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

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LEAF requests sound awfully similar to TPS reports.
Office Space GIF by 20th Century Fox Home Entertainment
office space workplace GIF by Tech Noir


There is a key difference. The complaint usually comes from a Milton, not a Lomberg. Few folks rocking suspenders in the feds.
 
Is it just my facility or are the gif games in facility wide chats extremely unhinged?

Also, I’m a probationary employee—anyone have any experience asking for religious holiday schedule adjustments in the first year? Is it a no-go?
This is honestly the only way I want to communicate in the facility wide chats. I will adopt this approach. I want people to know that I'm a burnt out millennial who has lost the ability to speak in full sentences. Bother me at your own risk.

Happy Hour Drinking GIF by Saturday Night Live
 
This is honestly the only way I want to communicate in the facility wide chats. I will adopt this approach. I want people to know that I'm a burnt out millennial who has lost the ability to speak in full sentences. Bother me at your own risk.

Tangentially related--if that's Barefoot wine I believe drinking it in this fashion is decorum.
 
Tangentially related--if that's Barefoot wine I believe drinking it in this fashion is decorum.
That is definitely Barefoot. The pinot grigio got me through grad school. Now I'm classy and spent slightly more than $6 a bottle on wine.
 
Is it just my facility or are the gif games in facility wide chats extremely unhinged?

Also, I’m a probationary employee—anyone have any experience asking for religious holiday schedule adjustments in the first year? Is it a no-go?
It is consistent with the current workplace theme complete with nonsensical daily virtual 'safety' check-in meetings (infantilization), obsession with concrete tasks of moving virtual 'blocks' (MH Suite problems/goals/objectives/interventions) around the playpen, and daily spankings.

At some point in the past 30 years and over the course of my career the professional psychological workplace in large institutions has morphed into an adult daycare setting with commensurate plummeting clinical efficiency and efficacy.
 
Also, I’m a probationary employee—anyone have any experience asking for religious holiday schedule adjustments in the first year? Is it a no-go?
No personal experiences but if you plan well in advance and especially if you can offer something positive in return (eg I’m happy to work the regular Thanksgiving week schedule and can help with clinical coverage that week), I think your supervisor will be more likely to help you with this process.

Also whether your preferred holiday adjustment will fall in a time when everybody wants leave or if it’s during a time when very little leave is being asked for might matter. Good luck!
 
Is it just my facility or are the gif games in facility wide chats extremely unhinged?

Also, I’m a probationary employee—anyone have any experience asking for religious holiday schedule adjustments in the first year? Is it a no-go?
Your probationary status should have no impact here. If it is a religious holiday in which your religion does not allow you to work, your boss pretty much has to allow you to do "religious compensatory time," within reason. Many managers, and even timekeepers are unfamiliar with this as it was a new policy rolled out under the trump admin for all feds in 2019, and my guess is, very underutilized. I had multiple bosses greenlight it just fine once they learned what it was. If it is a religious holiday where your faith does technically permit you to be at work, YMMV, but your newbie status shouldn't matter.
 
 
Hiring freeze is going to last longer, it seems like at least another fiscal year. My manager, bless them (and not in the sarcastic southern way), is holding the line and making it very clear to upper management that we will not be able to decrease wait times without more staff.
 
Hiring freeze is going to last longer, it seems like at least another fiscal year. My manager, bless them (and not in the sarcastic southern way), is holding the line and making it very clear to upper management that we will not be able to decrease wait times without more staff.

It is unlikely that we will see any major decisions until 2026 at the earliest given the upcoming elections. Government is not known for their speed.
 
It is unlikely that we will see any major decisions until 2026 at the earliest given the upcoming elections. Government is not known for their speed.
Which would mean that the current status quo would likely persist until then?
 
Which would mean that the current status quo would likely persist until then?
I no longer work at VA, but based on what I've seen/heard, that's what I'd assume until proven otherwise. I do think trainee recruitment events may still be occurring, though.
 
Which would mean that the current status quo would likely persist until then?

If by current status quo you mean minimal hiring, most likely. There is a $12 billion budget shortfall for 2025 that starts in October. Even if congress patch it before election season, no one is being overly generous. That estimate is based on cutting 10k jobs.
 
Yeah, I don't see this self-inflicted wound being staunched any time soon. The VHA/VBA has acted like it's had a blank check for a long time, and now they actually have to do something about their budget. Hard to argue for continuous double digit budget increases when nearly every other non-defense area is seeing cuts.
 
Yeah, I don't see this self-inflicted wound being staunched any time soon. The VHA/VBA has acted like it's had a blank check for a long time, and now they actually have to do something about their budget. Hard to argue for continuous double digit budget increases when nearly every other non-defense area is seeing cuts.

More than that, they either messed up the budget estimate or intentionally lowballed the budget prior to approval by congress and then came back asking for more money when some of the PACT Act subsidies expired. All this during an election year (or maybe because it is an election year). Let's see if anyone in congress wants to play hero.
 
If by current status quo you mean minimal hiring, most likely. There is a $12 billion budget shortfall for 2025 that starts in October. Even if congress patch it before election season, no one is being overly generous. That estimate is based on cutting 10k jobs.
I'm callin' it now. We ain't seen NUTHIN yet. The current 'shortfall' is the leading edge of a massive storm that--given the status quo--is going to roll over the entire organization in the coming years.

Just spend a little time Googling year-to-year increases in overall (VHA + VBA) budgets over time (spoiler alert, they've been exponentially increasing), disability payouts (also nonlinearly increasing), and total VHA enrollment (patient population) which has also increased dramatically recently due to the PACT Act. The train has left the station and all of these trends are accelerating with no brakes and no governor on the system. We're gonna continue to be "broke" and we are gonna be exponentially "more broke" with each passing year. "Leadership" is just saying how we are going to "increase productivity" and "do more with less" but people are already beginning to leave, retire early, or seek non-clinical (non-caseload-bearing) positions. The remaining few are being stretched to their limit and burnout is real (though largely ignored or blamed on the providers themselves). There is only so much blood you can squeeze from a stone. The only thing I've seen "leadership" provide is pseudo-corporarist feelgood platitudes, endlessly- repeated thought-terminating cliches, doublespeak/doublethink, rehearsed language, super-slick psychopathic speeches to "rally the troops" to engage in better "self-care" and to "be more productive" and "eliminate suicide."

Frankly, I think our budget is more than adequate but it is astonishingly poorly managed. Over the years, the actual caseload-bearing (patient-seeing) positions at my facility have, by my count, actually DECREASED in absolute number terms while three other things have significantly increased: (a) positions for licensed and nonlicensed non-patient-seeing experts-without-caseloads, (b) panel sizes, and (c) amount of work/paperwork per patient encounter (most often with ZERO associated clinical utility/benefit).

Mental Health Suite is a ridiculous, time-wasting, Visual Basic concocted monstrosity whose only useful purpose has been to illustrate the massive gulf between mental health 'leadership' and the front-line clinicians who actually provide the care/psychotherapy.
 
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"Keep government out of healthcare! Well, except for my healthcare, which they need to fully subsidize and also provide me with universal basic income/SC. The rest of you can go pound sand."

Could you imagine if all of society acted like some of the veterans we see? Uhh, there's a thought....
 
I'm callin' it now. We ain't seen NUTHIN yet. The current 'shortfall' is the leading edge of a massive storm that--given the status quo--is going to roll over the entire organization in the coming years.

Just spend a little time Googling year-to-year increases in overall (VHA + VBA) budgets over time (spoiler alert, they've been exponentially increasing), disability payouts (also nonlinearly increasing), and total VHA enrollment (patient population) which has also increased dramatically recently due to the PACT Act. The train has left the station and all of these trends are accelerating with no brakes and no governor on the system. We're gonna continue to be "broke" and we are gonna be exponentially "more broke" with each passing year. "Leadership" is just saying how we are going to "increase productivity" and "do more with less" but people are already beginning to leave, retire early, or seek non-clinical (non-caseload-bearing) positions. The remaining few are being stretched to their limit and burnout is real (though largely ignored or blamed on the providers themselves). There is only so much blood you can squeeze from a stone.

Frankly, I think our budget is more than adequate but it is astonishingly poorly managed. Over the years, the actual caseload-bearing (patient-seeing) positions at my facility have, by my count, actually DECREASED in absolute number terms while three other things have significantly increased: (a) positions for licensed and nonlicensed non-patient-seeing experts-without-caseloads, (b) panel sizes, and (c) amount of work/paperwork per patient encounter (most often with ZERO associated clinical utility/benefit).

Mental Health Suite is a ridiculous, time-wasting, Visual Basic concocted monstrosity whose only useful purpose has been to illustrate the massive gulf between mental health 'leadership' and the front-line clinicians who actually provide the care/psychotherapy.

I have already seen some of the supervisors with non-clinical roles get pulled back into patient care where I am. The patient population is just going to continue to increase for two reasons, IMO

1. Greying of the population and Va benefits that are not available outside (Home-based primary care, free durable medical equipment, paid caregiver programs, social workers to help fill out all the paperwork, etc.)

2. A generally lower SES population with little social support among younger veterans. I'm seeing lots of substance abuse cases with them, but maybe that is just what I am exposed to regularly.
 
"Keep government out of healthcare! Well, except for my healthcare, which they need to fully subsidize and also provide me with universal basic income/SC. The rest of you can go pound sand."
As the current system becomes arithmetically impossible to sustain, the political posturings and shenanigans (from all involved) will not fail to entertain.

It will be fascinating to see if the entire VA system will be allowed to collapse due to cowardice or if someone will propose common sense reforms such as:

1) After being diagnosed with a MH condition, you get completely unlimited free therapy/meds for at least 5 years and two scheduled (whether you attend or not) courses of EBP. Thereafter, you will be responsible for a nominal co-pay ($5 to $30) on a sliding scale basis.

2) no more 100% disability ratings while employed at a full-time job making in excess of 100K/yr

3) make the C&P exam a bit more thorough and time-consuming on the front end, but get it right. Require structured interviews (CAPS, SCID) and REAL quality reviews of examiners and objective measures that at least flag GROSS over-reporting of psychopathology and send those cases to a more extensive workup with standalone measures of malingering/ response bias.

4) on the VHA side, eliminate useless horsecrap requirements like MH Suite and multiple separate notes per MH encounter. Fire anyone immediately and on the spot who says stupid demoralizing crap like, "we will not rest until there are ZERO veteran suicides." Or, at least, fairly apply the same standard to medicine. Like, require the cardiologists not to rest until they have eliminated all veteran deaths due to stroke or heart attacks from here to the end of eternity. No more deaths to diabetes, obesity, or substance abuse will be tolerated, either.

We could all go on, ad infinitum. So much stupid crap that is wasting $$$ and demoralizing frontline staff.
 
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I have already seen some of the supervisors with non-clinical roles get pulled back into patient care where I am.
If things are going to hurt more for clinicians, I hope this happens across the board so that supervisors are also experiencing these day to day realities so they can hopefully be a bit more realistic in their expectations while having a more vested stake in what happens.
 
If things are going to hurt more for clinicians, I hope this happens across the board so that supervisors are also experiencing these day to day realities so they can hopefully be a bit more realistic in their expectations while having a more vested stake in what happens.
Hasn't happened at my site. Probably won't, either. I'd love it if the 'higher ups' in the org would start analyzing relevant stats on this in relation to 'access' issues and wait times. My guess is there's probably a lot of site-to-site variability. One relevant stat would be percentage of licensed MH staff (LCSW, PhD/PsyD, LMFT, etc.) who COULD be providing clinical services or bearing caseloads, but who aren't. At my site, for example, I think that something like less than 10% of mental health LCSWs actually provide therapy. The vast majority of therapists are exclusively PhDs/PsyDs. It is rare to encounter an LCSW with a clinical caseload even though we employ tons of LCSWs. If there are 'access' issues for psychotherapy and we are being discouraged from sending people to community care and can't re-fill positions lost to attrition...then why can't an LCSW shoulder a mini-caseload and at least see patients one or two days per week? What are they doing otherwise (in terms of nonclinical duties) that is higher priority than providing care to patients? I thought our highest priority was 'eliminating suicide.'
 
Hasn't happened at my site. Probably won't, either. I'd love it if the 'higher ups' in the org would start analyzing relevant stats on this in relation to 'access' issues and wait times. My guess is there's probably a lot of site-to-site variability. One relevant stat would be percentage of licensed MH staff (LCSW, PhD/PsyD, LMFT, etc.) who COULD be providing clinical services or bearing caseloads, but who aren't. At my site, for example, I think that something like less than 10% of mental health LCSWs actually provide therapy. The vast majority of therapists are exclusively PhDs/PsyDs. It is rare to encounter an LCSW with a clinical caseload even though we employ tons of LCSWs. If there are 'access' issues for psychotherapy and we are being discouraged from sending people to community care and can't re-fill positions lost to attrition...then why can't an LCSW shoulder a mini-caseload and at least see patients one or two days per week? What are they doing otherwise (in terms of nonclinical duties) that is higher priority than providing care to patients? I thought our highest priority was 'eliminating suicide.'

What is the classification of the LCSW though? If not a supervisor, they are likely a union position and good luck getting a union covered position reclassified. The folks I am referring to are gs-14 and up or non-union covered postions such as physicians that can easily be reclassified. Same as how dept chiefs and managers were immediately forced in office but anyone covered under the union was still home because the union had not signed off.
 
If things are going to hurt more for clinicians, I hope this happens across the board so that supervisors are also experiencing these day to day realities so they can hopefully be a bit more realistic in their expectations while having a more vested stake in what happens.
Eh, I have friends that are or have been managers and dept chiefs. The directives are not coming from them. Frankly, they have no interest in creating more paperwork for themselves when employees fight back. They are just between a rock and a hard place. The question becomes how much of a backbone that particular person happens to have and can afford to have.
 
Eh, I have friends that are or have been managers and dept chiefs. The directives are not coming from them. Frankly, they have no interest in creating more paperwork for themselves when employees fight back. They are just between a rock and a hard place. The question becomes how much of a backbone that particular person happens to have and can afford to have.
Cool. If the people in those positions would successfully fight/resist seeing patients one or two days per week (God forbid!) then maybe we can just eliminate their position in the future when we encounter successively larger budget shortfalls in the years to come.

I mean, I get that (traditionally) "you can't fire/discipline/reclassify union folks/positions" but I think we're getting ready to see annual budget shortfalls the causes of which aren't going to be able to be mitigated or curtailed.

Unless some relatively politically drastic measures are taken to mitigate the forces driving the shortfalls, they will continue to increase exponentially. What happens then?
 
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Cool. If the people in those positions would successfully fight/resist seeing patients one or two days per week (God forbid!) then maybe we can just eliminate their position in the future when we encounter successively larger budget shortfalls in the years to come.

I mean, I get that (traditionally) "you can't fire/discipline/reclassify union folks/positions" but I think we're getting ready to see annual budget shortfalls the causes of which aren't going to be able to be mitigated or curtailed.
Honestly, I am of two minds with regard to this and I don't think this will work well. I know the dynamics are your site are different from mine and the LCSW vs psychologist issues there not anything I have encountered. That said, VA really only has two types of folks they can 'squeeze' to do more work. Those that qualify for the FERS .08 percent pension and are above age 45 and under age 57 and younger folks getting $200k reimbursed through EDRP. If you are not one of those two folks, you have plenty of comparable non-VA options if the job is no longer cushy or it will simply be time to avail yourself of that government early retirement.
Unless some relatively politically drastic measures are taken to mitigate the forces driving the shortfalls, they will continue to increase exponentially. What happens then?

This will depend on who is in power over the next decade. Republicans will let it fail and happily ship off as much to contractors or private industry as they can (look at the C&P evals, those were government jobs that now cost more for garbage evals). The democrats are so busy handing out money and playing culture war games, I think they will just focus on band-aids. These changes are about as politically volatile as reforming Social Security and Medicare. Except these folks have more guns.
 
Honestly, I am of two minds with regard to this and I don't think this will work well. I know the dynamics are your site are different from mine and the LCSW vs psychologist issues there not anything I have encountered. That said, VA really only has two types of folks they can 'squeeze' to do more work. Those that qualify for the FERS .08 percent pension and are above age 45 and under age 57 and younger folks getting $200k reimbursed through EDRP. If you are not one of those two folks, you have plenty of comparable non-VA options if the job is no longer cushy or it will simply be time to avail yourself of that government early retirement.


This will depend on who is in power over the next decade. Republicans will let it fail and happily ship off as much to contractors or private industry as they can (look at the C&P evals, those were government jobs that now cost more for garbage evals). The democrats are so busy handing out money and playing culture war games, I think they will just focus on band-aids. These changes are about as politically volatile as reforming Social Security and Medicare. Except these folks have more guns.

Oh, I don't think we can genuinely call the culture wars a one-sided partisan issue. Or that the modern GOP is in any way fiscally conservative. 🙂
 
Oh, I don't think we can genuinely call the culture wars a one-sided partisan issue. Or that the modern GOP is in any way fiscally conservative. 🙂

Agreed on both counts. However, I don't think that democrats are going to be the ones to force cuts to disability payments. Neither is the GOP, they will just funnel the money to different groups.

While I am not a fan of the Hill generally, the stats in this article are pretty damning:

https://thehill.com/opinion/nationa...y-compensation-is-straining-veterans-affairs/
 
Agreed on both counts. However, I don't think that democrats are going to be the ones to force cuts to disability payments. Neither is the GOP, they will just funnel the money to different groups.

While I am not a fan of the Hill generally, the stats in this article are pretty damning:

https://thehill.com/opinion/nationa...y-compensation-is-straining-veterans-affairs/
The Hill article is damning. Part of the problem is the VA pays service connection for normal aging related illnesses, illnesses associated with obesity, and other things that have zero to do with military service. As the article articulates, there is also encouragement to remain sick, probably inadvertently. There has always been a problem on the mental health issue due to difficulty in verification. But veterans are coached in how to maximize service connection, e.g., 8 Ways to Increase Your VA Disability Rating (The Insider’s Guide). It is viewed as another retirement benefit by many.

There is not currently a fiscally conservative party. Libertarians don't count. There is only accelerate spending and accelerate spending faster.
 
Yeah, the current SC compensation system is not sustainable and it's a GIANT elephant in the room that no one will address (probably because it'd be political suicide)... apart from Project 2025, haha.
 
Yeah, the current SC compensation system is not sustainable and it's a GIANT elephant in the room that no one will address (probably because it'd be political suicide)... apart from Project 2025, haha.
And what's even worse than the damning year-to-year numbers (which the Hill article references) is what I guess I would call an 'insider's front-line perspective' as a clinician who has worked (for a time) both as a full-time C&P examiner and as a full-time outpatient psychotherapist at VA. I have become intimately familiar with the specifics of the organizational dysfunction rife in both of those contexts as well as the absolute and utter refusal of the higher ups in the organization's willingness to acknowledge the existence of (let alone begin to attempt to address) these issues.

I'm not sure many people realize just how bad it is.
 
Did you all see the latest MH guidance that we're supposed to tell patients that, if they text us, we will only respond during office hours? Like, shouldn't it be obvious that, if we aren't going to respond to VMs, we won't respond to texts? Why does all VA policy assume our patients are idiots?
 
Did you all see the latest MH guidance that we're supposed to tell patients that, if they text us, we will only respond during office hours? Like, shouldn't it be obvious that, if we aren't going to respond to VMs, we won't respond to texts? Why does all VA policy assume our patients are idiots?

The bigger question, do you text them outside official work hours to let them know you won't be responding until official work hours or wait until official work hours begin at which point you are already responding to their concern anyway?

Inquiring minds want to know...
 
I've always avoided giving patients my VA cell phone number just because it's so rife for misuse. What are your parameters for giving out your VA cell phone number? One of my patients just "accidentally" sent a sexual text that was supposedly meant for his girlfriend to his nurse care coordinator and it's caused a whole slew of issues. These are the sorts of scenarios I'd like to avoid as much as possible.
 
I've always avoided giving patients my VA cell phone number just because it's so rife for misuse. What are your parameters for giving out your VA cell phone number? One of my patients just "accidentally" sent a sexual text that was supposedly meant for his girlfriend to his nurse care coordinator and it's caused a whole slew of issues. These are the sorts of scenarios I'd like to avoid as much as possible.

Are we sure this was a mistake or was it a "mistake unless you like it"?
 
I've always avoided giving patients my VA cell phone number just because it's so rife for misuse. What are your parameters for giving out your VA cell phone number? One of my patients just "accidentally" sent a sexual text that was supposedly meant for his girlfriend to his nurse care coordinator and it's caused a whole slew of issues. These are the sorts of scenarios I'd like to avoid as much as possible.

I give them my VA cell number but don't typically tell them it's a cell. Some do text me, though. I haven't had too many problems with texts, the worst is usually a patient texting me when they're having a hard time, in which case I just call them.
 
For those who do private practice
I've always avoided giving patients my VA cell phone number just because it's so rife for misuse. What are your parameters for giving out your VA cell phone number? One of my patients just "accidentally" sent a sexual text that was supposedly meant for his girlfriend to his nurse care coordinator and it's caused a whole slew of issues. These are the sorts of scenarios I'd like to avoid as much as possible.
I don’t have one now but I had one at a previous VA where we were all working remotely. I had people text me occasionally but usually I did not tell them it was a cell phone. And I never responded to texts. I used Doximity more often though which you can set to display your facility # instead of your VA cell.

EDIT: I didn’t give out my number directly, I just called people when they no showed. So most probably assumed it was an office phone.

EDIT2: My phone was also off outside of business hours, and my voicemail included a statement that they need to call VCL for immediate assistance.
 
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I give out my VA cell phone to all of my veterans and they are aware it is a cell phone. I generally do no text back unless it is a cancellation text and I am just confirming that I am cancelling their appt. Anything else gets a phone call. After hours calls and texts are not generally answered until business hours or I am having issues getting into contact with a caregiver that works and is calling me back.
 
On the clinical side of VBA, we have a system that allows us to send and receive texts to and from veterans from our computers within the system. It's a nice system that lets us communicate with them via text without the pressure to provide access to us after working hours. Our VOIP phone system is completely useless, though--like, it might as well not even exist.
 
I no showed a medical appt accidentally and they never even notified me. Like, I only found out because I randomly remembered it. such a different world in the private sector.
 
I no showed a medical appt accidentally and they never even notified me. Like, I only found out because I randomly remembered it. such a different world in the private sector.

Private world runs the gamut. Some you would never hear about until you go to reschedule and owe a fee. Others send the obligatory email and text spams as reminders. Very rarely do I receive a reminder call from a staff member. What no one in the private world has ever done is have the doctor call me personally unless I am dying.
 
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