The Inspector General for the Department of Veterans Affairs released a report Monday which found needed improvements to a suicide hotline for veterans have not been made. The report said many veterans who called the hotline were being routed to overflow call centers and some were being placed in a queue for up to 30 minutes waiting for their call to be answered.

The Veterans Crisis Line (VCL) was established in 2007 and answers roughly 500,000 calls a year. The goal was to have no more than 10% of calls routed to overflow call centers but in fact, the rate was nearly 30% as recently as last November. Here’s a chart from the report showing the “rollover rate” from April through November:

The reason the high rollover rate is a problem is that callers sent to two of the overflow call centers were being placed in a queue where they could be left waiting up to 30 minutes for their call to be answered. Conveniently, the staff did not consider this to be equivalent to being “on hold” because no one had yet answered the phone. But the report points out there is no difference as far as the caller is concerned:

Two of the four backup centers used a call answering system that placed VCL rollover calls in a queue. The queue retained the incoming call indefinitely until a responder answered it; however, the call answering system did not re-route the call to another backup center if no responder was available. The backup centers had processes to record caller wait times and call abandonment rates…

VCL staff described that queuing a call before a responder answered was not the same process as placing a call on hold after a responder answered. We found that VCL leadership had not established expectations or targets for queued call times or thresholds for taking action on queue times. A veteran could be queued for 30 minutes, for example, and that wait time might not be reflected in hold time data; however, the result of the delay is the same, whether the veteran was in a queue or on hold.

Vets calling a suicide prevention hotline should not be asked to wait on hold for half an hour. And having the staff make the absurd claim this time doesn’t count for the purpose of official weekly reports tells me they are intentionally gaming the system, not unlike the VA hospitals that had off-book waiting lists for appointments.

Hopefully, someone in the White House is paying attention to this report and will use the White House megaphone to amplify the disappointing results of this investigation. President Trump campaigned on taking better care of veterans and this report presents a great opportunity to highlight the issue and, hopefully, do something to fix it.