank you, Senator Hirono. Thank you to2150our witnesses. And I think there are no further questions. I2151want to thank members of the audience as well as our witnesses.2152And please convey to your colleagues, not only at the Veterans2153Crisis Line, but throughout the VA, our profound thanks for2154their service.2155    As harsh as I may have sounded in some of my criticism of2156the top leadership, I have profound admiration and gratitude2157for the service of the VA workforce, including present company,2158because your job is doubly difficult because of the cutbacks2159that are occurring and the slashing of programs. So, I'm not2160asking you to comment, but please convey my thanks to your2161colleagues and with that----2162    Senator Hirono. I join in that by the way.2163    Senator Blumenthal. Thank you, thanks Senator Hirono. And I2164think by the way, that comment reflects the vast majority of2165United States Senators, if not everyone.2166    The hearing record will remain open for five legislative2167days should any Committee members want to submit additional2168statements or questions for the record. And I ask our2169witnesses, both from this panel and the previous one, to2170respond to any questions that may be submitted in a timely2171manner.2172    And with that, the hearing is adjourned.2173    [Whereupon, at 5:57 p.m., the hearing was adjourned.]21742175                            A P P E N D I X21762177                          Prepared Statements21782179   [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]21802181                       Submissions for the Record21822183   [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]21842185                           [all]