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

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I'm currently in a national training where a 'subject matter expert' on 'brain injury' is spreading utter misinformation about the likely course of concussuon/mTBI.

"Brain injury is forever...it affects everything...it is forever"

"We used to think concussion was temporary, but it is not just a single event, it is a lifelong problem"

Of course the expert is not medically trained

Sigh

I asked in the chat, "What is the 'nocebo effect' and why should clinicians working with veterans who have a history of mild traumatic brain injury (an event) be aware of this effect in order to avoid doing harm?"

It won't be acknowledged and it sure as hell won't be answered.

#MAKEORWELLFICTIONAGAIN
 
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cara susanna said:
This isn't a neuropsychologist, is it?
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Absolutely not. Some M.A. in a non-scientific and non-medical field. However, appears to be some sort of political 'big-wig-grand-poobah' ('Director of Professional Development, National Association of State Head Injury Administrators (NASHIA)') affiliated with half of the capital letters in the alphabet in varying combinations. Associated with lots of big time organizations commanding tons of $$ in non-profit funds dedicated to 'treating' muh epidemic of 'invisible injuries.' [sarcasm]No conflict of interest there [/sarcasm]. Probably hasn't read a single scientific article on mTBI in her life. Hasn't hurt her career, 'subject matter expert' status, or bank account in the slightest, though.

As I've said before, the VA is merely a public relations and fund-raising (political) organization *masquerading* as a healthcare organization. The amount of meaningful healthcare (or effective psychotherapy) that I've seen the org deliver has steadily decreased over the years while the budget skyrockets to fund fluff, fraud, waste, and abuse.

Spreading harmful nonsense 180 degrees opposite of the medical literature and the VA/DoD's own Clinical Practice Guidelines on mTBI. Just another day at the circus here.

"You can't see it because it's an '*invisible* injury (spooky)'." [insert dramatic, but knowing and wise, facial expression here as the audience nods solemnly in awed agreement]. Schpooooooky, lady...schpooky and profound.

You know what else is 'invisible' and can't be measured? Sh/+ that isn't there.

primum non nocere
 
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cara susanna said:
This isn't a neuropsychologist, is it?
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The title of the training was, "SAMHSA -- invisible Wounds of Service: PTSD, TBI, and Moral Injury."

I should have known better, but was curious what they'd say about TBI.

It was awful.
 
futureapppsy2 said:
Did anyone use their voting admin leave?
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Nah. Anecdotally, a colleague shared with me that she was encountering tremendous resistance from a supervisor (who cited HR in denying the request).

Apparently, there's a controversy in how it was granted at some VAs, denied at others. Our VA sucks particularly bad, so I wasn't surprised (and it's why I didn't even try to take the leave).
 
Fan_of_Meehl said:
Nah. Anecdotally, a colleague shared with me that she was encountering tremendous resistance from a supervisor (who cited HR in denying the request).

Apparently, there's a controversy in how it was granted at some VAs, denied at others. Our VA sucks particularly bad, so I wasn't surprised (and it's why I didn't even try to take the leave).
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Huh. I took 1.5 hours to early vote, and my supervisor was just like “sounds good!” I lucked out there, apparently.
 
My supervisor is allowing us to flex our time to go vote, assuming it doesn't impact patient care.

I've heard some nightmare stories at other agencies, including supervisors threatening to check public voting records.
 
cara susanna said:
My supervisor is allowing us to flex our time to go vote, assuming it doesn't impact patient care.

I've heard some nightmare stories at other agencies, including supervisors threatening to check public voting records.
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I'm sure some supervisors requisitioned funds for private investigators and Apple AirTags.

We should just bite the bullet and make Election Day a Federal holiday.
 
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cara susanna said:
My supervisor is allowing us to flex our time to go vote, assuming it doesn't impact patient care.

I've heard some nightmare stories at other agencies, including supervisors threatening to check public voting records.
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Good luck with that. I would happily allow any supervisor that threatened this to do so and then file a EEOC and workplace harassment complaint if they did.
 
Fan_of_Meehl said:
I'm sure some supervisors requisitioned funds for private investigators and Apple AirTags.

We should just bite the bullet and make Election Day a Federal holiday.
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Santa Mayorkas gave his people off. Makes you wonder what we do that is so much more important that the security of our homeland.
 
cara susanna said:
My supervisor is allowing us to flex our time to go vote, assuming it doesn't impact patient care.

I've heard some nightmare stories at other agencies, including supervisors threatening to check public voting records.
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Did they say why they are letting you take flex and not just the admin leave?
 
futureapppsy2 said:
Did they say why they are letting you take flex and not just the admin leave?
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I think it's just easier. Apparently our local leadership was told to "be judicious." When I say flex, I mean it's similar to flex time but we don't have to make up for it later on.
 
cara susanna said:
I think it's just easier. Apparently our local leadership was told to "be judicious." When I say flex, I mean it's similar to flex time but we don't have to make up for it later on.
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Ah, that makes sense. When our local admin says “flex,” they mean that you’re making up time.
 
I called out today. I just don't have the mental space to be someone's therapist today. I plan on playing Stardew Valley and hanging out in nature as I recalibrate. I'll be curious how this will change some aspects of my job.

I'll reflect on big stuff like how my mom wasn't born with the right to vote, and we have never been on a linear path toward anything. I'll also think about chill stuff like whether it's too late to plant flower bulbs this season.
 
Shiori said:
I called out today. I just don't have the mental space to be someone's therapist today. I plan on playing Stardew Valley and hanging out in nature as I recalibrate. I'll be curious how this will change some aspects of my job.

I'll reflect on big stuff like how my mom wasn't born with the right to vote, and we have never been on a linear path toward anything. I'll also think about chill stuff like whether it's too late to plant flower bulbs this season.
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On the bright side, global warming has meant summer weather in November today. Nice day for a walk.
 
I just read that Project 2025 was going to replace all GS-13 and higher positions sooooo guess we'll see.

If they do fire me, I am going to be very open with all my Trump supporting patients that they are losing me as a therapist because of him, lol.
 
Is there a link to this? I know there' a massive doc put out by a think tank (Heritage Foundation) and that the Trump campaign has explicitly denied that it's the administration's plan. I'll have to take a look at the VA specific section of the Heritage Foundation pdf tonight (to go directly to the source material.
 
cara susanna said:
I just read that Project 2025 was going to replace all GS-13 and higher positions sooooo guess we'll see.

If they do fire me, I am going to be very open with all my Trump supporting patients that they are losing me as a therapist because of him, lol.
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IIRC, that was only for administrative/policy-making GS-13+’s but with the move to privatize/contract out the VHA /VBA who knows?
 
futureapppsy2 said:
IIRC, that was only for administrative/policy-making GS-13+’s but with the move to privatize/contract out the VHA /VBA who knows?
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Well, if that's the case, I'd agree with it. I think that we should probably take a hard look at a lot of those non-clinical GS 13s+. The bloat is ridiculous.
 
Fan_of_Meehl said:
Well, if that's the case, I'd agree with it. I think that we should probably take a hard look at a lot of those non-clinical GS 13s+. The bloat is ridiculous.
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For VA, the goals were to cut disability benefits for vets, reduce the number of CBOCs and low volume hospitals, and privatize tricare. Removing any jobs related to transgender, DEI, and women's health are likely. Cuts to the geriatrics programs and remote workers would not surprise me either.
 
futureapppsy2 said:
IIRC, that was only for administrative/policy-making GS-13+’s but with the move to privatize/contract out the VHA /VBA who knows?
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With his last presidency, there was definitely a big push to privatize care delivery. It did not result in cost savings or improved care (I strongly suspect the opposite), but that doesn't mean much.

Although I believe the push to privatize VBA may have pre-dated 2016.
 
Sanman said:
For VA, the goals were to cut disability benefits for vets, reduce the number of CBOCs and low volume hospitals, and privatize tricare. Removing any jobs related to transgender, DEI, and women's health are likely. Cuts to the geriatrics programs and remote workers would not surprise me either.
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That (the bolded) is actually fairly shocking. I'm surprised anyone was willing to put that in writing anywhere.
 
AcronymAllergy said:
That (the bolded) is actually fairly shocking. I'm surprised anyone was willing to put that in writing anywhere.
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From a political standpoint, they want to streamline the disability process and will campaign on getting more vets through the system and connected. Rolling back SC percentages and PACT Act allowances are likely not going to be mentioned.

They also mentioned scrutinizing hybrid and remote work, FYI.
 
psycho1391 said:
Just had my first vet break down crying on the phone due to this election.

Remind me in 4 years to take the rest of the week off after the election.
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I run the LGBTQ+ support group, and it will be a rough time. I don't even know what to say, so I know I'll just be doing a lot of listening. I have a week to think about it.
 
Sanman said:
For VA, the goals were to cut disability benefits for vets, reduce the number of CBOCs and low volume hospitals, and privatize tricare. Removing any jobs related to transgender, DEI, and women's health are likely. Cuts to the geriatrics programs and remote workers would not surprise me either.
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If these changes go into play, it'll almost make UCC work look appealing.
 
The Cinnabon said:
If these changes go into play, it'll almost make UCC work look appealing.
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As a BHIP provider at a main hospital who isn't remote, I'm actually okay with most of these changes if they even happen. I've been hoping most specialty positions would get axed that are unproductive and do not provide much clinical care. Definitely okay with not paying remote therapists special salary or local pay rates if they're not local. Okay if VA fires all of us to be honest. Pillory me if you want!
 
Behaviorismiscool said:
As a BHIP provider at a main hospital who isn't remote, I'm actually okay with most of these changes if they even happen. I've been hoping most specialty positions would get axed that are unproductive and do not provide much clinical care. Definitely okay with not paying remote therapists special salary or local pay rates if they're not local. Okay if VA fires all of us to be honest. Pillory me if you want!
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To clarify, remote folks are paid based on the location of their home. If their home falls into an SSR locale, then they get it. If not, they do not.

That said, I am not going to argue about personal opinions. I will say as a specialty psych provider, there is not a job I have taken yet that has not gone unfilled for at least 3 yrs. The VA gets rid of me, I will no longer practice my specialty most likely. The patients will lose, not me. I will likely make more in PP.
 
Behaviorismiscool said:
As a BHIP provider at a main hospital who isn't remote, I'm actually okay with most of these changes if they even happen. I've been hoping most specialty positions would get axed that are unproductive and do not provide much clinical care. Definitely okay with not paying remote therapists special salary or local pay rates if they're not local. Okay if VA fires all of us to be honest. Pillory me if you want!
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Nah. I agree. I see a lot of rinkydink overspecialization/trivial/'sliver-focused'/narrow specialization of care along with significant reductions in general mental health (caseload bearing) FTE's over time. LOTS of diffusion of responsibility for psychotherapy care/followup, lots of patients bouncing from intake to intake appointment without anyone trying to deliver even a brief intervention, lots of patients consulted to specialty care who just did an intake and started therapy with another therapist two weeks ago (in my day, this would be a no-go).
 
futureapppsy2 said:
Here’s the Project 2025 VA chapter: https://static.project2025.org/2025_MandateForLeadership_CHAPTER-20.pdf
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"Increase employee satisfaction/experience to improve recruitment and retention of VA personnel. Go beyond the traditional focus on the extrinsic (monetary pay and bonuses) and seek creative ways to instill teamwork, loyalty, and pride."

I'm so curious what this would look like. Cheap plastic drink tumblers like we've been given in the past? Meaningless shout outs at meetings?
 
This

"Hire more private companies to perform disability medical examinations. Delays in completing the examinations could be eliminated with more external capacity."

Seems incompatible with this

"Reduce improper payment and fraud. About $500 million is improperly paid out each year. Better tools, training, and management could reduce this substantially, but rule changes at the departmental level would be needed."
 
WisNeuro said:
This

"Hire more private companies to perform disability medical examinations. Delays in completing the examinations could be eliminated with more external capacity."

Seems incompatible with this

"Reduce improper payment and fraud. About $500 million is improperly paid out each year. Better tools, training, and management could reduce this substantially, but rule changes at the departmental level would be needed."
Click to expand...

I imagine this means more government contractors but maybe stricter criteria and lower payments. For example, 10% sc for PTSD instead of 100%. Nothing for diabetes or other conditions later in life.

Guess I can open a C&P mill after they fire me.
 
WisNeuro said:
This

"Hire more private companies to perform disability medical examinations. Delays in completing the examinations could be eliminated with more external capacity."

Seems incompatible with this

"Reduce improper payment and fraud. About $500 million is improperly paid out each year. Better tools, training, and management could reduce this substantially, but rule changes at the departmental level would be needed."
Click to expand...

A quote from 1984 by George Orwell that defines doublethink as:
  • Doublethink: "Doublethink means the power of holding two contradictory beliefs in one's mind simultaneously, and accepting both of them"
"Doublethink is a psychological tool that the Party uses to control the past and the future. The Party controls the past by creating a history of misery and slavery, and then claiming to have liberated the human race. This creates a sense of urgency for people to work towards the Party's goals. The Party also controls the present by controlling how people think about the past. For example, history books reflect Party ideology, and citizens are not allowed to keep mementos of their own pasts."

The Party's slogans, "War is Peace", "Freedom is Slavery", and "Ignorance is Strength", are examples of doublethink.

Both sides use it (Dems and Republicans, Fox News and CNN).

And it's damn near a requirement to be promoted at VA.
 
I probably needed another day or two at home. I'm just sitting in my office in tears. Fortunately, I almost never get emotional in session, so that shouldn't be an issue. I'll set firm boundaries about election talk. I truly just want to be left alone by the vast majority of people right now.

My stance at work has always been to fix a problem when I see one and advocate hard when I see injustices. It is a weekly, often multiple times a week, grind that I have been doing behind the scenes to make things less terrible for everyone. It's funny that I was just talking about burning out. I think I, along with a lot of Black women, are letting other people lead the charge for change. We are tired. Whatever folks need in this moment is probably in a book written by a Black woman/queer person in the 70s.
 
Shiori said:
I probably needed another day or two at home. I'm just sitting in my office in tears. Fortunately, I almost never get emotional in session, so that shouldn't be an issue. I'll set firm boundaries about election talk. I truly just want to be left alone by the vast majority of people right now.

My stance at work has always been to fix a problem when I see one and advocate hard when I see injustices. It is a weekly, often multiple times a week, grind that I have been doing behind the scenes to make things less terrible for everyone. It's funny that I was just talking about burning out. I think I, along with a lot of Black women, are letting other people lead the charge for change. We are tired. Whatever folks need in this moment is probably in a book written by a Black woman/queer person in the 70s.
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I actually revealed to a Republican patient today that I am a Democrat (honestly they had previously assumed I was a Democrat and always made remarks like I was). I probably shouldn't have done that, but I'm a human being. And it's not a Hatch Act violation because he's no longer a candidate.
 
cara susanna said:
Went from a giddy Trump supporting patient to a tearful Harris supporting patient who presented as a walk-in. It's gonna be a weird week.
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When exactly did reactions to elections become the same as that of sports fanatics after the super bowl or world series? I guess that's why the hats are so popular.
 
cara susanna said:
I actually revealed to a Republican patient today that I am a Democrat (honestly they had previously assumed I was a Democrat and always made remarks like I was). I probably shouldn't have done that, but I'm a human being. And it's not a Hatch Act violation because he's no longer a candidate.
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I just told everyone I can't take the whiplash of discussing politics all day with everything being so fresh and my patients have been mostly respectful of that boundary. It's fine if it's relevant to therapy goals. Otherwise, I need them to save it for friends and family. I won't be therapeutic.
 
cara susanna said:
I actually revealed to a Republican patient today that I am a Democrat (honestly they had previously assumed I was a Democrat and always made remarks like I was). I probably shouldn't have done that, but I'm a human being. And it's not a Hatch Act violation because he's no longer a candidate.
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"I'm a Democrat. I also prefer cheddar cheese and am a Green Bay Packers fan. Can we do this professional psychotherapy thing now? Yes? Great."
 
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