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

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AsOneDoes said:
Does anyone's VA (or the VA in general) have a specific policy about writing Emotional Support Animal letters?
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When I was at VA, ours (IIRC) had a policy that we did not complete these letters. They actually had an internal training as to why completing the letters can be problematic. We also had a policy that MH clinicians didn't complete DBQ forms.
 
R. Matey said:
Indifference to bureaucrats is my survival strategy. They need us far more than we need them.
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Yes, it seems more offensive when it's coming from one of our own.

Use MBC
Use OUR limited selection of MBC
Use OUR MBC in your treatment planning and be specific about how often you'll use it
Use OUR MBC and document all the ways in which you used MBC in EVERY note
Document how you changed your treatment planning as a result of OUR MBC in EVERY note

I like my BH leadership and generally try to do what they ask. I am losing my mind here though.
 
Shiori said:
Yes, it seems more offensive when it's coming from one of our own.

Use MBC
Use OUR limited selection of MBC
Use OUR MBC in your treatment planning and be specific about how often you'll use it
Use OUR MBC and document all the ways in which you used MBC in EVERY note
Document how you changed your treatment planning as a result of OUR MBC in EVERY note

I like my BH leadership and generally try to do what they ask. I am losing my mind here though.
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Yeah, that's dumb. I'm all for EBPs, but onerous documentation requirements are one big reason people burn out, IME. If you're going to demand more of my time to check boxes, you sure as hell better make those boxes easy to check.
 
R. Matey said:
Yeah, that's dumb. I'm all for EBPs, but onerous documentation requirements are one big reason people burn out, IME. If you're going to demand more of my time to check boxes, you sure as hell better make those boxes easy to check.
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Because the VA is known for making people's lives easier through the use of more red tape, lol. I say this after a morning of having to play IT guy to get the RQI BLS dummy to work and then having to jury-rig the mechanical ventilator that was missing a bag to complete it.
 
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Shiori said:
If I used my RQI training on a real person, they would definitely be dead.
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I'm gonna break their nose because I have to shove the mask incredibly hard, otherwise air leaks through.

I usually sing "Lady Marmalade" but I just found out that "Dancing through Life" from Wicked also works so obviously gonna switch to that in the future.
 
Fan_of_Meehl said:
So...yours is also a feckless circle-j3rk, pompom waving pep rally at which absolutely no meaningful topics are discussed?
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That's ours. I don't know how I've done it but I've just decided to skip our other meetings other than our interdisciplinary meeting where we disposition veterans. I didn't make an announcement I just stopped.

I might start doing that with the psychology meeting. Because it frees up time for admin, nothing is lost, and I don't end up thinking about the garbage bureaucratic muck. Your mileage may vary in trying this.
 
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Our main hospital forgets that the CBOCs exist so we aren't even included in the meeting (I mean, we're invited, but they never block our clinics unless we ask).
 
Fan_of_Meehl said:
So...yours is also a feckless circle-j3rk, pompom waving pep rally at which absolutely no meaningful topics are discussed?
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I think it's their version of malicious compliance where they're required to administer lashings and they do it via meeting. I suppose it's the easiest thing to ignore since nothing is in writing.
 
cara susanna said:
Our main hospital forgets that the CBOCs exist so we aren't even included in the meeting (I mean, we're invited, but they never block our clinics unless we ask).
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I find this a great excuse when I am not following a random policy announced at said meeting.
 
Just the Biden declaration. Still waiting for something more local. I took off Dec 24, anyway.
 
futureapppsy2 said:
Our local admin said that they are waiting to hear guidance on who it does and doesn’t apply to.
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Our local admin was taking the approach pending guidance that you could take the 24th off if you could reschedule the veterans to the 20th or 23rd...our therapists probably wouldn't be able to reschedule people before February.
The memorandum (and email) that went out this morning seem to state that everyone should get the 24th off unless the national director says otherwise.

I think it is mostly an issue for physicians (and I think dentists and podiatrists) because by law we can't get any additional compensation beyond salary and bonus (i.e. no overtime or holiday pay) and can't get comp time, so there's no benefit in working the 24th anyway.

I think Santa should give the White House a gift of a calendar so next year they will know more than week in advance when Christmas Eve is.
 
aim-agm said:
Our local admin was taking the approach pending guidance that you could take the 24th off if you could reschedule the veterans to the 20th or 23rd...our therapists probably wouldn't be able to reschedule people before February.
The memorandum (and email) that went out this morning seem to state that everyone should get the 24th off unless the national director says otherwise.

I think it is mostly an issue for physicians (and I think dentists and podiatrists) because by law we can't get any additional compensation beyond salary and bonus (i.e. no overtime or holiday pay) and can't get comp time, so there's no benefit in working the 24th anyway.

I think Santa should give the White House a gift of a calendar so next year they will know more than week in advance when Christmas Eve is.
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We heard today.

Our guidance is similar for all outpatient direct care providers: appointments can be moved up but not back. Otherwise, you have to work the 24th. Inpatient/residential services don’t get the day.
 
That's what we were told as well. And if you put in leave for the 24th, you need to remove it.
 
AsOneDoes said:
Does anyone's VA (or the VA in general) have a specific policy about writing Emotional Support Animal letters?
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No policy at mine, but as the primary assessment provider that takes these types of referrals, I have never recommended one and very vocally recommend against them to the referring providers that are considering it, even if only a little bit. Telling the poor Veteran that really wants one or has already paid out of pocket to start getting a puppy trained how there is no good evidence for them in addition to what you’d get out of normal human-pet interaction is rough sometimes.
 
The language of the executive order for the Day of Respect 1/9 is the exact same as the one for Christmas Eve one, so I would expect that however your VA handled the latter is how the will handle the former.
 
MSAs are under guidance to try to get people earlier appts and then close any slots that are still open that day. Why did it have to be the day I have the most appts that week? Haha.
 
cara susanna said:
MSAs are under guidance to try to get people earlier appts and then close any slots that are still open that day. Why did it have to be the day I have the most appts that week? Haha.
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My MSA (me) worked closely with the service provider (also me) to schedule all of my RTCs for 1/16 this morning. This guy wants 1/9 off if he can manage it. Though I have heard absolutely nothing yet from higher up about how to handle this.
 
Now my supervisor is saying we aren't supposed to be r/sing? Even though the MSAs have been working with us to r/s, and I even had some patients r/s for earlier that week.

I am sooooo confused
 
cara susanna said:
Now my supervisor is saying we aren't supposed to be r/sing? Even though the MSAs have been working with us to r/s, and I even had some patients r/s for earlier that week.

I am sooooo confused
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I have too many people already scheduled for that day, won't get the day off. My concern is that they'll try to 'nickle and dime' stress me out by pressing me to take little bits of time (15 or 30 mins here or there--time I'd ordinarily use to do notes, make phone calls, respond to emails, etc.) so that the net result will be that me theoretically / possibly getting (some of) the day 'off' will end up creating far more pain and suffering than if we had never even bothered with the hypothetical 'pretense' that I could possibly take the day (or large parts of the day) off in the first place. Sigh. Welcome to the world of the VA provider.

The GenX phrase, "Let's don't and say we did" comes to mind.
 
We were told MSAs can't r/s for us for that day and if we want the day off we'd have to find an appointment before 1/9 or within a week after. And call ourselves. So basically... we'll get holiday premium pay for working the day. My question, and I'd never ask directly...what if I called in? Lol
 
Veterans are getting a lot of attention in the media.
 
psy.d. 2021 said:
We were told MSAs can't r/s for us for that day and if we want the day off we'd have to find an appointment before 1/9 or within a week after. And call ourselves. So basically... we'll get holiday premium pay for working the day. My question, and I'd never ask directly...what if I called in? Lol
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Call in, they'll fix it on the timecard. No one has any idea right now because VAC has sent no instructions. All the medical center directors are just guessing.
 
WisNeuro said:
Shh, we need people to swallow the "immigrants are dangerous narrative," not the inconvenient fact that mass shooters are disproportionately vets/military.
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You mean that mass shooters are generally people that have been trained to shoot people as opposed to someone that has never handled a gun in their life? I am shocked by that realization.
 
Sanman said:
You mean that mass shooters are generally people that have been trained to shoot people as opposed to someone that has never handled a gun in their life? I am shocked by that realization.
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Well, there is that other chunk of variance, disaffected young male adolescents. They're generally "untrained." Unless you count their redneck parents taking them to a field to shoot once or twice.
 
The uncle of the person in the Tesla said a lot of unsettling things about patriotism and bomb making skills. I wish the different media outlets giving his perspective oxygen would stop.
 
WisNeuro said:
Well, there is that other chunk of variance, disaffected young male adolescents. They're generally "untrained." Unless you count their redneck parents taking them to a field to shoot once or twice.
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There are very few mass shooters with no previous experience at all. The more familiarity someone has with something, the more likely they are to utilize that knowledge.. Europe and the U.K. generally have mass stabbings rather than mass shootings due to the general unavailability of guns to the populace. The mental health piece is still there but manifests differently.
 
Sanman said:
There are very few mass shooters with no previous experience at all. The more familiarity someone has with something, the more likely they are to utilize that knowledge.. Europe and the U.K. generally have mass stabbings rather than mass shootings due to the general unavailability of guns to the populace. The mental health piece is still there but manifests differently.
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Eh, partially. But, there is also things that are unique to US culture that drive this. Plenty of nations with compulsory military service and/or relatively high gun ownership rates that don't show the same relationship we have.
 
WisNeuro said:
Eh, partially. But, there is also things that are unique to US culture that drive this. Plenty of nations with compulsory military service and/or relatively high gun ownership rates that don't show the same relationship we have.
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That's true. However, we know that it in the U.S., veterans are also significantly more likely to use guns for suicide as well. Regarding compulsory military service in other countries, I feel like that increased variance in SES washed out some of the issues we see in the United States. Military members here tend to suffer higher rates of childhood poverty, at least in the post-Vietnam all voluntary military era. This disproportionately puts them at risk of acute stressors and other issues compared to a country with greater variance. I do agree that there are some unique attributes to U.S. culture. There are also some unique attributes to how be select military forces that might make them disproportionately likely to struggle with certain stressors.
 
I hope everyone is staying warm! We have all the snow (by Midwest standards).
 
Does anyone else have random days where you come into the clinic and you have a bunch of open appt slots, and you're like... did they all cancel? Did the slots not get filled? Like, how did this happen?

Note: I'm not complaining, lol. Just confused
 
cara susanna said:
Does anyone else have random days where you come into the clinic and you have a bunch of open appt slots, and you're like... did they all cancel? Did the slots not get filled? Like, how did this happen?

Note: I'm not complaining, lol. Just confused
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Yes. This is one of the inefficiencies of our system. I'd say that only about 1 in 5 APPARENT cases of 'I need/want psychotherapy' is an ACTUAL case of a veteran who will engage and follow through with weekly mtgs, goals/structure, self-focus, homework, etc. 80% NS/cancel their way out of a course of weekly psychotherapy.

It is an irony of our system that if you schedule weekly appts with veterans and try to hold yourself/themselves accountable in therapy, then you will take a hit on your RVUs and apparent "productivity" due to frequent no shows and cancellations.

But since we can't have honest adult conversations regarding why this is the case, the circus continues.
 
Fan_of_Meehl said:
Yes. This is one of the inefficiencies of our system. I'd say that only about 1 in 5 APPARENT cases of 'I need/want psychotherapy' is an ACTUAL case of a veteran who will engage and follow through with weekly mtgs, goals/structure, self-focus, homework, etc. 80% NS/cancel their way out of a course of weekly psychotherapy.

It is an irony of our system that if you schedule weekly appts with veterans and try to hold yourself/themselves accountable in therapy, then you will take a hit on your RVUs and apparent "productivity" due to frequent no shows and cancellations.

But since we can't have honest adult conversations regarding why this is the case, the circus continues.
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Yeah, it's weird how our access can be so awful and yet on a daily basis we have so many appt openings.

Random new complaint: I love when patients get referred for neuropsych testing but no one, like, actually talked to them about it.
 
cara susanna said:
Yeah, it's weird how our access can be so awful and yet on a daily basis we have so many appt openings.

Random new complaint: I love when patients get referred for neuropsych testing but no one, like, actually talked to them about it.
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Yep, and unfortunately, it was not uncommon; happened with me maybe a quarter of the time. When I would then tell the patient why they were there and how long it would take, a handful would get upset and refuse. Which meant I then had basically a wasted appointment slot.

Edit: although I should add, I also don't doubt that sometimes the patients were told and forgot, or didn't fully understand/appreciate at the time and didn't think to ask questions about it.
 
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