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

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futureapppsy2 said:
Apparently the RIF injunction got overturned by the Supreme Court. Kind of feels like we’re quickly getting rid of the legislative branch and just governing solely by the executive now. 🤷‍♀️
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To be fair, the current legislative branch has willingly given that power away recently.
 
Sanman said:
Hearing a lot of grumbling about burnout from both other MH providers and primary care teams. The short staffing and hiring freezes are starting to take their toll. Anyone else?
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Morale is....not high with my friends and colleagues at the local VAMC
 
Sanman said:
Hearing a lot of grumbling about burnout from both other MH providers and primary care teams. The short staffing and hiring freezes are starting to take their toll. Anyone else?
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Our staffing is okay, but RTO is burning us out since it's a more rural hospital. I have two days week where I only see virtual clients, and it's a wasted hour commute plus traffic. I'm having to use a lot of sick leave for OB appointments since my doctor is close to home, not work. I wonder if I can push for RA since it's temporary.
 
futureapppsy2 said:
I’ve posted about this before but our staffing shortage is notable and we’ve had multiple meetings about how our caseloads are unmanageable.
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The classic meeting to discuss "how we are all too busy to even be having these meetings, but are not actually planning to change things." My favorite.
 
cara susanna said:
Nothing imo is as bad as meetings to discuss your clinic's/team's goals for the year. I've even seen that eat up half day team retreats or meetings.
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My old mentor was the PTSD section chief at her VAMC. Her parting wisdom was "for the love of god, stay away from anything supervisory" as her entire life is what you described over and over.
 
The Cinnabon said:
My old mentor was the PTSD section chief at her VAMC. Her parting wisdom was "for the love of god, stay away from anything supervisory" as her entire life is what you described over and over.
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For a high enough salary, I would be in that meeting, but I'm guessing my number is above what the VA ponies up for such a position.
 
R. Matey said:
For a high enough salary, I would be in that meeting, but I'm guessing my number is above what the VA ponies up for such a position.
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In my last VA position, someone was cycling out of the MH lead position in our area and they were literally begging people to apply for the position because absolutely no one wanted it. The "pay raise" was nowhere near the ballpark most would consider for stepping into the role.
 
cara susanna said:
Anyone else find the REACH Vet program insulting to clinicians?
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Sanman said:
If we are going to fire a group of people...
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Yikes. Almost all of the people assigned to be a REACH VET coordinator didn’t ask or choose to be in that role, but have had to take it on due to job descriptions that require us to be involved with suicide prevention and/or suicide prevention staff shortages. I know it’s a nuisance, but don’t take it out on the providers who are assigned to that role without any choice.

I used to be a reach vet coordinator and the amount of rude messages we received from our colleagues was astonishing. It’s not meant to be an offense to your clinical skills — we literally just receive a list of 50 veterans at high risk for negative outcomes and have to alert their provider. For most providers, this is just for awareness and nothing about their clinical approach/case conceptualization changes because they are already doing everything that would be recommended. Just enter a note stating that no changes are clinically indicated.

Believe me — I always wished REACH VET would go away because it’s a ton of busy work on the coordinator’s end, but I doubt it’s going anywhere because the VA never gets rid of these sort of things. Don’t take it on the REACH VET coordinator and bring up your concerns with suicide prevention and VA higher ups! I always told our suicide prevention team how much hate we get as coordinators, but that hasn’t transferred to any changes…
 
VintageRed said:
Yikes. Almost all of the people assigned to be a REACH VET coordinator didn’t ask or choose to be in that role, but have had to take it on due to job descriptions that require us to be involved with suicide prevention and/or suicide prevention staff shortages. I know it’s a nuisance, but don’t take it out on the providers who are assigned to that role without any choice.

I used to be a reach vet coordinator and the amount of rude messages we received from our colleagues was astonishing. It’s not meant to be an offense to your clinical skills — we literally just receive a list of 50 veterans at high risk for negative outcomes and have to alert their provider. For most providers, this is just for awareness and nothing about their clinical approach/case conceptualization changes because they are already doing everything that would be recommended. Just enter a note stating that no changes are clinically indicated.

Believe me — I always wished REACH VET would go away because it’s a ton of busy work on the coordinator’s end, but I doubt it’s going anywhere because the VA never gets rid of these sort of things. Don’t take it on the REACH VET coordinator and bring up your concerns with suicide prevention and VA higher ups! I always told our suicide prevention team how much hate we get as coordinators, but that hasn’t transferred to any changes…
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I can have some due sympathy for those forced into the position.

However, I think that overall it's another one of those situations in which those providers would be better utilized engaging in direct clinical work with patients rather than administrative 'oversight' of the practicing clinicians.
And, I guess I should clarify...I find the existence of the REACH VET program itself insulting to clinicians. I have never felt insulted by the poor souls tasked with that work nor have I ever vented my frustrations at them.
 
The Cinnabon said:
My old mentor was the PTSD section chief at her VAMC. Her parting wisdom was "for the love of god, stay away from anything supervisory" as her entire life is what you described over and over.
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1000%. My former VA mentor told me the same thing. He was a lifer, but a lot had changed in the past 10-15 years, mostly for the bad.
 
Fan_of_Meehl said:
I can have some due sympathy for those forced into the position.

However, I think that overall it's another one of those situations in which those providers would be better utilized engaging in direct clinical work with patients rather than administrative 'oversight' of the practicing clinicians.
And, I guess I should clarify...I find the existence of the REACH VET program itself insulting to clinicians. I have never felt insulted by the poor souls tasked with that work nor have I ever vented my frustrations at them.
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Agreed. Plus, a bit of gallows humor on my part.
 
The Cinnabon said:
My old mentor was the PTSD section chief at her VAMC. Her parting wisdom was "for the love of god, stay away from anything supervisory" as her entire life is what you described over and over.
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Ok. But... "PTSD Section Chief" is...nothing. Lets be honest. I mean, is that even middle management? The title literally seems made up. And, 'section?" Get real. I've never seen anything called a "section" in my lifetime. This is 1940s nonsense. Its 2025. No one talks like that anymore.

But this is probably the problem too, right? Anyone who has more than 8 on a team people has to have a..."manager." Then a "director" beyond that. Then a "Section Chief." Then....whatever the ****. This isn't how corporate America works or is used to, right? It then gets very easy to trim government fat...yea?
 
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docloufan said:
Ok. But... "PTSD Section Chief" is...nothing. Lets be honest. I mean, is that even middle management? The title literally seems made up. And, 'section?" Get real. I've never seen anything called a "section" in my lifetime. This is 1940s nonsense. Its 2025. No one talks like that anymore.

But this is probably the problem too, right? Anyone who has more than 8 on a team people has to have a..."manager." Then a "director" beyond that. Then a "Section Chief." Then....whatever the ****. This isn't how corporate America works or is used to, right? It then gets very easy to trim government fat...yea?
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Have you worked in corporate America? That is exactly how it works. In fact, there are more layers of middle management. CEO, president, senior VP, associate VP, senior director, director, associate director, manager, associate manager, etc.
 
docloufan said:
Ok. But... "PTSD Section Chief" is...nothing. Lets be honest. I mean, is that even middle management? The title literally seems made up. And, 'section?" Get real. I've never seen anything called a "section" in my lifetime. This is 1940s nonsense. Its 2025. No one talks like that anymore.

But this is probably the problem too, right? Anyone who has more than 8 on a team people has to have a..."manager." Then a "director" beyond that. Then a "Section Chief." Then....whatever the ****. This isn't how corporate America works or is used to, right? It then gets very easy to trim government fat...yea?
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I feel like you're trying to do a @Fan_of_Meehl shtick right here but he's often imitated never duplicated
 
docloufan said:
Ok. But... "PTSD Section Chief" is...nothing. Lets be honest. I mean, is that even middle management? The title literally seems made up. And, 'section?" Get real. I've never seen anything called a "section" in my lifetime. This is 1940s nonsense. Its 2025. No one talks like that anymore.

But this is probably the problem too, right? Anyone who has more than 8 on a team people has to have a..."manager." Then a "director" beyond that. Then a "Section Chief." Then....whatever the ****. This isn't how corporate America works or is used to, right? It then gets very easy to trim government fat...yea?
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Here we have a psychologist Program Manager over the PTSD Clinic. Not sure if that's what a PTSD Section Chief is. Maybe at a bigger hospital network they have multiple PTSD clinics and there is someone over all of them. All I can say is that dealing with PTSD-related issues (assessment/diagnosis, treatment, managing co-morbidities) is a helluva thing at VA these days.
 
Is the big push to do the PHQ-9 more often everywhere or are we just special?
 
Shiori said:
Is the big push to do the PHQ-9 more often everywhere or are we just special?
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Everywhere as part of the FLOW initiative (AKA people get discharged from MH). It's actually the only metric being used for the FLOW initiative, which makes perfect sense because it has nothing to do with FLOW.
 
aim-agm said:
Everywhere as part of the FLOW initiative (AKA people get discharged from MH). It's actually the only metric being used for the FLOW initiative, which makes perfect sense because it has nothing to do with FLOW.
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I had no idea the two were connected. All we're doing for FLOW is awkwardly secure messaging/calling patients we haven't seen in forever to let them know they're being discharged from MHC back to PC. Then we have to explain what that means. I understand it conceptually. It has just been a mess. The PCPs hate it. It's only appropriate for a handful of patient. It requires the providers to reach out individually to each person. It's not been smooth so far.
 
Shiori said:
I had no idea the two were connected. All we're doing for FLOW is awkwardly secure messaging/calling patients we haven't seen in forever to let them know they're being discharged from MHC back to PC. Then we have to explain what that means. I understand it conceptually. It has just been a mess. The PCPs hate it. It's only appropriate for a handful of patient. It requires the providers to reach out individually to each person. It's not been smooth so far.
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What an incredibly efficient way to utilize providers’ time.
 
Shiori said:
Is the big push to do the PHQ-9 more often everywhere or are we just special?
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The more and more I work on the front lines of MH care with veterans, the more and more I've come to regard the symptom self-report measures we're mandated to use with them (PCL, PHQ, GAD7) as, generally, utterly useless wastes of time and energy. People know how to circle higher rather than lower numbers next to cited symptoms.

I'm using the MMPI-2-RF much more frequently these days and I actually look forward to interpreting the profiles it produces since there is almost always clinically useful info generated by that measure. Psychology is interesting/fun again.
 
VintageRed said:
Yikes. Almost all of the people assigned to be a REACH VET coordinator didn’t ask or choose to be in that role, but have had to take it on due to job descriptions that require us to be involved with suicide prevention and/or suicide prevention staff shortages. I know it’s a nuisance, but don’t take it out on the providers who are assigned to that role without any choice.

I used to be a reach vet coordinator and the amount of rude messages we received from our colleagues was astonishing. It’s not meant to be an offense to your clinical skills — we literally just receive a list of 50 veterans at high risk for negative outcomes and have to alert their provider. For most providers, this is just for awareness and nothing about their clinical approach/case conceptualization changes because they are already doing everything that would be recommended. Just enter a note stating that no changes are clinically indicated.

Believe me — I always wished REACH VET would go away because it’s a ton of busy work on the coordinator’s end, but I doubt it’s going anywhere because the VA never gets rid of these sort of things. Don’t take it on the REACH VET coordinator and bring up your concerns with suicide prevention and VA higher ups! I always told our suicide prevention team how much hate we get as coordinators, but that hasn’t transferred to any changes…
Click to expand...

Oh, I would never take it out on the coordinator! That's why I vented here, lol.

aim-agm said:
Everywhere as part of the FLOW initiative (AKA people get discharged from MH). It's actually the only metric being used for the FLOW initiative, which makes perfect sense because it has nothing to do with FLOW.
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That explains a lot. Pretty much every supervisor I've seen has said, yeah, it's for stupid reasons (metrics) but it's good clinical care. I haven't heard anything about FLOW though.
 
cara susanna said:
How are we supposed to place boundaries on therapy when people are literally paid to attend appts?
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Referring to travel pay stipend? This seemed absolutely out of control and mostly uncalled for years ago. Is it even worse now? I am all for the rural farm boy drafted some years ago....but this stuff? Get real.
 
Sanman said:
The inevitable result of recruiting from the lowest SES levels for decades.
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Probably not, I would say, actually. But it certainly has something to do with who they largely recruited 40 years ago. Not to mention who they managed to recruit at various other low periods (late 90s, 2010s?). I mean, in 1980, 81, 82, 83, who hell is joining the Army? And why? They even made a joke movie about them, for goodness sakes. Literally underachievers, poor health, or bad choice young men. But they came from all walks of life back then. Today, the idea that your screw-up son will be "fixed up right" by boot camp and some structure is outdated (rightfully so) and not welcome by the US armed forces. But not so back then.

Jeff Dahmer was an obese drunkard with asthma when he was signed up in 1979. That's not even a secret.
 
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WisNeuro said:
To be fair, the current legislative branch has willingly given that power away recently.
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I wouldn’t say recently - they’ve been ok with presidents waging wars abroad without a war declaration for decades
 
After completing the required 'VA Core Values' training today in TMS, the thought occurred to me that the cringeworthy "Lifetime Movie-of-the-Week" quality of the instructional video did clearly illustrate the 'core values' of the institution. I feel like I've been witness to a three decades long metamorphosis of healthcare devolving from a scientific and professional calling into a saccharine "customer service" Hallmark greeting card / ABC After School Special Hollywood production with really bad acting and outrageously inflated production budgets.
 
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psy.d. 2021 said:
Finally going to get out from the VA....feels strange
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Yeah, leaving VA can be a bit jarring at first, especially depending on how long you've been there, but I suspect you'll quickly come to appreciate the changes.
 
DoubtfulDoc said:
Not much more than normal here. But it was bad to begin with for psychologists.
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Literally, 20 MH staff (Psychologist, Psychiatrists, SWs) have quit at my local VAMC and affiliated CBOCs since March. There have been 3 MH staff hires (so I'm told) during this time...and of course they have not been cleared yet to work. Wait times increased, services have been cut, BHIP teams overwhelmed. Moral? Motivation? In the toilet. An entire IOP program is at risk of being shutdown here. While it may not be this bad at other places...even close to that is bad enough. And 100% more layoffs are coming. Like, 100%.
 
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