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

[summerbabe]

I thought it was a psychological approach. I looked up the acronym to verify. They want me to tap meridian points on my Veteran to induce a calmer state.

You mean you didn’t do a joint PhD/PsyD/acupuncture degree? Slacker!

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[cara susanna]

Our VA offers EFT for employees and I die inside everytime I see it.

 

[Sanman]

Our VA offers EFT for employees and I die inside everytime I see it.

Probably cheaper than an actual EAP program. Same with CISM really.

 

[eeor1006]

Our VA offers EFT for employees and I die inside everytime I see it.

This may be a stupid question. What is EFT? emotion focused therapy?

 

[cara susanna]

This may be a stupid question. What is EFT? emotion focused therapy?

Emotional freedom techniques (aka battle tapping)

 

[Sanman]

Emotional freedom techniques (aka battle tapping)

In case anyone wants a visual on how to practice.

 

[Shiori]

EFT was not desired even a little bit by the patient. Crisis averted. Recently, another person was curious about a particular drug they saw in a drugstore. We looked through the evidence together and decided it was snake oil. We got to talk about the blood brain barrier and reputable sources. It was a good time.

 

[summerbabe]

Curious about the current state of affairs regarding VA budgeting & if that's been a topic of discussion at your site.

Anybody at a facility that's going through a hiring freeze, have had open positions pulled recently, no annual bonuses being awarded this year, etc?

 

[WisNeuro]

Curious about the current state of affairs regarding VA budgeting & if that's been a topic of discussion at your site.

Anybody at a facility that's going through a hiring freeze, have had open positions pulled recently, no annual bonuses being awarded this year, etc?

VA budget shortfalls lead to pause of some health care hiring

One office pledged to “reduce FTEs through attrition.”

www.govexec.com

I imagine it was good while it lasted. Still glad to be in private practice.

 

[Sanman]

Curious about the current state of affairs regarding VA budgeting & if that's been a topic of discussion at your site.

Anybody at a facility that's going through a hiring freeze, have had open positions pulled recently, no annual bonuses being awarded this year, etc?

VA seeks to manage size of its health care workforce, keeps growing benefits staffing

Our VISN in in the red and I am told that there will be hiring freezes. However, it looks like mental health and primary care still have priority with regard to hiring. I imagine the recent trend in retention incentives and special salary rates will come to an end if not already approved.

 

[cara susanna]

What the frick are they spending all this money on??

 

[Sanman]

What the frick are they spending all this money on??

At the moment, they seem to hiring more benefits people and prioritizing pact act stuff. I imagine that this will just lead to more headaches.

 

[AcronymAllergy]

I could be misreading, but it looks like the article is saying that not only will they slow/stop hiring, but they may remove positions for people already hired. See:

“If we no longer need to fill a position in a certain location, we will look to place any affected individuals in another position at VA if at all possible,” Hayes said.

 

[Shiori]

All the providers who have been around a while are shrugging their shoulders at this. I will follow their lead unless they signal otherwise. The bean counters will count more beans, and I'll half-implement stuff until they inevitably change their mind.

 

[AcronymAllergy]

All the providers who have been around a while are shrugging their shoulders at this. I will follow their lead unless they signal otherwise. The bean counters will count more beans, and I'll half-implement stuff until they inevitably change their mind.

This is the way.

 

[summerbabe]

I could be misreading, but it looks like the article is saying that not only will they slow/stop hiring, but they may remove positions for people already hired. See:

This reminds me of when my local VA (at the time) axed their C&P program and the 2 or 3 psychologists working there were re-assigned in mental health. I think 1 left voluntarily pretty quickly after that since they didn't want to do outpatient therapy.

All the providers who have been around a while are shrugging their shoulders at this. I will follow their lead unless they signal otherwise. The bean counters will count more beans, and I'll half-implement stuff until they inevitably change their mind.

My local site is under a hiring freeze already. Some people seem to be more concerned than I am.

I think this will be the 3rd hiring freeze that I've been through in my 6+ years (including training). The previous 2 seemed to pass pretty quickly and without hoopla but they also seemed to be more related to local budget deficits only, versus there being some national attention right now. Time will tell but thanks for sharing the sentiment at your site.

 

[Sanman]

This reminds me of when my local VA (at the time) axed their C&P program and the 2 or 3 psychologists working there were re-assigned in mental health. I think 1 left voluntarily pretty quickly after that since they didn't want to do outpatient therapy.

I will say that at this stage of my career, this possibility is worse than getting fired. I know what I like to do and don't particularly want to be an intern again, getting placed here and there. This would make me leave fairly quick.

 

[AcronymAllergy]

This reminds me of when my local VA (at the time) axed their C&P program and the 2 or 3 psychologists working there were re-assigned in mental health. I think 1 left voluntarily pretty quickly after that since they didn't want to do outpatient therapy.

Yep, same thing happened at my site. The C&P psychologists were given a heads-up well in advance, from my understanding. They ultimately either left or transitioning to general MH positions.

 

[cara susanna]

Our VA made all psychologists do C&Ps (myself included), so it was a relief when they stopped doing them in-house. Don't get me started on what a conflict of interest THAT was.

 

[AcronymAllergy]

Our VA made all psychologists do C&Ps (myself included), so it was a relief when they stopped doing them in-house. Don't get me started on what a conflict of interest THAT was.

Yep, one of the VAs I trained at also did that.

Medical leadership at another VA wanted me to do a fitness for duty evaluation on one of the physicians at my clinic. They didn't understand why that might be problematic.

 

[summerbabe]

The more I think about this, my barometer on if this is a real problem (since it runs pretty counter to the other priority of access) or something that will pass pretty quickly like previous hiring freezes is if administrators with clinical licenses who have continued to carve our more and more admin time get pushed back into doing (or doing more) front-line work.

Not just program managers but also roles like administrative officers, telemental health coordinators, & care coordinators and maybe especially the ones that didn't exist a few years ago & you're not quite sure what that person does all day lol.

 

[Sanman]

The more I think about this, my barometer on if this is a real problem (since it runs pretty counter to the other priority of access) or something that will pass pretty quickly like previous hiring freezes is if administrators with clinical licenses who have continued to carve our more and more admin time get pushed back into doing (or doing more) front-line work.

Not just program managers but also roles like administrative officers, telemental health coordinators, & care coordinators and maybe especially the ones that didn't exist a few years ago & you're not quite sure what that person does all day lol.

I think that will depend on how long certain staffing is vacant. From reading the articles, it think it will depend more on implementation than on policy (as usual). When they say that MH hiring will be prioritized, what will that mean? You'll have a full staff of clinicians and no staffing support or will the hospital have enough leeway to hire support staff or mental health and the like. Because without enough support, clinicians will leave or greener pastures.

 

[cara susanna]

The more I think about this, my barometer on if this is a real problem (since it runs pretty counter to the other priority of access) or something that will pass pretty quickly like previous hiring freezes is if administrators with clinical licenses who have continued to carve our more and more admin time get pushed back into doing (or doing more) front-line work.

Not just program managers but also roles like administrative officers, telemental health coordinators, & care coordinators and maybe especially the ones that didn't exist a few years ago & you're not quite sure what that person does all day lol.

MST National actually just released guidance saying that MST Coordinators need even more protected admin time

 

[JustNoticing]

Our VA made all psychologists do C&Ps (myself included), so it was a relief when they stopped doing them in-house. Don't get me started on what a conflict of interest THAT was.

yeah, but also a shame that they moved in the direction of privatizing that whole service, rather than having psychologists employed by VBA or some other division to remove the conflict of interest.

 

[Sanman]

MST National actually just released guidance saying that MST Coordinators need even more protected admin time

That's great, but you ever notice how no one cares what national says? Or maybe that is just GEC.

 

[cara susanna]

Me: Spends hour with patient challenging cognition that "military leadership doesn't care about me"

Me: goes home and watches the latest episode of Masters of Air, which depicts a WWII battle in which leadership prioritized proving the viability of daytime precision bombing at the cost of many, many casualties

Awkward.

 

[Sanman]

Me: Spends hour with patient challenging cognition that "military leadership doesn't care about me"

Me: goes home and watches the latest episode of Masters of Air, which depicts a WWII battle in which leadership prioritized proving the viability of daytime precision bombing at the cost of many, many casualties

Awkward.

Yeah, not sure I would challenge that cognition. That's like suggesting VA leadership cares about us. Large organizations don't usually give consideration to individuals. Now, they are not out to do us harm either.

 

[cara susanna]

Yeah, not sure I would challenge that cognition. That's like suggesting VA leadership cares about us. Large organizations don't usually give consideration to individuals. Now, they are not out to do us harm either.

Yeah, I was more doing Socratic questioning and "what does this mean to you?" sort of work

 

[clausewitz2]

Me: Spends hour with patient challenging cognition that "military leadership doesn't care about me"

Me: goes home and watches the latest episode of Masters of Air, which depicts a WWII battle in which leadership prioritized proving the viability of daytime precision bombing at the cost of many, many casualties

Awkward.

The odds of someone completing their first tour of duty without being killed or captured in the US 8th Army Air Force (probably what you are talking about) in WWII was about 23%. This is why it's a huge deal in Catch-22 that the crews keep getting sent on more missions, it means they're probably done for.

 

[WisNeuro]

The odds of someone completing their first tour of duty without being killed or captured in the US 8th Army Air Force (probably what you are talking about) in WWII was about 23%. This is why it's a huge deal in Catch-22 that the crews keep getting sent on more missions, it means they're probably done for.

So it goes.

 

[cara susanna]

The odds of someone completing their first tour of duty without being killed or captured in the US 8th Army Air Force (probably what you are talking about) in WWII was about 23%. This is why it's a huge deal in Catch-22 that the crews keep getting sent on more missions, it means they're probably done for.

Yeah, I had no idea until I started watching this! It does put Catch-22 into a new light.

 

[WisNeuro]

So it goes.

I might be messing up my KV references. In hindsight, that may have been Slaughterhouse Five.

 

[cara susanna]

I might be messing up my KV references. In hindsight, that may have been Slaughterhouse Five.

Yup, it was Slaughterhouse Five

 

[WisNeuro]

Yup, it was Slaughterhouse Five

Fair enough, those two haven't come off my shelf for a re-read in quite some time.

 

[psy.d. 2021]

Anyone that's gone through the EDRP process remember how long it took for the completed application to get reviewed? I'm sure it'll be a different timeline at my site (if you've been at one VA...) but just curious

 

[psycho1391]

Anyone that's gone through the EDRP process remember how long it took for the completed application to get reviewed? I'm sure it'll be a different timeline at my site (if you've been at one VA...) but just curious

I think my app process took like a month all together including sending in the loan statements. I also dragged my feet a little too.

 

[cara susanna]

Really feeling bitter and beaten down about the SC disability system and how it interacts with MH treatment today (moreso than even usual)

 

[Sanman]

Really feeling bitter and beaten down about the SC disability system and how it interacts with MH treatment today (moreso than even usual)

On the one hand, it really drives me nuts. On the other hand, how many psychologists have decent paying jobs because of it?

 

[Fan_of_Meehl]

Really feeling bitter and beaten down about the SC disability system and how it interacts with MH treatment today (moreso than even usual)

I was feeling the same way. 80% of my therapy appointments feel like we're playing the game where the client pretends to be here for therapy and I pretend to believe it (radical credulity). I do find that limiting things to episodes of care helps. Then they at least go to the back of the line for a few months until they come back around again. Adopting a spirit of bemused curiosity at the entire spectacle also helps. Reassuring interns/trainees that the incredibly prevalent disengagement w/ psychotherapy isn't their fault nor is it indicative of practice outside VA helps. Judicious use of the MMPI-2-RF also helps. Using CBT workbooks with clients who otherwise passive-aggressively sabotage attempts to implement evidence-based protocols helps.

 

[PsyDr]

How runaway disability compensation is straining Veterans Affairs

The share of veterans receiving disability compensation benefits is increasing rapidly and is at an all-time high.

thehill.com

 

[psy.d. 2021]

Really feeling bitter and beaten down about the SC disability system and how it interacts with MH treatment today (moreso than even usual)

Me too, just this week I had a few situations that bothered me (e.g., people who are presenting with increased risk because they don't feel heard by the process, people asking to engage in treatment they don't necessarily need in support of a claim)

 

[Fan_of_Meehl]

Me too, just this week I had a few situations that bothered me (e.g., people who are presenting with increased risk because they don't feel heard by the process, people asking to engage in treatment they don't necessarily need in support of a claim)

It's the $100 billion elephant in the room that anyone who isn't on the front lines of MH care delivery flat out refuses to believe even exists.

If admin did take the problem seriously and leveraged some intellect, courage, and organization against the problem, we'd need 80% fewer psychotherapy providers but this kinda gets at the point another poster was making...many psychologists would be out of a job. Not excusing it, just being real.

Over the years, I've come up with a pretty good system/approach that allows me to get people in/out/through my clinics pretty rapidly. The only problem is, any 'gains' or benefits from being able to do so are crushed when admin just pours as many intakes as they can into any open slots to the point where I'm just as backed up as all the people with relatively static caseloads who never move.

 

[Sanman]

It's the $100 billion elephant in the room that anyone who isn't on the front lines of MH care delivery flat out refuses to believe even exists.

If admin did take the problem seriously and leveraged some intellect, courage, and organization against the problem, we'd need 80% fewer psychotherapy providers but this kinda gets at the point another poster was making...many psychologists would be out of a job. Not excusing it, just being real.

Over the years, I've come up with a pretty good system/approach that allows me to get people in/out/through my clinics pretty rapidly. The only problem is, any 'gains' or benefits from being able to do so are crushed when admin just pours as many intakes as they can into any open slots to the point where I'm just as backed up as all the people with relatively static caseloads who never move.

Instead we get two different versions of community care and the PACT act, which will worsen the fiscal problem. At least the latter came with a pay raise for us.

 

[WisNeuro]

How runaway disability compensation is straining Veterans Affairs

The share of veterans receiving disability compensation benefits is increasing rapidly and is at an all-time high.

thehill.com

Love this part "Considering how much easier it has become to qualify for disability benefits, it is perhaps unsurprising that 5,000 pilots who passed their Federal Aviation Administration physicals are now under investigation for receiving veterans’ disability benefits for conditions that should disqualify them from the cockpit."

Lot of people ****ing around about to find out.

 

[Behaviorismiscool]

What do you all think of the Indiana model to help bridge the gap between supply and demand for outpatient psychotherapy in VA? They recently published a paper on it.

APA PsycNet

doi.org

 

[Sanman]

What do you all think of the Indiana model to help bridge the gap between supply and demand for outpatient psychotherapy in VA? They recently published a paper on it.

APA PsycNet

doi.org

What happens when the bulk of the referrals fall into track 3?

 

[AcronymAllergy]

Really feeling bitter and beaten down about the SC disability system and how it interacts with MH treatment today (moreso than even usual)

Completely understand. This, and issues related to it, was probably my biggest source of frustration and burnout at VA.

 

[cara susanna]

What do you all think of the Indiana model to help bridge the gap between supply and demand for outpatient psychotherapy in VA? They recently published a paper on it.

APA PsycNet

doi.org

My clinic is trying to implement this model and it has a lot of benefits, but it's highly dependent on the clinician implementing it effectively (which is harder to do).

 

[Fan_of_Meehl]

My clinic is trying to implement this model and it has a lot of benefits, but it's highly dependent on the clinician implementing it effectively (which is harder to do).

Which is--in turn--dependent on clinical/administrative supervisors ACTUALLY providing meaningful proactive supervision of what their supervisees are actually doing in therapy. To be fair to those supervisors, they are overburdened with BS tasks as well.

However, instead of considering RVU totals to measure therapist 'productivity' as a therapist (it doesn't), they need to compute, analyze and provide feedback on more valid measures of actual productivity such as a measure of the average "age" of cases in your clinic, for example, for how long have you been seeing the pt in context of the current episode of care and what session # are you on. Crunching a months worth of data on pts scheduled appointments could be done very quickly and give you a snapshot of who has stagnant vs flowing clinics.

If provider A's patients are, on average, on session 32 (and been seen for an average of three years) while provider B's patients are, on average, on session 4 (and been seen for an average of 2.5 months), then you have some work to do as a supervisor.

But the 'I don't even wanna look' approach prevails.

 

[Sanman]

Which is--in turn--dependent on clinical/administrative supervisors ACTUALLY providing meaningful proactive supervision of what their supervisees are actually doing in therapy. To be fair to those supervisors, they are overburdened with BS tasks as well.

However, instead of considering RVU totals to measure therapist 'productivity' as a therapist (it doesn't), they need to compute, analyze and provide feedback on more valid measures of actual productivity such as a measure of the average "age" of cases in your clinic, for example, for how long have you been seeing the pt in context of the current episode of care and what session # are you on. Crunching a months worth of data on pts scheduled appointments could be done very quickly and give you a snapshot of who has stagnant vs flowing clinics.

If provider A's patients are, on average, on session 32 (and been seen for an average of three years) while provider B's patients are, on average, on session 4 (and been seen for an average of 2.5 months), then you have some work to do as a supervisor.

But the 'I don't even wanna look' approach prevails.

They can see these metrics. The dashboard shows the number of unique patients seen. However, there is no metric for that in the standard performance plan, so no one looks at it.