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

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WisNeuro said:
The only thing we heard VSOs telling people was to make a boatload of appointments while they put in their SC claims. This was from our Vet psychometrists.
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Yeah, that's how it has been generally. I have seen an uptick of people being told to just do a round of therapy as evidence of distress. The veteran is then confused when the rating doesn't change.
 
Shiori said:
Yeah, that's how it has been generally. I have seen an uptick of people being told to just do a round of therapy as evidence of distress. The veteran is then confused when the rating doesn't change.
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I would be surprised too. One would expect that the therapy would at least partially improve the condition, resulting in a decrease in rating.

Shiori said:
I wish well-meaning VSOs would stop telling people they need to come to me.
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I had a VSO recommend a veteran have me fill out a DBQ for their mental health condition. I educated the veteran that per directive that is not something we do.
Tangentially, can anyone at the VA fill out a mental health related DBQ? I assume that you are supposed to only fill out DBQs for conditions you are treating, but directive is "for requests for completion of mental health DBQs, it is recommended that the Veteran's treating provider not complete the DBQ to maintain the integrity of the patient-provider relationship."
 
What happens at the AMSUS conference? Any utility in attending?
 
aim-agm said:
I would be surprised too. One would expect that the therapy would at least partially improve the condition, resulting in a decrease in rating.


I had a VSO recommend a veteran have me fill out a DBQ for their mental health condition. I educated the veteran that per directive that is not something we do.
Tangentially, can anyone at the VA fill out a mental health related DBQ? I assume that you are supposed to only fill out DBQs for conditions you are treating, but directive is "for requests for completion of mental health DBQs, it is recommended that the Veteran's treating provider not complete the DBQ to maintain the integrity of the patient-provider relationship."
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I believe the DBQ only needs to be filled out by the person completing the C&P evaluation and this should not be a treating provider. It won't affect most people given that C&P is largely contracted out. However, I believe a few places still do them.
 
Shiori said:
I wish well-meaning VSOs would stop telling people they need to come to me.
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I'm not so sure they're 'well-meaning.' Nor are the colleagues who incompetently/blithely state, "Mr. Smith definitely has PTSD (cause I say so)" and write them letters to support their s/c claims after I've spent several sessions ruling out PTSD with accompanying paragraphs of observations, objective test findings, and rationale.
 
Shiori said:
Yeah, that's how it has been generally. I have seen an uptick of people being told to just do a round of therapy as evidence of distress. The veteran is then confused when the rating doesn't change.
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Just wait til they change the rating criteria for MH (coming soon).

And--thanks to the PACT Act--I'm still drinking from the firehose of all the aged 70-80 crowd presenting for the first time with PTSD (many of these are legit Vietnam Era folks who actually have the condition, but still...there are a great many cases where it is obvious that we are trying so hard to make a 'PTSD' diagnosis out of nothing [or very little])
 
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Shiori said:
Yeah, that's how it has been generally. I have seen an uptick of people being told to just do a round of therapy as evidence of distress. The veteran is then confused when the rating doesn't change.
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I have literally used the whiteboard in my office to illustrate the dilemma for such vets with an "increased s/c disability" arrow pointing one way and a "decreased PTSD sxs from treatment" arrow pointing the opposite way to make the very obvious (but awkward) logical point that I wish more people working with veterans grasped

And what I really wish is that mental health providers and administrators would stop pretending that they don't grasp this point.
 
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My clients these last few weeks are starting to knock some of the shine off of me.

Are you...fake crying? Are you fake crying so poorly that even my Pollyanna self can tell you're faking?

No, you cannot claim the natural deaths of your parents from old age in your S/C claim.

I am not a dating service, so no I can't help you find a partner who is only interested in meeting a few times a week and definitely won't ask for money.

I'm a doctor, not a magician.
 
Shiori said:
My clients these last few weeks are starting to knock some of the shine off of me.

Are you...fake crying? Are you fake crying so poorly that even my Pollyanna self can tell you're faking?

No, you cannot claim the natural deaths of your parents from old age in your S/C claim.

I am not a dating service, so no I can't help you find a partner who is only interested in meeting a few times a week and definitely won't ask for money.

I'm a doctor, not a magician.
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Look on the bright side, they want your help finding a partner and don't want to date you!
 
If I ever want a side hustle, I will create a dating site to connect the individuals who want absolutely no emotional connection. However, they would very occasionally like a person to travel with and on wild nights... do a puzzle. No calls, no texts, no responsibilities to each other. Just puzzles. Also, they can only date each other or they'll get jealous.
 
Shiori said:
If I ever want a side hustle, I will create a dating site to connect the individuals who want absolutely no emotional connection. However, they would very occasionally like a person to travel with and on wild nights... do a puzzle. No calls, no texts, no responsibilities to each other. Just puzzles. Also, they can only date each other or they'll get jealous.
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Don't worry they'll still come back to you broken hearted because one only likes jigsaw puzzles and the other only likes crossword puzzles.
 
Oh! And if I'm feeling really ambitious, I can add a fee to "match based on intelligence" because everyone always feels desperate for intellectual conversations, but they think everyone else is dumb. If I gently nudge them to give people are chance, they'll have those coveted conversations.
 
Shiori said:
Oh! And if I'm feeling really ambitious, I can add a fee to "match based on intelligence" because everyone always feels desperate for intellectual conversations, but they think everyone else is dumb. If I gently nudge them to give people are chance, they'll have those coveted conversations.
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Don't forget all the "I hate small talk" folks that crave deep conversations, just not any of the efforts it takes to get there.
 
In a semi-related note, I have gotten a big influx of estranged parents lately. It hurts my heart how little work some parents want to do related to repairing the relationship even when it's their therapy goal. I will lose my mind if I hear "the phone works both ways" one more time. I have heard it in cases where the child is literally under the age of 5.

It's fortunate that it's fairly easy work though. I just have to point out the inconsistencies over the course of a few weeks and nudge them to set realistic expectations. I have also been more direct with my feedback. "It is inconsistent with your therapy goal of strengthening your relationship with your children to cut them out of your will as punishment for not traveling 600 miles with three small children to visit you for Christmas."

No Way What GIF by Originals
 
Shiori said:
In a semi-related note, I have gotten a big influx of estranged parents lately. It hurts my heart how little work some parents want to do related to repairing the relationship even when it's their therapy goal. I will lose my mind if I hear "the phone works both ways" one more time. I have heard it in cases where the child is literally under the age of 5.

It's fortunate that it's fairly easy work though. I just have to point out the inconsistencies over the course of a few weeks and nudge them to set realistic expectations. I have also been more direct with my feedback. "It is inconsistent with your therapy goal of strengthening your relationship with your children to cut them out of your will as punishment for not traveling 600 miles with three small children to visit you for Christmas."

No Way What GIF by Originals
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Omg I just had a patient who said, "My granddaughter never reaches out anymore. She used to call me regularly, but now I get nothing, so I don't even try to reach out to her either anymore if she doesn't want to bother." When I asked how old his granddaughter is, he said, "7." Like, sir, please.
 
Shiori said:
In a semi-related note, I have gotten a big influx of estranged parents lately. It hurts my heart how little work some parents want to do related to repairing the relationship even when it's their therapy goal. I will lose my mind if I hear "the phone works both ways" one more time. I have heard it in cases where the child is literally under the age of 5.

It's fortunate that it's fairly easy work though. I just have to point out the inconsistencies over the course of a few weeks and nudge them to set realistic expectations. I have also been more direct with my feedback. "It is inconsistent with your therapy goal of strengthening your relationship with your children to cut them out of your will as punishment for not traveling 600 miles with three small children to visit you for Christmas."

No Way What GIF by Originals
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Lol, I just had a session about this and might have heard that statement verbatim.
 
Shiori said:
In a semi-related note, I have gotten a big influx of estranged parents lately. It hurts my heart how little work some parents want to do related to repairing the relationship even when it's their therapy goal. I will lose my mind if I hear "the phone works both ways" one more time. I have heard it in cases where the child is literally under the age of 5.

It's fortunate that it's fairly easy work though. I just have to point out the inconsistencies over the course of a few weeks and nudge them to set realistic expectations. I have also been more direct with my feedback. "It is inconsistent with your therapy goal of strengthening your relationship with your children to cut them out of your will as punishment for not traveling 600 miles with three small children to visit you for Christmas."

No Way What GIF by Originals
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This is true a lot of the time in my experience too but the bigger challenge is situations in which it is clear that the adult children have (often explicitly) renounced communication or any interaction with the parent, and the parent-patient is somewhat in the dark about why or doesn't seem to understand why. I mean perspective-taking is helpful for the "so if you had decided to do this with your dad, and yes, I understand he would never have allowed it, etc etc, but if you had, what do you think your reaction would be if he kept trying to call you anyway?" but best I can usually come up with is leaning into acceptance. I often do badly want to talk to the adult children involved cause I'm sure there story I get is . . . underspecified but naturally they are not likely to take my call.
 
Sanman said:
Letting them fire me and starting a private practice.
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They’ll have to pry my hybrid and compressed schedule from my cold, dead hands.

Relatedly, I’ve started getting everything together to have my side PP up and running by the middle/latter half of this year. I hit a milestone birthday end of last year and decided to finally Do The Thing. But my head is spinning from all the ridiculous local regulations. There’s about a zillion licenses and taxes and affidavits. I won’t be here forever, and I’ll be glad to leave these backward local and state politics behind.
 
cara susanna said:
EO issued for 90 day hiring freeze. Exception for "veterans benefits"

Oh, sure, protect the people that give them money but those that give them healthcare? Screw them, I guess
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Our VA has been not hiring psychologists anyway so this really doesn't matter. When you can work remotely for more money in the private sector no one will work there anyway. Then they can privatize VA after they fully destroy it. Simple but effective plan from them.
 
psy.d. 2021 said:
Our VA has been not hiring psychologists anyway so this really doesn't matter. When you can work remotely for more money in the private sector no one will work there anyway. Then they can privatize VA after they fully destroy it. Simple but effective plan from them.
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They're well on their way to destroying it. The 'death spiral' is real and starting to accelerate.

I predict that the next phase will involve someone finally starting to report/analyze all of the 'measurement based care' (MBC) data on PCL-5's/PHQ-9's/GAD-7's over time (for the general population of vets in outpatient care at VA) and be forced to admit that--though there are exceptions (maybe 20% of outpatients) who demonstrate some improvements over reasonable time frames (e.g., 3 to 9 months of outpatient treatment), the vast majority of rank-and-file veterans in MH treatment not only don't get better over time...they actually 'ratchet' their way up the service-connection scale over time, generally by increasing their total scores on those 'MBC' symptom self-report measures over time. They've already published (last summer, I think) on some of the abysmal rates of treatment response from the residential programs for PTSD at VA...next is general outpatient numbers.

Of course, the dysfunctional organizational schema of 'The providers are always to blame' for any 'negative' observation will kick in and they will, perforce, double down on efforts to 'enforce compliance' from the providers (as if we could FORCE successful engagement in therapy), making it even more hellish to work here, causing more people to leave and those remaining to just give up due to learned helplessness (I already see this happening among colleagues), and things just keep getting worse as part of the positive feedback loop.

Perhaps when the last admin person is left alone with the last remaining provider they may be able to have a frank, adult conversation about what is actually going on in the outpatient mental health population at VA.

Nah...not even then.
 
cara susanna said:
EO issued for 90 day hiring freeze. Exception for "veterans benefits"

Oh, sure, protect the people that give them money but those that give them healthcare? Screw them, I guess
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The VBA has already been under a total hiring freeze for a month, so I’m not sure what’s going on there. Also, because benefits isn’t capitalized, a lot of people are thinking that the VHA is included in that (my personal bet? Neither VBA or VHA will be included as exceptions to the freeze).
 
I have been reading about the founding of our country in an attempt to remind myself we have always been better at storytelling than being good people. Today, I'm reading about how one of the Jamestown residents murdered and ate his pregnant wife during the Starving Times. None of my social studies textbooks gave many details about the horrors of Jamestown at all.

This is also the second time we've elected a person who has a history of assault to two non-consecutive terms.

History is fun.
 
Shiori said:
I have been reading about the founding of our country in an attempt to remind myself we have always been better at storytelling than being good people. Today, I'm reading about how one of the Jamestown residents murdered and ate his pregnant wife during the Starving Times. None of my social studies textbooks gave many details about the horrors of Jamestown at all.

This is also the second time we've elected a person who has a history of assault to two non-consecutive terms.

History is fun.
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I am thinking we will be seeing less Grover Cleveland and more Andrew Jackson this term unfortunately.
 
Sanman said:
I am thinking we will be seeing less Grover Cleveland and more Andrew Jackson this term unfortunately.
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Definitely. I wonder who our Samuel Swartwout equivalent will be.
 
WisNeuro said:
If we're talking about financial misconduct, too many choices to just pick one.
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It needs to be so flagrant and egregious, they flee the country (and they'll return with no real punishment several years later).
 
Shiori said:
It needs to be so flagrant and egregious, they flee the country (and they'll return with no real punishment several years later).
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I don't know how they could be more flagrant and egregious. At this point, why would they need to flee the country? We've already demonstrated that you can literally attempt to overthrow the government with zero repercussions. No fleeing necessary after fleecing US citizens, it's already happening. Anyone want to buy some TRUMP or MELANIA meme coins?
 
I joked with my husband that the people buying meme coins might have been the settlers of Jamestown back in the day. Dozens have starved to death trying to cultivate this place? Sounds like a perfect opportunity to make some money. We'll send our best gentlemen and soldiers and no farmers. It'll be great.

When do you think we'll try to colonize Mars?
 
The "as soon as practicable" in the RTO EO seems quite vague.
 
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