	Background

In 2007, VA established the VCL, a 24-hour crisis line staffed by  responders trained to assist veterans in emotional crisis. 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

In our covert testing of the VCL’s call response time in July and August  2015, we found that it was uncommon for VCL callers to wait an extended  period before reaching a responder since all of our calls that reached the  VCL were answered in less than 4 minutes. However, we also found VA  did not meet its goal of answering 90 percent of calls to the VCL within 30  seconds for test calls that we made. VA officials told us that, during fiscal year 2015, about 65 to  75 percent of VCL calls were answered at the VCL primary center and  about 25 to 35 percent of VCL calls were answered at the backup call  centers. These VA-reported results indicate that about 65 to 75 percent of  VCL calls were answered within either 30 or 60 seconds. These  included: (1) incompatibilities between some devices used to send text  messages to the VCL and the software VA used to process the text  messages, (2) occasional software malfunctions that freeze the text  messaging interface at the VCL primary center, (3) inaudible audio  prompts used to alert VCL primary center responders of incoming text  messages, (4) attempts by people with bad intentions to disrupt the VCL’s  text messaging service by overloading the system with a large number of  texts, and (5) incompatibilities between the web browsers used by the  VCL primary center and the text messaging software. They said that the  provider had not reported any issues with this system. We recommended that VA regularly test the VCL’s text messaging  system to identify issues and correct them promptly. In response, VA  developed and implemented procedures to regularly test the VCL’s text  messaging system, as well as its telephone and online chat systems. VA Had Taken Steps to Improve Its Monitoring of VCL Primary Center Performance but Had 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

As we reported in May 2016, VA had 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. These  targets should be quantifiable or otherwise measurable and indicate how  well or at what level an agency or one of its components aspires to  perform. For example, for VA’s key performance indicator for the percentage of  calls answered by the VCL, the department had not included a date by  which it would expect the VCL to complete this action. We recommended that VA document clearly stated and measurable  targets and time frames for key performance indicators needed to assess  VCL performance. VA Was Strengthening Requirements for VCL Backup Call Centers, but VA and SAMHSA Did Not Collect Information to Assess How Often and Why Callers Were Not Reaching the VCL

		VA Was Enhancing Performance Requirements for Its Backup Call Coverage Contractor

As we reported in May 2016, VA’s backup call coverage contract,  awarded in October 2012 and in place at the time of our review, did not  include detailed performance requirements in several key areas for the  VCL backup call centers. Using the  information collected from the Lifeline local crisis centers on how often  and why veterans reach Lifeline, as opposed to the VCL, VA and  SAMHSA officials could then assess whether the extent to which this  occurs merits further review and action. We concluded that without  collecting information to examine how often and why veterans do not  press “1” when prompted to reach the VCL, VA and SAMHSA could not  determine the extent veterans reach the Lifeline network when intending  to reach the VCL and may experience longer wait times as a result. We recommended VA and SAMHSA collaborate in taking the following  two actions: (1) collect information on how often and why callers intending  to reach the VCL instead reach Lifeline local crisis centers and (2) review  the information collected and, if necessary, develop plans to address the  underlying causes. We understand that VA and SAMHSA have been  coordinating on these issues. However, as of March 2017, both of these  recommendations remain open. Contact points for our Offices of Congressional Relations and Public  Affairs may be found on the last page of this statement.
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.
This statement summarizes GAO's May 2016 report on VA's oversight of the VCL. Specifically, the statement describes (1) the extent to which VA met response-time goals for VCL calls and text messages, (2) how VA monitored VCL primary center call center operations, and (3) how VA worked with VCL service partners to help ensure veterans receive high-quality service. For the May 2016 report, 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 officials. GAO contacted VA and SAMHSA for an update on actions taken in response to the report's recommendations.

What GAO Found

In May 2016, 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; issues with text messages were also found. VA's goal was to answer 90 percent of VCL calls at the VCL primary center within 30 seconds in the period GAO studied. Calls not answered within 30 seconds were to 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. According to VA officials 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 confirmed this. Specifically, 119 covert test calls showed that an estimated 73 percent of calls made during this period were answered within 30 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. GAO recommended that VA regularly test the VCL's text messaging system to identify issues and correct them promptly. In response, VA developed and implemented procedures to regularly test the VCL's text messaging system, as well as its telephone and online chat systems.
In May 2016, GAO found that VA had taken a number of steps to improve its monitoring of the VCL primary center operations. For example, VA had 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 had not specified quantifiable or otherwise measurable targets and had not included dates for when it would expect the VCL to complete actions covered by each key performance indicator. This was inconsistent with guidance provided by the Office of Management and Budget. GAO recommended that VA document clearly stated and measurable targets and time frames for key performance indicators needed to assess VCL performance. Although VA agreed, as of March 2017, this recommendation remains open.
GAO also found that VA had 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 Lifeline (a public-private network that provides free and confidential support to people in suicidal crisis or emotional distress). Despite these efforts to coordinate, VA and SAMHSA did 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. As a result, VA and SAMHSA did not know the extent to which this occurred and could not determine the underlying causes that may need to be addressed. GAO recommended that VA and SAMHSA (1) collect information on how often and why callers intending to reach the VCL instead reach Lifeline local crisis centers and (2) review the information collected and, if necessary, develop plans to address the underlying causes. Although VA and SAMHSA agreed, as of March 2017, these recommendations remain open.

What GAO Recommends

In its May 2016 report, GAO made four recommendations to VA and HHS to improve the VCL. VA and HHS concurred with the recommendations and while action has been taken on one, three remain open as of March 2017.