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

cara susanna

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At our facility all psychologists are* expected to do them part-time, like 1-2x/month. Don't get me started - we all absolutely hate doing them.

*I guess that'd be "were" now since it's changing
 
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Thought folks in this thread would find this interesting....
where are we with the entire intravenous disinfectants and internal UV lights?
 

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Thought folks in this thread would find this interesting....
I read this, but a lot of doctors are still using this cocktail in and out of the VA.
 

cara susanna

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This isn't a vent but I'm wondering. Outside of the VA, how do MH patients react when they show up and find out that their appt has been cancelled or something? Do they also often get very upset and act rudely towards the front desk staff? I guess I'm wondering if this is a MH thing or a VA thing. I've never had a clinical job outside of the VA so I wouldn't know.
 

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This isn't a vent but I'm wondering. Outside of the VA, how do MH patients react when they show up and find out that their appt has been cancelled or something? Do they also often get very upset and act rudely towards the front desk staff? I guess I'm wondering if this is a MH thing or a VA thing. I've never had a clinical job outside of the VA so I wouldn't know.
I think the real question is why would this ever happen.
 

cara susanna

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I think the real question is why would this ever happen.
They don't get the cancellation phone call, like let's say their provider calls out sick that day. More recently it's been people who weren't aware their appt was switched to phone or video.
 
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Sanman

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They don't get the cancellation phone call, like let's say their provider calls out sick that day. More recently it's been people who weren't aware their appt was switched to phone or video.
The rude thing happens with all patients in all settings. I find that the highest and lowest SES folks have the strongest reactions. The difference with the VA is that it is a large organization and you lack control over the way admins handle these issues. This is similar to other large orgs. Smaller practices seem to do more quality control of staff. That said, I once had a mother make excuses about why she could not pay my session fee (fee-for-service) while complaining about her behaviorally challenging child (client) who peed on the seats of her brand new Cadillac SUV. So, there are all kinds.
 

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I've had folks wildly inappropriate because they thought the front desk didn't say hello nicely enough and one poor guy who showed up twice in a row without being seen who was completely understanding (which is good because it was actually his fault - set up your darn voicemail people).

I think this just goes with the territory of any job involving human interactions.
 

Therapist4Chnge

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Think we can get Trump to do some Nelly Karaoke? Maybe instead of a presidential debate. Would be the most useful thing he has done since the pandemic started.
I once crashed a private party w. Nelly. Super nice guy. He impromptu did an entire set of Jackson Five songs. It was really good, and you can tell he was a big fan. Yes, he wore the band-aid under his eye.
 
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PsychPhDone

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This isn't a vent but I'm wondering. Outside of the VA, how do MH patients react when they show up and find out that their appt has been cancelled or something? Do they also often get very upset and act rudely towards the front desk staff? I guess I'm wondering if this is a MH thing or a VA thing. I've never had a clinical job outside of the VA so I wouldn't know.
I've seen this happen at a non-va medical clinic and went over to check on the staff after. It was weird to see it in the wild.
 

AbnormalPsych

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This isn't a vent but I'm wondering. Outside of the VA, how do MH patients react when they show up and find out that their appt has been cancelled or something? Do they also often get very upset and act rudely towards the front desk staff? I guess I'm wondering if this is a MH thing or a VA thing. I've never had a clinical job outside of the VA so I wouldn't know.
I've never had this happen outside of VA.

One of the biggest and most helpful changes I experienced leaving VA was a reception/support staff who were competent, motivated, and super on top of their and my stuff. Maybe a relation there.
 

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I've never had this happen outside of VA.

One of the biggest and most helpful changes I experienced leaving VA was a reception/support staff who were competent, motivated, and super on top of their and my stuff. Maybe a relation there.
Yeah, as soon as I know I am out for the day, which is usually 5AM, it goes into the provider call out line, and then they clear my schedule, usually calling the patients at 7. Very few patients live more than an hour away, so it captures the majority. Also, I very rarely call out, so don't worry about it too much yet.

But, in general, I've found patient attitudes towards front office staff to be remarkably better outside the VA., And, our general clinic caters to serious comorbidities (SUD, lots of Axis II, low SES, etc). The entitlement of the patients in the VA, combined with few or no consequences for aggressive or violent behavior towards staff definitely contributes to some of the VA issues.
 
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IWillSurvive

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Not really a venting or problem-solving related question...but what are the things I need to know when considering a temporary/NTE VA position?

Also what is the difference between the direct hire process vs. the usajobs posting process (in terms of interview, on-boarding, etc.)? Why might a facility go that route?
 
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Fan_of_Meehl

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Not really a venting or problem-solving related question...but what are the things I need to know when considering a temporary/NTE VA position?

Also what is the difference between the direct hire process vs. the usajobs posting process (in terms of interview, on-boarding, etc.)? Why might a facility go that route?
1) working with veterans is cool
2) ignore administration
 

iliketohelppeople

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Not really a venting or problem-solving related question...but what are the things I need to know when considering a temporary/NTE VA position?

Also what is the difference between the direct hire process vs. the usajobs posting process (in terms of interview, on-boarding, etc.)? Why might a facility go that route?
My understanding is that the direct hire position allows them to make certain types of flexibilities (don't have to have certain things on your resume/qualifications?, can hire folks easier/quicker [this i am pretty sure is the case]). I talked with some MH recruiter types and they made it sound like usually the usajobs posting process (instead of the direct hire process) is a result of HR not really knowing what they are doing (and thus posting on USAjobs and then often rejecting qualified trainees that the VA just spent oodles of money training). From what I hear, this is a pretty bad problem broadly (and costs the VA millions of dollars), hence the VA hiring recruiters to smooth this process over...

I personally know a few qualified trainees who were completing their fellowships and applied to staff jobs via usajobs and HR rejected them immediately and the recruiters/mh admin were less than pleased that it was posted on usajobs in the first place. If you want to stay in the VA as a trainee at the staff level, I recommend considering the MH recruitment process they have (fall and spring I think). This process is in place to smooth out all of these issues and secure the investment the VA made in trainees. May not be as helpful in competitive metros, but there are quite a few VAs really looking for psychologists. For a VA process, the MH trainee recruitment event is a pleasant surprise: it is not a hot mess.
 

IWillSurvive

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My understanding is that the direct hire position allows them to make certain types of flexibilities (don't have to have certain things on your resume/qualifications?, can hire folks easier/quicker [this i am pretty sure is the case]). I talked with some MH recruiter types and they made it sound like usually the usajobs posting process (instead of the direct hire process) is a result of HR not really knowing what they are doing (and thus posting on USAjobs and then often rejecting qualified trainees that the VA just spent oodles of money training). From what I hear, this is a pretty bad problem broadly (and costs the VA millions of dollars), hence the VA hiring recruiters to smooth this process over...

I personally know a few qualified trainees who were completing their fellowships and applied to staff jobs via usajobs and HR rejected them immediately and the recruiters/mh admin were less than pleased that it was posted on usajobs in the first place. If you want to stay in the VA as a trainee at the staff level, I recommend considering the MH recruitment process they have (fall and spring I think). This process is in place to smooth out all of these issues and secure the investment the VA made in trainees. May not be as helpful in competitive metros, but there are quite a few VAs really looking for psychologists. For a VA process, the MH trainee recruitment event is a pleasant surprise: it is not a hot mess.
Thanks for your response. I am actually a psychologist in a VA position currently and was actually initially hired the recruitment initiative which was seemed to go well w/ some facilities and less well with others, but I was grateful to get a job out of it! I'm curious about what might be different in a direct hire process vs. a usajobs process in terms of interviewing and onboarding. I'm also curious about any cons to a time-limited/temporary position (thinking on the benefits side of things...is there any sort of step/rank increase I won't qualify for? is there any sort of leave I wouldn't be able to receive? I believe EDRP is automatically off the table? etc)
 

iliketohelppeople

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Thanks for your response. I am actually a psychologist in a VA position currently and was actually initially hired the recruitment initiative which was seemed to go well w/ some facilities and less well with others, but I was grateful to get a job out of it! I'm curious about what might be different in a direct hire process vs. a usajobs process in terms of interviewing and onboarding. I'm also curious about any cons to a time-limited/temporary position (thinking on the benefits side of things...is there any sort of step/rank increase I won't qualify for? is there any sort of leave I wouldn't be able to receive? I believe EDRP is automatically off the table? etc)
I don't know too much about the benefits - EDRP is likely off the table I imagine as well. I think paid trainees fall into this category of employee (or a similar type of time-limited) and get all benefits that other employees get with the exception of access to TSP (and matching funds). Also, trainee time does not count towards pension. Aside from that, I think everything else is similar. Again, that is what is true for paid trainees, but I know HR has talked about us as time-limited before...

My only guess is that direct hire makes it a bit quicker - they may not have to wait as long as required if it is posted on USAjobs? I don't know if anything would make onboarding quicker at the VA...
 

IWillSurvive

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I don't know too much about the benefits - EDRP is likely off the table I imagine as well. I think paid trainees fall into this category of employee (or a similar type of time-limited) and get all benefits that other employees get with the exception of access to TSP (and matching funds). Also, trainee time does not count towards pension. Aside from that, I think everything else is similar. Again, that is what is true for paid trainees, but I know HR has talked about us as time-limited before...

My only guess is that direct hire makes it a bit quicker - they may not have to wait as long as required if it is posted on USAjobs? I don't know if anything would make onboarding quicker at the VA...
Yea, HR seems to have a lot of influence on the definition of 'employee.' During my fellowship, I was not able to get paperwork signed for PSLF because HR said they would not say I was an employee, which was insane because PSLF doesn't care about VA's definition of employee...they literally mean you get paid to work there. Sigh.
 
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PsychPhDone

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Not really a venting or problem-solving related question...but what are the things I need to know when considering a temporary/NTE VA position?

Also what is the difference between the direct hire process vs. the usajobs posting process (in terms of interview, on-boarding, etc.)? Why might a facility go that route?
In terms of the nte, if the appt was less than 1 year, you're considered temporary in some situations which can affect your eligibility for some benefits. You may not be eligible for certain retention bonuses. It used to be the case that you were not eligible for health benefits for the first year but I believe that changed - you should confirm with hr. Also may be some limitation in retirement as others mentioned.

I was a direct hire. I did not have to interview. If hr hadn't royally f-ed up, I could have been hired in 6-8 weeks.
 
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Thanks for your response. I am actually a psychologist in a VA position currently and was actually initially hired the recruitment initiative which was seemed to go well w/ some facilities and less well with others, but I was grateful to get a job out of it! I'm curious about what might be different in a direct hire process vs. a usajobs process in terms of interviewing and onboarding. I'm also curious about any cons to a time-limited/temporary position (thinking on the benefits side of things...is there any sort of step/rank increase I won't qualify for? is there any sort of leave I wouldn't be able to receive? I believe EDRP is automatically off the table? etc)
Direct hire is (theoretically) faster and less administratively burdensome. It's what supervisors probably wish they were able to do for all providers' positions.

I actually don't know what NTE/temporary positions are and are not eligible for, but I have a sneaking suspicion they wouldn't count toward things like pension/retirement (although as you probably know, if you contribute to FERS, then it counts), and wouldn't be eligible for EDRP or other "perks." Checking with HR is probably your best bet, there, as much of a crapshoot as that can be.
 
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cara susanna

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Random vent: I wish therapy referrals would be less about "does this person need therapy?" and more about "is this person actually ready for therapy?"
 
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I feel sad for some people that had bad experience in their work, hoping to find the right one for you!
 

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I once got VA HR to respond in a timely, reasonable, and logical manner to a request. A proud and rare accomplishment indeed.
I once stopped by Travel to get some reimbursements approved and paid for at 9:30am. There was a note on his chair stating that he was at lunch and would return at 3:30 pm. I am not even joking.
 

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'increased mental health access but no plan for improved access to ongoing care'
THIS x 1000!

The idiot administrators in mental health (at the level of implementation) are implementing the whole 'initial access' push at the level of 'same day access' (which I agree is cool and make sense) for a triage intake and/or a full intake (arguably 'session #1'). Fine.

However, this has resulted in some areas--especially in CBOCs or in 'open access' 'generalist' mental health settings such as post-deployment clinics, psychology clinics, etc.--being placed in the ridiculous situation of being so overloaded with clients (HUGE caseload numbers) such that the AVERAGE time between sessions (even ignoring no-shows or cancellations) would have to be between 30 and 60 days IN BETWEEN SESSIONS.

No mental health provider can consider such infrequently occurring therapy sessions to constitute standard of care/practice psychotherapy. However, whenever this is brought up to administrators, they immediately play 'blame the provider' and default to 'you need to manage your caseload better.' Now, this MAY be a fair point or argument to make, assuming equal influx and efflux of cases across clinics. However, there are often HUGE shifts in rate of referrals to various clinics (and extreme inequities in terms of patient flow) and basic arithmetic/logic and logistical planning in order to try to influence caseloads to be approximately comparable across clinicians or clinics is never applied to the problem of an overloaded clinic (at least at my facility). The problem is either ignored or explanations arbitrarily and automatically blame the provider in some way.

Compounding the problem are inflexible 'mental health no-show followup' policies/procedures that MANDATE that--after any no-show, for example--the provider MUST call (and document on separate days) at least three attempts to contact the veteran by phone, then the clerk must send a letter to the veteran, then (if 14 days have passed with no response), the ball gets kicked back to the clinician who has to do a 'risk assessment' of the client/situation to determine 'what to do from there' (including performing a welfare check by the cops). And try to document a 'risk assessment' process when a) you have no client information to feed into that process (since it's likely been several weeks or even months since you had any contact with them) and b) you have to justify why you're NOT taking the step of sending the cops over to their place to check on them. What is so ridiculous about this is that there are tons of folks who are simply in the pre-contemplation phase (or they vacillate up to the contemplation or action phases of a transtheoretical model of behavior change and then back down again) and who are simply trying to self-select (passively) out of therapy. Now, of course in the context of repeated no-shows, not answering phone calls, etc. as a therapist I directly address this behavior with the veteran when/if I get ahold of them or when they come back into therapy 6 to 18 months later. However, many veterans (esp. those who depend on service-connection for income/housing/medical/educational benefits) are EXTREMELY reluctant to acknowledge either not needing or wanting therapy at any point in time because they figure that it will 'mess with their benefits.' The whole system is a dumpster fire because there is absolutely no leadership above the level of the rank-and-file clinicians who are willing to a) acknowledge and address certain inconvenient truths in the system (e.g., that we are paying people to be and to remain sick and this influences their behavior) and/or b) make a choice between logically contradictory philosophical approaches to, say, outpatient mental health service delivery (on the one hand, OMG we have to provide it to everyone, all the time, with no limitations or rationing because #BeThere and one suicide is too many while, on the other hand, OMG we have a budget crisis so we need people in your caseload to only be there for the 12 weeks it takes for them to successfully complete an EBT protocol and get better so they never have to use the MH system again).
Wow, where is this crazy no-show policy and procedure in place?
 

cara susanna

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Is it three appts and a letter or two appts and a letter? Having no actual appts in the system I don't remember.
Three calls and a letter. At least where I am. I used to do two calls and a letter but then they made it VERY clear that it was three calls, lol.
 
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blueslily

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Every VA has this, although some are more leniant with who makes the phone calls and how many days you have to make the three attempts.
[/QUOTE


Oh, we have the three calls and 1 letter requirement. Thats it. And we can do that all in one day. If no response in 14 days from the letter, we enter a discharge note. To me thats already a lot. We can also discharge for a pattern of cancellations or not engaging in treatment (not working on goals).
 

cara susanna

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I'm jealous of your 14 day rule! We can cancel future appts after two consecutive NSes or late cancellations, and the patient isn't allowed to schedule therapy appts again until they've demonstrated they can attend (by, say, attending a group a few times). We theoretically can discharge for lack of treatment goals, but... it's not as clean in practice.
 

blueslily

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I'm jealous of your 14 day rule! We can cancel future appts after two consecutive NSes or late cancellations, and the patient isn't allowed to schedule therapy appts again until they've demonstrated they can attend (by, say, attending a group a few times). We theoretically can discharge for lack of treatment goals, but... it's not as clean in practice.
Yes, its just hard to enforce sometimes.
 

blueslily

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I'm jealous of your 14 day rule! We can cancel future appts after two consecutive NSes or late cancellations, and the patient isn't allowed to schedule therapy appts again until they've demonstrated they can attend (by, say, attending a group a few times). We theoretically can discharge for lack of treatment goals, but... it's not as clean in practice.
Sadly, sometimes clinicians are so busy they dont have time to enter the discharge notes so the clock keeps ticking. Thanks for the reminder. I will put that on my to do list for Monday. Catch up on those discharges.
 
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Unfortunately the 2 years is firm. I was in the same boat :( Although the department was supportive, there is no wiggle room.
 
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