The Trump administration said from its first days that preventing suicide was its top clinical priority for veterans.

The performance of its national outreach campaign shows otherwise, though, because of a leadership vacuum at the Department of Veterans Affairs and nonexistent means to measure effectiveness, a new report by the Government Accountability Office found.

As the number of veterans taking their own lives climbed, VA’s media outreach plunged in fiscal years 2017 and 2018 — with fewer social media posts, public service announcements and paid advertisements compared with the agency’s efforts during the Obama administration, auditors said.

About 20 veterans die by suicide every day, VA data shows. That’s nearly twice the suicide rate among Americans who did not serve in the military.

VA set aside $6.2 million this year alone to advertise its crisis hotline — the centerpiece of its suicide-prevention efforts — online, on billboards, buses and trains, and via local and national radio commercials. But as of September, the agency had spent $57,000 — less than 1 percent of that budget, auditors wrote.

By not reaching as many vulnerable veterans as it could have, the Veterans Health Administration, the agency’s health-care arm, “may not have exposed as many people in the community, such as veterans at risk for suicide, or their families and friends, to its suicide prevention outreach content,” the report concluded.

VA concurred with the GAO’s findings. In response to the report, VA Secretary Robert Wilkie told auditors that “every death by suicide is a tragedy. We will not relent in our efforts to connect veterans in need with lifesaving support.”

Agency spokesman Curt Cashour blamed the weak outreach on President Trump’s first VA secretary, David Shulkin, who served from February 2017 to March 2018, when he was fired.

“During former VA employee David Shulkin’s brief tenure as secretary, VA’s suicide prevention outreach dropped significantly, and the suicide prevention office had no permanent leader for nearly nine months,” Cashour said in an email. Wilkie appointed a new permanent director for suicide prevention shortly after arriving as acting secretary in April, Cashour said, “and she is reviewing the spending for this important program.”

Shulkin declined to comment.

The outreach campaign was one component of VA's suicide prevention efforts, which under Shulkin increased the number of prevention coordinators, established same-day mental health visits at VA hospitals and gave mental health benefits to veterans who were not honorably discharged from the military.

Social media postings dropped by more than two-thirds from fiscal 2017 to 2018, and two planned public service announcements were delayed. For more than a year, VA did not air any outreach messages on television or radio.

The GAO blamed the subpar campaign on turmoil within VA’s senior ranks and on departures of top officials — instability that has consumed the agency for more than a year — and said vacancies and rudderless leadership left staff working on suicide prevention without clear direction.

“This became particularly evident during a recent period of turnover and reorganization in the office responsible for the suicide prevention outreach campaign,” auditors wrote. VHA “did not assign key leadership responsibilities or establish clear lines of reporting, and as a result, its ability to oversee the outreach campaign was hindered.”

The agency had no permanent director of suicide prevention for months. So the staff spent its resources updating the website of the crisis hotline. Its employees also began reporting to VA’s Office of Mental Health, which pulled them away from suicide prevention, the report says.

The agency also lacked an effective strategy to measure whether its efforts were reaching veterans, such as by comparing the campaign with previous years or capturing the number of people who click on messages, the GAO determined.

Rep. Tim Walz (Minn.), the top Democrat on the House Veterans’ Affairs Committee who requested the study, said the report “conveys a deeply troubling level of incompetence on the part of the Trump Administration.”

“At a time when 20 veterans a day still die by suicide, VA should be doing everything in its power to inform the public about the resources available to veterans in crisis,” Walz said in a statement. “Unfortunately, VA has failed to do that, despite claiming the elimination of veteran suicide as its highest clinical priority.”

VA launched a program in 2010 to reach at-risk veterans and encourage them to call its hotline, hiring a contractor to develop a messaging campaign. The outreach grew steadily before dropping last year.

A spokesman for Sen. Johnny Isakson (R-Ga.), chairman of the Senate Veterans’ Affairs Committee, said suicide prevention is one of his priorities, and “he remains steadfastly committed to working with the VA to ensure it has all the resources needed to provide mental health care to veterans who need it.”