VCL Workload and Funding Obligations

The number of calls reaching the VCL has increased substantially since  the VCL’s first full year of operation. Extended Call Wait Times Were Uncommon in July and August 2015, but VA Did Not Meet Its Call Response Time Goals and Some Text Messages Did Not Receive Responses

		VA Responded to Most Calls within 30 Seconds in July and August 2015, but Did Not Meet Its Goal to Answer 90 Percent of Calls within 30 Seconds at the VCL Primary Center

To determine how well VA performed against its goal for responding to  VCL callers, we covertly tested the VCL’s call response time in July and  August 2015. On the basis of our test calls, we estimate that during July and  August 2015 about 73 percent of all VCL calls were answered at the VCL  primary center within 30 seconds. These VA-reported  results indicate that about 65 to 75 percent of VCL calls were answered  within either 30 or 60 seconds. VA officials told us that they do not monitor and test the timeliness and  performance of the VCL text messaging system, but rather rely solely on  the VCL’s text messaging service provider for such monitoring and  testing. They said that the provider had not reported any issues with this  system. According to the provider, no routine testing of the VCL’s text  messaging system is conducted. Without routinely testing its text messaging  system, or ensuring that its provider tests the system, VA cannot ensure  that it is identifying limitations with its text messaging service and  resolving them to provide consistent, reliable service to veterans. VA Has Taken Steps to Improve Its Monitoring of VCL Primary Center Performance but Has Not Established Targets and Time Frames for VCL Key Performance Indicators

		VA Established a Call Center Evaluation Team, Implemented Revised Responder Performance Standards, and Analyzed VCL Caller Complaints

VA has sought to enhance its capabilities for overseeing VCL primary  center operations through a number of activities—including establishing a  call center evaluation team, implementing revised performance standards  for VCL primary center responders, implementing silent monitoring of  VCL primary center responders, and analyzing VCL caller complaints. In October 2014, VA created a  mechanism for tracking complaints it receives from VCL callers and  external parties, such as members of Congress and veterans, about the  performance of the VCL primary and backup call centers. For example, for VA’s key performance indicator for the percentage of  calls answered by the VCL, the department did not include a date by  which it would expect the VCL to complete this action. For example, the contract did not include any  information on several key aspects of VCL backup call center  performance, including: (1) the percentage of VCL calls routed to each  VCL backup call center that should be answered, (2) VA’s expectations  on whether or not VCL backup call centers could use voice answering  systems or caller queues for VCL calls, and (3) VA’s documentation  requirements for VCL calls answered at the VCL backup call centers. VA and SAMHSA Do Not Collect Information Needed to Assess How Often and Why Callers Do Not Reach the VCL

We found that when callers do not press “1” during the initial Lifeline  greeting, their calls may take longer to answer than if the caller had  pressed “1” and been routed to either the VCL primary center or a VCL  backup call center. In addition, SAMHSA  officials said that they also do not collect this information. VA has developed additional plans to address other concerns with VCL  operations. VA officials  said they anticipate that the second phase will be completed in fiscal year  2017. In February 2016, VA officials told us that they are considering  implementing this type of queue. Despite efforts to coordinate the operations of the VCL and Lifeline  through an interagency agreement, VA and SAMHSA have not collected  information necessary to determine how often and why veterans intending  to reach the VCL reach Lifeline instead. As a result, neither VA nor  SAMHSA can assess the extent this occurs and the underlying causes  that may need to be addressed. Recommendations for Executive Action

To improve the timeliness and quality of VCL responses to veterans and  others, we recommend that the Secretary of Veterans Affairs direct the  Under Secretary for Health to take the following two actions:  regularly test the VCL’s text messaging system to identify issues and  correct them promptly; and document clearly stated and measurable targets and time frames for  key performance indicators needed to assess VCL performance. We further recommend that under the applicable terms of their  interagency agreement, the Secretary of Veterans Affairs and the  Secretary of Health and Human Services direct the Under Secretary for  Health and the Administrator of the Substance Abuse and Mental Health  Services Administration (SAMHSA), respectively, to collaborate and take  the following two actions:  collect information on how often and why callers intending to reach  the VCL instead reach Lifeline local crisis centers; and  review the information collected and, if necessary, develop plans to  address the underlying causes. These VA and HHS actions, if implemented effectively, would address the  intent of our recommendations. Appendix I: Scope and Methodology

	Testing VCL Response Times

To determine the extent to which the Department of Veterans Affairs (VA)  meets response-time goals for calls, online chats, and text messages  received through the Veterans Crisis Line (VCL), we conducted several  tests of VCL services during July and August 2015. The VCL is accessed by calling a single national  toll-free number—1-800-273-TALK (8255)—shared by both the VCL and  the National Suicide Prevention Lifeline (Lifeline).
Why GAO Did This Study

VA established the VCL in July 2007 to provide support to veterans in emotional crisis. Between fiscal years 2008, its first full year of operation, and 2015, the number of calls received by the VCL increased almost 700 percent, exceeding VA's expectations. As VA began to address increasing numbers of requests for assistance, reports of dissatisfaction with VCL's service periodically appeared in the media.
GAO was asked to review VA's administration of the VCL. This report, among other issues, examines (1) the extent to which VA meets response-time goals for VCL calls and text messages, (2) how VA monitors VCL primary center call center operations, and (3) how VA works with VCL service partners to help ensure veterans receive high-quality service. GAO visited the VCL's primary center and two backup call centers; tested VCL response time through a generalizable sample of covert telephone calls and a nongeneralizable sample of text messages in July and August 2015; reviewed internal reports and policies and plans; and interviewed VA and SAMHSA officials.

What GAO Found

GAO found that the Department of Veterans Affairs (VA) did not meet its call response time goals for the Veterans Crisis Line (VCL), although extended call wait times were not common. VA's goal is to answer 90 percent of VCL calls at the VCL primary center within 30 seconds. Currently, calls not answered within 30 seconds route to VCL backup call centers; however, for 5 months of fiscal year 2015, calls were routed to VCL backup call centers after 60 seconds. VA officials told GAO that VA data show about 65 to 75 percent of VCL calls were answered at the VCL primary center in fiscal year 2015 within either 30 or 60 seconds. GAO's covert testing in July and August 2015 confirms VA's data. Specifically, 119 covert test calls show that an estimated 73 percent of calls made during this period were answered within 30 seconds. GAO also estimates that 99 percent of all VCL calls during this period were answered within 120 seconds. GAO also covertly tested the VCL's text messaging services and found that 4 of 14 GAO test text messages did not receive responses. VA officials said they do not monitor or test the timeliness and performance of the VCL text message system and instead rely solely on the VCL's text messaging provider for these functions. VA officials told GAO that the provider had not reported any issues with the system, but the provider told GAO that routine testing of the VCL system is not conducted. Without routinely testing its text messaging system or ensuring that its provider does so, VA cannot identify limitations to this service.
While VA has taken a number of steps to improve its monitoring of the VCL primary center operations, VA has not developed measurable targets and time frames for its key performance indicators, such as the program's percentage of abandoned calls. VA established a permanent VCL call center evaluation team and created a mechanism for tracking complaints about the performance of the VCL primary center from VCL callers or external parties. However, GAO found that VA has not specified quantifiable or otherwise measurable targets and has not included dates for when it would expect the VCL to complete actions covered by each key performance indicator. This is inconsistent with guidance provided by the Office of Management and Budget. As a result, VA cannot ensure that the VCL is providing consistent, high-quality services to callers and cannot effectively track and publicly report progress or results.
VA established an interagency agreement with its service partner, the Department of Health and Human Services' (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA), to manage the shared operations of the VCL and the National Suicide Prevention Lifeline (Lifeline), which include a single national toll-free number used by both. Despite these efforts to coordinate, VA and SAMHSA do not collect information needed to assess how often and why callers intending to reach the VCL do not follow voice prompts and instead reach Lifeline local crisis centers. VA officials told GAO that the type of information that would be needed to do so is not collected because VA has focused on addressing the concerns of those callers who did reach the VCL. In addition, SAMHSA officials said that they do not require Lifeline local crisis centers to collect this type of information, noting that it would be possible to collect it. As a result, VA and SAMHSA do not know the extent to which this occurs and cannot determine the underlying causes that may need to be addressed.

What GAO Recommends

GAO recommends that VA regularly test VCL's text messaging system and document targets and time frames for key performance indicators. GAO also recommends that VA and SAMHSA collect information on how often and why callers reach Lifeline when intending to reach the VCL, review this information, and, if necessary, develop plans to address the causes. VA and HHS concurred with GAO's recommendations and described planned actions to address them.