Veterans suicide prevention line still falling short, more than a year after troubling report

Matthew Leonard | Rochester

Show Caption Hide Caption Veterans event hopes to yield better community support An event held at Dutchess Community College hoped to bring together both community leaders and veterans to help improve support for those who served.

More than a year after an investigation, the government agency that manages the nation’s suicide-prevention hotline for veterans has not been able to put in place seven recommendations from its own inspector general designed to improve the crisis line’s performance.

The February 2016 investigation of the Veterans Health Administration, which manages the nation’s suicide-prevention hotline for veterans, found significant problems with response times and quality assurance at the call center, headquartered in Canandaigua.

The 2016 report substantiated allegations that “some calls routed to backup crisis centers were answered by voicemail and callers did not always receive immediate assistance from VCL (Veterans Crisis Line) and/or backup staff.”

The recommendations included gathering better data when callers were routed to backup centers, silent monitoring of responders, and ensuring orientation and training goals for staff were being met.

Veterans might face a number of challenges upon ­returning home, which can be further complicated by post-traumatic stress disorder and traumatic brain injury.

According to the Department of Veterans Affairs’ own assessment, an average of 20 veterans die by suicide every day.

The VCL was established in 2007 and operates on its own site at the Canandaigua VA Medical Center with an additional center in Atlanta that opened in October.

The VA estimates that the VCL has answered close to 2.8 million calls since it was launched, and initiated emergency services over 74,000 times.

The VHA was scheduled to implement the recommendations for the crisis line by September, and then asked for an extension to this past March; a deadline it also hasn’t met. The report by the VA’s office of the inspector general released on March 20 found that the VHA’s “... failure to implement our previous recommendations impairs the VCL’s ability to increase the quality of crisis-intervention services to veterans seeking help.”

Other findings included:

• The VCL did not respond adequately to a veteran’s urgent need.

• There are continuing deficiencies in the way the VCL managed incoming calls.

• There are ongoing deficiencies in governance and oversight of VCL operations.

Local efforts

Dutchess County Legislator Marc Coviello, an Army veteran, said he was “severely disappointed in the lack of progress” at the federal level. Once a veteran is “willing and ready to ask for help ... it needs to be addressed immediately.”

But where the federal government is falling short in providing services for veterans, the county is not, he said.

From the Pfc. Joseph Dwyer PTSD Peer-to-Peer Veterans Support program to the Hudson Valley Hero Project and more, “We certainly make up for the services that are not provided,” Coviello said.

Mental health resources in Dutchess — for its 18,000-plus veterans and others — include a 24/7 helpline and free mobile app, a mobile crisis-intervention team and stabilization center.

The peer-to-peer support program pairs veterans with mentors, Coviello said.

“Other veterans can empathize with you,” he said. “They understand where you’re coming from.”

Meanwhile, the Hudson Valley Hero Project, which Coviello founded after returning to Beekman from tours in Iraq and Afghanistan, helps veterans and active-duty service members with medical expenses, pays for PTSD therapy, raises money for scholarships and sends care packages overseas.

Changes needed

The veteran’s interaction with the VCL and the backup centers led the office of the inspector general to identify problems with the manual writing down of VCL caller numbers, a lack of process to review adverse outcomes, an inability to record calls and an inability to track the quality performance of the backup call centers that take the overflow calls.

The most recent evaluation from the office also said that, currently, “VCL leaders did not collect data regarding attempted or completed suicides following a veteran’s contact with the VCL.”

The office also observed that there were no reviews by VCL leadership if veterans who had been in contact with the agency attempted or completed suicide.

In a statement accompanying the release of the report, Inspector General Michael Missal acknowledged the professional dedication of VCL staff but said “... it is imperative that VA take further steps to increase effectiveness of VCL operations.”

The report also found that the VCL lacks permanent leadership: “As of December 2016, the VCL continued to operate without a permanent director.” As reported by The Military Times last June, the VCL director appointed after a leadership shakeup following the February 2016 report resigned four months later.

The March 20 report makes an additional 16 recommendations intended to address the ongoing deficiencies, including holding backup call centers to the same standards as the VCL, developing more robust reporting of the clinical outcomes, implementing an automated transcription function for caller’s phone numbers, and reviewing data on outcomes.

Atlanta call center

The issues have continued, in part, as the result of the launch of the additional call center in Atlanta in October that redeployed Canandaigua staff to provide training. The VA estimates that the crisis line handles a half million calls a year — in addition to texts and emails — and space requirements in upstate New York and recruitment pool limitations underpinned the expansion to a second site.

“Lack of formal planning and inaccurate forecasting resulted in more than 16,000 hours of Canandaigua (full-time equivalent) employees being temporarily redirected to the Atlanta Call Center for training and operations. This led to an increase in the number of calls that rolled over to backup centers and delays in the development and implementation of VCL processes, policies and procedures,” Missal said.

The report showed that the VCL “rollover rate,” the number of inbound calls that were not answered by the VCL in November, was close to 30 percent.

In response to the latest recommendations, the acting undersecretary for health, Dr. Poonam L. Alaigh, concurred with the report and all 16 of the OIG’s recommendations and outlined a list of responses with target dates from May to December 2017, including a “root-cause analysis” to the lack of analysis of adverse outcomes.

Help is available

Veterans, their friends and family and military personnel can confidentially call 1-800-273-8255 and press 1; text 838255; or chat online with qualified responders at https://www.veteranscrisisline.net.

Locally, veterans suffering with PTSD or TBI can call or text the Dutchess County helpline 24/7 at 845-485-9700.

Staff writer Nina Schutzman contributed to this report. Matthew Leonard writes for the Rochester Democrat and Chronicle.

Internal audit shows broader progress

Indicators from Veterans Affairs own internal confidential reporting shows that the Canandaigua VA Medical Center has made steady progress toward meeting quality benchmarks in the first quarter of 2017, compared with the last quarter of 2016.

The VA’s Strategic Analytics for Improvement and Learning (SAIL) are internal indicators that VA uses as a basis for the ongoing improvement of services.

A score out of 100 used as a measurement of efficiency at the facility showed a jump from 83.532 in the last three months of 2016 to nearly 92 in the first quarter of 2017.

The VA’s benchmark score is 96.153. The same benchmarking system shows that Canandaigua VA consistently rates 4 out of 5 stars for quality-of-care.