On August 22, 2024, the Department of Veterans Affairs (VA) Office of Inspector General (OIG) submitted a Report concerning a review of the Veterans Crisis Line’s (VCL’s) preparation for the implementation of the National Suicide Prevention Hotline three-digit dialing code “9-8-8 press 1.”

The VCL was established in 2007. Callers could reach the Crisis Line by contacting the National Suicide Prevention Hotline (1-800-273-8255) and following instructions in a recorded greeting.

In 2020, the Federal Communications Commission (FCC) designated “988” as the new suicide prevention hotline number, and later that year, the National Suicide Designation Act was signed into law, which required “988” to be used as the universal suicide prevention hotline number.

After the National Suicide Hotline Designation Act of 2022 was signed into law, the name of the hotline was changed from the National Suicide Prevention Hotline to the 988 Suicide and Crisis Lifeline.

On July 16, 2022, callers were able to contact the VCL by using “988 press 1.” Using an external contractor’s forecasting model that the VCL applied, the VCL operational leaders projected an increased call volume of 122 percent to 154 percent.

In response to the projected volume increase, the VA’s plan was to increase frontline staff through monthly hiring; identify VCL needs from the VA Office of Information and Technology (OIT), and ensure quality assurance.

The OIG Report determined that while VCL leaders increased the hiring of frontline staff, the number of supervisors hired did not maintain the previously established supervisor-to-staff ratio of approximately one (1) to ten (10) staff.

When the OIG review was conducted, the supervisor-to-staff ratio was one (1) supervisor to twenty (20) staff responders.

The operational leaders explained there were discussions about hiring supervisors at the same time as responders, supervisor positions were posted as on-site, directly limiting the number of available candidates.

However, in April of 2024, the OIG received information that supervisor positions have been classified as remote and posted for hire.

The OIG believed to provide adequate supervision of the responders, the operational leaders should ensure the appropriate ratio of supervisors to frontline staff. The OIG is concerned that one supervisor overseeing, assessing, and mentoring approximately 20 responders may impact the VCL’s ability to identify and remedy quality concerns.

The VCL frontline staff are exposed to potentially traumatic experiences when interacting with veterans, spouses, and family members in crisis. In the preparation made by the operational VCL leaders, they planned for postvention services to the frontline staff.

However, when the Study was conducted, it found that only 28 percent were aware that the postvention resources services were available. The OIG concluded that VCL frontline staff would benefit from increased awareness and training regarding postvention resources.

Prior to the implementation of the system, the VCL leaders collaborated with OIT leaders to identify and plan for necessary infrastructure and modernization to support the 988 press 1 implementation.

A review of the OIG survey data demonstrated that the majority of staff reported having the necessary equipment and technical support to perform their work. The OIG concluded VCL did not encounter technology concerns related to the “988 press 1” implementation.

The OIG Report found post “988 press 1” quality metrics data were reported monthly to VCL leaders at Executive Leadership Council meetings.

The data reported included (1) call volume, (2) timeliness to answer calls, (3) average time per call, (4) number of dispatches, (5) number of staff cleared for independent work, and (6) the interactive quality of the call through silent monitoring.

The OIG Study obtained and compared both pre- and post-988 press 1 call volumes. The volume of calls reported when “988 press 1” initiated in July through December 2022 was compared to the prior year interval from July through December 2021. Call volume increased only by 12.5 percent.

Data from July through December 2023 indicated a 15.1 percent increase over the July through December 2022 call volume. Although the number of calls increased, the overall volume was substantially lower than the 122 percent to 154 percent percent projected increase.

Four (4) months before the implementation of the new three-digit number, VCL operational leaders learned the subcontractor who supplied the existing external backup call center for VCL would no longer provide the service.

Within five weeks of notification, VCL operational leaders partnered with OIT to create an “internal backup call center”. According to VCL operational leaders, the internal backup option was successful, and the current plan is to continue using this existing resource.

My Opinion: The transfer of the old National Suicide Prevention Hotline system to the new 988 Suicide and Crisis Lifeline system required meticulous and detailed planning for a successful implementation.

Veterans should remember the magnitude of problems that the VA encountered and experienced when it tried to implement the 2014 Veterans Choice Program (VCP) without meticulous, detailed planning.

It appears, from studying the OIG Report, that the VA’s VCL operational leaders have done an outstanding job in preparing for the implementation of the 988 Suicide and Crisis Lifeline and they should be commended!

BioSketch: John Plahovinsak is a 32-year retired Army veteran who served from 1967 to 1999. He is the Disabled American Veterans (DAV) Department of Ohio’s Hospital Chairman and Adjutant of DAV Chapter #63 (Clermont County). He can be contacted at: plahovinsak@msn.com.