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

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Sanman said:
Recently, the answer over here seems to be shove them into HBPC? All I am getting is suicidal folks and non-compliant bipolar folks off their meds. Who needs a whole team when there is one guy driving around the middle of nowhere.
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If you kill yourself, you can't benefit from therapy. If you kill someone else (unless in self-defense), you are in prison (and can't engage in psychotherapy).

Let's keep you alive and out of prison.
 
Fan_of_Meehl said:
If you kill yourself, you can't benefit from therapy. If you kill someone else (unless in self-defense), you are in prison (and can't engage in psychotherapy).

Let's keep you alive and out of prison.
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I've had this conversation. It just devolves into comments about disappearing bodies and witness intimidation.
 
That's when you pretend you didn't hear that ****, right? Am I alone here?

"You know I can hospitalize you, right?" Let's not do that.

Damned ethical dilemmas.

I/we are honestly trying to help desperate dudes. But we do not play 'hall monitor.' It isn't easy.
 
Sanman said:
I've had this conversation. It just devolves into comments about disappearing bodies and witness intimidation.
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The universe has seen fit to throw our feckless asses together.

I'll get you a cup of coffee, a.s.s.h.o.l.e., if you put down the knife.
 
Fan_of_Meehl said:
That's when you pretend you didn't hear that ****, right? Am I alone here?

"You know I can hospitalize you, right?" Let's not do that.

Damned ethical dilemmas.

I/we are honestly trying to help desperate dudes. But we do not play 'hall monitor.' It isn't easy.
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Fun fact, for the suicide prevention stuff. The VA has very little official policy on homicide prevention.

I just explain the policy to them. You name a specific target, I get to report you to the cops. Cool? Only had one person ever admit to homicidal intent so far.
 
Sanman said:
Fun fact, for the suicide prevention stuff. The VA has very little official policy on homicide prevention.

I just explain the policy to them. You name a specific target, I get to report you to the cops. Cool? Only had one person ever admit to homicidal intent so far.
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random tangent: HBO Rome is an excellent series (just two seasons).

My dad (and my natural bent) is more along the personality of the Lucius Vorenus character.

You may be more of a Titus Pullo dude.

Ray Stevenson was an awesome actor. Sad to see him go.
 
Fan_of_Meehl said:
random tangent: HBO Rome is an excellent series (just two seasons).

My dad (and my natural bent) is more along the personality of the Lucius Vorenus character.

You may be more of a Titus Pullo dude.

Ray Stevenson was an awesome actor. Sad to see him go.
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Coolest scene is between the Vorenus character and Marc Antony:



Antony: "Ah...tell me anyway..."

I love the tension between the two soldiers.

And I love that Vorenus says, 'yeah, I'll nut up and tell you the truth.'
 
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Sanman said:
Find a nice older female vet for him? Maybe one with a hearing aid that turns off?
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But why bother when he could have a young female psychologist listen to him for hours for free! In exchange she is now doing much better on Vietnam questions when they show up in Trivial Pursuit.

Seriously though I need to have another talk with him about appropriate treatment options including support groups (with attractive lady Veterans perhaps lol) . It's just hard to get someone unsocialized from expectations built over 19 years of weekly therapy when the system allows it.
 
Grenth said:
But why bother when he could have a young female psychologist listen to him for hours for free!
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Look, if you haven’t tried being a young male psychologist who withholds validation, try that before you come back with all this complaining /s.

But seriously, is there a kind soul on your team who might consider taking this case as a transfer?

Like I’ve taken on some sexual deviance related cases from female colleagues who felt super uncomfortable with that individual.

Did I necessarily want that on my caseload? Not really but I understand the value of taking one for the team sometimes and being able to call in a favor later.
 
Grenth said:
But why bother when he could have a young female psychologist listen to him for hours for free! In exchange she is now doing much better on Vietnam questions when they show up in Trivial Pursuit.

Seriously though I need to have another talk with him about appropriate treatment options including support groups (with attractive lady Veterans perhaps lol) . It's just hard to get someone unsocialized from expectations built over 19 years of weekly therapy when the system allows it.
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Sounds like you have the proper perspective. We may not have all the answers as therapists. We are not gods. But it would be appropriate for him to explore options of his changes in behavior with you to try to expand his social circle.
 
summerbabe said:
Look, if you haven’t tried being a young male psychologist who withholds validation, try that before you come back with all this complaining /s.

But seriously, is there a kind soul on your team who might consider taking this case as a transfer?

Like I’ve taken on some sexual deviance related cases from female colleagues who felt super uncomfortable with that individual.

Did I necessarily want that on my caseload? Not really but I understand the value of taking one for the team sometimes and being able to call in a favor later.
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Sure. If the weird countertransference (male to female) is an issue, then transferring to a male colleague at least sidesteps that barrier to engagement in therapy.

It's all a chess-game (in service to helping the client).
 
summerbabe said:
Look, if you haven’t tried being a young male psychologist who withholds validation, try that before you come back with all this complaining /s.

But seriously, is there a kind soul on your team who might consider taking this case as a transfer?

Like I’ve taken on some sexual deviance related cases from female colleagues who felt super uncomfortable with that individual.

Did I necessarily want that on my caseload? Not really but I understand the value of taking one for the team sometimes and being able to call in a favor later.
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We're so short staffed right now. We have BHIPs down to 1.5 therapists but if we ever get staffing levels up to something resembling normal this is a solid idea. I've definitely done similar things for others in the past.
 
It's a bit of a masculine paradigm...which has become neglected in psychology, of late. But it is still awesome.

Let's sidestep the wife, you horny bastard, and let's address the issue that you are fundamentally a coward. You might want to slip a trident up my arse, but you can't.

I need therapy.
 
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@Fan_of_Meehl I am highly entertained this evening. Don't stop being you, ya idealistic bastard.

I got a direct hire offer for a remote job at a rural CBOC. The job is mine if I want it. They have other candidates, but they want me if I am willing. Sometimes I think a fresh start with a really good supervisor would be enough to keep me in the VA a bit longer. Sometimes I think I should just accept what I'm doing now until there is no path forward.

I am not sure what to do, and by that I mean I am not sure how much longer I can/want to keep working for the VA or how much money and time to spend on building a pathway out of working for the VA or for another large organization. I still do not know exactly what I want to do with my career or how to do it. I am not really looking for guidance so much as solidarity that it is hard to figure this stuff out and it is normal for it to feel like you have never quite made it.
 
IloveCBT said:
@Fan_of_Meehl I am highly entertained this evening. Don't stop being you, ya idealistic bastard.

I got a direct hire offer for a remote job at a rural CBOC. The job is mine if I want it. They have other candidates, but they want me if I am willing. Sometimes I think a fresh start with a really good supervisor would be enough to keep me in the VA a bit longer. Sometimes I think I should just accept what I'm doing now until there is no path forward.

I am not sure what to do, and by that I mean I am not sure how much longer I can/want to keep working for the VA or how much money and time to spend on building a pathway out of working for the VA or for another large organization. I still do not know exactly what I want to do with my career or how to do it. I am not really looking for guidance so much as solidarity that it is hard to figure this stuff out and it is normal for it to feel like you have never quite made it.
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you do you..and classic Rome and masculinity, forever!
 
IloveCBT said:
@Fan_of_Meehl I am highly entertained this evening. Don't stop being you, ya idealistic bastard.

I got a direct hire offer for a remote job at a rural CBOC. The job is mine if I want it. They have other candidates, but they want me if I am willing. Sometimes I think a fresh start with a really good supervisor would be enough to keep me in the VA a bit longer. Sometimes I think I should just accept what I'm doing now until there is no path forward.

I am not sure what to do, and by that I mean I am not sure how much longer I can/want to keep working for the VA or how much money and time to spend on building a pathway out of working for the VA or for another large organization. I still do not know exactly what I want to do with my career or how to do it. I am not really looking for guidance so much as solidarity that it is hard to figure this stuff out and it is normal for it to feel like you have never quite made it.
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Congrats to having options!

At the end of the day, it's a steady paycheck and we don't have to worry about getting fired.

In my 4 years as staff (plus 2 as trainee), the VA has meant many things, ranging from trying to build a career that includes management to checking boxes and hoping next week/month is better to serious thought of leaving.

And I can shift back and forth very easily between what I want the job to represent, including as a safety net until we leave.

Good luck as you navigate these next steps!
 
Agreed. I am a grim reaper of reality with vets, but they are generally okay with my visage
 
summerbabe said:
Congrats to having options!

At the end of the day, it's a steady paycheck and we don't have to worry about getting fired.

In my 4 years as staff (plus 2 as trainee), the VA has meant many things, ranging from trying to build a career that includes management to checking boxes and hoping next week/month is better to serious thought of leaving.

And I can shift back and forth very easily between what I want the job to represent, including as a safety net until we leave.

Good luck as you navigate these next steps!
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I will physically pin vets and tell them that I kinda don't want to lie to them, lol
 
she probably liked women. I can sympathize. This is seriously a wonderful song, though
 
I love listening to this voice.

"mostly white, and black, and blue"

You try writing a line like that 🙂
 
Does anybody know how long you can avoid updating your first aid CPRS/dummy demo thing before they start talking about revoking clinical privileges?

Does that actually happen or is it an empty threat? Also I'm a fully virtual employee but they are slow at updating things like that.

I guess I can find some time to do that really long interactive online thing this week but I'm hoping to avoid the actual dummy for as long as possible, especially since it's now about a 1.5 hr drive each way to my nearest medical center.
 
summerbabe said:
Does anybody know how long you can avoid updating your first aid CPRS/dummy demo thing before they start talking about revoking clinical privileges?

Does that actually happen or is it an empty threat? Also I'm a fully virtual employee but they are slow at updating things like that.

I guess I can find some time to do that really long interactive online thing this week but I'm hoping to avoid the actual dummy for as long as possible, especially since it's now about a 1.5 hr drive each way to my nearest medical center.
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Contact your BLS coordinator. VA started accepting the every two year AHA credential for virtual employees. I know a few folks who opted for this.
 
Sanman said:
Contact your BLS coordinator. VA started accepting the every two year AHA credential for virtual employees. I know a few folks who opted for this.
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Thanks, if I had to guess, I probably got certified about 2 years ago so what I'm actually wondering is just how bad it can get if I totally ignore this lol.

In my defense (maybe), my specialty service is getting absolutely overrun with referrals.

And since we have some more autonomy with scheduling (versus MSAs who put everything into strict grids), I have found myself squeezing more people in than any other time in my almost 3 years in this job, including 30 min appointments for people who can't really make hour apts due to work/personal preference (on top of my regular hourly folks).
 
summerbabe said:
Thanks, if I had to guess, I probably got certified about 2 years ago so what I'm actually wondering is just how bad it can get if I totally ignore this lol.

In my defense (maybe), my specialty service is getting absolutely overrun with referrals.

And since we have some more autonomy with scheduling (versus MSAs who put everything into strict grids), I have found myself squeezing more people in than any other time in my almost 3 years in this job, including 30 min appointments for people who can't really make hour apts due to work/personal preference (on top of my regular hourly folks).
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How close are you to recredentialing? That is usually when they get around to checking the paperwork at my VA.
 
If you get past the expiration date, you can't see patients and that is non-negotiable (my supervisor tried to get an exception for me back in the day).
 
cara susanna said:
If you get past the expiration date, you can't see patients and that is non-negotiable (my supervisor tried to get an exception for me back in the day).
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Been a while, and I don't know the underlying rules and regs, but yeah, we had someone who was pulled from clinical duties for a couple weeks while the situation got resolved back when I was staff.
 
I got completely locked out of the system a few months ago when I was like a day overdue on a TMS training I wasn’t even supposed to do as a postdoc. I couldn’t sign onto a VA computer at all until I called the HelpDesk and got it escalated. So I wouldn’t play chicken with the deadlines.
 
summerbabe said:
Thanks, if I had to guess, I probably got certified about 2 years ago so what I'm actually wondering is just how bad it can get if I totally ignore this lol.

In my defense (maybe), my specialty service is getting absolutely overrun with referrals.

And since we have some more autonomy with scheduling (versus MSAs who put everything into strict grids), I have found myself squeezing more people in than any other time in my almost 3 years in this job, including 30 min appointments for people who can't really make hour apts due to work/personal preference (on top of my regular hourly folks).
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I get it and appreciate that you are working hard, but understand that as far as higher ups are concerned this is the least important part of the job unless you are below 80% of expected RVUs. Just look at your performance eval and the amount of your performance bonus. The TMS delinquency (that you don't need given your position) will count against you more.
 
Sanman said:
Just look at your performance eval and the amount of your performance bonus. The TMS delinquency (that you don't need given your position) will count against you more.
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Speaking of performance evals, what is the actual utility of these?

As far as I can tell, it's tied to your performance bonus (if your facility does them) & EDRP is contingent on being satisfactory in all areas. I'm guessing it matters for promotions (since step increases are automatic)?

I don't have EDRP, would leave VA before taking a supervisory position and a couple hundred bucks after tax is definitely not enough to shape my behavior.

Is there anything else that I'm missing based on other people's experience?

I always skip doing things like filling in your own narrative each time these evals come up and always procrastinate things like TMS and OPPE because I haven't found much incentive to do otherwise lol.
 
summerbabe said:
Speaking of performance evals, what is the actual utility of these?

As far as I can tell, it's tied to your performance bonus (if your facility does them) & EDRP is contingent on being satisfactory in all areas. I'm guessing it matters for promotions (since step increases are automatic)?

I don't have EDRP, would leave VA before taking a supervisory position and a couple hundred bucks after tax is definitely not enough to shape my behavior.

Is there anything else that I'm missing based on other people's experience?

I always skip doing things like filling in your own narrative each time these evals come up and always procrastinate things like TMS and OPPE because I haven't found much incentive to do otherwise lol.
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Step increases are automatic as long as you receive all satisfactory scores. They can deny a step increase with an unsatisfactory eval. Other than that, you missed that you are working too hard.
 
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