VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

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psy.d. 2021 said:
Just what I've heard from my vets on my panel. Might not apply to your VA. I know many who are fantastic but I've had other vets who have had bad experiences.
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I have met perfectly nice chaplains and some very not great ones. I was just wondering if there was a general reputation. I am currently having a bad experience, so we'll see!
 
In other news, the Supreme Court finally rendered a decision on the Bufkin case:

www.courthousenews.com

High court tips the scales against veterans seeking disability benefits

The justices tested the limits of a longstanding rule that puts extra weight behind veterans’ claims.
www.courthousenews.com www.courthousenews.com

Drilling down to the pdf of the opinion, we see a case that made it all the way to the Supreme Court of an Air Force veteran who claimed PTSD with his primary in service trauma/stressor being that he feared that his wife may act on her suicidal thoughts due to her own mental illness. And, no, I'm not even kidding.

And check out the misleading phrasing of the headline in the press.

I suppose that a more balanced/accurate title like, "Supreme Court Clarifies Application of the 'Benefit of the Doubt' Doctrine in Veterans Disability Claims' wouldn't provide sufficient 'rage bait' or clicks.

Basically, they recognized that not all evidence was of equal probative value. For example, a primary care physician placing PTSD on your Problem List in CPRS (or your wife claiming you have PTSD) is not 'equal' to a thorough and detailed psychological evaluation that convincingly demonstrates that you don't meet DSM criteria for the diagnosis.

But somehow this represents 'Tipping the Scales Against Veterans Seeking Benefits for PTSD.'
 
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Uh Huh Yes GIF

me when my patients go on political tangents that are the exact opposite of what I believe
 
Fan_of_Meehl said:
In other news, the Supreme Court finally rendered a decision on the Bufkin case:

www.courthousenews.com

High court tips the scales against veterans seeking disability benefits

The justices tested the limits of a longstanding rule that puts extra weight behind veterans’ claims.
www.courthousenews.com www.courthousenews.com

Drilling down to the pdf of the opinion, we see a case that made it all the way to the Supreme Court of an Air Force veteran who claimed PTSD with his primary in service trauma/stressor being that he feared that his wife may act on her suicidal thoughts due to her own mental illness. And, no, I'm not even kidding.

And check out the misleading phrasing of the headline in the press.
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I mean, I thought Vets just voted that someone should not get special consideration just because of their demographic group. They should be happy with this ruling, it's what they stand for, supposedly.
 
OH, I saw that case being discussed on Reddit in a negative fashion. Didn't know it was the same one!
 
cara susanna said:
OH, I saw that case being discussed on Reddit in a negative fashion. Didn't know it was the same one!
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Yeah, I'm sure that the 'University of Facebook/Twitter Press' is on fire and on overdrive this morning decrying the decision as well. The outrage. The horror.
 
I'm in a VISN town hall and they are sharing new info about ad hoc telework moving forward once full RTO is implemented (eg basically not at all):
- Supervisors can authorize 1 day per week maximum & it cannot be recurring
- It has to benefit the agency so the examples given were if power was out at your facility and you would otherwise be out on weather and safety leave but would be willing to work at home and if an employee has a medical appointment close to their home and would otherwise take a full day of sick leave versus partial SL plus telework

Also, in addition to recurring 5 things email, there is likely another email coming out soon asking us to identify how we have been working (fully in office, fully virtual, split). The presenter did not clarify if a response is mandatory.

Lastly, on RIF:
- VHA will be targeting ~60k cuts with the remaining spread between VBA and cemetery to meet the overall 80k figure
- VA will be aggressive in offering VERA and VISP (including a current proposal to allow VERA with 20 years of service if you are less than 50 years old) to try to target as much voluntary resignations in areas deemed less mission critical before RIF occurs
- It seems like mission critical areas for RIF will be announced by 4/15 by Sec Collins once the VISN submitted RIF plans have been reviewed
 
cara susanna said:
Does anyone know if psychologists are considered mission critical?
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We'll find out when the Sec Collins approved RIF plans come out on/around 4/15.

But to cut 60k from the VHA workforce, especially when redundancy is supposedly a main factor, I have to imagine that every type of position will experience some cuts in some facilities somewhere.
 
cara susanna said:
Does anyone know if psychologists are considered mission critical?
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I don't work at the VA since I'm still a student, but since I matched at a VA for internship I've been following this closely.

A cursory Google search showed me that Psychologists have *historically* been considered mission critical. In 2015, a VHA Missions Critical Occupations Report placed Psychologist as the #6 most mission critical occupation.
An OIG report last year also showed "Psychology was the most frequently reported clinical occupation with severe staffing shortages and the most frequently reported Hybrid 38 severe shortage occupation."

I realize that 1) time has passed since these reports, and 2) the new administration likely doesn't give af about these prior reports. I'm remaining hopeful that these reports and present concerns re: psychologist staffing shortage are taken seriously, but this administration has shown me that even something an elementary age child would take seriously is embarrassingly disregarded.
 
summerbabe said:
I'm in a VISN town hall and they are sharing new info about ad hoc telework moving forward once full RTO is implemented (eg basically not at all):
- Supervisors can authorize 1 day per week maximum & it cannot be recurring
- It has to benefit the agency so the examples given were if power was out at your facility and you would otherwise be out on weather and safety leave but would be willing to work at home and if an employee has a medical appointment close to their home and would otherwise take a full day of sick leave versus partial SL plus telework

Also, in addition to recurring 5 things email, there is likely another email coming out soon asking us to identify how we have been working (fully in office, fully virtual, split). The presenter did not clarify if a response is mandatory.

Lastly, on RIF:
- VHA will be targeting ~60k cuts with the remaining spread between VBA and cemetery to meet the overall 80k figure
- VA will be aggressive in offering VERA and VISP (including a current proposal to allow VERA with 20 years of service if you are less than 50 years old) to try to target as much voluntary resignations in areas deemed less mission critical before RIF occurs
- It seems like mission critical areas for RIF will be announced by 4/15 by Sec Collins once the VISN submitted RIF plans have been reviewed
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Now, that sounds like a terrible deal for us. I'd rather they revoke the ad hoc telework agreement altogether.
 
summerbabe said:
I'm in a VISN town hall and they are sharing new info about ad hoc telework moving forward once full RTO is implemented (eg basically not at all):
- Supervisors can authorize 1 day per week maximum & it cannot be recurring
- It has to benefit the agency so the examples given were if power was out at your facility and you would otherwise be out on weather and safety leave but would be willing to work at home and if an employee has a medical appointment close to their home and would otherwise take a full day of sick leave versus partial SL plus telework

Also, in addition to recurring 5 things email, there is likely another email coming out soon asking us to identify how we have been working (fully in office, fully virtual, split). The presenter did not clarify if a response is mandatory.

Lastly, on RIF:
- VHA will be targeting ~60k cuts with the remaining spread between VBA and cemetery to meet the overall 80k figure
- VA will be aggressive in offering VERA and VISP (including a current proposal to allow VERA with 20 years of service if you are less than 50 years old) to try to target as much voluntary resignations in areas deemed less mission critical before RIF occurs
- It seems like mission critical areas for RIF will be announced by 4/15 by Sec Collins once the VISN submitted RIF plans have been reviewed
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Haha. Loved taking full day SL for my 30 minute dentist appts.
 
Yeah, I would usually feel guilty and only request what I needed for appointments if I reasonably expected I could make it back for at least half a day. As imagined, the amount of SL I had by the time I left was ridiculous.

In the current environment, I'd have no qualms taking a full day.
 
summerbabe said:
I'm in a VISN town hall and they are sharing new info about ad hoc telework moving forward once full RTO is implemented (eg basically not at all):
- Supervisors can authorize 1 day per week maximum & it cannot be recurring
- It has to benefit the agency so the examples given were if power was out at your facility and you would otherwise be out on weather and safety leave but would be willing to work at home and if an employee has a medical appointment close to their home and would otherwise take a full day of sick leave versus partial SL plus telework

Also, in addition to recurring 5 things email, there is likely another email coming out soon asking us to identify how we have been working (fully in office, fully virtual, split). The presenter did not clarify if a response is mandatory.

Lastly, on RIF:
- VHA will be targeting ~60k cuts with the remaining spread between VBA and cemetery to meet the overall 80k figure
- VA will be aggressive in offering VERA and VISP (including a current proposal to allow VERA with 20 years of service if you are less than 50 years old) to try to target as much voluntary resignations in areas deemed less mission critical before RIF occurs
- It seems like mission critical areas for RIF will be announced by 4/15 by Sec Collins once the VISN submitted RIF plans have been reviewed
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Thanks for sharing this! 20k from the VBA/NCA seems like a ton considering they only have 34k as of December 2024: Human Capital Contingency Plan - VA Contingency Planning

Damn.
 
Even if you are considered "mission critical," how fun is your job going to be when you lose a decent amount of support staff? You thought VA HR was the absolute worst before? DOGE just said "hold my beer" to that. Even if you keep your job, your working conditions are going to absolutely spiral. Compound that with the fact that Vets will be that much surlier as they also have to deal with fewer support staff and take it out on you. I don't mean to sound hyperbolic, but I'd be more than slightly concerned that code greens will increase significantly, and that it will start involving MH providers in more tangible ways.
 
WisNeuro said:
Even if you are considered "mission critical," how fun is your job going to be when you lose a decent amount of support staff? You thought VA HR was the absolute worst before? DOGE just said "hold my beer" to that. Even if you keep your job, your working conditions are going to absolutely spiral. Compound that with the fact that Vets will be that much surlier as they also have to deal with fewer support staff and take it out on you. I don't mean to sound hyperbolic, but I'd be more than slightly concerned that code greens will increase significantly, and that it will start involving MH providers in more tangible ways.
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Even so, I'd like it to be my decision.
 
Bit of normal times VA gripes, the new ICARE video no longer inexplicably includes a psychologist who leaves a vet unattended in her office while she's in her trauma group where they list IED names as part of treatment. I'm gonna miss her 🥲

Now it has rogue VBA employees in the waiting room acting like ads and a helpful VCA employee, so yay representation.

Can ICARE just be my five points anyway?
 
Grenth said:
Bit of normal times VA gripes, the new ICARE video no longer inexplicably includes a psychologist who leaves a vet unattended in her office while she's in her trauma group where they list IED names as part of treatment. I'm gonna miss her 🥲

Now it has rogue VBA employees in the waiting room acting like ads and a helpful VCA employee, so yay representation.

Can ICARE just be my five points anyway?
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There was a DEI hire. Must have been redone under Biden
 
Sanman said:
There was a DEI hire. Must have been redone under Biden
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Right, the new one includes an Asian female Veteran and a VHA employee with a rainbow lanyard so probably next year we get new new one that's like "Tom is a Veteran who is a man, as all Veterans are. Tom's injuries are from manly combat as all injuries are. Tom gets MDMA to cure him as recommended by the HHS secretary."

I'm catching up on a ton of TMS and I noticed the MST training also included references to "gender assigned at birth" and "considerations for LGBTQ Veterans" so that's probably not going to last either.
 
Grenth said:
Bit of normal times VA gripes, the new ICARE video no longer inexplicably includes a psychologist who leaves a vet unattended in her office while she's in her trauma group where they list IED names as part of treatment. I'm gonna miss her 🥲

Now it has rogue VBA employees in the waiting room acting like ads and a helpful VCA employee, so yay representation.

Can ICARE just be my five points anyway?
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I'm gonna pretend that they read our snarky remarks about that video and took them to heart.

Although, part of me will always miss the mental health group where apparently you go over time because the veterans are too busy listing the different kinds of IEDs. Goodnight, sweet prince.
 
cara susanna said:
I'm gonna pretend that they read our snarky remarks about that video and took them to heart.

Although, part of me will always miss the mental health group where apparently you go over time because the veterans are too busy listing the differentkinds of IEDs. Goodnight, sweet prince.
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More like the different complaints they have about the VA. That I would have believed.
 
Grenth said:
Right, the new one includes an Asian female Veteran and a VHA employee with a rainbow lanyard so probably next year we get new new one that's like "Tom is a Veteran who is a man, as all Veterans are. Tom's injuries are from manly combat as all injuries are. Tom gets MDMA to cure him as recommended by the HHS secretary."

I'm catching up on a ton of TMS and I noticed the MST training also included references to "gender assigned at birth" and "considerations for LGBTQ Veterans" so that's probably not going to last either.
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Oh, he’s not getting MDMA to cure him—he’s being sent to a work camp until he “decides” not to be mentally ill anymore. Also, he will contract measles while there.
 
Sanman said:
More like the different complaints they have about the VA. That I would have believed.
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Our program manager shared the dismal statistics today with the providers regarding avg # of completed EBP (PE/CPT/EMDR) sessions when we schedule courses of 12 weekly sessions. Avg # of attended sessions vary by provider, but avg is between 3 and 5 sessions (surprising absolutely no one). Of course, 'leadership' is 'concerned' because it is obviously the providers' fault and is 'why we have poor access.' Of course the providers realize that the APPARENT demand for EBP's in our population far exceeds the ACTUAL demand for sessions that are structured and require homework. This is entirely driven by patient no-shows, cancellations, and dropout. And, of course, with us having implemented zero requirements for the clinic consultation process (we never say "no"). And did I mention that therapy is free...for life...with zero penalties for cancellations/NS's...and establishing 'chronic sxs of PTSD' that don't respond to tx sure does provide excellent documentation for that re-submission of that disability claim to help you "get your 100%?"

I say that, with all due respect, "no statistic is interpretable in the absence of the appropriate norms." That's interpreted as a 'defensive' attitude (rather than an observation rooted in proper UNDERGRADUATE training). Are other clinics getting better results? If so, maybe they can provide us with some suggestions. Are we still to follow the VA/DoD practice guidelines? We don't know. Only that our results are 'unacceptable' and hurting 'access' and it's obviously the fault of providers.

I think we're nearing the event horizon of infinite demoralization.
 
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Fan_of_Meehl said:
Our program manager shared the dismal statistics today with the providers regarding avg # of completed EBP (PE/CPT/EMDR) sessions when we schedule courses of 12 weekly sessions. Avg # of attended sessions vary by provider, but avg is between 3 and 5 sessions (surprising absolutely no one). Of course, 'leadership' is 'concerned' because it is obviously the providers' fault and is 'why we have poor access.' Of course the providers realize that the APPARENT demand for EBP's in our population far exceeds the ACTUAL demand for sessions that are structured and require homework. This is entirely driven by patient no-shows, cancellations, and dropout. And, of course, with us having implemented zero requirements for the clinic consultation process (we never say "no"). And did I mention that therapy is free...for life...with zero penalties for cancellations/NS's...and establishing 'chronic sxs of PTSD' that don't respond to tx sure does provide excellent documentation for that re-submission of that disability claim to help you "get your 100%?"

I say that, with all due respect, "no statistic is interpretable in the absence of the appropriate norms." That's interpreted as a 'defensive' attitude (rather than an observation rooted in proper UNDERGRADUATE training). Are other clinics getting better results? If so, maybe they can provide us with some suggestions. Are we still to follow the VA/DoD practice guidelines? We don't know. Only that our results are 'unacceptable' and hurting 'access' and it's obviously the fault of providers.

I think we're nearing the event horizon of infinite demoralization.
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That a pointless statistic because the distribution is skewed. I would bet good money the dropout rate is much higher after the initial consult and completion rate is much higher if that is removed from the distribution. Of course, there are other issues. However, they are not even measuring the correct thing.
 
WisNeuro said:
I'm obviously biased as I think you all should leave, but if you have an offer for a good pay increase and (hopefully) a great deal more stability/security, seems like the right move. Only real downside is that I can't see the grant funding situation getting any better in the near term. Personally, I'd make the move, but start putting the building blocks for private practice in place in case you need to make a quick pivot.
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I started a private practice in November and just had my first client Virtually last week. I am still working out how to get referrals, I am credentialed with several insurance panels.

I am doing as you said, starting the building blocks, because I foresee my VA career is coming to an end within the next year.
 
Sanman said:
That a pointless statistic because the distribution is skewed. I would bet good money the dropout rate is much higher after the initial consult and completion rate is much higher if that is removed from the distribution. Of course, there are other issues. However, they are not even measuring the correct thing.
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Yup. I made a similar comment in the meeting, I said, "the first step prior to any further data analysis or interpretation is to examine the distribution of scores (again, an UNDERGRAD level of competence)."

20% of veterans are actually appropriate for these therapies (and actually have PTSD); about half of these drop out, about half complete the protocol and demonstrate substantial improvement.

The other 80% are simply "putting their time in" in order to get that 70 or 90% s/c bumped up to "the 100% club."

The sad reality is that we have to "grind it out" with 9 cases in order to get to the one or two veterans whose lives we can turn around or save. That's the game at VA. Those 1 or 2 veterans keep you going through it all.
 
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Fan_of_Meehl said:
Yup. I made a similar comment in the meeting, I said, "the first step prior to any further data analysis or interpretation is to examine the distribution of scores (again, an UNDERGRAD level of competence)."

20% of veterans are actually appropriate for these therapies (and actually have PTSD); about half of these drop out, about half complete the protocol and demonstrate substantial improvement.

The other 80% are simply "putting their time in" in order to get that 70 or 90% s/c bumped up to "the 100% club."
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Are they aware that PTSD EBPs in general have up to a 40% dropout rate in the VA?
 
cara susanna said:
Are they aware that PTSD EBPs in general have up to a 40% dropout rate in the VA?
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They don't know, and don't care to know. They're pushing "more groups" despite the "neither for nor against" recommendation from the literature/CPGs. And I guarantee you that those populations from the studies are NOT representative of the general population at VA presenting "for muh PTSD." I've been a protocol therapist on NIMH funded outcome studies. They have 'quality control' criteria to weed out a lotta folks. Hell, I hear the new cohort of PE trainees are gonna have to complete a CAPS-5 on all candidates before even seeing them for PE, lol.

The real dropout rate is more like 80% in VA clinic populations these days.

We are at the end stages of decades of VA MH 'leadership' ignoring realities while waving pompoms. The more data they collect on "outcomes" from MBP (measurement based care) initiatives, the more the narratives will unravel. We've had decades of extrememly poor assessment/diagnostic practices which are basically nonexistent at this point. We've utterly ignored the impact of s/c and $$$ on what MH charts look like when they're based ENTIRELY on self-report and warped incentives.
 
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cara susanna said:
Are they aware that PTSD EBPs in general have up to a 40% dropout rate in the VA?
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I have to modify them a bit to make them tolerable for the veterans. I can get some decent movement, but I'm no longer doing the protocol to fidelity. We get nudged to use the standardized templates anyway because the bean counters want beans, but it creates terrible data for the researchers and different bean counters. I wish they would fight amongst themselves instead of demanding we meet both standards.
 
cara susanna said:
I have good luck with EBPs, but I'm also in a clinic where administration is very supportive of them.
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I have great luck with structured therapies (always have, especially pre-VA) reliably resulting in substantial symptom reduction over time...when patients will actively engage in the empirically supported principles of behavior change (and associated exercises). Two main culprits greatly limiting psychotherapeutic effectiveness in the VA system appear to be: (1) over/misdiagnosis of 'PTSD' [no treatment for a diagnosis is going to effectively treat a condition that doesn't actually exist within that individual] and (2) paying people in direct proportion to their levels of (over)reported symptomatology and inversely to their demonstrated improvement in self-reported symptoms over time. The behaviorists were right--behavior actually IS a function of its consequences (and $$$ is a potent reinforcer for verbal behavior).

People who did their internships at VA hospitals (followed by their entire careers) and who have never really practiced outside of the VA setting may very well have little experience with just how effective the principles underlying good CBT actually are (and tend to be) in the non-veteran population. I also think that they can develop bad habits like thinking that 'seeing (indistinct) shadows out of the corners of their eyes' (shadowy visual hallucinations?) or other extreme/rare psychopathological symptoms that are often seen in malingered or pseudo-PTSD are indicative of 'the real thing.' Up to half of patients endorsing "nightmares" on the PCL-5 will respond to follow up queries regarding dream content with a pronouncement that "[they] never remember their dreams." I've read the chart notes of self-(and other-) described VA PTSD expert clinicians that are rife with flat out false statements/generalities about PTSD being 'a lifelong illness' that sufferers can learn to cope with but that is 'for life' and 'never goes away.' These same experts proclaim 30 year olds with PTSD to be 'totally unemployable' (for life, right?) due to their illness without a shred of professional humility or caution against making such a flat pronouncement--and...always (ALWAYS) written in response to and in support of a request for help in securing a higher s/c %age, or permanent and total disability, or individual unemployability, or a full time caregiver...under the guise of 'veteran-centric 'advocacy.' There is a culture endemic to VA that is utterly alien in many ways to that of mainstream clinical psychology that really wears on 'outsiders' who weren't 'raised' in VA settings. Maybe Christopher Frueh is hiring.
 
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cara susanna said:
I have good luck with EBPs, but I'm also in a clinic where administration is very supportive of them.
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I am just a softy. I have inherited a lot of clients who saw more old school providers and got used to a particular style of therapy. I also seem to get those 40% dropouts who think PE and CPT are "torture." They think they're going to get something different, but I just lure them into my web before eventually having them do 80% of CPT, PE, or WET. As I give them the "softer" version of a protocol, I also tell them all the good, ethical reasons why the VA is moving away from forever style supportive therapy. Our PCT folks just don't have the time to train better therapy habits, so I take on as much of that as I can. Our peer support folks are also totally swamped. I think there will come a point where I can do less of this kind of therapy, but it's pretty fun in the meantime.
 
Fan_of_Meehl said:
I have great luck with structured therapies (always have, especially pre-VA) reliably resulting in substantial symptom reduction over time...when patients will actively engage in the empirically supported principles of behavior change (and associated exercises). Two main culprits greatly limiting psychotherapeutic effectiveness in the VA system appear to be: (a) over/misdiagnosis of 'PTSD' [no treatment for a diagnosis is going to effectively treat a condition that doesn't actually exist within that individual] and (2) paying people in direct proportion to their levels of (over)reported symptomatology and inversely to their demonstrated improvement in self-reported symptoms over time. The behaviorists were right--behavior actually IS a function of its consequences (and $$$ is a potent reinforcer for verbal behavior).

People who did their internships at VA hospitals (followed by their entire careers) and who have never really practiced outside of the VA setting may very well have little experience with just how effective the principles underlying good CBT actually are (and tend to be) in the non-veteran population. I also think that they can develop bad habits like thinking that 'seeing (indistinct) shadows out of the corners of their eyes' (shadowy visual hallucinations?) or other extreme/rare psychopathological symptoms that are often seen in malingered or pseudo-PTSD are indicative of 'the real thing.' Up to half of patients endorsing "nightmares" on the PCL-5 will respond to follow up queries regarding dream content with a pronouncement that "[they] never remember their dreams." I've read the chart notes of self-(and other-) described VA PTSD expert clinicians that are rife with flat out false statements/generalities about PTSD being 'a lifelong illness' that sufferers can learn to cope with but that is 'for life' and 'never goes away.' These same experts proclaim 30 year olds with PTSD to be 'totally unemployable' (for life, right?) due to their illness without a shred of professional humility or caution against making such a flat pronouncement--and...always (ALWAYS) written in response to and in support of a request for help in securing a higher s/c %age, or permanent and total disability, or individual unemployability, or a full time caregiver...under the guise of 'veteran-centric 'advocacy.' There is a culture endemic to VA that is utterly alien in many ways to that of mainstream clinical psychology that really wears on 'outsiders' who weren't 'raised' in VA settings. Maybe Christopher Frueh is hiring.
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Despite knowing this intellectually, it was still a shock leaving VA for an AMC job. Therapy was suddenly almost easy.
 
thebalmofhurtminds said:
Despite knowing this intellectually, it was still a shock leaving VA for an AMC job. Therapy was suddenly almost easy.
Click to expand...

I have conducted a lot of PTSD treatment, in and out of the VA. Especially for a neuropsychologist. Patient engagement and outcomes in the VA system were far worse than outside of the VA. That includes Vets that I saw in non-VA contexts. My drop out rate in non-VA PTSD patients was single digits.
 
Fan_of_Meehl said:
I have great luck with structured therapies (always have, especially pre-VA) reliably resulting in substantial symptom reduction over time...when patients will actively engage in the empirically supported principles of behavior change (and associated exercises). Two main culprits greatly limiting psychotherapeutic effectiveness in the VA system appear to be: (a) over/misdiagnosis of 'PTSD' [no treatment for a diagnosis is going to effectively treat a condition that doesn't actually exist within that individual] and (2) paying people in direct proportion to their levels of (over)reported symptomatology and inversely to their demonstrated improvement in self-reported symptoms over time. The behaviorists were right--behavior actually IS a function of its consequences (and $$$ is a potent reinforcer for verbal behavior).

People who did their internships at VA hospitals (followed by their entire careers) and who have never really practiced outside of the VA setting may very well have little experience with just how effective the principles underlying good CBT actually are (and tend to be) in the non-veteran population. I also think that they can develop bad habits like thinking that 'seeing (indistinct) shadows out of the corners of their eyes' (shadowy visual hallucinations?) or other extreme/rare psychopathological symptoms that are often seen in malingered or pseudo-PTSD are indicative of 'the real thing.' Up to half of patients endorsing "nightmares" on the PCL-5 will respond to follow up queries regarding dream content with a pronouncement that "[they] never remember their dreams." I've read the chart notes of self-(and other-) described VA PTSD expert clinicians that are rife with flat out false statements/generalities about PTSD being 'a lifelong illness' that sufferers can learn to cope with but that is 'for life' and 'never goes away.' These same experts proclaim 30 year olds with PTSD to be 'totally unemployable' (for life, right?) due to their illness without a shred of professional humility or caution against making such a flat pronouncement--and...always (ALWAYS) written in response to and in support of a request for help in securing a higher s/c %age, or permanent and total disability, or individual unemployability, or a full time caregiver...under the guise of 'veteran-centric 'advocacy.' There is a culture endemic to VA that is utterly alien in many ways to that of mainstream clinical psychology that really wears on 'outsiders' who weren't 'raised' in VA settings. Maybe Christopher Frueh is hiring.
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Reading this right after a rant on the r/therapists subreddit makes me realize that VA patients are a match made in heaven for these people. They can both talk about complex trauma that is super common and never improves while they do IFS and EMDR.
 
Sanman said:
Reading this right after a rant on the r/therapists subreddit makes me realize that VA patients are a match made in heaven for these people. They can both talk about complex trauma that is super common and never improves while they do IFS and EMDR.
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Oh God, do I dare look?
 
Check out the 70+ comments on a "video message from Secretary Doug Collins" on VA Insider. They look like a combination of elderly people trying to use the internet for the first time, pro administration chat bots programmed by Elon, and some brave or foolhardy folks with actual criticisms.

Edited to add a photo of a confused VBA employee.
17417302979768491515583123591548.jpg
 
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Grenth said:
Check out the 70+ comments on a "video message from Secretary Doug Collins" on VA Insider. They look like a combination of elderly people trying to use the internet for the first time, pro administration chat bots programmed by Elon, and some brave or foolhardy folks with actual criticisms.
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If I find out that Doug Collins, the Navy Chaplain, is 100% service-connected for PTSD that will definitely make my week.

Edit: Little did I know that 'VA Claims Insider' (obviously) enjoys a much higher default Google search rating, lol

Edit #2: Is there just a 'VA Insider' website/(media site?) or did you really mean 'VA Claims Insider?'
 
Fan_of_Meehl said:
If I find out that Doug Collins, the Navy Chaplain, is 100% service-connected for PTSD that will definitely make my week.

Edit: Little did I know that 'VA Claims Insider' (obviously) enjoys a much higher default Google search rating, lol
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Hey now, it's 100% for *chronic* PTSD that cannot be treated or cured for reasons, financial reasons.
 
Fan_of_Meehl said:
If I find out that Doug Collins, the Navy Chaplain, is 100% service-connected for PTSD that will definitely make my week.

Edit: Little did I know that 'VA Claims Insider' (obviously) enjoys a much higher default Google search rating, lol

Edit #2: Is there just a 'VA Insider' website/(media site?) or did you really mean 'VA Claims Insider?'
Click to expand...
Yeah open up your set default browser (Edge) and it opens automatically on my PC or it's vaww.insider.va.gov
 
Apparently, an MD in congress in committee today was saying that hyperbaric oxygen therapy has been shown in RTC's to significantly improve sequelae of (m)TBI. Any truth to this? New research? A 'proven, successful' alternative and it is 'medical malpractice' for not using this treatment at VA???

Edit: Okay, a quick Google search basically reassured me that not much has changed since I was more on top of that literature about 5-10 years ago, to wit:

Mild TBI:
For mild TBI or post-concussion syndrome, there is limited evidence to support the routine use of HBOT, with studies showing no significant improvement compared to sham treatment.

Chronic TBI:
There is some evidence suggesting potential benefits of HBOT in chronic TBI, but further research is needed to confirm these findings and determine optimal protocols
 
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