Abstract: Crisis line data show it had about 3.8 million customer interactions from fiscal year 2021 through 2024, with the number increasing each year (see figure). We found the crisis line faces challenges: • Customers with complex needs. The crisis line provides specialized training to responders in a unit that addresses complex callers. However, these callers are increasingly being routed to responders who may not have received the training, raising service quality and staffing concerns that could put customers at risk. • Chat and text. Procedures for staff in this unit— such as responding to more than one customer at once—as well as how the unit is staffed may have adverse effects, including increased customer wait times and responder burnout, which could also put customers at risk. Further, in July 2024, VA determined that, as a nonclinical service, the procedure the crisis line was using to disclose incidents to customers or their representatives in cases when actions or inactions created a significant risk of harm to the customer was not applicable. The crisis line withdrew the procedure and a new one has not been established. This runs counter to VA’s goal of building trust with stakeholders through transparency and accountability.