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

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Fan_of_Meehl said:
Yeah. One of the physicians providing testimony was founder and CEO of some private company that does hyperbaric oxygen therapy for 'PTSD and TBI.' Should write his name down...I'm sure it will be on a big fat govt contract soon.
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First we had MyPillow....and soon we will have MyChamber....it's a hyperbaric oxygen chamber that (unironically) blasts "Born In The USA". Upgraded music options include Lee Greenwood's "God Bless The USA", Kid Rock's "We The People", and for a limited time: Lara Trump's "Colors Don't Run". MyChamber units are available in Red/White/Blue or a limited edition US Flag Edition.

The MyChamber mascot is a flannel-wearing bald eagle that drives a branded Tesla Truck, wrapped to look like the "General Lee" from the Dukes of Hazzard. Diecast 1:6 models of the Tesla Truck General Lee and life-sized plushie bald eagles (made In China) are both available in the MyChamber gift shop. ICE armbands, Jack Boots (made in China), and Fill In The Blank Warrants can also be purchased there.

For a limited time, you can order your own General Lee Tesla Truck, quantities are limited! Free "This is not a trash dumpster!" bumper sticker with every Tesla purchase. Also included with all Tesla purchases is the "Ultra Patriot Package", which includes a eagle-sized Red Hat and special edition eagle-sized AR-15 with a wing-friendly extendable stock and laser sight. Children's Red Hats and Hello-Kitty branded AR-15s can also be purchased when scheduling delivery.

If ordered in the next 15 minutes, MyChamber will also include a FREE pair of (unisex) US Flag bootie shorts or a plastic ball sack that can be attached to the base of the MyChamber; available colors are WHITE ONLY. Each unit is shipped via freight carrier. Anyone who upgrades to the "True Patriot Delivery Service" gets white (only) glove service and a fireworks show. Unfortunately, some states hate freedom, so fireworks shows are not available in every state, so check with the MyChamber staff for more details.

The designers really thought of everything. So. Much. Winning!
 
Therapist4Chnge said:
First we had MyPillow....and soon we will have MyChamber....it's a hyperbaric oxygen chamber that (unironically) blasts "Born In The USA". Upgraded music options include Lee Greenwood's "God Bless The USA", Kid Rock's "We The People", and for a limited time: Lara Trump's "Colors Don't Run". MyChamber units are available in Red/White/Blue or a limited edition US Flag Edition.

The MyChamber mascot is a flannel-wearing bald eagle that drives a branded Tesla Truck, wrapped to look like the "General Lee" from the Dukes of Hazzard. Diecast 1:6 models of the Tesla Truck General Lee and life-sized plushie bald eagles (made In China) are both available in the MyChamber gift shop. ICE armbands, Jack Boots (made in China), and Fill In The Blank Warrants can also be purchased there.

For a limited time, you can order your own General Lee Tesla Truck, quantities are limited! Free "This is not a trash dumpster!" bumper sticker with every Tesla purchase. Also included with all Tesla purchases is the "Ultra Patriot Package", which includes a eagle-sized Red Hat and special edition eagle-sized AR-15 with a wing-friendly extendable stock and laser sight. Children's Red Hats and Hello-Kitty branded AR-15s can also be purchased when scheduling delivery.

If ordered in the next 15 minutes, MyChamber will also include a FREE pair of (unisex) US Flag bootie shorts or a plastic ball sack that can be attached to the base of the MyChamber; available colors are WHITE ONLY. Each unit is shipped via freight carrier. Anyone who upgrades to the "True Patriot Delivery Service" gets white (only) glove service and a fireworks show. Unfortunately, some states hate freedom, so fireworks shows are not available in every state, so check with the MyChamber staff for more details.

The designers really thought of everything. So. Much. Winning!
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This is awesome! I think you enjoyed writing this WAY too much, lol (but it's good to frolick in the absurdity of all this, too)
 
Fan_of_Meehl said:
This is awesome! I think you enjoyed writing this WAY too much, lol (but it's good to frolick in the absurdity of all this, too)
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I wanted to include an “add-on” SARCO (assisted suicidal pod) upgrade; but that was even a bit too dark for me.

It was a good distraction from my billing/paperwork I need to get done.
 
If anybody is curious, here are some updates from a brief VISN town hall this morning:

RIF plans were submitted last Friday to realign with 2019 staffing levels, which included a review of organizational charts throughout the VISN.

It is expected that OPM will review these plans soon and work with specific facilities to make any additional adjustments.

It's not expected that formal RIF plans will be released prior to June but things can change.

60 day notices will be given to impacted employees and it is not expected that these would come out before June.

VERA and VSIP were requested as part of the RIF plan.

No additional updates on RTO exemptions besides the approval VCL exemption and HR is continuing to work on finding space for employees.

A system to report RTO space concerns will be released shortly but as of right now, communicate concerns to supervisors.

The people running these meetings in my VISN are way too perky lol.
 
summerbabe said:
If anybody is curious, here are some updates from a brief VISN town hall this morning:

RIF plans were submitted last Friday to realign with 2019 staffing levels, which included a review of organizational charts throughout the VISN.

It is expected that OPM will review these plans soon and work with specific facilities to make any additional adjustments.

It's not expected that formal RIF plans will be released prior to June but things can change.

60 day notices will be given to impacted employees and it is not expected that these would come out before June.

VERA and VSIP were requested as part of the RIF plan.

No additional updates on RTO exemptions besides the approval VCL exemption and HR is continuing to work on finding space for employees.

A system to report RTO space concerns will be released shortly but as of right now, communicate concerns to supervisors.

The people running these meetings in my VISN are way too perky lol.
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The fact that they're perky is bizarre and unsettling. Not the presentation you'd expect if plans were to include:

(A) reassigning them to direct patient care duties or
(B) eliminating non-patient care (admin/supervisory/assistant) positions

If they cut ANY direct service (caseload bearing clinical) positions it's only going to hasten the death spiral. If they pull some BS of pushing everyone into group therapy and/or increase # of pts seen per shift, it will only accelerate the death spiral. Clinicians are barely holding it together under the current workload as it is.
 
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futureapppsy2 said:
Saw that and thought of you <3
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I don't even know what to tell people. Of course, they didn't do the normal rulemaking process. We can't just pull a healthcare benefits package like this legally. So now the veterans are entitled to these benefits, but there is a pseudo-directive saying they can't access it. As of Friday, we were going to leave everything in place until the rulemaking process happened. Someone must have lost their mind because here we are Monday with a barely coherent directive.
 
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summerbabe said:
If anybody is curious, here are some updates from a brief VISN town hall this morning:

RIF plans were submitted last Friday to realign with 2019 staffing levels, which included a review of organizational charts throughout the VISN.

It is expected that OPM will review these plans soon and work with specific facilities to make any additional adjustments.

It's not expected that formal RIF plans will be released prior to June but things can change.

60 day notices will be given to impacted employees and it is not expected that these would come out before June.

VERA and VSIP were requested as part of the RIF plan.

No additional updates on RTO exemptions besides the approval VCL exemption and HR is continuing to work on finding space for employees.

A system to report RTO space concerns will be released shortly but as of right now, communicate concerns to supervisors.

The people running these meetings in my VISN are way too perky lol.
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Apparently, part of the return to 2019 staffing levels is a push to cut the PACT/TEF act. As someone who's position is funded by that and is a probie, the odds don't seem to be in my favor here, ngl.
 
summerbabe said:
If anybody is curious, here are some updates from a brief VISN town hall this morning:

RIF plans were submitted last Friday to realign with 2019 staffing levels, which included a review of organizational charts throughout the VISN.

It is expected that OPM will review these plans soon and work with specific facilities to make any additional adjustments.

It's not expected that formal RIF plans will be released prior to June but things can change.

60 day notices will be given to impacted employees and it is not expected that these would come out before June.

VERA and VSIP were requested as part of the RIF plan.

No additional updates on RTO exemptions besides the approval VCL exemption and HR is continuing to work on finding space for employees.

A system to report RTO space concerns will be released shortly but as of right now, communicate concerns to supervisors.

The people running these meetings in my VISN are way too perky lol.
Click to expand...
I have heard NOTHING from my leadership and receive 90% of my updates from folks outside of my VA, so this is incredibly helpful - thanks for sharing!
 
I think this is as close to my breaking point as I've been since everything started. Messing with healthcare packages for political purposes and doing it without regard for procedure immediately opens all healthcare up to political whims. I don't want to be yet another instrument to inflict pain on people who the sake of political theater. It's healthcare. Someone's personal feelings about someone else's healthcare should be irrelevant. We cover Viagra, PreP, fertility treatment, and a wide array of other things people have moral hang-ups about. Not everything is for everyone. Making that fodder for political gain is asking for a bad time.
 
Ugh, we can't even do letters of support or readiness assessments. We are begging for discrimination issues with accreditation bodies.
 
psy.d. 2021 said:
Who's we? The VA is the one that should end up paying for this garbage. You are so much more than the VA which is a joke leadership wise.
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To be fair, a lot of leadership at the facility and midlevel, really can't do ****. If they deny directives, they make DOGE's job easier as they can now be fired for cause. Which can probably affect severance and other things.
 
psy.d. 2021 said:
Who's we? The VA is the one that should end up paying for this garbage. You are so much more than the VA which is a joke leadership wise.
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I get to easily see the clients I enjoy who would have a much harder time accessing treatment in the community. It's often around $100 just for a simple letter of support. The price goes up quickly if there are any complicating factors. It isn't a lot in the assessment world, but it adds up when services that takes insurance will often ask for one. Many places will only use the letter for 6 months to 1 year and then you need to ask for a new one.

This isn't the regular processes of VA doing this. My clients receiving this kind of care didn't vote for this. My leadership all the way up to the local VISN has been supportive of my work. I will place the blame where it belongs.

I am not trapped. I like what I do. I can do it elsewhere, but the types of clients I see will change.
 
I don't think I've ever been a big fan of our VA secretaries. I would have quit a long time ago if they could influence my behavior.
 
Shiori said:
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So basically, I’m punishing the veterans that did or vote for me because I’m assuming that overlap in the venn diagram is very tiny.

On a related note, until they go after the fraud, waste and abuse in the VA, I can’t take doge seriously. Not that I was taking them seriously to begin with. And that overlap in the venn diagram is MASSIVE. But the face eating leopards are getting really hungry so I’ll be very excited when that happens.
 
PsyDWannabe said:
So basically, I’m punishing the veterans that did or vote for me because I’m assuming that overlap in the venn diagram is very tiny.

On a related note, until they go after the fraud, waste and abuse in the VA, I can’t take doge seriously. Not that I was taking them seriously to begin with. And that overlap in the venn diagram is MASSIVE. But the face eating leopards are getting really hungry so I’ll be very excited when that happens.
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That's one big target, but far from the biggest. Underreporting and fraudulent tax reporting, particularly at the upper end, account from 500 billion to 1 trillion a year. If we were really serious about balancing the budget, we wouldn't neuter the department that has been shown to be able to actually collect that money efficiently (returns $5 for every dollar spent on below median audits, $12 for audits of high earners). But, we all know that this was never really about balancing the budget.
 
Shiori said:
I'm linking the reddit thread with the gift article:

Click to expand...

So uh how exactly is putting someone in a cubicle farm and asking them to do therapy consistent with privacy laws? Allowing yourself to engage in that is asking for a board complaint to be made against. "The VA told me to do it" is not a valid reason.
 
psy.d. 2021 said:
So uh how exactly is putting someone in a cubicle farm and asking them to do therapy consistent with privacy laws? Allowing yourself to engage in that is asking for a board complaint to be made against. "The VA told me to do it" is not a valid reason.
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According to the lovely VA spokesperson, it obviously complies with "industry standards for privacy."

If by "industry standards," they mean Amazon customer service call centers.
 
Therapist4Chnge said:
The MyChamber mascot is a flannel-wearing bald eagle that drives a branded Tesla Truck, wrapped to look like the "General Lee" from the Dukes of Hazzard. Diecast 1:6 models of the Tesla Truck General Lee and life-sized plushie bald eagles (made In China) are both available in the MyChamber gift shop. ICE armbands, Jack Boots (made in China), and Fill In The Blank Warrants can also be purchased there.
Click to expand...

I know this is a joke, but it uses more imagination than 99% of Cybertruck owners seem to have. If I see one more of those things in flat black or or some holographic wrap, I will vomit (on it). I seriously see more of those than in the actual stainless steel. I was thankful one guy decided to go for White just for something different.
 
Sanman said:
I know this is a joke, but it uses more imagination than 99% of Cybertruck owners seem to have. If I see one more of those things in flat black or or some holographic wrap, I will vomit (on it). I seriously see more of those than in the actual stainless steel. I was thankful one guy decided to go for White just for something different.
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Careful, this will get you tried as a terrorist in federal court these days. Have fun in an El Salvadoran prison.
 
AcronymAllergy said:
According to the lovely VA spokesperson, it obviously complies with "industry standards for privacy."

If by "industry standards," they mean Amazon customer service call centers.
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In a Dystopian But True moment, Amazon has already started getting into healthcare, and counseling can’t be far behind.
 
WisNeuro said:
Careful, this will get you tried as a terrorist in federal court these days. Have fun in an El Salvadoran prison.
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It's a balmy 88 deg there now and meals are included. Things keep going the way they are and this is going to seem like an all inclusive resort soon.
 
WisNeuro said:
That's one big target, but far from the biggest. Underreporting and fraudulent tax reporting, particularly at the upper end, account from 500 billion to 1 trillion a year. If we were really serious about balancing the budget, we wouldn't neuter the department that has been shown to be able to actually collect that money efficiently (returns $5 for every dollar spent on below median audits, $12 for audits of high earners). But, we all know that this was never really about balancing the budget.
Click to expand...

www.yahoo.com

IRS braces for $500bn drop in revenue as taxpayers skip filings in wake of DOGE cuts at agency

Individuals were ‘wagering that auditors will not examine their accounts’ amid DOGE’s plans to downsize the IRS by nearly 20 percent ahead of tax filing season
www.yahoo.com www.yahoo.com


Surprising no one, as this is likely one of the reasons for cutting IRS staff dramatically, rewarding your tax dodging friends.
 
Fan_of_Meehl said:
Eliza Prime subscriptions start at $29.99/mo
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I remembering hearing about their plans/attempts to get involved in telehealth. Then I thought I'd read that they were pulling out because they realized it was harder than anticipated to make a profit. But maybe I'm confusing them with someone else.
 
I came back to work after a week off and my workstation (that my laptop plugs into) isn't working so I have to use it as a laptop with VPN like I'm working remotely. Everytime I unplug my PIV card, my VPN terminates and CPRS etc crash. Our IT guy is offsite today. FABULOUS.
 
Monday morning VHA news update from my VISN town hall:

There is a national VHA group that is overseeing restructuring and they will be reaching out to specific facilities for data to assess VHA functioning and areas for potential restructuring.

No info yet on total RIF targets. Currently it's in the data review process and June would be the target to identify specific positions for elimination. VERA and VISP details have been requested but no updates yet on approval or monetary details.

Second round of DRP rumors: it has not been approved yet but it is going through formal channels and would be a different process such as applying to request DRP and the decision being based on impact on operations.

We are in Phase 2 of RTO. Phase 1 was supervisors. Phase 2 is within 50 miles of a facility in our VISN with a NLT 4/14 deadline and HR is working on formalizing space, sending notifications and changing telework arrangements.

If somebody does not get a space, extensions will be requested to continue to search for space Supervisors in our VISN who couldn't locate a space in Phase 1 were given 60 day extensions.

Our HR is anticipating 8-9 occupations that may not return to office due to impact on patient care but no official word yet. They do not know which positions or when to expect notice. (I wasn't sure how this relates to some of the overall exemptions that have been submitted, whether this is a different, physical space focused matter).

Improper probationary fires had notices sent out last Friday to rescind that action and were placed on Authorized Absence and they are waiting on the green light to return these employees to duty.

All organizational charts are to remain on hold until further notice. They are not sure how this impacts things like temporary details. Normal step increases will still go as planned. (I was confused because there are some positions that are still actively hiring but I have also heard that our VISN network director may literally have to approve each one).

VATAS is having technical issues and they are requesting non-timekeepers and supervisors to not use VATAS if possible.
 
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summerbabe said:
Monday morning VHA news update from my VISN town hall:

There is a national VHA group that is overseeing restructuring and they will be reaching out to specific facilities for data to assess VHA functioning and areas for potential restructuring.

No info yet on total RIF targets. Currently it's in the data review process and June would be the target to identify specific positions for elimination. VERA and VISP details have been requested but no updates yet on approval or monetary details.

Second round of DRP rumors: it has not been approved yet but it is going through formal channels and would be a different process such as applying to request DRP and the decision being based on impact on operations.

We are in Phase 2 of RTO. Phase 1 was within 50 miles of a facility in our VISN (4/14 deadline to RTO) and HR is working on formalizing space, sending notifications and changing telework arrangements. If somebody does not get a space, extensions will be requested to continue to search for space.

Our HR is anticipating 8-9 occupations that may not return to office due to impact on patient care but no official word yet. They do not know which positions or when to expect notice.

Improper probationary fires had notices sent out last Friday to rescind that action and were placed on Authorized Absence and they are waiting on the green light to return these employees to duty.

All organizational charts are to remain on hold until further notice. They are not sure how this impacts things like temporary details. Normal step increases will still go as planned. (I was confused because there are some positions that are still actively hiring but I have also heard that our VISN network director may literally have to approve each one).

VATAS is having technical issues and they are requesting non-timekeepers and supervisors to not use VATAS if possible.
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Thanks for the update--and the 'intel.'

I'm reminded of the military strategic advice to watch enemy "troop movements" rather than listen to (and believe) enemy propaganda, lol
 
Shiori said:
Why do so many people want me to do therapy with individuals who have dementia? Like, not even recently diagnosed dementia. Fully documented, has a caregiver, is literally in a nursing home dementia.
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What's even worse is when they want you to diagnose/treat ostensibly 50+ year latent/'delayed-onset' PTSD in 80+ year old veterans with dementia. But, I feel ya. The PACT Act has led to an influx of elderly patients and the system is struggling with that, especially in context of chronic MH provider shortages.
 
Shiori said:
Why do so many people want me to do therapy with individuals who have dementia? Like, not even recently diagnosed dementia. Fully documented, has a caregiver, is literally in a nursing home dementia.
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My suggestion, do a BOMC (Blessed) in MHAweb with them. If they pass, they may be able to benefit from some brief modified psychotherapy. If they flunk, you have proof of impairment.

The problem with dementia is that it is often so poorly diagnosed in the VA or the public as to be meaningless. Few have a proper neuropsych or even a staging tool to show the level of functional impairment (FAST, GDS).
 
Fan_of_Meehl said:
What's even worse is when they want you to diagnose/treat ostensibly 50+ year latent/'delayed-onset' PTSD in 80+ year old veterans with dementia. But, I feel ya. The PACT Act has led to an influx of elderly patients and the system is struggling with that, especially in context of chronic MH provider shortages.q
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So many that want SC do late in the process for nursing home placement unfortunately.
 
Sanman said:
My suggestion, do a BOMC (Blessed) in MHAweb with them. If they pass, they may be able to benefit from some brief modified psychotherapy. If they flunk, you have proof of impairment.

The problem with dementia is that it is often so poorly diagnosed in the VA or the public as to be meaningless. Few have a proper neuropsych or even a staging tool to show the level of functional impairment (FAST, GDS).
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This is a great suggestion. I have a ton of new consults and I will keep that in mind. We are fortunate that our neuropsychologist is great and gives good, thoughtful recommendations.

The people putting in the consults are rushing and missing things. The last patients sent my way would not have passed the BOMC. I usually do a MoCA, so this is a nice addition to the toolbox. Thank you!
 
Shiori said:
This is a great suggestion. I have a ton of new consults and I will keep that in mind. We are fortunate that our neuropsychologist is great and gives good, thoughtful recommendations.

The people putting in the consults are rushing and missing things. The last patients sent my way would not have passed the BOMC. I usually do a MoCA, so this is a nice addition to the toolbox. Thank you!
Click to expand...

I like the MoCA if you are willing to complete the required training and need a broader overall screening of cognitive functioning. The BOMC is faster to administer and good enough in terms of determining ability to participate in psychotherapy. It is also easy enough to administer via telehealth or telephone.

The biggest question when making a determination becomes the ability to retain information between sessions.
 
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Sanman said:
I like the MoCA if you are willing to complete the required training and need a broader overall screening of cognitive functioning. The BOMC is faster to administer and good enough in terms of determining ability to participate in psychotherapy. It also easy enough to administer via telehealth or telephone.

The biggest question when making a determination becomes the ability to retain information between sessions.
Click to expand...

In terms of screening, I'd say most of us neuropsychs prefer to see the MoCA over the others. Maybe a SLUMS. Just don't grab some obscure instrument that only you use, and no one else has ever seen, like the goddamn Mayo clinic.
 
Sanman said:
I like the MoCA if you are willing to complete the required training and need a broader overall screening of cognitive functioning. The BOMC is faster to administer and good enough in terms of determining ability to participate in psychotherapy. It also easy enough to administer via telehealth or telephone.

The biggest question when making a determination becomes the ability to retain information between sessions.
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Our site gave us access to the training for free which was really nice. I would use the BOMC if I had a consult coming in where dementia was mentioned in the chart. We see anyone who is able to track session to session. However, we recently switched to the RCI system so a lot more folks who are inappropriate for therapy are getting through. The last MoCA BLIND I did in a pinch scored less than 10 and the person thought it was sometime in the 1990s. Another came in with a few previous neuropsych examinations that documented their progressive, significant dementia symptoms. This person was not supposed to make decisions alone. They called up for an appointment and got through. There are some kinks to work out.
 
Shiori said:
Our site gave us access to the training for free which was really nice. I would use the BOMC if I had a consult coming in where dementia was mentioned in the chart. We see anyone who is able to track session to session. However, we recently switched to the RCI system so a lot more folks who are inappropriate for therapy are getting through. The last MoCA BLIND I did in a pinch scored less than 10 and the person thought it was sometime in the 1990s. Another came in with a few previous neuropsych examinations that documented their progressive, significant dementia symptoms. This person was not supposed to make decisions alone. They called up for an appointment and got through. There are some kinks to work out.
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MoCA is now free for VA employees to use assuming you didn't make an account years before and forget your password and then have OIT and the MoCA people blame each other when you don't get the reset email 😡!

VA owns the SLUMs so I am sticking to that at the moment.
 
WisNeuro said:
In terms of screening, I'd say most of us neuropsychs prefer to see the MoCA over the others. Maybe a SLUMS. Just don't grab some obscure instrument that only you use, and no one else has ever seen, like the goddamn Mayo clinic.
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I know a guy creating, using, and marketing his own screening system if you really want to go nuts!
 
Found out that a colleague is leaving (for personal reasons, unrelated to the job or what's happening with the VA). So we're losing another therapist and not sure if we'll be able to backfill.


This Is Fine GIF
 
cara susanna said:
Found out that a colleague is leaving (for personal reasons, unrelated to the job or what's happening with the VA). So we're losing another therapist and not sure if we'll be able to backfill.


This Is Fine GIF
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I know that my VISN is hiring and has extended offers to two different people in the last week and a half. Whether those positions will still exist in 3 to 9 months is still an unknown. On a different note I am still waiting to be converted from my term position after getting licensed back at the beginning of January. I only get a run around from management anytime I ask on when that will be finished. My term is up in November so I am starting the process now to start a Private Practice.
 
SunshinePsych said:
I know that my VISN is hiring and has extended offers to two different people in the last week and a half. Whether those positions will still exist in 3 to 9 months is still an unknown. On a different note I am still waiting to be converted from my term position after getting licensed back at the beginning of January. I only get a run around from management anytime I ask on when that will be finished. My term is up in November so I am starting the process now to start a Private Practice.
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I think you're getting the run around because nobody really knows what we can do/can't do and who needs to sign off on these types of moves.

Our VISN has issued guidance to freeze all org charts until further RIF details are confirmed, which I would assume would cover conversion of an NTE into an FTE. And the VISN network director is apparently personally signing off on any hires that are moving forward.

Hopefully there is more clarity and guidance for you shortly.
 
summerbabe said:
I think you're getting the run around because nobody really knows what we can do/can't do and who needs to sign off on these types of moves.

Our VISN has issued guidance to freeze all org charts until further RIF details are confirmed, which I would assume would cover conversion of an NTE into an FTE. And the VISN network director is apparently personally signing off on any hires that are moving forward.

Hopefully there is more clarity and guidance for you shortly.
Click to expand...

You know things are going smoothly when the information about what is happening comes via unofficial social media channels.
 
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