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

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cara susanna

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Glad I received this memorandum with some vital clarifications today:
View attachment 316283
I am... so confused by this. Is it a joke? A genuine mistake? If it's a joke, I don't get it. If it's a mistake, how do you make a mistake like that?

In terms of my own venting, we've had some really bad therapy referrals lately. The intake people are not getting any administrative support not to assign them for therapy, so... fun times. I'm also soooo sick of no show calls. I've had about one NS per day on average lately.
 

WisNeuro

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I am... so confused by this. Is it a joke? A genuine mistake? If it's a joke, I don't get it. If it's a mistake, how do you make a mistake like that?

In terms of my own venting, we've had some really bad therapy referrals lately. The intake people are not getting any administrative support not to assign them for therapy, so... fun times. I'm also soooo sick of no show calls. I've had about one NS per day on average lately.

No shows for virtual stuff wouldn't be so bad if it weren't for all the extra setup that's involved, at least for our system. I think I spend at least 4ish hours a week tech troubleshooting these days.
 
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Sanman

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I am... so confused by this. Is it a joke? A genuine mistake? If it's a joke, I don't get it. If it's a mistake, how do you make a mistake like that?

In terms of my own venting, we've had some really bad therapy referrals lately. The intake people are not getting any administrative support not to assign them for therapy, so... fun times. I'm also soooo sick of no show calls. I've had about one NS per day on average lately.

No shows for me a have been annoying lately. People keep wanting to reschedule virtual because they forgot and don't know how to set it up. So much easier to show up at their front door and just get my stuff done. Also, other people's incompetent trainees are driving me extremely nuts. Why did I decide to be a good person and help other people with supervision? Having extra liability and no authority over others is exactly why I hated my last job, so I should have expected this to be terrible.
 

Fan_of_Meehl

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I am... so confused by this. Is it a joke? A genuine mistake? If it's a joke, I don't get it. If it's a mistake, how do you make a mistake like that?

In terms of my own venting, we've had some really bad therapy referrals lately. The intake people are not getting any administrative support not to assign them for therapy, so... fun times. I'm also soooo sick of no show calls. I've had about one NS per day on average lately.
One thing that would help would be a small co-pay / penalty charged for no-shows. We also work with a relatively young population who are often at work--on the clock--during the appointments. When all of this began, I asked the chain of command if I could have that as a 'hard' boundary but was told to just handle it the way I would homework noncompliance. Right. Now it seems no-shows are up because the novelty of telehealth has worn off and I suspect a lot of client resistance to doing video is because that's harder to do at work on the sly. Haven't quite gotten to the point of utter temerity/cynicism to share that hypothesis with admin, though. There are a LOT of systemic issues contributing to high no-show/cancellation rates in the VA system but they aren't ackowledged because that would mean holding management or veterans responsible. Instead, we just go round and round blaming providers constantly.
 
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Sanman

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One thing that would help would be a small co-pay / penalty charged for no-shows. We also work with a relatively young population who are often at work--on the clock--during the appointments. When all of this began, I asked the chain of command if I could have that as a 'hard' boundary but was told to just handle it the way I would homework noncompliance. Right. Now it seems no-shows are up because the novelty of telehealth has worn off and I suspect a lot of client resistance to doing video is because that's harder to do at work on the sly. Haven't quite gotten to the point of utter temerity/cynicism to share that hypothesis with admin, though. There are a LOT of systemic issues contributing to high no-show/cancellation rates in the VA system but they aren't ackowledged because that would mean holding management or veterans responsible. Instead, we just go round and round blaming providers constantly.

Of course, it will not be acknowledged because the VA has this habit of adopting ridiculous "all or nothing" policies. Like everything can always be fixed. I am waiting for them to bring out the "Zero deaths for any reason" campaign to put an end to aging and medical illness.
 

cara susanna

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One thing that would help would be a small co-pay / penalty charged for no-shows. We also work with a relatively young population who are often at work--on the clock--during the appointments. When all of this began, I asked the chain of command if I could have that as a 'hard' boundary but was told to just handle it the way I would homework noncompliance. Right. Now it seems no-shows are up because the novelty of telehealth has worn off and I suspect a lot of client resistance to doing video is because that's harder to do at work on the sly. Haven't quite gotten to the point of utter temerity/cynicism to share that hypothesis with admin, though. There are a LOT of systemic issues contributing to high no-show/cancellation rates in the VA system but they aren't ackowledged because that would mean holding management or veterans responsible. Instead, we just go round and round blaming providers constantly.
That makes a lot of sense. In the community, if you NS, you get charged anyway.

I've also heard theorizing that the higher NS/cx rate is because people aren't getting travel pay for phone or video appts.
 

Fan_of_Meehl

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That makes a lot of sense. In the community, if you NS, you get charged anyway.

I've also heard theorizing that the higher NS/cx rate is because people aren't getting travel pay for phone or video appts.
It could well play into it. I'm also noting fewer cancellations (they just no show the telehealth appointment). Apparently they have the MSA's combing through and tallying the cancellation and no-show rates and call kinds of statistics and will probably pummel us with these and accusations of us doing something wrong to 'cause' it. They will NEVER examine systemic causes/solutions offered by front-line providers.
 

AbnormalPsych

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who are often at work--on the clock--during the appointments.
I am sober from VA for a few years now, but I get this in my private system too. It annoys the **** outta me when people have 20-25 min for lunch break and that is when they schedule their appointment and do not tell me this until halfway in when they need to leave their parked car in the parking lot and go back in.
 

summerbabe

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I've also heard theorizing that the higher NS/cx rate is because people aren't getting travel pay for phone or video appts.
Yup, lots of phone/VVC no shows here as well and I would bet money on the lack of travel pay playing a role, especially at my VA, where a large portion of our patients live 30-90 miles away. I also think some feel like they still need to stay somewhat engaged with MH to maintain their disability benefits.
 
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WisNeuro

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Does anyone else wish you could put in the note "patient went on long rant about politics, including espousing theories that have been debunked by mainstream media"?

I guess this isn't unique to the VA, probably, although you don't have to worry about Hatch Act violations.
I have definitely documented patients going on long political rants with difficulty redirecting them to the purpose of the appointment. Although, I try to keep it somewhat nonspecific ;) I will say, I get much less in the way of political rants outside of the VA. Last one I can remember was actually a pts son who asked me about COVID, wanting me to tell him it was "just the flu." I simply told him, "yeah, if the flu killed about 10 times more people than it normally does, than I guess this is just like the flu." I'll have to revise up that number now that another month has passed.
 
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beginner2011

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I have definitely documented patients going on long political rants with difficulty redirecting them to the purpose of the appointment. Although, I try to keep it somewhat nonspecific ;) I will say, I get much less in the way of political rants outside of the VA. Last one I can remember was actually a pts son who asked me about COVID, wanting me to tell him it was "just the flu." I simply told him, "yeah, if the flu killed about 10 times more people than it normally does, than I guess this is just like the flu." I'll have to revise up that number now that another month has passed.
Don't forget that the 10x number is in the context of extensive physical distancing policies and directives... :thumbup:
 

WisNeuro

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Don't forget that the 10x number is in the context of extensive physical distancing policies and directives... :thumbup:
True, but we'd have to balance slightly on the side of ~40% getting a flu vaccine every year, though you'd have to average out the effectiveness as it varies on several factors. Complicated equation, but yes, unequivocally, much much much worse than flu in many ways.
 
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Sanman

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Does anyone else wish you could put in the note "patient went on long rant about politics, including espousing theories that have been debunked by mainstream media"?

I guess this isn't unique to the VA, probably, although you don't have to worry about Hatch Act violations.
There should be a check box for this, it is half my sessions. Oh, election year...

Really though the bigger issue to me is RQI BLS stuff. How has national not suspended this again? Work form home due to COVID, but come in and stand in lines to cough and spit over the same CPR dummy?
 

cara susanna

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Really though the bigger issue to me is RQI BLS stuff. How has national not suspended this again? Work form home due to COVID, but come in and stand in lines to cough and spit over the same CPR dummy?
SERIOUSLY. And in our clinic we have to go into the Primary Care building to access it. Not exactly my favorite place to be right now...
 

Fan_of_Meehl

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There should be a check box for this, it is half my sessions. Oh, election year...

Really though the bigger issue to me is RQI BLS stuff. How has national not suspended this again? Work form home due to COVID, but come in and stand in lines to cough and spit over the same CPR dummy?
The VA does not think. It implements. Mercilessly and perversely.
 

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Does anyone else wish you could put in the note "patient went on long rant about politics, including espousing theories that have been debunked by mainstream media"?

I guess this isn't unique to the VA, probably, although you don't have to worry about Hatch Act violations.
One friend who worked at a VA said that they had to turn off the TVs in the waiting rooms because patients were watching political news and getting into literal physical fights about it,
 

summerbabe

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One friend who worked at a VA said that they had to turn off the TVs in the waiting rooms because patients were watching political news and getting into literal physical fights about it,
It's sad but I don't doubt it. I was at a VA that showed HGTV 24/7, which I rarely saw any veterans actually watch. Not sure if actual altercations happened or if the facility was trying to be proactive.
 
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Sanman

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It's sad but I don't doubt it. I was at a VA that showed HGTV 24/7, which I rarely saw any veterans actually watch. Not sure if actual altercations happened or if the facility was trying to be proactive.
HGTV and Food Network, the best channels for background TV. How can you not be in a good mood after Fixer Upper? How to do I get the VA to make it an EBP?
 

Fan_of_Meehl

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One friend who worked at a VA said that they had to turn off the TVs in the waiting rooms because patients were watching political news and getting into literal physical fights about it,
We had to do that a while back in our clinic. I suggested that a bunch of VA higher-ups could create a compelling documentary series on all the VA slogans and buzzwords for the past several years and air that instead. The vets would unite in common hatred against that. Remember, #We'reAllinThisTogether.
 

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One friend who worked at a VA said that they had to turn off the TVs in the waiting rooms because patients were watching political news and getting into literal physical fights about it,
A well known and frustrating tactic is Fox News training their viewers to change any public TV to Fox News. Not kidding.....and that is probably what starts the disputes.
 
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A well known and frustrating tactic is Fox News training their viewers to change any public TV to Fox News. Not kidding.....and that is probably what starts the disputes.
Apparently, veterans fighting about whether the TV should be on CNN/MSNBC/Fox News was the major cause of these brawls, actually!
 
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A well known and frustrating tactic is Fox News training their viewers to change any public TV to Fox News. Not kidding.....and that is probably what starts the disputes.
Media Use Disorder:
Watch more than intended (Y)
Desire/failure to control (N)
Excessive time spent obtaining/using/recovering (Y)
Craving (Y)
Use leading to role failure at work/school/home (N; retired)
Use despite social problems due to use (Y)
Gave up/reduced social/occupational/recreational (N; retired)
Use in physically hazardous situations (N)
Tolerance (Y)
Withdrawal (Y)

Diagnostic impression:
Severe FOX News Use Disorder
 
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cara susanna

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But shiplap and pleasant color palettes....

I mean, I get the rage over unfair practices in the real estate industry, but that goes for most things in this country.
It's just that I can't stop being reminded of the extreme inequality where some people in our country can't even have secure housing whereas some can can... well, you've seen HGTV, you know. I still like Love It Or List It though.

I'd MUCH, MUCH rather HGTV be showing in the waiting room than any news station though. One VA I was at always had the game show network on, lol.
 
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Our VA, back when the waiting room TVs were on, were changed primarily to HGTV or some variant thereof for the exact reasons state above. Patients were getting into altercations.

Also, yeah, we're still doing RQI BLS. We at least get to use the bag for breaths, and they wipe the dummies down after every use.
 
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cara susanna

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One of the VAs that I worked at regularly had One America 'News' Network on in the waiting room - whew was that not the right thing to have on before someone came in for therapy sessions. Never could get it to get changed, though.
Jeez, and I was mad about our local Fox News station (which is owned by Sinclair media) being on in the waiting room once.
 

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I gave a didactic to interns at my local VA recently (my buddy wont let me give it up even though I haven't worked there in 3 years), and one of the interns told me his assigned MHC supervisor quit 3 months after he started, saying: "This is not a good place to work right now." Apparently, they have all the MH staff in a Bullpen type thing and are using medical/physical exam rooms on a rotating basis for therapy and MH work at that particular CBOC. It's not a temporary set-up either. I cant imagine being treated like that (both as a patient and a psychologist)...especially when working in an area of VA care that is so highly utilized. How bizarre is that???
 
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Therapist4Chnge

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Zero percent shocked. While there can be large variations between hospitals and VISNs, the focus on metrics and "optics" across the VA system has really wreaked havoc. Clinical care continues to suffer, but don't worry....They Have A Slogan For That! As a bonus, they also have continuous "policy improvements" to "maximize Veteran care." In reality all that means is more red tape and less support because they aren't going to actually pay for clinical staff, but they will pay plenty of $ to market their new BS slogans and "programs".

Wow...that sounds pretty bitter. Yet accurate.
 

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I gave a didactic to interns at my local VA recently (my buddy wont let me give it up even though I haven't worked there in 3 years), and one of the interns told me his assigned MHC supervisor quite 3 months after he started, saying: "This is not a good place to work right now." Apparently, they have all the MH staff in a Bullpen type thing and are using medical/physical exam rooms on a rotating basis for therapy and MH work at that particular CBOC. It's not a temporary set-up either. I cant imagine being treated like that (both as a patient and a psychologist)...especially when working in an area of VA care that is so highly utilized. How bizarre is that???
O wow. That is not surprising to me at all that some places are like that. Another VA I was at had major space issues. Although I was a trainee, it was so stressful to find a place to meet with Veterans and there were tons of trainee and staff in the same boat. I always had to do mindfulness once I secured a room (if I found one) before I could be fully present with a Vet after that. They had us in bullpens, sometimes in other building from where we saw patients. I once was in the bullpen doing work and calling Veterans when other staff members in a different department (interior decorating I think) had an argumentative discussion with another employee that resulted in yelling. I never used that bullpen again...
 

erg923

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O wow. That is not surprising to me at all that some places are like that. Another VA I was at had major space issues. Although I was a trainee, it was so stressful to find a place to meet with Veterans and there were tons of trainee and staff in the same boat. I always had to do mindfulness once I secured a room (if I found one) before I could be fully present with a Vet after that. They had us in bullpens, sometimes in other building from where we saw patients. I once was in the bullpen doing work and calling Veterans when other staff members in a different department (interior decorating I think) had an argumentative discussion with another employee that resulted in yelling. I never used that bullpen again...
Jumpin Jesus! I have trouble tolerating how my wife chews a typical lunch sandwich (way too loud, IMO)....how do you do this? :)

I require alot from my office. Fortunately, it's a well-designed home office. Got the Prime and Netflix enabled 20 inch TV on corner of the desk and everything...

The crazy part about all this is that while the psychologist was older (maybe he doesn't really need to work?).....he quit and went back to the Department of Corrections! I mean, who does that? Seriously?! Who goes from secure federal work and salary...albeit "inconvenient and quite ridiculous" to working inside a dinky, state-run maximum security prison facility/complex?! It takes 30 minutes to get from your car to your desk for cryin out loud, lol! And, it's like a 20-30k/year pay cut (at least in my state) and all kinds of other quality-of-life downgrade nonsense.

Takes all kinds, I guess?
 
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Sanman

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I gave a didactic to interns at my local VA recently (my buddy wont let me give it up even though I haven't worked there in 3 years), and one of the interns told me his assigned MHC supervisor quite 3 months after he started, saying: "This is not a good place to work right now." Apparently, they have all the MH staff in a Bullpen type thing and are using medical/physical exam rooms on a rotating basis for therapy and MH work at that particular CBOC. It's not a temporary set-up either. I cant imagine being treated like that (both as a patient and a psychologist)...especially when working in an area of VA care that is so highly utilized. How bizarre is that???
Yeah, not shocked either. There was a lot confusion and local leadership (down to clinic leads) making decisions on who was showing up and who was not. I am and will be working from home utilizing phone and VVC for the foreseeable future. I can't imagine being in a bullpen. I would have quit or just refused.
 

erg923

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Yeah, not shocked either. There was a lot confusion and local leadership (down to clinic leads) making decisions on who was showing up and who was not. I am and will be working from home utilizing phone and VVC for the foreseeable future. I can't imagine being in a bullpen. I would have quit or just refused.
This happened/was implemented about a year before "the COVID..."
 

AbnormalPsych

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I gave a didactic to interns at my local VA recently (my buddy wont let me give it up even though I haven't worked there in 3 years), and one of the interns told me his assigned MHC supervisor quite 3 months after he started, saying: "This is not a good place to work right now." Apparently, they have all the MH staff in a Bullpen type thing and are using medical/physical exam rooms on a rotating basis for therapy and MH work at that particular CBOC. It's not a temporary set-up either. I cant imagine being treated like that (both as a patient and a psychologist)...especially when working in an area of VA care that is so highly utilized. How bizarre is that???
I hear you.

2 of the 4 VAs I trained/worked at had us in these setups. It was insulting and killed morale. None of these were CBOCs, 1 was a smaller division site from the larger city medical center down the road. 2 of these 4 places are considered 'top' national VA sites for MH training/research.
 
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Fan_of_Meehl

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I hear you.

2 of the 4 VAs I trained/worked at had us in these setups. It was insulting and killed morale. None of these were CBOCs, 1 was a smaller division site from the larger city medical center down the road. 2 of these 4 places are considered 'top' national VA sites for MH training/research.
I'll bet all the 'Whole Health Champion Crusaders-of-The-Court' who had no caseloads and never saw patients had awesome setups, though.
 

AbnormalPsych

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Those lucky champions.

After writing the above comment I had flashback to times in one of those (unnamed for some privacy) external temporary structures set up in parking lots they bullpen-ed us in and how the power would randomly go out mid-day while report writing, working in CPRS, or while on the phone.

Someone needs to PCL-5 me
 
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Fan_of_Meehl

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Those lucky champions.

After writing the above comment I had flashback to times in one of those (unnamed for some privacy) external temporary structures set up in parking lots they bullpen-ed us in and how the power would randomly go out mid-day while report writing, working in CPRS, or while on the phone.

Someone needs to PCL-5 me
Ain't no medicine like Frontier Medicine...downtown.
 

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One good thing about being an intern/trainee at a VA now is that they have stopped using bullpens due to COVID. We now share offices and have more space, but scheduling a room for therapy has become more of a headache.
 
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