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

[WisNeuro]

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[deleted1129370]

What is a trap?

 

[erg923]

I am here to trap you into a "corporate life".....devoid of the freedoms of clinical and medicolegal psychological practice. Most of this is not true....although some of it is. Do you want me to dress up as Michael Meyers? It's what my son is doing this year.

 

[WisNeuro]

I am here to trap you into a "corporate life".....devoid of the freedoms of clinical and medicolegal psychological practice. Most of this is not true....although some of it is. Do you want me to dress up as Michael Meyers? It's what my son is doing this year.

I wouldn't characterize it as much in terms of the freedoms, as I would the opportunity for revenue generation. Which, in turn allows you more freedoms.

 

[cara susanna]

Curious...

At your VA, how do SPC handle VCL calls requesting services? At ours, they ask us providers to contact the patient to discuss therapy requests, even if they aren't an active patient (so like, someone we've seen in the past). I don't know why the SPC can't just do that themselves. Or am I not understanding how this should work?

 

[Therapist4Chnge]

Haha, close! I'm in the Heartland system. Weirdly, no one is feeling the Kansas and Missouri areas.

Depending on what someone is looking for, KS and MO can be a decent to good place to raise a family. I'm not sure how the Dobbs ruling and other cases have impacted healthcare in those areas, but cost of living and salaries tend to be pretty good bc they can't compete otherwise.

 

[Shiori]

Depending on what someone is looking for, KS and MO can be a decent to good place to raise a family. I'm not sure how the Dobbs ruling and other cases have impacted healthcare in those areas, but cost of living and salaries tend to be pretty good bc they can't compete otherwise.

The ruling has been a lot on the MO side, but KS showed up to the polls and did great things.

I do enjoy living in this area. I live in a nice house with a big yard. My family is happy. I'm settling into my job. Things have been really good.

 

[deleted1129370]

So, this will be a bit of a turn where I am posting a positive post about the VA. My supervisor will be allowing me to remote work 3 days out of the week! This will allow me to take on some contract work doing police evaluations in the evenings after my tour. I won't be as fatigued, and it shaves off about 45 minutes of drive time.

 

[WisNeuro]

So, this will be a bit of a turn where I am posting a positive post about the VA. My supervisor will be allowing me to remote work 3 days out of the week! This will allow me to take on some contract work doing police evaluations in the evenings after my tour. I won't be as fatigued, and it shaves off about 45 minutes of drive time.

Just make sure your personal liability insurance, not the VA coverage, is up to date 🙂

And yeah, that traffic is no joke.

 

[deleted1129370]

Just make sure your personal liability insurance, not the VA coverage, is up to date 🙂

And yeah, that traffic is no joke.

It is - in fact...I just received my annual renewal notice. Ugg, Trust is a bit pricey after the first year with them.

 

[Pragma]

It is - in fact...I just received my annual renewal notice. Ugg, Trust is a bit pricey after the first year with them.

It’s nothin compared to MDs

 

[WisNeuro]

It’s nothin compared to MDs

Yeah, the quotes I see for my wife are something. Same with licensing and testing fees.

 

[AcronymAllergy]

Just make sure your personal liability insurance, not the VA coverage, is up to date 🙂

And yeah, that traffic is no joke.

Yup. I'd actually recommend all VA providers get their own malpractice insurance if possible (full disclosure: I didn't do that for my first few years at VA). After all, VA's attorneys are ultimately there to protect VA, which may or may not involve protecting you.

 

[deleted1129370]

Yup. I'd actually recommend all VA providers get their own malpractice insurance if possible (full disclosure: I didn't do that for my first few years at VA). After all, VA's attorneys are ultimately there to protect VA, which may or may not involve protecting you.

Yeah, during internship one of my supervisors told us of a story where a vet wanted to file a complaint against them, and it was at that point they decided to get their own insurance due to the reasons you just mentioned. For me, since I also operate my own LLC, I wanted to have that extra layer to cover both myself and my LLC. Also, I will be sub-contracting my PLLC to do some LEO evals, and they require malpractice insurance as well.

 

[AcronymAllergy]

Yeah, during internship one of my supervisors told us of a story where a vet wanted to file a complaint against them, and it was at that point they decided to get their own insurance due to the reasons you just mentioned. For me, since I also operate my own LLC, I wanted to have that extra layer to cover both myself and my LLC. Also, I will be sub-contracting my PLLC to do some LEO evals, and they require malpractice insurance as well.

Yes, you'll definitely want malpractice if doing any work outside VA. I don't think LLCs/PLLCs do much of anything to protect against malpractice.

 

[summerbabe]

Curious...

At your VA, how do SPC handle VCL calls requesting services? At ours, they ask us providers to contact the patient to discuss therapy requests, even if they aren't an active patient (so like, someone we've seen in the past). I don't know why the SPC can't just do that themselves. Or am I not understanding how this should work?

If there is a local SPC consult input by the VCL hotline responder, I think the SOP indicates a SPC should provide outreach via phone within 24 hours and make 3 attempts if the veteran is not reached. Are they doing this?

If they are and the veteran is requesting services on this subsequent call at the local level, they should either put in any relevant consults or alert active members of the care team.

If it's an inactive mental health patient, it would make sense if they follow the typical procedures for your facility for engaging/re-engaging veterans who want therapy.

 

[summerbabe]

So, right now, I am seeing some potential red flags, I am unsure if they are legitimate or if my brain is being biased, but I just don't know how much more I will tolerate of VAs crap. This is my third VA. Houston VA had a ton of openings recently - I was told they magically acquired some funding and were expanding, but evidently, the program I am in lost a bulk of its providers for some reason. New management came in, and now the place is getting full staffed, albeit slowly. Heck, today they voluntold me to do contingency management for an undetermined period of time since the provider doing it is stopping that. I was like "I can't emphasize enough how much I do not want to do CM, so how long will I be required to do this as VA-speak for short-term is highly variable."

It’s probably legit. I’m in a role where I connect with multiple local systems in my VISN regularly and I have seen/heard similar things.

My sense is that people have been leaving VAs at much higher rates than standard recently, including jumping to other VAs like yourself. And recruitment is slower than normal across the board and onboarding is even worse at some facilities which are having trouble retaining HR staff.

Since most of our positions are written so broadly that any of us can be slotted into anything within mental health, leadership is definitely taking advantage of that. And with increasing staff turnover combined with increased veteran engagement with mental health, the plugging holes by all means necessary approach is probably going to be happening at a lot of facilities, if it hasn’t already.

Hope that you can continue to advocate for yourself and emphasize that you doing CM is most definitely not a permanent solution and at least pressure your supervisors to be proactive.

And at VAs ‘stressed’ with access/staffing issues, my general sense is that leadership would rather add on more duties to current staff rather than make hard choices such as choicing out care or choicing out even more care and hoping enough current staff don’t burn out enough to leave while they try to hire new people and keep the ship afloat.

 

[Sanman]

It’s probably legit. I’m in a role where I connect with multiple local systems in my VISN regularly and I have seen/heard similar things.

My sense is that people have been leaving VAs at much higher rates than standard recently, including jumping to other VAs like yourself. And recruitment is slower than normal across the board and onboarding is even worse at some facilities which are having trouble retaining HR staff.

Since most of our positions are written so broadly that any of us can be slotted into anything within mental health, leadership is definitely taking advantage of that. And with increasing staff turnover combined with increased veteran engagement with mental health, the plugging holes by all means necessary approach is probably going to be happening at a lot of facilities, if it hasn’t already.

Hope that you can continue to advocate for yourself and emphasize that you doing CM is most definitely not a permanent solution and at least pressure your supervisors to be proactive.

And at VAs ‘stressed’ with access/staffing issues, my general sense is that leadership would rather add on more duties to current staff rather than make hard choices such as choicing out care or choicing out even more care and hoping enough current staff don’t burn out enough to leave while they try to hire new people and keep the ship afloat.

Sounds a lot like what I am seeing currently. Sucks for those of us at VAs, but I am glad it is happening overall. Means the market for other work is getting better.

 

[cara susanna]

Yup, there is a ton of issues hiring at VAs because everyone is leaving for VAs with full time telework positions. I heard it from VISN leadership.

 

[deleted1129370]

Yup, there is a ton of issues hiring at VAs because everyone is leaving for VAs with full time telework positions. I heard it from VISN leadership.

Where are these non-VA telework jobs?

 

[Sanman]

Where are these non-VA telework jobs?

If you are doing therapy, literally everywhere.

 

[deleted1129370]

I am curious - is it possible to work for someone in private practice and make above $140K? Would it be salary or per hour?

 

[Sanman]

I am curious - is it possible to work for someone in private practice and make above $140K? Would it be salary or per hour?

Anything is possible if someone offers it to you. The question is what are they going to make you do for that compensation.

 

[WisNeuro]

I am curious - is it possible to work for someone in private practice and make above $140K? Would it be salary or per hour?

Depends on what services you provide, how many hours/week, and what benefits you are expecting.

 

[AcronymAllergy]

I am curious - is it possible to work for someone in private practice and make above $140K? Would it be salary or per hour?

Short answer: yes. Longer answer, as was said above: it depends. I've seen job postings listing compensation at that level in neuropsych, which have been a mix of salary and hourly/based on what you bill (e.g., "the typical provider will make XXX per year").

 

[deleted1129370]

Eh...I would be looking to do assessments and therapy. If I wanted to make $135K and do primarily therapy, I can just stay with the VA. At least they threw me a bone and allowed 1 day a week I can do testing....and I get to work remotely for 3 days out of the week.

 

[WisNeuro]

Eh...I would be looking to do assessments and therapy. If I wanted to make $135K and do primarily therapy, I can just stay with the VA. At least they threw me a bone and allowed 1 day a week I can do testing....and I get to work remotely for 3 days out of the week.

Depends on the practice. Most large practices are offering 50/50 splits, in which 135k+ might be hard to come by in just clinical work unless you are working more than 40hrs/week. You'll likely find better splits in smaller practices, though the benefits may be variable.

 

[IWillSurvive]

Regarding the 'more time off' (to prevent burnout) I totally feel that. Seeing heavily burdened (with psychopathology) veteran patients all day long, every day, without end is incredibly draining. One alternative to more time off might be having the burden of seeing veterans for psychotherapy more evenly distributed among all mental health staff licensed (and therefore able) to do so. What I mean is that instead of having people basically divided into two classes: (a) those who see veteran patients for therapy all day, every day and are mapped like 95-100 clinical time; vs (b) those who never see veterans for therapy or who see them extremely infrequently (couple of sessions per week or some ancillary 'support group' once per month) and are almost 100% non-clinical in their labor mapping. **Please note: I am not including actual supervisors/ service chiefs in the (b) category; I definitely realize that they have other duties that make it impossible for them to have caseloads beyond maybe a couple of patients just to keep their 'toes in the water' to keep a bearing on what practice is like in their systems. I am more talking about all of the other ancillary positions that have been proliferating in the past several years. So one possible solution would be to ramp down the amount of clinic time for everyone down to something like 65% - 75% of their work time mapped to clinical encounters/therapy and to divide up the administrative duties more evenly among staff so that staff don't show up to their shift grimly staring down a list of back-to-back-to-back-to-back-to-back-to-back psychiatric trainwrecks until they get to the end of their shifts. Something like back-to-back-to-back, then an afternoon of one additional client and some administrative duties would be far less likely to induce burnout.

100% agree with this and have been sayin this for awhile. As someone working in a large VA always flooded with veterans newly looking to initiate MH care, this would be a significant retention incentive for me and many providers I know. I understand that reducing my clinical hours even by a small number costs the VA in terms of having to pay for community care but not being able to retain providers would also seem costly over the long-term. They are constantly talking about hiring as a way to fix the problem...but it's not really fixed if those hired are not retained. Very short-sighted thinking in my view...

 

[Fan_of_Meehl]

100% agree with this and have been sayin this for awhile. As someone working in a large VA always flooded with veterans newly looking to initiate MH care, this would be a significant retention incentive for me and many providers I know. I understand that reducing my clinical hours even by a small number costs the VA in terms of having to pay for community care but not being able to retain providers would also seem costly over the long-term. They are constantly talking about hiring as a way to fix the problem...but it's not really fixed if those hired are not retained. Very short-sighted thinking in my view...

Agreed. It's not really fixed if those hired aren't going to be seeing patients, either.

 

[deleted1129370]

Funny thing happened about a week ago. In our team meeting, one of the senior social workers was complaining about the never-ending buildup of consults for SDTP that need to be routed to providers to be seen for EBA intakes. Another senior social worker chimes in and they both start "going at each other" while we all watch them try to find a way to balance the VAs policies on wait times vs. the fact that people are booked. The other senior social worker was like "didn't Dr. X start, can't we just give him a lot of these cases?" They looked at my facial reaction (which was dramatic) and I was like "so, I will be transparent with you, if you saddle me with all of those cases in addition to my other responsibilities I have and what my grid affords me, I will burn out. I've been burnt out before, and I refuse to go back to that dark place, so I highly recommend you not do that." To be honest, ever since getting to this new VA, I have put my foot down and told folks "nope, that's not happening." They wanted me to have a phone clinic to see veterans and I was like "I will not be conducting assessments or therapy sessions over phone, you can find another provider who might be more comfortable doing so, but that's not me." I also told them that 12-1 is my lunch hour, so whatever I do, my grid will be structured around that, and I told them I am out the door by 4:30 every day.

 

[Sanman]

100% agree with this and have been sayin this for awhile. As someone working in a large VA always flooded with veterans newly looking to initiate MH care, this would be a significant retention incentive for me and many providers I know. I understand that reducing my clinical hours even by a small number costs the VA in terms of having to pay for community care but not being able to retain providers would also seem costly over the long-term. They are constantly talking about hiring as a way to fix the problem...but it's not really fixed if those hired are not retained. Very short-sighted thinking in my view...

It is short-sighted thinking. However, most VA retention incentives and the systemic structure is skewed toward hiring early career folks. The late career folks are there for the golden handcuffs of the old pension system. However, there is little they have done to retain mid career folks and I don't believe there will be much. Those folks either leave altogether or do their duties and head for their PP office at 4pm if they are in one the easier to balance positions.

 

[deleted1129370]

It is short-sighted thinking. However, most VA retention incentives and the systemic structure is skewed toward hiring early career folks. The late career folks there for the golden handcuffs of the old pension system. However, there is little they have done to retain mid career folks and I don't believe there will be much. Those folks either leave altogether or do their duties and head for their PP office at 4pm if they are in one the easier to balance positions.

Indeed - I just signed my contract to sub-contract my PLLC to do police evaluations, so once I am done at the VA, I will be "shooting" over to do private practice work 8 hours a week. Not sure how long I will be doing the VA gig.

 

[Shiori]

What kind of boundaries do you all set with Veterans? Throughout training, I think I allowed a level of flexibility that was no longer therapeutic to patients and impacted treatment fidelity. It also burned me out. I also worked with some pretty irritable folks. I am thinking through what I am okay tolerating in session regarding angry outbursts, swearing, etc. Do you all have general guidelines for yourselves or is it more organic and case by case?

Edited to clarify that I mean swearing at me, not in general.

 

[Sanman]

What kind of boundaries do you all set with Veterans? Throughout training, I think I allowed a level of flexibility that was no longer therapeutic to patients and impacted treatment fidelity. It also burned me out. I also worked with some pretty irritable folks. I am thinking through what I am okay tolerating in session regarding angry outbursts, swearing, etc. Do you all have general guidelines for yourselves or is it more organic and case by case?

Edited to clarifying that I mean swearing at me, not in general.

I think it depends on the individual provider and the support from the facility. In general, no aggression, minimal cursing, no sexual harassment of coworkers, and most recently following masking requirements. I also don't pick up phone calls after hours or on weekends (I have a VA cell phone). The issue with boundaries is how far are you willing to push them. Being as a stage of life where I can walk away from this job and start a PP means I don't get bullied into doing much. Younger people or those that are in a more precarious financial position might feel differently.

 

[Fan_of_Meehl]

What kind of boundaries do you all set with Veterans? Throughout training, I think I allowed a level of flexibility that was no longer therapeutic to patients and impacted treatment fidelity. It also burned me out. I also worked with some pretty irritable folks. I am thinking through what I am okay tolerating in session regarding angry outbursts, swearing, etc. Do you all have general guidelines for yourselves or is it more organic and case by case?

Edited to clarifying that I mean swearing at me, not in general.

This is a good topic yet rarely discussed.

Veterans swearing (in general) in session? I don't really care and think that--in general--trying to get them to stop would be a non-starter...you can't really make them stop and it's not worth the effort and why does it matter if they swear during their sessions?

On the other hand, veterans swearing AT me isn't tolerated because it is a disrespectful and dangerous escalation of hostility that needs to be managed from a risk assessment perspective at that point. I mean, if it was the first time seeing me (in crisis) and I was able to get them to reign in their hostility and participate safely in the interview process as it goes forward then fine but being sworn AT means that therapy isn't even occurring at that point.

 

[summerbabe]

What kind of boundaries do you all set with Veterans? Throughout training, I think I allowed a level of flexibility that was no longer therapeutic to patients and impacted treatment fidelity. It also burned me out. I also worked with some pretty irritable folks. I am thinking through what I am okay tolerating in session regarding angry outbursts, swearing, etc. Do you all have general guidelines for yourselves or is it more organic and case by case?

Edited to clarifying that I mean swearing at me, not in general.

This stuff is really tough when it happens so I think a combination of general guidelines and evaluating case by case is appropriate.

I often start by trying to objectively evaluate whether the action meets criteria for submitting a report to the disruptive behavior committee. I've experienced lots of "well you work for the VA so you're part of the f-ing problem......." (which I try to diffuse if possible) and rarer situations where it was definitely directed and personalized towards me with varying degrees of feeling more subjectively threatened, mostly with inpatient work.

If your answer is yes or possibly (could be good to consult with some colleagues or your local DBC with questions or gray area), then that's the kind of stuff I would probably want to address in some fashion.

If your supervisor is helpful, loop them in early on. If they are not helpful, they might need to be looped in anyways once you've largely decided on a course of action.

 

[Shiori]

Yeah, I've been fortunate most of my more inappropriate clients are brief encounters. VVC has also been helpful in removing some of the threat. We have a few individuals here recently who have caused us to have to lock things down because they're pretty threatening. It's something I've been thinking about more. I keep my door locked even though my preference is the friendliness of an open door.

We're also slowly, but firmly shifting to a dose-based approach, which has caused a lot of resistance here. I'm trying to be proactive about introducing therapy as it will be done in the VA. Most people only need about 12ish session to see improvement. EBPs are strongly encouraged. Groups are also encouraged. I no-show at the end of the day SO PLEASE CALL. Also, I am mandated to chase a person down if they don't tell me with words that they would like to quit therapy. I want to lay out expectations earlier with the hope that I won't agitate someone unnecessarily.

I think I'll add not calling after hours to the list. I also want to find a balance between helping someone navigate a complicated system rather than doing it for them. I don't mind case management, but it puts me behind schedule pretty fast.

So many things to think about now that I get to make more decisions!

 

[erg923]

This stuff is really tough when it happens so I think a combination of general guidelines and evaluating case by case is appropriate.

I often start by trying to objectively evaluate whether the action meets criteria for submitting a report to the disruptive behavior committee. I've experienced lots of "well you work for the VA so you're part of the f-ing problem......." (which I try to diffuse if possible) and rarer situations where it was definitely directed and personalized towards me with varying degrees of feeling more subjectively threatened, mostly with inpatient work.

If your answer is yes or possibly (could be good to consult with some colleagues or your local DBC with questions or gray area), then that's the kind of stuff I would probably want to address in some fashion.

If your supervisor is helpful, loop them in early on. If they are not helpful, they might need to be looped in anyways once you've largely decided on a course of action.

Agree that this is interesting to talk about.

I can recall the tail end of my VA tenure when I got an "emergency" case in my PCMHI room (he was already enrolled in MHC, but that's a whole other story) who was ranting a raving about this that and the other thing...and not in a polite manner. Aside from me trying to be relatively frank with him in a therapeutic manner, I recall him asking what would happen if he came to the VA or some other such place and started shooting people because he was damaged and was pissed that he was not willing not work on his own life. I told him "Look son....you will go to jail for the rest of your life." I mean....this guy truly believed that he should get off from it because he was a "veteran!!!" I really don't know how one deals with that level of societal entitlement? Security was ultimately called.

Right after that (maybe the same day?) I had a guy call me a ****** because he saw a California license plate in my office that was a decoration. I told him we are done here and asked he be escorted out. It's really hard to have therapeutic conversations with people in this state...or that level of personality disorder (whichever it is?). Either way, I didn't have the patience for it. And neither should anyone else.

 

[Shiori]

If I were to operationalize boundaries for myself in this conversation, it would be things I have control over (myself and what I will tolerate), can articulate to my client, and are enforceable. For me, it also involves interpersonal factors rather than things like enforcement of policy. There are rules in the VA I enforce, but I wouldn't call those boundaries. I'm sure there are other factors, but those come to mind for me.

 

[PsychPhDone]

Yeah, I've been fortunate most of my more inappropriate clients are brief encounters. VVC has also been helpful in removing some of the threat. We have a few individuals here recently who have caused us to have to lock things down because they're pretty threatening. It's something I've been thinking about more. I keep my door locked even though my preference is the friendliness of an open door.

We're also slowly, but firmly shifting to a dose-based approach, which has caused a lot of resistance here. I'm trying to be proactive about introducing therapy as it will be done in the VA. Most people only need about 12ish session to see improvement. EBPs are strongly encouraged. Groups are also encouraged. I no-show at the end of the day SO PLEASE CALL. Also, I am mandated to chase a person down if they don't tell me with words that they would like to quit therapy. I want to lay out expectations earlier with the hope that I won't agitate someone unnecessarily.

I think I'll add not calling after hours to the list. I also want to find a balance between helping someone navigate a complicated system rather than doing it for them. I don't mind case management, but it puts me behind schedule pretty fast.

So many things to think about now that I get to make more decisions!

I don't tolerate being cursed at. I don't care about profanity otherwise but I don't tolerate hate speech directed at groups. I have a low threshold for reporting to disruptive behavior committee. I also have a document about expectations for working together that I review with every patient at session 1 so they know my boundaries at the outset.

 

[Fan_of_Meehl]

Agree that this is interesting to talk about.

I can recall the tail end of my VA tenure when I got an "emergency" case in my PCMHI room (he was already enrolled in MHC, but that's a whole other story) who was ranting a raving about this that and the other thing...and not in a polite manner. Aside from me trying to be relatively frank with him in a therapeutic manner, I recall him asking what would happen if he came to the VA or some other such place and started shooting people because he was damaged and was pissed that he was not willing not work on his own life. I told him "Look son....you will go to jail for the rest of your life." I mean....this guy truly believed that he should get off from it because he was a "veteran!!!" I really don't know how one deals with that level of societal entitlement? Security was ultimately called.

Right after that (maybe the same day?) I had a guy call me a ****** because he saw a California license plate in my office that was a decoration. I told him we are done here and asked he be escorted out. It's really hard to have therapeutic conversations with people in this state...or that level of personality disorder (whichever it is?). Either way, I didn't have the patience for it. And neither should anyone else.

I couldn't agree more about being matter-of-fact and, frankly, blunt in response to such questions. If they're a sociopath and just trying to manipulate you into being scared and giving them what they want then you're 'popping their balloon' matter-of-factly (while still being professional) and that's 100% the right call. If they're being serious...well, you're providing reality orientation and that's 100% the right call as well.

Sociopathic attempts at manipulation are--pun intended--a criminally under-recognized phenomenon in VA mental health settings.

 

[deleted1129370]

This topic has perfect timing. I had a nice lunch hour with a colleague of mine, then came back to my desk, was going to catch up on some things and then BAM, I get a message on teams from an MSA tell me that a veteran who no-showed me last week for our initial intake evaluation showed back up and needed to speak to me to ask some "questions." I went over to the waiting room and inquired about the question(s) they had...I didn't know the answer, so I consulted with a colleague who also accompanied me to speak with the veteran privately who then got pretty upset they couldn't go back to a residential treatment program they were just discharged from like 3 days ago. We consulted a bit more with our same day access team who evidently, this veteran also visited with this morning (4 other people). I had to break the news that we would not be submitting a referral in for RPT and that the option still remained for us to meet this week for our re-scheduled intake. The veteran then complained about all of the red tape and was like "you know, I don't think I abuse the system, I could easily start saying the right key phrases to get in, but I'm not suicidal, I don't want to die." Once they said that, it prompted me to inquire about me, in which they were like "naw man, now you just want to cover your ass" then they stood up, flung the door open and left.

Idk...on my drive home today in traffic, I just seriously contemplated "what the hell am I doing? Is it really with it anymore to be with the VA?" I know this was an emotional reaction, but isn't the first time, and all honesty, I have seriously contemplated just cutting ties with the VA for a over a year. I am unsure how much more I am willing to tolerate of the entitlement.

 

[WisNeuro]

This topic has perfect timing. I had a nice lunch hour with a colleague of mine, then came back to my desk, was going to catch up on some things and then BAM, I get a message on teams from an MSA tell me that a veteran who no-showed me last week for our initial intake evaluation showed back up and needed to speak to me to ask some "questions." I went over to the waiting room and inquired about the question(s) they had...I didn't know the answer, so I consulted with a colleague who also accompanied me to speak with the veteran privately who then got pretty upset they couldn't go back to a residential treatment program they were just discharged from like 3 days ago. We consulted a bit more with our same day access team who evidently, this veteran also visited with this morning (4 other people). I had to break the news that we would not be submitting a referral in for RPT and that the option still remained for us to meet this week for our re-scheduled intake. The veteran then complained about all of the red tape and was like "you know, I don't think I abuse the system, I could easily start saying the right key phrases to get in, but I'm not suicidal, I don't want to die." Once they said that, it prompted me to inquire about me, in which they were like "naw man, now you just want to cover your ass" then they stood up, flung the door open and left.

Idk...on my drive home today in traffic, I just seriously contemplated "what the hell am I doing? Is it really with it anymore to be with the VA?" I know this was an emotional reaction, but isn't the first time, and all honesty, I have seriously contemplated just cutting ties with the VA for a over a year. I am unsure how much more I am willing to tolerate of the entitlement.

About those police evals...

 

[deleted1129370]

About those police evals...

Well, I just signed the contract last week and got access to their platform, software, library, so I will begin training and getting oriented to their process. I get $125 per eval for a minimum of 8 evals a week. I can do more if wanted, and I know they are wanting a full time salary psychologist.

 

[WisNeuro]

Well, I just signed the contract last week and got access to their platform, software, library, so I will begin training and getting oriented to their process. I get $125 per eval for a minimum of 8 evals a week. I can do more if wanted, and I know they are wanting a full time salary psychologist.

How much time on task are these evals?

 

[deleted1129370]

How much time on task are these evals?

They described it to me that everything is templated, so they are writing the report as they do their interview, and typically, maybe spend 15 minutes after the interview is done (45 minutes). It sounded pretty straight forward. They already would send out a packet to the candidate who would have filed out the relevant background info, they would have already been administered the tests, so my role is to interview, then take all of those components to align them with the 10 dimensions per California POST and determine suitable vs. not.

 

[Sanman]

Agree that this is interesting to talk about.

I can recall the tail end of my VA tenure when I got an "emergency" case in my PCMHI room (he was already enrolled in MHC, but that's a whole other story) who was ranting a raving about this that and the other thing...and not in a polite manner. Aside from me trying to be relatively frank with him in a therapeutic manner, I recall him asking what would happen if he came to the VA or some other such place and started shooting people because he was damaged and was pissed that he was not willing not work on his own life. I told him "Look son....you will go to jail for the rest of your life." I mean....this guy truly believed that he should get off from it because he was a "veteran!!!" I really don't know how one deals with that level of societal entitlement? Security was ultimately called.

Right after that (maybe the same day?) I had a guy call me a ****** because he saw a California license plate in my office that was a decoration. I told him we are done here and asked he be escorted out. It's really hard to have therapeutic conversations with people in this state...or that level of personality disorder (whichever it is?). Either way, I didn't have the patience for it. And neither should anyone else.

This topic has perfect timing. I had a nice lunch hour with a colleague of mine, then came back to my desk, was going to catch up on some things and then BAM, I get a message on teams from an MSA tell me that a veteran who no-showed me last week for our initial intake evaluation showed back up and needed to speak to me to ask some "questions." I went over to the waiting room and inquired about the question(s) they had...I didn't know the answer, so I consulted with a colleague who also accompanied me to speak with the veteran privately who then got pretty upset they couldn't go back to a residential treatment program they were just discharged from like 3 days ago. We consulted a bit more with our same day access team who evidently, this veteran also visited with this morning (4 other people). I had to break the news that we would not be submitting a referral in for RPT and that the option still remained for us to meet this week for our re-scheduled intake. The veteran then complained about all of the red tape and was like "you know, I don't think I abuse the system, I could easily start saying the right key phrases to get in, but I'm not suicidal, I don't want to die." Once they said that, it prompted me to inquire about me, in which they were like "naw man, now you just want to cover your ass" then they stood up, flung the door open and left.

Idk...on my drive home today in traffic, I just seriously contemplated "what the hell am I doing? Is it really with it anymore to be with the VA?" I know this was an emotional reaction, but isn't the first time, and all honesty, I have seriously contemplated just cutting ties with the VA for a over a year. I am unsure how much more I am willing to tolerate of the entitlement.

The issue is that a lot of these folks buy into the marketing the government is selling. The truth is no one cares that much about your military service other than to be politically correct. You are still responsible for yourself, your actions, and your well-being.

 

[deleted1129370]

The issue is that a lot of these folks buy into the marketing.

It's a legit practice headed up by board members of ABPP who routinely contribute to the CONCEP/ Palo Alto series of PD courses. There's nothing about the setup that seems predatory or dishonest.

 

[summerbabe]

Idk...on my drive home today in traffic, I just seriously contemplated "what the hell am I doing? Is it really with it anymore to be with the VA?" I know this was an emotional reaction, but isn't the first time, and all honesty, I have seriously contemplated just cutting ties with the VA for a over a year. I am unsure how much more I am willing to tolerate of the entitlement.

Veteran entitlement in the most egregious forms is super off putting while also causing a lot of difficulties for us.

But I've seen entitlement in every setting I've ever trained/worked in, including in a drug court diversion residential A&D program. It seemed like a pretty sweet deal to spend 45 days eating real food and having down time everyday to play basketball/ping pong and watch TV while avoiding a jail sentence in exchange for following some pretty basic rules but nope, not good enough for multiple folks during my brief time there. It was kinda wild to see somebody go from sitting in group in the morning to being led out in handcuffs in the afternoon.

If you're feeling really fed up with VA/veterans, nothing wrong with jumping ship and trying to improve your quality of life since it sounds like you've got options that you've worked hard to develop. VA will be around if it ever makes sense to come back.

 

[Sanman]

It's a legit practice headed up by board members of ABPP who routinely contribute to the CONCEP/ Palo Alto series of PD courses. There's nothing about the setup that seems predatory or dishonest.

I was not talking about you. I was talking about veterans.