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

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abcdeltaforce said:
Hi everyone - rather than creating an entirely new thread I wanted to ask in here. I'm having difficulty finding specific covid vaccine requirements for the VA sites I'm applying to for internship. For example, I'm not sure if they have a time limit since you were last vaccinated or if they require boosters etc. I am trying to get all my medical stuff covered while my deductible is met (haha) so I'm preparing in advance for everything!
If you have any idea where I can find this info or how it works please let me know. Feel free to privately message if you don't want to spam this thread. Thanks a bunch!
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I think they just require the initial two vaccinations, regardless of how long ago that was. I could be mistaken, but I know many VA employees who has only gotten two shots. And when I was on internship not long ago, the same went for interns.
 
Yeah, we haven't been required to get additional boosters as staff or trainees since the covid national protocols lifted. We also offer free vaccines to our trainees. It definitely doesn't hurt to ask though.
 
WisNeuro said:
Email the TD/contacts in APPIC, or just be safe and get an updated vaccination and not worry about it.
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Shiori said:
Yeah, we haven't been required to get additional boosters as staff or trainees since the covid national protocols lifted. We also offer free vaccines to our trainees. It definitely doesn't hurt to ask though.
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Getting an update to be safe is probably the best course of action. Thank you!
 
Don't you love when you have a NS and finish NS calls (this is HRF btw) only to have another appt scheduled, which there is a 50% chance of also being NSed and starting the spurt of NS calls all over again? Man, that sure was a nice two days of not making calls.
 
Psychai said:
I'm no longer at the VA so I can't find the exact consult name, but there is a specialty clinic based out of California that focuses on treatment of functional neurologic disorder and conversion disorder, especially for psychogenic seizures. They see veterans nationwide by telehealth if your clients are open to referral, or the clinical team might be able to share some resources.
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Wow thank you for this. There’s a handful of us who randomly happen to all have referrals coming in with prior confirmed diagnoses. I will look into this in CPRS!

Fan_of_Meehl said:
Oxford University Press 'Treatments That Work' series has a client workbook and therapist manual:

- Taking Control of Your Seizures (workbook)
- Treating Non-epileptic Seizures (Therapist Guide)

At least it's an 'evidence-based' comprehensive and structured approach to case formulation and treatment.

However, off the record, in my experience, these patients tend to have treatment-interfering factors like:

-Resistance to psychological/behavioral explanations for their sxs
-Attendance/engagement issues
-Axis II comorbidities including a tendency to 'split' MH vs. general medical providers

This sort of treatment likely requires specialty settings where clinician (and organizational) sophistication, intercommunication, and collaboration is high. If I recall correctly, an important part of the protocol involves close collaboration between MH providers and the epileptologist/neurologist in tapering/titrating anticonvulsant med regimens. That aspect had always given me pause with respect to attempting to implement this particular protocol in a VA setting.

Plus, they have to do the work.

The Oxford U. Press materials could prove useful to review in prep to do a good old fashioned CBT case formulation and intervention, though.
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Thank you. That is the resource I mentioned finding but seemed bare bones. And I agree, my colleague has a person who strongly believes there is some rare disease that doctors are missing, though they’ve had lots of (sometimes invasive) testing that is clear. These folks have high engagement in outpatient and ER, hopefully we’ll be able to do *something* useful with them.
 
oliversacks4thewin said:
This is fascinating to hear that it is also permeating in the VA. I work at an AMC affiliated children's hospital, and we have seen a significant increase in FNSD presentations as well. I echo the use of the Treatments That Work manuals. I will also mention that there is some decent resources housed in the FNDhope.org website that while limited for providers, can be a helpful site to direct patients and families to to help reduce some of the interfering barriers that Fan_of_Meehl appropriately acknowledged.
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Oh wow, I’m curious about that. I have no experience with under 18 except pre-grad school, and wouldn’t know the first thing about therapy with children. I imagine that would be even more of a challenge to treat. Thank you for that website, I will certainly pass it around to my colleagues. I have a hard enough time getting folks with anxiety and panic attacks to accept/believe that their physical symptoms are psychological in nature. Hopefully hearing it from others who experience it will resonate more.
 
ccpsych16 said:
Wow thank you for this. There’s a handful of us who randomly happen to all have referrals coming in with prior confirmed diagnoses. I will look into this in CPRS!


Thank you. That is the resource I mentioned finding but seemed bare bones. And I agree, my colleague has a person who strongly believes there is some rare disease that doctors are missing, though they’ve had lots of (sometimes invasive) testing that is clear. These folks have high engagement in outpatient and ER, hopefully we’ll be able to do *something* useful with them.
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Absolutely! With a little digging I was able to track down the program. It's the VA Mind Brain program based out of the San Francisco VA. I believe the consult name is "VA National Expert Consultation & Specialized Services – Mental Health (NEXCSS-MH) VA Mind Brain Neuropsychiatry clinic". The fact sheet on their page has some links to TMS trainings including protocol training and supervision resources.

Diffusion Marketplace

marketplace.va.gov marketplace.va.gov
 
I just had a patient whose ONLY goal for treatment was to help teach ME more about the connection between supernatural influences and mental health. "I don't mean to discredit your training, but it's unbelievable that they don't teach you about that. It's easily a third of the major contributing factors to mental health concerns. I just watched a video before I came in here about how ghosts literally make couples fight because they feed off of their negative energy. I've seen it in my own marriage. I've seen it in my own neighborhood. It's honestly concerning you don't know about this. I don't know how you're helping your patients without this knowledge."

I discontinued treatment for lack of treatment goals. I'm done for the day.
 
VintageRed said:
I just had a patient whose ONLY goal for treatment was to help teach ME more about the connection between supernatural influences and mental health. "I don't mean to discredit your training, but it's unbelievable that they don't teach you about that. It's easily a third of the major contributing factors to mental health concerns. I just watched a video before I came in here about how ghosts literally make couples fight because they feed off of their negative energy. I've seen it in my own marriage. I've seen it in my own neighborhood. It's honestly concerning you don't know about this. I don't know how you're helping your patients without this knowledge."

I discontinued treatment for lack of treatment goals. I'm done for the day.
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Sounds like a good referral to a 'clinical chaplain' to me.
 
cara susanna said:
Whenever I do presentations, I get good evals but there are always complaints that I presented virtually. It's not my fault they asked me without 45 days notice so I couldn't block additional time for travel...
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Wait till they do and you get complaints that it could have been done virtually and there is no need for in person.
 
VintageRed said:
I just had a patient whose ONLY goal for treatment was to help teach ME more about the connection between supernatural influences and mental health. "I don't mean to discredit your training, but it's unbelievable that they don't teach you about that. It's easily a third of the major contributing factors to mental health concerns. I just watched a video before I came in here about how ghosts literally make couples fight because they feed off of their negative energy. I've seen it in my own marriage. I've seen it in my own neighborhood. It's honestly concerning you don't know about this. I don't know how you're helping your patients without this knowledge."

I discontinued treatment for lack of treatment goals. I'm done for the day.
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Not true. Magical thinking is taught in mental health circles. Psychiatry has a pill for that.
 
cara susanna said:
This is frustrating me all over again. So much for patient agency.
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I presume that no one will properly criticize the criticism of the SW for failing to freak out at a PHQ-9, item 9 endorsement of 1 out of 3...something that is extremely high base rate behavior in MH outpatients.

Leadership will likely create a whole new slew of policy/procedure and thou-shalt-auditing-and-percent-compliance crusades to be routinely cited at staff meetings as 'best practices' and utilized in performance review ratings. Sigh.

The attached article addresses the highly relevant but never clarified issue of exactly what TYPE of "risk" are we referring to with respect to our low/med/hi 'risk stratification' schemes? Absolute vs. Relative Risk? This patient compared to psychiatric inpatients/outpatients? This patient compared to himself at some earlier point in time? And practical questions such as, if I truly want to help this patient out, should I spend the next hour engaged in lengthy 'suicide risk stratification/assesment' rituals or spend the time increasing hope, exploring a cognitive behavioral chain analysis of hopelessness/depression, and helping him construct some useful coping cards and emotional self-regulatory mechanisms?

Not to mention that under a fair reading of the 2024 VA/DoD Assessment and Management Guidelines for Suicidal Behavior, pretty much all of the holy procedures/policies of the Church of Suicide Prevention enjoy little to no actual empirical support (generally, "no evidence to recommend for or against use" to "weak for").

www.healthquality.va.gov

VA.gov | Veterans Affairs

Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.
www.healthquality.va.gov www.healthquality.va.gov
 

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AcronymAllergy said:
"Chilly" is relative...
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winter is coming GIF
 
I have been getting an uptick in romance scam cases. They don't know it's a scam, but the red flags are painfully obvious. I have avoided confronting conspiracy theories where I can, but I feel like romance scams are little mini conspiracies between two people (or one person and a team of people pretending to be one person).
 
Shiori said:
I have been getting an uptick in romance scam cases. They don't know it's a scam, but the red flags are painfully obvious. I have avoided confronting conspiracy theories where I can, but I feel like romance scams are little mini conspiracies between two people (or one person and a team of people pretending to be one person).
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I've had more than a handful of older adults with cognitive impairment lose thousands or tens of thousands of dollars to these and other scams before their family stepped in and took over financial control. These worst was an older gentleman who was scammed for the entirety of his retirement savings.
 
Shiori said:
I have been getting an uptick in romance scam cases. They don't know it's a scam, but the red flags are painfully obvious. I have avoided confronting conspiracy theories where I can, but I feel like romance scams are little mini conspiracies between two people (or one person and a team of people pretending to be one person).
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We have a bunch of cases like that, too.
 
AcronymAllergy said:
I've had more than a handful of older adults with cognitive impairment lose thousands or tens of thousands of dollars to these and other scams before their family stepped in and took over financial control. These worst was an older gentleman who was scammed for the entirety of his retirement savings.
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Yeah, it's really sad. I have been seeing younger men falling for more obvious scams too. They think they're dating someone who is extremely attractive and manages to be both wealthy and in desperate need of money. They have the technical savvy to figure out something is wrong, but will talk themselves out of breaking things off.

I haven't encountered it yet with younger women.
 
Shiori said:
I generally like everyone. The PCPs have been testing me.
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I know the other psychologists I worked with would sometimes get frustrated with PCP referrals. Especially RE: pain referrals back during the opiate winddown. 90% of the referrals were basically, "told patient he can't have oxycodone anymore. Patient was upset. Referred for psychotherapy." I can't blame them, as their hands were also tied, but it wasn't much fun for anyone.

In neuropsych, my best referrals were usually from PCPs and neurology. The worst were usually social work and, in a few specific cases, psychiatrists and other psychologists. PCPs were also always super appreciative of the reports.
 
AcronymAllergy said:
I know the other psychologists I worked with would sometimes get frustrated with PCP referrals. Especially RE: pain referrals back during the opiate winddown. 90% of the referrals were basically, "told patient he can't have oxycodone anymore. Patient was upset. Referred for psychotherapy." I can't blame them, as their hands were also tied, but it wasn't much fun for anyone.

In neuropsych, my best referrals were usually from PCPs and neurology. The worst were usually social work and, in a few specific cases, psychiatrists and other psychologists. PCPs were also always super appreciative of the reports.
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In this case, it's not even the referrals. The VA has made them the gatekeeper of everything, so all care comes to a halt when they decide something isn't their job. I would love for it not to be their job. I didn't make the rules, and I can't place medical orders.
 
Shiori said:
In this case, it's not even the referrals. The VA has made them the gatekeeper of everything, so all care comes to a halt when they decide something isn't their job. I would love for it not to be their job. I didn't make the rules, and I can't place medical orders.
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Oh, yeah, I've seen so many PCPs fob off patients onto other staff when it's their own damn job. Just managing testing consults, sometimes they can't even be bothered to fill out the referral question.

Right now we're having a heck of a time getting PCPs to do cognitive screens instead of just sending them off to PCMHI.
 
cara susanna said:
Oh, yeah, I've seen so many PCPs fob off patients onto other staff when it's their own damn job. Just managing testing consults, sometimes they can't even be bothered to fill out the referral question.

Right now we're having a heck of a time getting PCPs to do cognitive screens instead of just sending them off to PCMHI.
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Yeah, I get people in MHC who need medical prosthetics and the PCPs want me to gather all the item numbers for them. I will also get patients who have gotten stuck in consult hell because no one will just pull the medical records, even from another VA. In my administrative role, I still work with patients and PCP will refuse to do the medical side of their own patient's care. These folks are not even my patients. Even if I could place the consult for the medical device, I'm not their provider. I'm losing my mind.
 
Shiori said:
Yeah, it's really sad. I have been seeing younger men falling for more obvious scams too. They think they're dating someone who is extremely attractive and manages to be both wealthy and in desperate need of money. They have the technical savvy to figure out something is wrong, but will talk themselves out of breaking things off.

I haven't encountered it yet with younger women.
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It is unlikely you will.
 
Shiori said:
Yeah, I get people in MHC who need medical prosthetics and the PCPs want me to gather all the item numbers for them. I will also get patients who have gotten stuck in consult hell because no one will just pull the medical records, even from another VA. In my administrative role, I still work with patients and PCP will refuse to do the medical side of their own patient's care. These folks are not even my patients. Even if I could place the consult for the medical device, I'm not their provider. I'm losing my mind.
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I found the problem...
 
Sanman said:
It is unlikely you will.
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Yeah, haven't seen this much in my younger populations, though they are definitely a smaller portion of my clinical population. As for the 65+, I See much more older women falling for the scams, though I also see a higher proportion of women, and they happen to be more often widowed in my clinic population.
 
Sanman said:
I found the problem...
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I enjoy the job, but they definitely want me to quit. I get 6 hours a week to try to build a system that would actually take pressure off of the PCPs if they could stop sending me paragraphs of text about what they won't be doing. What's funny is I'm getting chewed out for patients that aren't even within my hospital. Fortunately, I'm motivated enough to do it for the patients regardless of what the PCPs do. Then I'll probably bounce.
 
Shiori said:
Yeah, I get people in MHC who need medical prosthetics and the PCPs want me to gather all the item numbers for them. I will also get patients who have gotten stuck in consult hell because no one will just pull the medical records, even from another VA. In my administrative role, I still work with patients and PCP will refuse to do the medical side of their own patient's care. These folks are not even my patients. Even if I could place the consult for the medical device, I'm not their provider. I'm losing my mind.
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I'm an MST coordinator and it's hilarious how PCPs are like "oh, I don't feel comfortable doing the screening reminder." But when I offer to train them... crickets.
 
WisNeuro said:
Yeah, haven't seen this much in my younger populations, though they are definitely a smaller portion of my clinical population. As for the 65+, I See much more older women falling for the scams, though I also see a higher proportion of women, and they happen to be more often widowed in my clinic population.
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Yeah, Milley is a popular figure for scammers to use. (Retired) General Milley will be stranded in the middle of another country and requires Apple gift cards from some poor older woman.
 
Shiori said:
Yeah, Milley is a popular figure for scammers to use. (Retired) General Milley will be stranded in the middle of another country and requires Apple gift cards from some poor older woman.
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This...isn't satire?
 
Shiori said:
Yeah, it's really sad. I have been seeing younger men falling for more obvious scams too. They think they're dating someone who is extremely attractive and manages to be both wealthy and in desperate need of money. They have the technical savvy to figure out something is wrong, but will talk themselves out of breaking things off.

I haven't encountered it yet with younger women.
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At that point, is that a scam or is that willfully buying into the delusion? When one refuses to acknowledge clear red flags that they themselves have noticed?
 
PsyDWannabe said:
At that point, is that a scam or is that willfully buying into the delusion? When one refuses to acknowledge clear red flags that they themselves have noticed?
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These are good questions.
 
cara susanna said:
The closer we get to the election the more my patients are talking politics and getting harder to redirect

Sometimes as I hear the things they are saying, I can just feel my soul leaving my body
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I often feel as if I have been involuntarily placed in the role of "White House Press Secretary" for the VA with respect to my patients' concerns, questions, and frustrations.

But I hear ya on the politics talk by patients. We all know that it's not an appropriate topic "per se" for psychotherapy (mostly) because it tends to just degenerate into complaining about 'others' and factors outside the patient's control as a source of suffering. But it does wear you down to have to constantly address.
 
cara susanna said:
The closer we get to the election the more my patients are talking politics and getting harder to redirect

Sometimes as I hear the things they are saying, I can just feel my soul leaving my body
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No kidding. Last week I was trying to get a relatively new patient to identify some treatment goals in our second session, and his only goal was to "put Trump back in the White House." Needless to say, the discussion went nowhere and we agreed to terminate.
 
butteredtoast27 said:
No kidding. Last week I was trying to get a relatively new patient to identify some treatment goals in our second session, and his only goal was to "put Trump back in the White House." Needless to say, the discussion went nowhere and we agreed to terminate.
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I always knew the Hatch Act was good for something...
 
butteredtoast27 said:
No kidding. Last week I was trying to get a relatively new patient to identify some treatment goals in our second session, and his only goal was to "put Trump back in the White House." Needless to say, the discussion went nowhere and we agreed to terminate.
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Hey at least he agreed to terminate and didn't ask for never ending supportive therapy around this goal that your program managers won't back you on when you say no
 
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