What I have encountered (over and over again) and, yes, in psychologist leaders as well is whenever concerns/questions are raised (which is exceedingly rare given the organizational climate and its tendency to punish critical discussion), the immediate responses appear directly geared toward shutting down any and all discussion. They even pre-emptively say things like, 'We're going to discuss X {some new politically/administratively unjustifiable burden on the providers}, now there's no point in saying we shouldn't be doing things this way because {the higher ups say we're going to do it and so we're going to do it}.' So, we're not really going to 'discuss' anything; we're going to receive our marching orders.
However, as I am tried making the point to them (before giving up entirely), even if 'there's nothing that we can do about it' in terms of 'reversing' some mandate from Central Office (I agree, we're not going to do that), it is still worthwhile for the front-line psychologists to be able to COMMUNICATE to their leadership (and one another) challenges, rationale (or lack thereof), implementation barriers, frustrations (and potential solutions), ethical/legal/moral dilemmas (which are frequent), and the challenge of reconciling often conflicting policies/procedures, and efforts to manage role conflicts and conflicts among various duties in the day to day clinical practice in VA outpatient settings. What I have universally experienced is the immediate tendency to 'shut down' any and all discussion. A competent and high-quality leader WANTS TO HEAR about such things from her/his subordinates because, otherwise, they are flying blind when sitting in meetings with the other 'higher-ups' and deciding local policy/procedure and can, therefore, be an articulate advocate for his/her psychology staff. Moreover, it really contributes to provider burnout to not even be able to articulate your concerns to leadership without being shut down. Finally, one psychologist may have innovated (because we have to) a decent solution to a role conflict or other clinical problem and it would be worthwhile for them to be able to share it with the group.
A couple of case examples of what I consider a failure in MH leadership all the way up and down the organization are how things like 1) caregiver support (for MH problems) and 2) service dogs have been handled over the years. And, yes, I know about the recently made public monograph on the two-arm study but that topic is worthy of its own discussion thread.
Regarding 'caregiver support' (as a paid benefit to spouses) to 'treat/manage' mental health conditions like PTSD and depression (most frequently requested). Nine or ten years ago when this was just rolling out to VA hospitals, it was obvious to any clinician worth their salt that this was a terrible idea from a mental health recovery perspective. There is no literature on using a paid family member as a 'caregiver' to treat PTSD. In fact, a very good argument can be made that it is actually iatrogenic (for reasons I can spell out if I need to). But I didn't (still don't) see any evidence of any real articulated opposition to the idea from leadership in mental health. If they DID articulate any meaningful dissenting views, why couldn't they have just shared that with us, say, in private one-on-one meetings or in service meetings? For example, 'Folks, I know this doesn't comport with the professional/scientific literature but I have raised my concerns to leadership in X meeting but we are still being given the directive.' Nope. That's not what we get. We get them 'selling' the idea to us (like it's a used car) and we're supposed to 'sell' it to veterans and/or go along with the practice. Now (finally) several years later, the organization is realizing what a bad idea caregiver support for PTSD is and they have completely re-vamped the program to handle it very differently. Would have been nice if the organization had listened 10 years ago.
There is so much to say about the service dog issue I'll try to be as brief as possible and focus on just one really frustrating part. The new idea of considering the service dog a 'prosthetic' to be 'prescribed' by a MH provider (and they came up with a new term/concept of the 'Mental Health Mobility Dog.' We are supposed to get with our 'interprofessional team' when a veteran makes a request for a 'Mental Health Mobility Dog' for his PTSD and do an 'evaluation' and if we believe that the mobility dog is the 'optimal' (their words) intervention to address his 'mental health mobility issue' then we are to write a prescription (to 'prescribe,' their word) and articulate how it is necessary to their mental health treatment plan. This is so that they can qualify to have the VA pay lifetime insurance/equipment costs for the dog. Setting aside for the moment the legal/ethical issues involved in 'prescribing' animals (for which there is no serious literature or training programs to teach folks how to do this, nor are there any references or resources in the clinical and scientific literature that operationally define such an 'assessment' procedure--in fact, it seems to be simply a (golden) rubber-stamping procedure in which everyone who wants a dog gets a dog or there will be hell to pay. And if the 'assessment' is merely a background check and review to make sure the person isn't a homeless debilitated alcoholic who hates dogs then it's trivial and doesn't require a doctoral level psychologist to complete it. Who's going to say 'no' to a veteran requesting this? Under what conditions WOULD you say no? I mean, what exactly does a 'dog prescriber' do in terms of their assessment procedures and deliberations before 'deciding' to prescribe the dog? I can take down from my bookshelf Stahl's prescriber guide and see quite clearly the things a competent medication prescriber needs to take into account, the knowledge necessary to prescribe, and the responsible execution of that duty to prescribe. The dog? What is wrong with the term 'recommend?' I'll stop, but you get the point. Where was the 'leadership' in psychology within the VA organization on this one. Did they articulate similar concerns? Where is the evidence for this? They sure as hell haven't communicated this to the rank-and-file. I imagine that when this comes down and we 'receive' 'further guidance' from on high that the 'discussion' on the topic will take the predictable form of: (1) Here is what you are to do; (2) you must comply (or else); (3) there's no point in raising concerns, objections, or ethical dilemmas about it, we have to do it so just do it.
I should also say that I'm equally disappointed in the psychology leadership/luminaries in the field OUTSIDE of the VA for failing to speak up on such issues. Back in the day when the 'r thecovered memory' nonsense was rampant, at least back then the leaders of the field (many of them) had the bravery to do the right thing and voice unpopular opinions regarding how this was indeed nonsense (no matter how popular in the tabloids and news). I don't see anything of the sort happening on some of these other fads recently like emotional support/ service animals as treatments for mental health conditions or caregiver support. We should expect better. We should at least expect a decent expression of their struggles (as leaders) to communicate to other non-psychologists the issues that we struggle with (and to listen to us, as we struggle to implement some of this nonsense).
