A highly emotional Senate Veterans Affairs Committee hearing last month focused on a damning report from the Veterans Affairs Office of Inspector General: a veteran dying by suicide minutes after ending his conversation with the Veterans Crisis Line.
988 +1 was proposed as a simple solution to a complex problem. With just a call, text or an online chat, a struggling veteran could immediately be connected to a supportive crisis counselor. According to 2021 data from the American Foundation for Suicide Prevention, there are an average of 132 suicides per day. The most recent data from the VA indicates that, on a given day, veterans account for an average of 17 suicides. With these staggering statistics in mind, the Department of Veterans Affairs has renewed its focus on mental health and suicide prevention. However, this issue is far from solved.
While American crisis hotlines have existed since the 1950s, the National Suicide Hotline Designation Act was the beginning of the convenient 988. This 2020 bipartisan bill invested $432 million into crisis centers, providing the financial basis for increased staff and therefore lower wait times. As the National Suicide Prevention Lifeline transitioned to 988, so did the Veterans’ Crisis Line, with the small addition of pressing 1.
As the September VA hearing illuminated, the well-trained responders are vital to the success of the Veterans Crisis Line. The OIG report of the incident in question summarized that the veteran caller shared that he not only had a plan to commit suicide but possessed the means to do so. In this circumstance, a counselor is trained to directly call the veteran’s number or alert local emergency services. When the veteran’s conversation cut off, his crisis counselor failed to do either.
Wait time is another significant and crucial factor in providing support with the hotline service. However, it is also one of the biggest fluctuations based on the season or time of day. In 988 +1’s first year of operation, the average speed to answer was 9.37 seconds. However, during the first weekend of 2023, the crisis line experienced an unprecedented spike in calls, increasing wait times. VA leaders report that 99.2% of calls were answered within two minutes. The substantial disparity between 10 seconds and 2 minutes is critical. When it comes to a crisis call, every second matters.
Staffing is another large problem facing 988. According to Matthew Miller, executive director for suicide prevention at the Veterans Health Administration, 900 crisis line workers have been hired in the last year and a half. While the VA website explains that many responders are veterans themselves, the accountability system within these call centers remains unclear. In the case of the San Antonio suicide, the crisis centers’ leadership failed to disclose the suicide or update its internal records. This mistake meant that the family of the veteran continued to receive communication from the VA about scheduling appointments and updates, a careless oversight for grieving loved ones.
Are we truly committed to preventing veteran suicides? The Senate hearing was successful in spreading awareness, but the case never should have progressed far enough to need such intervention; the crisis center leaders must follow protocol beginning the moment a call is taken. And if that protocol isn’t enough, then data and community-based evaluation is the next step toward protecting our nation’s heroes.
It may be time to reapproach this crisis focused on a state perspective. While 988’s first year of operations was fully funded by the federal government, funding is now split between federal, state and local support. However, only 26 states have passed legislation specifically to support the ongoing implementation of 988. For example, Washington’s H.B. 1134 requires comprehensive training in suicide assessment, treatment and management for its call center mental staff, as well as establishes statewide supervisory and disciplinary rules. California’s A.B.-988 commits to improvement analysis and the publication of a five-year 988 plan. Though most states include 988 somewhere in their budgets, establishing specific state guidelines and procedures closes the gap that exists between federal money and tangible implementation.
Though the veteran suicide rate has fallen to its lowest point since 2006, there are still more than 6,000 senseless deaths each year, and 988 +1 in its current form is not enough. A community-based approach to mental health includes the perspectives & experiences of those who have lived through it. Moving forward, veterans must be given a seat at the table where solutions are being discussed. In the wake of not only this tragedy but the thousands of preventable veteran deaths each year, it is clear that there is more work to be done.
988 +1 must be a reliable and standardized resource for veterans in need.
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