Workers at the 24-hour veterans crisis line had about 3.8 million interactions with veterans from fiscal 2021 through 2024, with the number increasing each year, according to the Government Accountability Office. (Defense Department)

WASHINGTON — Responders at the 24-hour veterans crisis line encounter abusive callers, incessant contacts from “disruptive” callers and pressure from their own managers to answer multiple texts from suicidal veterans simultaneously.

Leaders at the national suicide hotline run by the Department of Veterans Affairs are focused more on worker productivity as call volumes grow than on addressing the needs of individuals in crisis.

Former crisis line workers delivered that message at a hearing Wednesday of the Senate Veterans’ Affairs Committee that looked at the performance of the veterans crisis line that fields 80,000 to 90,000 calls, texts and chats monthly.

The hearing focused on internal complaints by front-line staff about inadequate oversight and lack of clear guidance for handling the flood of calls, texts and chats the crisis line fields each day, according to the committee.

Sen. Jerry Moran, R-Kan., chairman of the committee, thanked “whistleblowers” for stepping forward in 2023 with concerns about operations at the crisis line. But he said the crisis line has yet to complete an investigation into reported problems.

“The veterans crisis line is filled with caring professionals who are frequently encouraged to dim their lights and just answer the call, prioritizing quantity over quality,” said Marcia Blane, a former veterans line crisis worker. “Responders also face racially, misogynistic, abusive and sexually inappropriate interactions with callers.”

The committee also heard from a representative from the Government Accountability Office, which issued a report Wednesday titled “Actions Needed to Better Ensure Effectiveness of Communications with Veterans.”

Suicides among veterans occur at twice the rate of nonveterans, the GAO said. More than 17 veteran suicides on average occur each day.

The GAO report looked at challenges crisis line workers have trying to manage multiple chat and text interactions with veterans simultaneously as the number of contacts with the crisis line grows.

Workers had about 3.8 million interactions from fiscal 2021 through 2024, with the number increasing each year, according to the GAO.

There is “significant and growing demand for service” at the crisis line, said Thomas O’Toole, the VA deputy assistant undersecretary for health for clinical services.

The crisis line reported 787,000 interactions with veterans in fiscal 2025, which have included more than 125,000 texts and chats, he said. There are more than 1,000 responders employed by the crisis line to answer calls, texts and online chats from veterans at risk of suicide.

Sen. Richard Blumenthal, D-Conn., described the crisis line as at the forefront of combating veteran suicide. But he said it needs a bigger investment from Congress to increase staffing, add resources and improve technology.

Blumenthal also questioned the potential impact of reduction-in-force plans on staffing of the veterans crisis line, though VA Secretary Doug Collins said he will not terminate front-line workers performing essential duties.

The crisis line has a $306 million budget for fiscal 2025 that is expected to increase to $312 million in 2026.

Another challenge is making certain that veterans who are abusive or make frequent contacts are routed properly to staff trained to handle the interactions.

A team to manage callers with “complex needs” was created to interact with veterans “who call at a high frequency, as well as those who are abusive, exhibit sexually inappropriate behavior or make threats of violence toward staff,” according to the GAO report.

“The team was led by clinicians who willingly engaged with the most difficult and vulnerable veterans,” said Brad Combs, a lead auditor with the veterans crisis line from 2019 to 2023.

He said some of these callers “are in a heightened emotional state” arising from an acute mental health crisis.

But the calls more recently are abandoned or rerouted to responders not trained to handle inappropriate behaviors, he said.

Blane said responders often face a barrage of contacts from individuals calling 30 to 40 times a day or crashing the text platforms from repeated contacts. She said there has been a lack of operating procedures for managing the communications.

The GAO also found these types of calls increasingly are redirected to main-line phone responders who might not have the training to handle them, “raising service quality and staffing concerns that could put [veterans] at risk.”

“We need to be doing a better job,” O’Toole said, adding the VA is focused on addressing problems identified by the GAO through better training and “formalizing” procedures, among other solutions.

Sen. Maggie Hassan, D-N.H., asked Combs what type of changes are needed to manage disruptive callers and connect them with the help that they need.

Combs responded: “Reconstitute the team” trained to handle these complex cases. He also said, starting in August 2023, the “simultaneous handling” of multiple chats or texts from veterans became standard practice.

Responders are expected to answer two or three texts at a time, Blane said.

The GAO report also looked at challenges crisis line workers have trying to manage two interactions from veterans at the same time.

“Concurrent interactions” were more likely to be abandoned by veterans, according to the GAO.

Crisis responders also took longer to send initial responses when there were concurrent texts and chats, the GAO said.

The VA is in the process of developing a service goal for responding to chats and texts, which it anticipates finalizing in the summer, according to the GAO.

“Our veterans deserve to get prompt support when they reach out to the veterans crisis line, and our responders shouldn’t be asked to divide their attention between multiple veterans in crisis at once,” Hassan said.