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

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Therapist4Chnge said:
I can't believe they still do ESAs, given what we know in the research. If a veteran is suffering with PTSD, giving them an animal is going to do what? I think animals are great, especially dogs and cats. I think a lot of people would benefit from having an animal company (i.e. pet). However, that doesn't mean I think ESA are the correct solution.
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The same thing their 0 down VA home loan and car loan do. Get them to vote for the old white boomer that is campaigning on it.
 
AcronymAllergy said:
Because politicians totally know better than psychologists, psychiatrists, and other mental health experts in terms of what treatments are evidence-based and necessary. This is how we end up with hyperbaric oxygen for mTBI.
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You are giving me flashbacks to concussion legislation I acted as a consulting expert on. The committee asked each speaker who they trust to make the "return to play" call and the majority of people said neurologist and/or neuropsychologist. PM&R too. Do you know who the committee added? Chiropractors. Do you know why? Because the neighbor and good friend of the head of that committee was a chiropractor and told him they were the experts. The committee was basically split in supporting the addition of chiropractors, but because of politics and money, the addition of chiropractors was forced through. It was so infuriating.
 
WisNeuro said:
Ah, only in the VA. "It's lightly sprinkling out, no way I'm going out in that!"
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I remember seeing more than a couple of veterans who drove through nasty snowstorms to get to my consult appt....bc I was the lynchpin consult required for them to pursue service connection for TBI/PTSD/Both. Our VA was the primary provider for OEF/OIF veterans in the region, and there was a huge backlog of cases, so I was booked out 4+ months. For a therapy or feedback appt, even the rumor of a rainstorm could be enough for a cancellation/no show.
 
Really really hate MHV and secure messaging today. Or perhaps not secure messaging in itself (I love using it with my own doctors!) but perhaps the way the VA handles it? Also that MHV is down the one time I actually need it to work.
 
Have you guys seen Trump's Project 2025 plan for the VA? It's pretty horrifying
 

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cara susanna said:
Have you guys seen Trump's Project 2025 plan for the VA? It's pretty horrifying
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psy.d. 2021 said:
Pretty vague but I'm assuming the 19/day is about PACT? Still horrifying of course but don't think that necessarily applies to the work of MH
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Implementation will likely vary, but the goal will likely be to bring the VA more in line with private hospitals. Given the population and the headaches, I imagine the result will be staff moving to the private sector for higher pay. Either way, I am prepared to leave if my current position becomes too much of a headache. For the lifers, it might be a bit scarier.
 
cara susanna said:
I had that thought as well, but the VA often applies primary care stuff to MH even if it's completely different (see: Access Sprint)
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Yeah, from a quick Google search, it seems that the average number of patients PCPs see per day is ~20. Not to say that's necessarily best practice, but the 19/day number then doesn't seem outlandish at least. But if they start applying that to certain specialties like MH, yeah, no bueno (even if a former boss was convinced psychiatrists only needed 15 mins per patient, for every patient).
 
cara susanna said:
I had that thought as well, but the VA often applies primary care stuff to MH even if it's completely different (see: Access Sprint)
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AcronymAllergy said:
Yeah, from a quick Google search, it seems that the average number of patients PCPs see per day is ~20. Not to say that's necessarily best practice, but the 19/day number then doesn't seem outlandish at least. But if they start applying that to certain specialties like MH, yeah, no bueno (even if a former boss was convinced psychiatrists only needed 15 mins per patient, for every patient).
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I doubt that we will be seeing 19/day. However, I can certainly see them pushing for 7 per day from 5 minimum. I have also encountered problems with non-grid focused areas (neuropsych, HBPC, CLC) getting pulled to MHC telehealth if there is excess capacity. Either way it becomes about time. Why deal with 7 disgruntled vets who have multiple MH issues and no show constantly when I can deal with 7 middle or upper middle class folks with mild depression, life transitions, grief, etc. It is the community care all over again. Sure you can send them to the community. Most community docs won't want to deal with them. It will be a bunch of poorly trained counselors that need work and have no idea how to treat complex patients. I see it happen all the time already in the places I have worked. You certainly are not going to keep specialty trained psychologists with options around. I already see some of the geriatric jobs going unfilled for multiple years.
 
Sanman said:
I doubt that we will be seeing 19/day. However, I can certainly see them pushing for 7 per day from 5 minimum. I have also encountered problems with non-grid focused areas (neuropsych, HBPC, CLC) getting pulled to MHC telehealth if there is excess capacity. Either way it becomes about time. Why deal with 7 disgruntled vets who have multiple MH issues and no show constantly when I can deal with 7 middle or upper middle class folks with mild depression, life transitions, grief, etc. It is the community care all over again. Sure you can send them to the community. Most community docs won't want to deal with them. It will be a bunch of poorly trained counselors that need work and have no idea how to treat complex patients. I see it happen all the time already in the places I have worked. You certainly are not going to keep specialty trained psychologists with options around. I already see some of the geriatric jobs going unfilled for multiple years.
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They will wait much longer to see me than they would in-VA for many locations. Additionally, that no-show rate would get a fir number bounced from my clinic. If you no-show/late cancel, you get put at the back of the line (few months out) for one re-schedule. After that, I give you some numbers of colleagues and say good luck.
 
WisNeuro said:
They will wait much longer to see me than they would in-VA for many locations. Additionally, that no-show rate would get a fir number bounced from my clinic. If you no-show/late cancel, you get put at the back of the line (few months out) for one re-schedule. After that, I give you some numbers of colleagues and say good luck.
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True, but they can see you in person. I know for some VAs, they are moving neuropsych to clinical resource hubs and it is telehealth only. I won't be surprised if there is a telehealth geriatric psych position at a clinical resource hub in the future in the future where I simply consult with non-specialty clinicians and they remove my current job entirely.
 
Sanman said:
True, but they can see you in person. I know for some VAs, they are moving neuropsych to clinical resource hubs and it is telehealth only. I won't be surprised if there is a telehealth geriatric psych position at a clinical resource hub in the future in the future where I simply consult with non-specialty clinicians and they remove my current job entirely.
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Neuropsych through the CRH? How does that work?
 
cara susanna said:
Neuropsych through the CRH? How does that work?
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Not 100% on specifics/logistics but I know that CRHs employs both neuropsychs and geropsychs who focus on assessment.

I imagine some pts go to their local VA and complete testing that somebody else can oversee. But a PAI is much easier than a WASI so I wonder if some types of testing heavy referrals might be declined & sent back to the local site?
 
cara susanna said:
Neuropsych through the CRH? How does that work?
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I have not personally seen a CRH neuropsych assessment, so I am not sure how limited they are in scope. People that have it in their VA have mentioned that an in person assistant is required to help with administration, so I assume that some paper and pencil instruments can be given with someone providing the data (or pictures of a clock draw, figure copy, etc). I don't imagine that there is a lot of depth to it. However, for something like a dementia diagnosis that is straight forward with imaging done at the on-site facility, I imagine it can be done.
 
Sanman said:
I have not personally seen a CRH neuropsych assessment, so I am not sure how limited they are in scope. People that have it in their VA have mentioned that an in person assistant is required to help with administration, so I assume that some paper and pencil instruments can be given with someone providing the data (or pictures of a clock draw, figure copy, etc). I don't imagine that there is a lot of depth to it. However, for something like a dementia diagnosis that is straight forward with imaging done at the on-site facility, I imagine it can be done.
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There's research supporting the broad equivalence telehealth neuropsych with this setup (i.e., someone locally with the patient, such as a psychometrist, who's trained to administer the testing). If I were reading that report, I probably wouldn't have substantial issues with it.

If there isn't someone on site, then you're of course much, much more limited. And if the person is being seen from their home, you're painting with very broad strokes at best.
 
psycho1391 said:
Know what I love? Being a program manager for an integrated pain program with no direct plan for a physical therapist.

Back story: Our PT gave less than a month's notice. Her last day was last Friday. The PT department had been showing as the dashboard as overstaffed for the past several quarters, so they have not been able to backfill any positions. So right now, they are down 7 positions.

The coverage plan is for the CRH to cover our virtual vets, but we have no one to cover in person.
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Sorry to dig this back up, but is less than a month's notice supposed to be a bad thing? Seems like a decent amount of time.
 
AsOneDoes said:
What are folks' thoughts on "Champion" roles? Worth doing or something to avoid?
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Depends on whether you like that thing, whether you'd get any protected time and/or if you want to move beyond frontline care and either be promoted into supervisory roles or into a same GS role with some responsibility (like team lead).

If the latter, you gotta start somewhere and it's often with a 'small' thing like this or slightly larger thing like EBP coordinator.

Once you get a small thing, folks in leadership might see you differently than somebody who 'seems' content just seeing their patients and slowly move up the step scale so this might open up doors for more opportunities.
 
thebalmofhurtminds said:
Sorry to dig this back up, but is less than a month's notice supposed to be a bad thing? Seems like a decent amount of time.
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I think it's felt short due to supervisor vacations and fed holidays. It has felt like a scramble to find coverage and have referral paths.
 
AsOneDoes said:
What are folks' thoughts on "Champion" roles? Worth doing or something to avoid?
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1 - They should all be axed with a fiery passion, and providers should see the endless patient referrals instead of avoiding doing clinical work.
2 - If we have to have these things, then the providers who have the most know-how for the specific role should be selected and given a small amount of admin time to accomplish the task. If many equally competent in the champion role team members are available, managers should select based on more subjective criteria with an eye toward fairness (distribute these roles across team members rather than piling them up on favored providers, then consider years experience on the team in VA, etc.). Don't volunteer for this sort of thing if you're being a dodgy colleague or if it's a bad gig with no admin time. Go for it if you will try to make a positive organizational difference and not add to excessive administrative bloat.
 
cara susanna said:
hot take: the no show calls still being required for HRF patients is dumb. it doesn't work any better with them than it does with non-HRF people
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my related hot take is that this runs quite antithetical to the other parts of the VA claiming to champion recovery oriented care, which involves treating patients like adults and respecting their autonomy. but this can not be acknowledged
 
Are we ready for MHS to be replaced by "Behavioral Insights?"
 
summerbabe said:
Oh woah, I hadn’t heard about this.

Sounds like a weekly email that I will auto delete without ever opening.
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I heard about it in passing during a presentation and then we got an email about it yesterday that it's happening. It looks that they're changing up MHS to look more like BI. Then they'll slowly move everyone over to BI only. I would rather just go straight to BI if that's what is coming anyway.
 
I'm expanding my skills and doing some of the trainings from Violet through my GLMA membership. They're so pretty and nice. They're text-based instead of videos. I feel like I'm retaining so much more information. There are some great TMS trainings, but I'm enjoying the different style.
 
cara susanna said:
VA leadership: we want you to see more patients
Providers: okay, do you want us to have better access or bigger panels
VA leadership: yes
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Or, we want you to see more patients, but only in your open slots.

Me: But what happens if a Vet prefers video

Them: Clinic utilization must be optimized. Stop overbooking.
 
psycho1391 said:
Or, we want you to see more patients, but only in your open slots.

Me: But what happens if a Vet prefers video

Them: Clinic utilization must be optimized. Stop overbooking.
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I just more or less have a video clinic I book all my clients into where they're video phone or f2f. Then I fix it later. Stops the issue of double booking and open slots. More admin work on the backend for me but people are off my case
 
Got to love the vets who constantly no show and since I'm in a mhc there's no support on how to get them off my panel when they always follow up with the MSAs to reschedule then doesn't show up again wash rinse repeat. How inefficient and detrimental to other veterans. I'm venting but I wish I could tell this vet how he's blocking access to people who can benefit
 
psy.d. 2021 said:
Got to love the vets who constantly no show and since I'm in a mhc there's no support on how to get them off my panel when they always follow up with the MSAs to reschedule then doesn't show up again wash rinse repeat. How inefficient and detrimental to other veterans. I'm venting but I wish I could tell this vet how he's blocking access to people who can benefit
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Can you tell your MSAs to direct that patient to you when they call to r/s? That's what we do. Not a perfect system, but...
 
How many of you pay for liability insurance? It seems like most VA psychologists don't, but I've had a few supervisors say they don't trust the VA to protect them, so they keep it. I am debating on renewing mine.
 
AsOneDoes said:
How many of you pay for liability insurance? It seems like most VA psychologists don't, but I've had a few supervisors say they don't trust the VA to protect them, so they keep it. I am debating on renewing mine.
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I have never had any.

My understanding is that tort laws basically work differently when it comes to the federal government (in a nutshell, an aggrieved patient needs to sue the federal govt and not you directly).

So all complaints will go through VA legal (if they can even find a lawyer to take on the fed govt for monetary gain).

Where the VA will not protect you is if a patient files a board complaint against your license.

I’ve never had liability insurance but if they offer legal representation for that and that would give you peace of mind, I can see that as a benefit.
 
AsOneDoes said:
How many of you pay for liability insurance? It seems like most VA psychologists don't, but I've had a few supervisors say they don't trust the VA to protect them, so they keep it. I am debating on renewing mine.
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I didn't have it for my first few years at VA, but got it for the last few years for the same reason your supervisors said. I also then started doing some side work that required it, but it's cheap enough that it makes sense to have in general, IMO.
 
Okay, I want to make sure I understand this rescheduling SOP correctly:

Unless a Veteran has a HRF:
1) If a Veteran cancels through VeText, we do not need to make rescheduling efforts.
2) If they cancel or no show twice in a row, we do not need to make rescheduling efforts.

Do we still need to send a letter? The SOP states we don't need to reschedule in the above circumstances, but then also states: "The no-show letter or communication must indicate the option for same day services and the phone number to contact for the service." But sending a letter seems to go against the guideline of not needing to make rescheduling efforts.

Are you all documenting in the Veterans chart that no rescheduling efforts are indicated per this SOP? Or are you just letting it go and not documenting and can reference the SOP if questioned about it later?

Am I missing anything else?
 
AsOneDoes said:
How many of you pay for liability insurance? It seems like most VA psychologists don't, but I've had a few supervisors say they don't trust the VA to protect them, so they keep it. I am debating on renewing mine.
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I have my own, though I have reduced the coverage over the years. Mainly because it is easier than carrying tail and switching coverage if I leave VA. Psychologist liability insurance is so little money, it is cheap insurance (mine is less than $500/yr).

If you start your career at VA, you can consider holding off.
 
VintageRed said:
Okay, I want to make sure I understand this rescheduling SOP correctly:

Unless a Veteran has a HRF:
1) If a Veteran cancels through VeText, we do not need to make rescheduling efforts.
2) If they cancel or no show twice in a row, we do not need to make rescheduling efforts.

Do we still need to send a letter? The SOP states we don't need to reschedule in the above circumstances, but then also states: "The no-show letter or communication must indicate the option for same day services and the phone number to contact for the service." But sending a letter seems to go against the guideline of not needing to make rescheduling efforts.

Are you all documenting in the Veterans chart that no rescheduling efforts are indicated per this SOP? Or are you just letting it go and not documenting and can reference the SOP if questioned about it later?

Am I missing anything else?
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In VA fashion, I have heard conflicting information about all of this and have no idea. I kind of do what I want to anyway as I can't actually turn anyone away.
 
VintageRed said:
2) If they cancel or no show twice in a row, we do not need to make rescheduling efforts.
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From my understanding, I think there is some variability facility by facility (as opposed to a national policy that everybody follows) but your clinic should have an SoP (that may not apply to another facility)
 
VintageRed said:
Okay, I want to make sure I understand this rescheduling SOP correctly:

Unless a Veteran has a HRF:
1) If a Veteran cancels through VeText, we do not need to make rescheduling efforts.
2) If they cancel or no show twice in a row, we do not need to make rescheduling efforts.

Do we still need to send a letter? The SOP states we don't need to reschedule in the above circumstances, but then also states: "The no-show letter or communication must indicate the option for same day services and the phone number to contact for the service." But sending a letter seems to go against the guideline of not needing to make rescheduling efforts.

Are you all documenting in the Veterans chart that no rescheduling efforts are indicated per this SOP? Or are you just letting it go and not documenting and can reference the SOP if questioned about it later?

Am I missing anything else?
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I like how while the SOP is getting friendlier to normalcy and personal responsibility OUR clinic is now getting worse with this and having MSAs call ALL no shows and only stopping responses after x3 no shows lol
 
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