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This was standard practice before AI was a thing.
VA Mental Health Provider Venting / Problem-solving / Peer Support Thread
Started by Fan_of_Meehl
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This was standard practice before AI was a thing.
100% agree.
I had a recent intake who completed a course of group CPT a few years back. Not a single PCL during/ after the course of CPT to see if it helped reduce self-reported sxs of PTSD as a result of treatment. It was infuriating. I believe in the principle of 'measurement-based care' and even (newly fashionable catchphrase) 'patient reported outcome measures.' I just don't particularly worship the recitation of 'MBC' and 'PROM' acronyms as synonymous with sophisticated clinical practice--though they are often present as features of such practice.
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ah, my apologies. I only did lab work in the VA, so my working knowledge is limited in that setting. Thanks!
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I think this is the story of the VA. There is a practice that is good and makes sense in a lot of contexts. Instead of providing an intuitive rationale and fostering good clinical judgement in providers, it's just mandated despite there probably being situations where it will not produce ideal outcomes.
I am thinking about the quality of my answers on all of those VA TMS surveys. Does it make sense that we need that data to improve the courses? Definitely. Is it going to happen when you force me to do it for hundreds of surveys? Probably not.
Just had to complete a 'PTSD screen' clinical reminder on a veteran who is already diagnosed with and service-connected for PTSD.
When I was doing a lot of PE/CPT work, I rarely had anyone voice any problems with weekly PCLs. I found as long as you explained the rationale, they were generally on board. And, they usually appreciated the graphing over time when we reviewed at certain points so they could see progress, especially if we mapped it on to their own observed functional changes in day-to-day life.
Yeah, it helps that my supervisor has framed it that way to us: I know this is a silly metric, but MBC is good clinical care so let's do it for that reason.
My TMS survey answers are SO not useful. Sometimes I just pick the same rating for every item to get through it faster.
Yep. Some of the post-training surveys were fine, but others were waaaaay too long.
Where things are REALLY going to get interesting will be when they actually start publishing (internally, at first) the 'findings' with respect to all those MBC PROM's across all VA MH outpatient treatment settings. It is going to be interesting, to say the least. Not too long ago they released/published some of the outcome data from the RRTPs and it was pretty bad. The outpatient data will be worse. There will be a percentage (10-20%?) who show clinical improvement as a result of treatment (and many of them will re-present 6 to 24 months later with sxs back at pre-tx levels, or worse). The majority won't show improvement and/or lack of attendance/engagement in psychotherapy.
Consistent with the "here-at-VA-we-blame-the-provider-first (and last, and always)" dysfunctional organizational schema, we'll see a renewed 'fire-and-brimstone accountability push' that will further burn out and alienate the provider corps, deepening the organizational death spiral.
Fun times ahead 🙂
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Sanman
O.G.
I don't think it is a bad metric, I do think that this is poor implementation. To be clear my MBC rate is 2.5x my unique patients seen and I am being told to increase the number. So, this is not just do some MBC.
Same. It's always 'slightly agree'
Sometimes I get annoyed enough to give them bad ratings. Like for the suicide prevention stuff I always say "strongly disagree" when they ask me if I learned anything new.
I mean...you weren't lying.
('The truth hurts...doesn't it, TMS Survey Algorithm?')
Sanman
O.G.
I do a lot of neutral reponses for things. Especially the annual trainings. My TMS trauma has made me believe that if I go any lower that they will redo the training and make it worse.
Yeah, I don't necessarily view that as a bad thing. A potentially more useful follow-up question might be, "this training helped to refresh and reinforce information that I already knew."
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"You did not like our training. We have a training module for that."
I have no concerns about the accuracy or validity of the outcomes of this trial, and I have no expectation that the inevitable "positive" results ("Now that you mention it, I did feel ecstatic on Ecstasy") will have terrible consequences.
news.va.gov
clinicaltrials.gov
VA launches MDMA-assisted mental health therapy trial
New VA clinical trial to evaluate the safety and efficacy of methylenedioxymethamphetamine-assisted therapy, or MDMA-assisted therapy, for the treatment of severe mental health disorders, including posttraumatic stress disorder and alcohol use disorder.
news.va.gov
ClinicalTrials.gov
clinicaltrials.gov
Opiates, stimulants, and benzodiazepines are out.I have no concerns about the accuracy or validity of the outcomes of this trial, and I have no expectation that the inevitable "positive" results ("Now that you mention it, I did feel ecstatic on Ecstasy") will have terrible consequences.
VA launches MDMA-assisted mental health therapy trial
New VA clinical trial to evaluate the safety and efficacy of methylenedioxymethamphetamine-assisted therapy, or MDMA-assisted therapy, for the treatment of severe mental health disorders, including posttraumatic stress disorder and alcohol use disorder.ClinicalTrials.gov
Cannabis, MDMA, and service-dogs are in.
However...
No matter how methodologically rigorous their study design is, MDMA will not be found to be a cure for Service-Connection Deficit Disorder.
SCDD is undefeated in clinical trials
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I worry about the mental health of some of my hospital colleagues.
I strongly considered leaving for another position because of some of the flexibility it offered. Once I had the official offer, my leadership was able to negotiate with the ELT and get more of that flexibility here for the therapists. Everything will need to be rolled out, so I'll be one of the first people in line. People are unhappy about that. It wasn't even going to be an option until I planned on leaving. I don't understand the angst.
I strongly considered leaving for another position because of some of the flexibility it offered. Once I had the official offer, my leadership was able to negotiate with the ELT and get more of that flexibility here for the therapists. Everything will need to be rolled out, so I'll be one of the first people in line. People are unhappy about that. It wasn't even going to be an option until I planned on leaving. I don't understand the angst.
Is there some way I can “observe” 8-12hrs of intoxicated people undergoing psychotherapy that would reduce their income? Preferably while I eat snacks? Because that is going to be hilarious. (I would also like to “observe” HR telling psychologists that they have to work 12-14hrs straight without breaks.
Sanman
O.G.
Something to remember as someone that has worked in multiple work settings and hospitals. People self select into the work culture they want. The others usually leave for greener pastures rather than fight for change . So you often end up with an echo chamber of their own making. Best to self select into the culture you want.
Yeah, it stung for a second. Our clinic has a lot of camaraderie, and everyone here is excited about the change. We try to keep things light and fun over here because the work can be a grind. There are a lot of unhappy rumblings outside of our clinic even though it'll be rolled out to everyone. It is kind of disappointing. Sometimes I have to be reminded that this job gets to people, and it shows up in not very productive ways.
Has anyone else been tasked with making/documenting the Post-Discharge Engagement (PDE) phone calls? There's a SAIL metric attached. Unfortunately, at my facility it appears some clever folks have repurposed/re-classified? these calls as fulfilling the requirements of a 'completed aftercare appointment with a mental health professional' post-discharge and they have been incrementally (and covertly) modifying the CPRS template we're 'supposed to use' (though this seems a local creation) to document these telephone calls. They have been adding some very 'psychiatric assessment/ psychological assessment' components, requiring asking about alcohol/drug use since discharge, auditory or visual hallucinations, etc. as well as a lot of 'mental status' type items that--according to content--makes it very similar to an actual mental health encounter for assessment/psychotherapy.
Originally, my understanding is that the phone calls were never conceptualized to take the place of (or count as) 'mental health appointments' in aftercare. I mean, we're just randomly calling (at random times and unsolicited by the patients) these people whom we don't know (we're not their established providers and have never seen them) and 'out of the blue' expecting them to drop what they're doing and answer all these intrusive psychiatric questions. The latest development was someone 'sneaking in' a 'required (asterisked)' item about 'Have you been having any suicidal thoughts (y/n?)' with instructions to follow up (essentially C-SSRS type questions) if they endorse the item. Me and two other psychologist colleagues have some concerns about this, especially without informed consent to a clinical encounter/appointment. There is just too much line blurring and ambiguity with respect to what the nature of the encounter actually is and what our professional role actually is with respect to these 'phone call' 'check-ins.' It doesn't help that it is a low-trust environment where things just get changed without provider input all the time and our historical experiences with raising concerns is that you will be 'blamed' or punished or attacked for doing so.
Is anyone else having to do these calls? Are there any national standards/templates for call content (if you are a psychologist)? Anyone else have concerns about not getting informed consent and essentially foisting a psychiatric interview on someone out of the blue when they may not feel comfortable saying 'no' since they were recently hospitalized and afraid of being forced to go back to the hospital if they are 'non-compliant' with our questions? I certainly respect their privacy and right to decline the phone call or to participate (should they resist or indicate that they are doing something else). I was just wondering if anyone else is having to do these.
Originally, my understanding is that the phone calls were never conceptualized to take the place of (or count as) 'mental health appointments' in aftercare. I mean, we're just randomly calling (at random times and unsolicited by the patients) these people whom we don't know (we're not their established providers and have never seen them) and 'out of the blue' expecting them to drop what they're doing and answer all these intrusive psychiatric questions. The latest development was someone 'sneaking in' a 'required (asterisked)' item about 'Have you been having any suicidal thoughts (y/n?)' with instructions to follow up (essentially C-SSRS type questions) if they endorse the item. Me and two other psychologist colleagues have some concerns about this, especially without informed consent to a clinical encounter/appointment. There is just too much line blurring and ambiguity with respect to what the nature of the encounter actually is and what our professional role actually is with respect to these 'phone call' 'check-ins.' It doesn't help that it is a low-trust environment where things just get changed without provider input all the time and our historical experiences with raising concerns is that you will be 'blamed' or punished or attacked for doing so.
Is anyone else having to do these calls? Are there any national standards/templates for call content (if you are a psychologist)? Anyone else have concerns about not getting informed consent and essentially foisting a psychiatric interview on someone out of the blue when they may not feel comfortable saying 'no' since they were recently hospitalized and afraid of being forced to go back to the hospital if they are 'non-compliant' with our questions? I certainly respect their privacy and right to decline the phone call or to participate (should they resist or indicate that they are doing something else). I was just wondering if anyone else is having to do these.
We have never been asked to do anything like this. We have FLOW, but that's it.
Judging from all the 'wow' reactions...the early consensus appears to be that my colleagues and I are not necessarily 'paranoid,' 'unreasonable,' or 'rebellious' psychology staff members to be concerned about this. We did complete a 'Report of Contact' form documenting and memorializing the main points of our meeting. I really hate the VA mental health environment right now. It has gotten increasingly disturbing over the past few years.
The other concern relates to how we were instructed to 'code' (CPT codes) these phone call 'encounters' that, you know, according to the people in charge 'aren't really encounters,' they're 'just post-discharge calls.' We were instructed to use the phone codes for non-physician providers doing a telehealth-related phone call (98966, 98967, and 98968). We are also told that we 'need to keep them on the phone for at least 11 mins' so we can use the code that will 'get us credit' for meeting the SAIL metric (or count toward the cell metric). It might have been suggested (wink wink) that...you know...7 or 8 minutes is 'close to' 11 minutes...you know...so... (I hate this place). It all feels so awkward and icky and I don't do it. I don't lie about the time. I don't 'pressure' these patients to talk to me about these clinical topics if they express any discomfort. I try to stick to the basics of making sure they're aware of their future scheduled appointments with mental health providers, ensuring that they don't have any 'emergent/ urgent clinical needs' and inform them of same day access policy for mental health, do you know the crisis line number, do you know how to refill your medications, etc. But, I'm telling you, it is incredibly taxing and stressful since everything is so chaotic right now and wait times are so high so we get pulled into EVERYTHING. Like 'yeah, how am I supposed to get to my doctor's appointment, can you get me transportation for that' and about a million other things. It is just so messy. I also had the question, 'Is there any precedent in clinical psychological practice where a clinical psychologist is expected to just 'cold call' a patient (whom they've never met, who isn't expecting the call and didn't ask for or solicit the call, and for whom they haven't received a consult for services...cold call that patient at a random time during the day, out of the blue, and start asking them sensitive clinical questions about things like suicidal ideation, any use of drugs/alcohol since discharge, psychotic symptoms (hallucinations), sleep, mood/affect, appetite, energy level, etc. The online info regarding proper use of the 98966, 98967, and 98968 appears to clearly indicate that these codes are only to be used for established patients who themselves initiate a phone call to you as their provider. We're not supposed to be using them to code for phone calls that we initiate to them unsolicited. I shared this with my supervisor (after getting critical feedback from an audit of why I am using these codes). I said, well, these were the codes that Dr. X instructed us to use for these calls. Am I supposed to be using a different code? She said, oh no, that's right, do what Dr. X instructed you to do, I forgot you were doing these calls. I said, by the way, I looked up the codes online and I don't think it's appropriate to use them when we initiate the calls to the patient, they're only supposed to be used when our established patient calls us. She said she would pass that concern along to our big supervisor. That was several weeks ago. Haven't heard anything back. I also asked for a reference/resource for proper use of the CPT codes in my work (since we all got an unannounced audit (first time in my 14 years working here) and critical and formal supervisory feedback on the codes we were using. I said, how do I know how to use the proper codes if I've never had any training on them, we have never discussed them, and you can't point me to a definitive resource describing how to properly use them? Haven't heard back an answer to that question, either.
The other thing is, we have a CPRS form (mandated) for a 'mental health triage' note. You know, the kind you use when someone walks in for a same-day access mental health appointment because they are presenting in crisis. There is no question on that form about recent thoughts of suicide that is mandated. But they just (covertly) altered the 'post discharge engagement' note to require the element/question about any thoughts of suicide. So, the form people use for someone presenting to mental health in a crisis doesn't even prompt the provider to ask about suicidal ideation but they just wedged that one into the post discharge followup template (but only for psychologists). Other professions (social work, RN's) who are doing these same calls are including completely different info and using a different template. The gist of the meeting between me and the other two psychologists today was that we determine what is clinically appropriate to ask these patients (if anything) above and beyond the basics of (1) here are your upcoming appointments, are you aware of them? (2) do you have any emergent / urgent clinical needs or questions. I do not get involved with entering consults for further services (I would need to do an actual examination/evaluation to do that), I do not alter their treatment plan, etc. Any attempts to engage supervisors or 'chosen one' staff members around questions about 'what is our role here in these appointments' or 'we need to have some boundaries around this activity and not give patients the impression that we are engaging in clinical services during these calls or establishing a treating relationship' are not received well. We've dealt with so many issues over the years we tried to get clarification on but we just end up being shamed, or ignored, or the recipient of passive aggressive and annoyed energy coming from the supervisory chain (or those politically favored).
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Sanman
O.G.
I am convinced no one in local VA leadership has ever read a cpt code. They all try to game the metrics without reading the text of the billing code. 11 min is only the difference between 98966 and 98967, which is .25 vs .50 RVUs. Bigger issue, all calls being billed under this code MUST BE PATIENT INITIATED. It also must be an established patient, though it can be argued they are an established MH service patient. Email Cliff Smith, if he is still around, for clarification.
Get the instructions to commit fraud (and violate the standard of care and subvert metrics) in writing if you can, ideally explicit about the core elements (billing when less than 11 minutes, using improper CPT goes, etc.).
Report to OIG. Actually, all the psychologists should so as to increase likelihood of response and ensure you all have whistleblower protections.
Contact OGC for legal guidance. Lawyers should tell you "don't do fraud, don't practice below the standard of care." See if you can get it in writing. Share with other psychologists. Present it to your supervisor and Dr. X, if they persist in telling you to do this (try to get it in writing) alert OGC, OIG, and ELT. Also report to HR. Check with OGC when you can report to pertinent members of Congress, to Medicare for fraud, state boards of supervisor and Dr. X, etc.
If your supervisor and Dr. X continue to be supervisors, plan to get the hell out of that VA. This will almost certainly not be the last time they do something like this. There is no shortage of people here who would be ecstatic to have someone of your quality join their team and would be happy to help get you a position.
I'm so sorry you and your peers are being subjected to this.
Oh snap, really? My facility does this too. I mean, the 11 min call thing. For post discharge, but also for HRF flag metrics etc
Sanman
O.G.
Telephone assessment and management services
Qualified health care professionals, including psychologists, can receive reimbursement for time spent on audio-only telephone services if a patient calls because they are experiencing mental health issues or symptoms.
www.apaservices.org
Telephone assessment and management services are patient-initiated non-face-to-face services provided by a QHP to a patient, parent, or guardian via real-time phone conversation.
There are times VA approves codes to be used incorrectly in the system because we don't bill for it and they need to be able to record workload credit. Cliff Smith makes those decisions for VHACO, hence my suggestion to check with him first.
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I just found this article that was published in January 2026 that appears to substantiate findings of increased incidents of suicide-related events (SRE's) associated with increased psychotherapist (mental health provider) workload (number of patients seen per day) in VA settings. It is a HUGE sample (using data from the national data 'warehouse').
The main findings of the study are (from the abstract):
Principal findings: A 1% increase in therapy provider work rate led to a 12.1% increase in SRE probability, regardless of staffing levels. Conversely, a 1% increase in staffing levels led to a 1.6% reduction in SREs, with the largest effect in low-staffed facilities. For medication management providers, work rate had no overall impact on SREs, except in medium-staffed facilities. A 1% increase in staffing levels for medication management providers led to a 1.7% reduction in SREs.
Conclusions: Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access to mental health clinics and ensure Veteran safety and care quality.
The study is titled, 'Impact of provider productivity on suicide-related events among veterans.'
Although the study findings/conclusions/recommendations are obvious (to anyone working in VA mental health right now on the front lines as a provider), the fact that this is, essentially, a publication that came from VA researchers (at the Boston VA) and is on veteran patients from within that system makes it all the more crucial to consider. Of course, it also has implication outside the VA and veterans. All over mental health, providers are being expected to do increasingly 'more with less' and this is harmful/neglectful to patients.
Was anyone else aware of this study? Are the people at your VA site talking about it? Is VA 'leadership-in-mental-health' aware of it?
I've shared the existence of the article with a couple of colleagues as well as my clinic workgroup.
Mental health administrators at my VA are going to be absolutely livid. Distributing findings like this from the empirical literature (even from the VA's own research efforts and publications) is to be considered heresy against the religion of exploiting providers and harming veterans as a means to the end of one's own career advancement. I don't really care at this point.
For some reason, SDN isn't allowing me to upload/attach a copy of the .pdf as a file.
Here is a link to the article page, though, if anyone has access:
pubmed.ncbi.nlm.nih.gov
The main findings of the study are (from the abstract):
Principal findings: A 1% increase in therapy provider work rate led to a 12.1% increase in SRE probability, regardless of staffing levels. Conversely, a 1% increase in staffing levels led to a 1.6% reduction in SREs, with the largest effect in low-staffed facilities. For medication management providers, work rate had no overall impact on SREs, except in medium-staffed facilities. A 1% increase in staffing levels for medication management providers led to a 1.7% reduction in SREs.
Conclusions: Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access to mental health clinics and ensure Veteran safety and care quality.
The study is titled, 'Impact of provider productivity on suicide-related events among veterans.'
Although the study findings/conclusions/recommendations are obvious (to anyone working in VA mental health right now on the front lines as a provider), the fact that this is, essentially, a publication that came from VA researchers (at the Boston VA) and is on veteran patients from within that system makes it all the more crucial to consider. Of course, it also has implication outside the VA and veterans. All over mental health, providers are being expected to do increasingly 'more with less' and this is harmful/neglectful to patients.
Was anyone else aware of this study? Are the people at your VA site talking about it? Is VA 'leadership-in-mental-health' aware of it?
I've shared the existence of the article with a couple of colleagues as well as my clinic workgroup.
Mental health administrators at my VA are going to be absolutely livid. Distributing findings like this from the empirical literature (even from the VA's own research efforts and publications) is to be considered heresy against the religion of exploiting providers and harming veterans as a means to the end of one's own career advancement. I don't really care at this point.
For some reason, SDN isn't allowing me to upload/attach a copy of the .pdf as a file.
Here is a link to the article page, though, if anyone has access:
The Impact of Provider Productivity on Suicide-Related Events Among Veterans - PubMed
Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access...
pubmed.ncbi.nlm.nih.gov
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Sanman
O.G.
I just found this article that was published in January 2026 that appears to substantiate findings of increased incidents of suicide-related events (SRE's) associated with increased psychotherapist (mental health provider) workload (number of patients seen per day) in VA settings. It is a HUGE sample (using data from the national data 'warehouse').
The main findings of the study are (from the abstract):
Principal findings: A 1% increase in therapy provider work rate led to a 12.1% increase in SRE probability, regardless of staffing levels. Conversely, a 1% increase in staffing levels led to a 1.6% reduction in SREs, with the largest effect in low-staffed facilities. For medication management providers, work rate had no overall impact on SREs, except in medium-staffed facilities. A 1% increase in staffing levels for medication management providers led to a 1.7% reduction in SREs.
Conclusions: Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access to mental health clinics and ensure Veteran safety and care quality.
The study is titled, 'Impact of provider productivity on suicide-related events among veterans.'
Although the study findings/conclusions/recommendations are obvious (to anyone working in VA mental health right now on the front lines as a provider), the fact that this is, essentially, a publication that came from VA researchers (at the Boston VA) and is on veteran patients from within that system makes it all the more crucial to consider. Of course, it also has implication outside the VA and veterans. All over mental health, providers are being expected to do increasingly 'more with less' and this is harmful/neglectful to patients.
Was anyone else aware of this study? Are the people at your VA site talking about it? Is VA 'leadership-in-mental-health' aware of it?
I've shared the existence of the article with a couple of colleagues as well as my clinic workgroup.
Mental health administrators at my VA are going to be absolutely livid. Distributing findings like this from the empirical literature (even from the VA's own research efforts and publications) is to be considered heresy against the religion of exploiting providers and harming veterans as a means to the end of one's own career advancement. I don't really care at this point.
For some reason, SDN isn't allowing me to upload/attach a copy of the .pdf as a file.
Here is a link to the article page, though, if anyone has access:
The Impact of Provider Productivity on Suicide-Related Events Among Veterans - PubMed
Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access...
Don't you hate it when research and reality get in the way of political priorities?
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Thanks for this...shared it among colleagues and will probably bring it up to my bhip even though it'll go nowhereI just found this article that was published in January 2026 that appears to substantiate findings of increased incidents of suicide-related events (SRE's) associated with increased psychotherapist (mental health provider) workload (number of patients seen per day) in VA settings. It is a HUGE sample (using data from the national data 'warehouse').
The main findings of the study are (from the abstract):
Principal findings: A 1% increase in therapy provider work rate led to a 12.1% increase in SRE probability, regardless of staffing levels. Conversely, a 1% increase in staffing levels led to a 1.6% reduction in SREs, with the largest effect in low-staffed facilities. For medication management providers, work rate had no overall impact on SREs, except in medium-staffed facilities. A 1% increase in staffing levels for medication management providers led to a 1.7% reduction in SREs.
Conclusions: Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access to mental health clinics and ensure Veteran safety and care quality.
The study is titled, 'Impact of provider productivity on suicide-related events among veterans.'
Although the study findings/conclusions/recommendations are obvious (to anyone working in VA mental health right now on the front lines as a provider), the fact that this is, essentially, a publication that came from VA researchers (at the Boston VA) and is on veteran patients from within that system makes it all the more crucial to consider. Of course, it also has implication outside the VA and veterans. All over mental health, providers are being expected to do increasingly 'more with less' and this is harmful/neglectful to patients.
Was anyone else aware of this study? Are the people at your VA site talking about it? Is VA 'leadership-in-mental-health' aware of it?
I've shared the existence of the article with a couple of colleagues as well as my clinic workgroup.
Mental health administrators at my VA are going to be absolutely livid. Distributing findings like this from the empirical literature (even from the VA's own research efforts and publications) is to be considered heresy against the religion of exploiting providers and harming veterans as a means to the end of one's own career advancement. I don't really care at this point.
For some reason, SDN isn't allowing me to upload/attach a copy of the .pdf as a file.
Here is a link to the article page, though, if anyone has access:
The Impact of Provider Productivity on Suicide-Related Events Among Veterans - PubMed
Increased work rates, particularly in low-staffed VHA facilities, may elevate suicide-related risks. In contrast, staffing increases simultaneously improve access and reduce adverse outcomes. Where possible, policymakers should prioritize staffing growth over productivity gains to improve access...
I'm not sure if this is the right thread for this question, but since presumably most of the people contributing work for the VA (I don't), I'll ask:
How normative is it for a veteran on 100% disability rating to work full-time? I'm not necessarily talking about working an oyster farm, just wondering about employment in general.
How normative is it for a veteran on 100% disability rating to work full-time? I'm not necessarily talking about working an oyster farm, just wondering about employment in general.
Sanman
O.G.
Here is a fun fact, 1 in 5 active American pilots who are veterans hold a 100% VA disability rating. Planning on taking any trips soon?
I hope I'm retired before the Congressional hearings begin.
I don't have hard numbers, but just based on anecdotal experience--it's not uncommon. I saw many who were full-time salaried employees, owned and operated one or more businesses, etc.
It's getting much, much less uncommon over time (as time goes on). Meaning, it appears to me (anecdotally, too) that more and more of the population is trying to 'qualify' for mental health / PTSD disability (especially veterans). The attitude seems to be, 'if you served/deployed and you haven't 'got your PTSD [service-connection] yet, then you're a fool/sucker/ missing out and Uncle Sam OWES you that money.' You did your time in the military, served your country, put up with the indignities of boot camp and all the suffering that comes with the uniform, they treated you like crap so you're owed that money. The newest conspiracy nonsense I'm hearing is the belief that 'the Federal government sets aside enough money for every veteran to draw 100% disability in retirement for life and anything less than 100% represents the government trying to 'steal that money' that was set aside for veterans.' I'm not even kidding. I think this is being spread online and by word of mouth. There is also the nonsense that 'service-connected disability' percentages don't have anything to do with actual disability or ability to work. I'm seeing frequent re-consults to PCT for people who are very well known in our mental health system (have been seen by many, many, many MH providers over the years all saying the same thing -- other than PTSD diagnoses) who nobody wants to say 'no' to on the PTSD questions so they just keep bugging them for a PTSD diagnosis. The common patterns here are: (a) externalizing personality disorders, aggression, non-compliance, histories of Article 15s and other disciplinary actions, other-than-honorable discharges, involvement with Veterans Justice Outreach, history of legal problems, homelessness, financial problems, substance abuse; (b) having a well-established non-PTSD diagnosis that they don't want to have (SUDS, schizophrenia), (c) total non-compliance with treatment for those conditions (as soon as someone enters the PCT consult for them, they start cancelling and no-showing all their SUDS appointments ('I don't need to work on that (alcohol abuse), my real problem is PTSD, I wanna take my PTSD classes now and focus on that'); (d) what I call 'The Easter Egg Hunt for Criterion A (an ever-changing/evolving series of more-and-more (8 to 12) 'stressful life events' that they begin reciting as soon as they sit down and you ask them why they're presenting to mental health; (e) rather than someone sharing their problems and experiences with you, they present as if they are 'auditioning' for the PTSD diagnosis, i.e., totally focusing on the jargon ('hypervigilance') and tropes ('sit with my back to the wall, avoid crowds, anxious about everything, all the time (but no clue what they are actually fearful of); (f) as soon as you ask them to 'zoom in' on some label ('hypervigilance,' 'anxiety,' or 'nightmares') there is nothing underneath the label ('what do you mean by 'hypervigilance,' tell me in your own words what that means, what do you experience?' 'Describe a typical dream'). Not infrequently, they become very irritable and start attacking you for asking these questions (standard interview questions) and saying you're 'interrogating' them (even though they were sent over for 'evaluate for PTSD'). 'Evaluate for PTSD' but doesn't want to talk about trauma history (at all) or ostensible trauma-driven symptoms (beyond 'labels'). Some of these people have been sent to PCT to 'evaluate for PTSD,' or 'treat for PTSD' or 'this veteran reports X trauma' up to three or four times and every psych eval/ intake has been a 'no' in the past. The question has been asked and answered before but they just keep trying over and over again to get the diagnosis and providers just keep referring them. I'm all for people who actually have the condition of PTSD getting properly diagnosed, treated, and service-connected for it. Just yesterday I recommended to bosses that we consider establishing a 'my vet says they have PTSD, what do I do?' e-consult. I'm just seeing more and more of really questionable (in terms of clinical facts) cases actively 'trying to get a PTSD diagnosis' than ever before. I think the bubble is going to pop someday and it may even have negative impacts on public image of what actual PTSD truly is and will actually potentially hurt veterans who have that condition one day. Time will tell.
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Can we get this AI advertisement slop out of here?
Edit: Thank you, it has been removed
Edit: Thank you, it has been removed
We're seeing our first influx of people who served in the Iran conflict (or war or whatever you call it) and it's awful. They're really struggling and we're already stretched so thin, but we don't want to send them to the community because God knows what sort of treatment they'd end up getting. And that's assuming the community providers wouldn't nope out and tell them that they need to go to the VA
The GOP is good for job security in the VA. Well...at least until they make another concerted effort to privatize it.
Sanman
O.G.
Y'all are nicer than me. At this point I am all about a little exposure to an adverse stimulus to elicit political change.
We just got a new memo. I am no longer an LGBTQ+ Veteran Care Coordinator. I am just a Veteran Care Coordinator and treat everyone the same. I don't even know what that means.
I'm wondering about the LGBTQ+ fellows. Are they just fellows now?
It didn't say in the email that apparently went out to everyone on a Friday afternoon. VCCs got a special mention for whatever reason. I don't think they can change too much because our role is required. They might just be annoyed with our title.
They do tend to send these e-mails out on Fridays ~15 minutes before EOD
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Yeah, I've noticed that too. They want to make us miserable for the weekend, I guess. And it's also Pride month...
Yeah I'm just going to refer to them as the lgbtq coordinator anyway and treat them as such. If they want to police the language I use in session, fire me
Sanman
O.G.
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