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

Started by Fan_of_Meehl
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parametric said:
Why do so many C&P exams from the 1990s diagnose veterans with personality disorders with very little supporting info in the note?? Seen some really incongruous diagnoses of borderline, schizoid, and antisocial PDs in particular and it doesn’t escape my attention that these seem to tend to be Black veterans... I was referred a few new therapy cases recently where their historical Psych diagnoses vs their presentation in our sessions made me go WTF.
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Stop cancel culturing!!! /s

In all seriousness, though, I haven't come across many cases like this myself. In fact, none spring to mind at the moment. I admittedly do have a smaller N than most, since I'm only a postdoc, but I've probably provided assessment/case management/individual psychotherapy to something like 200 vets over the last three years. Might be anomalous?
 
beginner2011 said:
Stop cancel culturing!!! /s

In all seriousness, though, I haven't come across many cases like this myself. In fact, none spring to mind at the moment. I admittedly do have a smaller N than most, since I'm only a postdoc, but I've probably provided assessment/case management/individual psychotherapy to something like 200 vets over the last three years. Might be anomalous?
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Fair enough! Could just be my human brain seeing patterns where none exist, or an idiosyncrasy to this particular site.

still, LOL at someone with supposed “schizoid PD” being referred for a chief complaint of pandemic-related isolation and loneliness.
 
parametric said:
Why do so many C&P exams from the 1990s diagnose veterans with personality disorders with very little supporting info in the note?? Seen some really incongruous diagnoses of borderline, schizoid, and antisocial PDs in particular and it doesn’t escape my attention that these seem to tend to be Black veterans... I was referred a few new therapy cases recently where their historical Psych diagnoses vs their presentation in our sessions made me go WTF.
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Being SC for personality disorder is sometimes code for "this person experienced military sexual trauma and we need to kick them out without actually saying why."
 
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Sanman said:
And it will be that way until we reach 0 veteran suicides ever. These people are only supposed to die when the government wants use them as cannon fodder, not when they have problems.
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Zero tolerance for suicide.

It's crazy. A vet was just telling me today how he and other vets are loathe to seek MH treatment at VA due to fears that we may overreact to reported SI. Did my best to reassure him. I also wonder if there is any evidence that lack of 'awareness' of suicide is even a problem (or even exists) in VA healthcare settings as of 2020. Least they could do is utilize survey data as part of 'measurement- based educational efforts' to see if their efforts are having an impact and increasing 'awareness.' What is the end point?
 
Fan_of_Meehl said:
Zero tolerance for suicide.

It's crazy. A vet was just telling me today how he and other vets are loathe to seek MH treatment at VA due to fears that we may overreact to reported SI. Did my best to reassure him. I also wonder if there is any evidence that lack of 'awareness' of suicide is even a problem (or even exists) in VA healthcare settings as of 2020. Least they could do is utilize survey data as part of 'measurement- based educational efforts' to see if their efforts are having an impact and increasing 'awareness.' What is the end point?
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Plus the data suggests that the people we really need to reach regarding veteran suicide are the ones who are outside of the VA system.
 
PsyDr said:
Last time I looked at that literature from the DoD, the top risk factors for suicide were gender, bipolar disorder, and alcohol abuse. Didn’t see anything about being cannon fodder there.
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DOD Releases Report on Suicide Among Troops, Military Family Members

Veterans die by suicide at greater rates, VA finds

Sure there was, they just refer to it as active duty or veteran status. Those are just the suicide rates and not counting the ones that die by enemy or friendly fire. The mortality rate ain't great if you choose that lifestyle. It makes one wonder about whether training folks to be desensitized to violence for the purposes of war also leads to them being desensitized to violence throughout their lives. Perhaps if they put anywhere close to the resources into readjustment services that they do into recruiting and basic training, that might not be the case.
 
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cara susanna said:
Haha, so I'm not the only one who's becoming more and more anti-military industrialized complex or anti-war throughout my years at the VA?
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I have never been particularly pro-military industrialized complex or pro-war. In my view war should always be a last resort given the risks to so many human lives. Of course there will be times when there is no other choice. I have always geared my career towards populations of chronic need (geriatrics, military) for purposes of job security.
 
Would anyone be willing to answer a few questions about working in the VA? I am a first year doc student and would much appreciate it!
 
Question for folks: I'm starting to look outside the VA and just wondering how you calculate the value of the pension in your compensation package. I realize this is something I won't get almost anywhere else. My initial calculations have this valued at a staggering amount of money that really would make most other compensation offers pale in comparison. What have your experiences been with this?
 
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JustNoticing said:
Question for folks: I'm starting to look outside the VA and just wondering how you calculate the value of the pension in your compensation package. I realize this is something I won't get almost anywhere else. My initial calculations have this valued at a staggering amount of money that really would make most other compensation offers pale in comparison. What have your experiences been with this?
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My higher salary allows me to invest above and beyond maxing my personal IRA and 401/403 to a point that it likely exceeds the benefit from the pension. As a frame of reference, my starting salary after jumping ship from the VA was in the range of 15-20% greater. Heck, the flexibility to schedule clinical work whenever I felt like it was worth it even if my salary was the same.
 
WisNeuro said:
My higher salary allows me to invest above and beyond maxing my personal IRA and 401/403 to a point that it likely exceeds the benefit from the pension. As a frame of reference, my starting salary after jumping ship from the VA was in the range of 15-20% greater. Heck, the flexibility to schedule clinical work whenever I felt like it was worth it even if my salary was the same.
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That's nice to hear. I'm definitely not looking at a 15-20% salary increase though. The jobs in my area either seem to pay comparably to the VA, if not significantly lower.
 
JustNoticing said:
Question for folks: I'm starting to look outside the VA and just wondering how you calculate the value of the pension in your compensation package. I realize this is something I won't get almost anywhere else. My initial calculations have this valued at a staggering amount of money that really would make most other compensation offers pale in comparison. What have your experiences been with this?
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Others may have a better method, but off the top of my head, I suppose you could: 1) calculate/estimate what your pension would be if you stayed with VA for your career (or X number of years), 2) calculate how much you would need to save on your own (monthly or annually) for the same number of years to obtain the same benefit, 3) subtract from #2 the amount you currently contribute to the pension. Pretty sure that should tell you what the pension is "worth" above and beyond your own direct contributions.

You could also break that down into the annual increase/amount of the pension benefit, which is 1% of your high-3 salary average for <20 years, or 1.1% for 20 or more years.
 
WisNeuro said:
My higher salary allows me to invest above and beyond maxing my personal IRA and 401/403 to a point that it likely exceeds the benefit from the pension. As a frame of reference, my starting salary after jumping ship from the VA was in the range of 15-20% greater. Heck, the flexibility to schedule clinical work whenever I felt like it was worth it even if my salary was the same.
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You can schedule clinical encounters WITHOUT involving an MSA? Blasphemy!
 
Sanman said:
Well, HBPC doesn't have actual appts. so I don't have to worry about that. My appts are more like PP with no real paperwork. I really don't think I would last as long if I had a traditional VA position.
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I think I've finally come up with an apt analogy to describe providers' frustration when we're being told how we must embrace the use of the Mental Health Suite software program for MH assessment, TX planning, and evaluation...despite competently practicing without it for decades and despite the complete absence of its presence in the clinical training literature or praxis.

It would be like a hospital organization insisting that skilled surgeons wear 'outcome enhancing oven mitts' to improve their surgical performance and outcomes.
 
One of the funniest things about the MHS rollout is attending meetings where providers are expressing their concerns about it to supervisors, and the supervisors are pretty much like "yeah, we know, but we still have to do this."
 
cara susanna said:
One of the funniest things about the MHS rollout is attending meetings where providers are expressing their concerns about it to supervisors, and the supervisors are pretty much like "yeah, we know, but we still have to do this."
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VA policies are probably one of the best real world examples of the Gambler's Fallacy that we have.
 
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I am about to accept a tentative offer from another VA. The hiring manager hopes to have me start by March.

For those who have transferred to another VA without a break in service, do you have any pearls of wisdom for ensuring a smooth transition, such as when to inform my current supervisor & chief, HR specifics to be aware of, and anything else to keep in mind? Thanks!
 
summerbabe said:
I am about to accept a tentative offer from another VA. The hiring manager hopes to have me start by March.

For those who have transferred to another VA without a break in service, do you have any pearls of wisdom for ensuring a smooth transition, such as when to inform my current supervisor & chief, HR specifics to be aware of, and anything else to keep in mind? Thanks!
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Is it within the same VISN?

I have no idea if this matters, but curious if anyone knows how that impacts things.
 
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