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

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ccpsych16 said:
I decided to be brave (more like at my wits end) and applied to non-VA jobs. Haven’t been anywhere else since first entering as a trainee. Keeping my fingers crossed that I get an interview and that the numbers work out reasonably (won’t beat VA though).
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I got a few offers in non private practice roles with organizations. The pay was a little bit higher. The benefits were definitely worse. Especially if you have EDRP through VA. I didn't want to leave VA unless it was a big win for me so I held out until I found something that worked for me. I think it depends on how you're feeling. If you can stand working there for a few more months you can be patient and find that something you want. If not then yeah it might not end up being ideal.
 
psy.d. 2021 said:
I got a few offers in non private practice roles with organizations. The pay was a little bit higher. The benefits were definitely worse. Especially if you have EDRP through VA. I didn't want to leave VA unless it was a big win for me so I held out until I found something that worked for me. I think it depends on how you're feeling. If you can stand working there for a few more months you can be patient and find that something you want. If not then yeah it might not end up being ideal.
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My sanity needed me to get out of dodge a long time ago, but there are no other jobs in my area and I wasn’t in a place to make my family move again. Also, I have EDRP as well as multiple stacked special salary rate adjustments. These days, most of the time I don’t care to leave that stuff behind because I’m losing my mind. My only concern is medical care because I take an expensive med ($13,000/mo) and fortunately pay a small fraction of the cost with an FEHB plan. I’ve been having more serious talks with my partner of picking up and moving, though we just recently moved house. Short term financial strain for longer term sanity is worth it in my book. If anything I could panel with a bunch of insurance companies and go F2F with my PP but I’d like to keep that as a side telehealth thing for now.
 
ccpsych16 said:
I decided to be brave (more like at my wits end) and applied to non-VA jobs. Haven’t been anywhere else since first entering as a trainee. Keeping my fingers crossed that I get an interview and that the numbers work out reasonably (won’t beat VA though).
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Good luck! And please keep us updated.
 
cara susanna said:
Is that something that happens a lot? I'm a VA lifer so I don't know this stuff. Sorry to hear either way
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Any hope for a compassionate release?

It does not happen a lot, but it does happen. With all the changes happening in government recently, I imagine that a lot of organizations are getting a little skittish about budgets and costs as well. Welcome to the new normal.
 
psy.d. 2021 said:
JK my contract got rescinded after a week.

Back at VA!!
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Would have to assume some kind of government contract??? Was big, big 10 year ago. Not sure now. Would never. Especially now.

Medicaid business is unclear at this time....but staff reductions at this time seem paranoid and silly.
 
cara susanna said:
Our VA network is now blocking Spotify! Noooo!
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Hah, they're pulling out all the stops to get people to quit. At least you can still use your phone, assuming you can get reception from the depths of a VA building.
 
AcronymAllergy said:
Hah, they're pulling out all the stops to get people to quit. At least you can still use your phone, assuming you can get reception from the depths of a VA building.
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Yeah, especially in one of my offices in the VA, I think we were under the imaging department and the shielding essentially made the psych offices cell phone dead zones. Only one that had good reception was my last VA job, and that was because I had a window office by the lake.
 
AcronymAllergy said:
Hah, they're pulling out all the stops to get people to quit. At least you can still use your phone, assuming you can get reception from the depths of a VA building.
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I refuse to use my phone since it will drain the battery. The good news is that I mostly use YouTube for music, and I'm not sure they can block it because we use it for a LOT of things here.
 
WisNeuro said:
Yeah, especially in one of my offices in the VA, I think we were under the imaging department and the shielding essentially made the psych offices cell phone dead zones. Only one that had good reception was my last VA job, and that was because I had a window office by the lake.
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Yeah...reception is always tricky in the bowels of the Death Star (gotta disable that tractor beam, old man!)
 
futureapppsy2 said:
Struggling greatly with likely leaving the VA, tbh. 🙁
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I went back and forth with it a few times myself, in my case because my position within VA, and the VA where I worked itself (e.g., co-workers, support staff, at least a few people in leadership), were net positives. I'd also never worked outside VA. But I also knew at that point that I'd probably reached terminal velocity for my VA career--I didn't really have any desire to move into leadership myself, and the work itself was starting to wear on me. It's n = 1, but it's been a few years and I've yet to regret the decision, even before all the recent ridiculousness.

That's not to say there aren't things about VA that are/were great (or at least good) and that I miss. But overall, I'm much happier now.
 
Fan_of_Meehl said:
The following link is to a Reddit post on 'veterans benefits' forum where apparently a VA 'doctor' gave them the CAPS-5 to fill out on their own time (self-administer). Nothing surprises me anymore.

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More like "VA Doctor". I've got money on this being a private contractor being paid a flat rate for these fulfill these contracts. This is how you get it done in 20 min and make it profitable.
 
psy.d. 2021 said:
What's also wild is the guy was given something to get 100 percent by someone unethical and all he is doing is complaining to reddit versus cashing checks
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Which makes the point I often try to make with coworkers who, essentially, advocate just 'loosening up' on the criteria and giving them the PTSD diagnosis to avoid 'making them upset.' That's not how personality disorders and their penchant for walking all over boundaries works. They will keep pressing and complaining until resistance is met. They will never be 'happy' with the results, either. They're going to get upset. They're going to be resentful/dissatisfied, no matter what. If we give them the PTSD diagnosis, next it will be demanding that we write down in our notes exactly what they want us to write in order to 'maximize' their chances for '100%.' Then, when they 'get 100%' for PTSD, they will go for 'Permanent & Total' or 'caregiver support' or 'aid and attendance' or will demand X, Y, and Z. May as well enforce the boundary where you think it belongs and get the 'they will get upset' over with up front.
 
Fan_of_Meehl said:
Which makes the point I often try to make with coworkers who, essentially, advocate just 'loosening up' on the criteria and giving them the PTSD diagnosis to avoid 'making them upset.' That's not how personality disorders and their penchant for walking all over boundaries works. They will keep pressing and complaining until resistance is met. They will never be 'happy' with the results, either. They're going to get upset. They're going to be resentful/dissatisfied, no matter what. If we give them the PTSD diagnosis, next it will be demanding that we write down in our notes exactly what they want us to write in order to 'maximize' their chances for '100%.' Then, when they 'get 100%' for PTSD, they will go for 'Permanent & Total' or 'caregiver support' or 'aid and attendance' or will demand X, Y, and Z. May as well enforce the boundary where you think it belongs and get the 'they will get upset' over with up front.
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Yeah. I make it very clear that my evaluation is what my evaluation is going to be and establish my role as a treating provider vs. someone who is rating disability. Folks can use the evaluation if they feel it's favorable to them but I'm not changing accurate records for their benefit
 
Sanman said:
More like "VA Doctor". I've got money on this being a private contractor being paid a flat rate for these fulfill these contracts. This is how you get it done in 20 min and make it profitable.
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At east when I was in the VA, people, Vets included, would frequently conflate the VBA with the VHA.
 
I have noticed a decrease of people seeking therapy/assessment over here for S/C. I have definitely seen a lot more requests for nexus letters though. The VSOs nearby seem to guide a lot of the information sharing and development of superstitious behaviors. I keep pushing back and letting the veterans know if there isn't enough information in their record, VBA will gather that information themselves. I have been offering to speak to any of the reps, but none of them have reached out so far.
 
Do other people let spouses attend therapy sessions? I can see having them come back for one or two, but not every session. I am trying to think through how I want to address it with an upcoming consult.
 
Shiori said:
Do other people let spouses attend therapy sessions? I can see having them come back for one or two, but not every session. I am trying to think through how I want to address it with an upcoming consult.
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I would let spouses be in the intake session if they and the veteran requested it. However, I would ask that they excuse me and the veteran to meet alone after a certain point to finish up the intake. I would never consider it acceptable for the spouse just routinely join us for INDIVIDUAL therapy sessions, though.
The treatment modality is either individual therapy OR couples therapy.
 
Shiori said:
Do other people let spouses attend therapy sessions? I can see having them come back for one or two, but not every session. I am trying to think through how I want to address it with an upcoming consult.
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I do. What is the purpose of the spouse attending the visit in this case?
 
Sanman said:
I do. What is the purpose of the spouse attending the visit in this case?
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It is longstanding. The spouse attends every appointment because the veteran wants them to be there.

It was a trauma consult, but is fortunately not a trauma case. I think they just needed reassurance and psychoeducation related to some weird, inappropriate feedback they received from a neurologist. Crisis averted!
 
Shiori said:
It is longstanding. The spouse attends every appointment because the veteran wants them to be there.

It was a trauma consult, but is fortunately not a trauma case. I think they just needed reassurance and psychoeducation related to some weird, inappropriate feedback they received from a neurologist. Crisis averted!
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Agree with @Fan_of_Meehl. You don't do it because it is infantilizing.

There are multiple ways to assure treatment plan communication.... and psychological safety (if that's needed) without this going on long-term.
 
Sanman said:
I do. What is the purpose of the spouse attending the visit in this case?
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This is an excellent point (considering the reason/purpose for spouse attendance). Maybe you're teaching the spouse how to log nighttime disturbed sleep behavior (parasomnias) or the spouse will be supporting the veteran to work their way up an exposure hierarchy or the veteran will be practicing assertive communication with the spouse, etc.

Without specific (and circumscribed) reasons, though, I can think of a million ways it would be contraindicated or problematic.
 
I make it clear this is the veteran's appointment and this isn't couples/marital counseling. Also I move to make clear the reasoning behind the spouse being present. There are some highlighted above (I'd also add memory problems where a spouse being present to aid in homework/treatment planning could be helpful) where it could be useful. Sometimes I've had spouses where it's clear after meeting them they are not going to be a helpful ally in doing that..then I'm done with it. Lol
 
Shiori said:
I have noticed a decrease of people seeking therapy/assessment over here for S/C. I have definitely seen a lot more requests for nexus letters though. The VSOs nearby seem to guide a lot of the information sharing and development of superstitious behaviors. I keep pushing back and letting the veterans know if there isn't enough information in their record, VBA will gather that information themselves. I have been offering to speak to any of the reps, but none of them have reached out so far.
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Any theories as to why you’re seeing the decrease? Maybe about two thirds of my caseload at any given point is in treatment with me simply because they’re applying for SC…
 
Psychologist1234 said:
Any theories as to why you’re seeing the decrease? Maybe about two thirds of my caseload at any given point is in treatment with me simply because they’re applying for SC…
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It's probably a combination of things. It was never all that high here. We attract a lot of older veterans who are already S/C, knowledgeable about the process, or have friends and family they can ask. There are also a lot of veteran-focused places to be here, so it's easy to chat with other veterans about their experiences. I think we saw a spike with the turnover in VSO reps + the PACT Act rollout. Now that everyone is mostly on the same page again and information is penetrating, we're seeing another dip.
 
Yeah I'm glad I work with a lot of older adults. Most of them already got SC. Except for folks continuing on for 100 percent, Aid and Attendance, CSP, TDIU etc. which exist but I'm usually pretty straight with them. It definitely helps with burnout to be working with motivated clients.
 
Shiori said:
Do other people let spouses attend therapy sessions? I can see having them come back for one or two, but not every session. I am trying to think through how I want to address it with an upcoming consult.
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Heck no. I find that it’s always been men wanting their wives to be there and the wives silently pleading with their eyes against this. Generally I have no issue with a loved one coming to the first session, but most of the time it irks me when wives are present in the intake, because the men just take a back seat with “I don’t know” and the wives just rant/vent. I’m sure you’ve all heard it… “my wife takes care of all my medical stuff, I don’t know anything.” I had someone (man) a couple weeks ago argue with me about his wife not being allowed at every therapy appointment. I said if you really “need” your wife here to each session then maybe individual therapy isn’t a good fit and maybe a different type of care is needed. He demanded to know if it was a “VA law”. I said it’s my law 😎 Wife was more than happy to skedaddle, she looked exhausted.
Shiori said:
I have not had good experiences with spouses in session outside of my PCMHI and neuropsych rotations. I purposely only have one patient chair in my office to make it inconvenient. I am mean though.
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I need to remove my second chair!
 
Psychologist1234 said:
Can you just print them instead?
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I mean sure but it's just yet another admin task being added on to the laundry list while they continue to push ever closer to having 100 percent of all of our time in session despite the fact that provides terrible care and leads to everyone leaving
 
psy.d. 2021 said:
I mean sure but it's just yet another admin task being added on to the laundry list while they continue to push ever closer to having 100 percent of all of our time in session despite the fact that provides terrible care and leads to everyone leaving
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This is the point...by far.

If this was any other work place, the assumption is that a doctor does.... doctor stuff. He/she doesn't scheduled/reschedule your appointments. He/she doesn't worry about the status of the printer. This is not unusual, or some kind kind of big thing. This is how healthcare (and dentistry) support works. "Do it yourself" should not be an acceptable answer. And it wouldn't be in any other practice setting. But for some reason, this gets tolerated...
 
docloufan said:
This is the point...by far.

If this was any other work place, the assumption is that a doctor does.... doctor stuff. He/she doesn't scheduled/reschedule your appointments. He/she doesn't worry about the status of the printer. This is not unusual, or some kind kind of big thing. This is how healthcare (and dentistry) support works.
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I have to take out my own trash most of the time, lol. And any 'work orders' to fix things generally have to be entered multiple times. I've had them commit absolute fraud and 'close' tickets as 'completed' when the bastards didn't even do anything. EVERYTHING is a multi-step PROJECT with multiple follow-up points and looping back around to hand-over-hand prompt people who aren't even in your chain of supervision just to basically do their jobs so you can try to do yours.

And then, when you do get around to doing the actual clinical work, 9 times out of 10 these days it's patients who react to you telling them that they DON'T have PTSD with extreme negative emotional displays. It's like being an oncologist (except in reverse). I feel like I'm delivering the news of terminal stage IV cancer to a patient every time I rule out PTSD and diagnose something else. Anything else.
It's like the entire universe has warped itself around the lie/myth that every veteran has PTSD (especially if they say they do) and it is some sort of unspoken law that you never are allowed to have an opinion that differs with that one. We are going to spend DECADES undoing the medium and long-term fallout of this crap.
 
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Fan_of_Meehl said:
I have to take out my own trash most of the time, lol. And any 'work orders' to fix things generally have to be entered multiple times. I've had them commit absolute fraud and 'close' tickets as 'completed' when the bastards didn't even do anything. EVERYTHING is a multi-step PROJECT with multiple follow-up points and looping back around to hand-over-hand prompt people who aren't even in your chain of supervision just to basically do their jobs so you can try to do yours.

And then, when you do get around to doing the actual clinical work, 9 times out of 10 these days it's patients who react to you telling them that they DON'T have PTSD with extreme negative emotional displays. It's like being an oncologist (except in reverse). I feel like I'm delivering the news of terminal stage IV cancer to a patient every time I rule out PTSD and diagnose something else. Anything else.
It's like the entire universe has warped itself around the lie/myth that every veteran has PTSD (especially if they say they do) and it is some sort of unspoken law that you never are allowed to have an opinion that differs with that one. We are going to spend DECADES undoing the medium and long-term fallout of this crap.
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Did the bastards kill Kenny too? Is that still a thing?
 
Psychologist1234 said:
Can you just print them instead?
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Fan_of_Meehl said:
I have to take out my own trash most of the time, lol. And any 'work orders' to fix things generally have to be entered multiple times. I've had them commit absolute fraud and 'close' tickets as 'completed' when the bastards didn't even do anything. EVERYTHING is a multi-step PROJECT with multiple follow-up points and looping back around to hand-over-hand prompt people who aren't even in your chain of supervision just to basically do their jobs so you can try to do yours.

And then, when you do get around to doing the actual clinical work, 9 times out of 10 these days it's patients who react to you telling them that they DON'T have PTSD with extreme negative emotional displays. It's like being an oncologist (except in reverse). I feel like I'm delivering the news of terminal stage IV cancer to a patient every time I rule out PTSD and diagnose something else. Anything else.
It's like the entire universe has warped itself around the lie/myth that every veteran has PTSD (especially if they say they do) and it is some sort of unspoken law that you never are allowed to have an opinion that differs with that one. We are going to spend DECADES undoing the medium and long-term fallout of this crap.
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One of the values I cherish most about my current work environment is centered around: "We do what is needed, not what is easy." And "We have difficult conversations with keeping whole health of person in mind." If these are not values cherished by the Department of Veterans Affairs, its a losing battle. Its over. It's done. The organization will either become fiscally insolvent and fail to maintain.... or will defer more and more to other care options until its over.

I've been telling people for years that that VA healthcare system cannot not continue to sustain itself at is current size and rate. It is going down. This is not in doubt. The post OEF/OIF bubble and all the added programs (and staff) are not sustainable to this current administration and political climate.
 
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