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

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allantois said:
I don’t even think they care about providing the care to veterans. Maybe they’ll give them vouchers to better help at best
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I expect them to shuffle some of the "savings" of staff salaries into the Community Care budget. I will then have zero surprise when many administration-adjacent private healthcare companies secure very large contracts to provide said community care (likely with little to no competitive bidding).

It's a win-win for them. They can feed into the ever-present narrative that VA providers are subpar, so the administration is allowing veterans to get "better" care and more choice privately, and they can ultimately blame it all on the VA providers anyway, because, "hey, we didn't fire them, they all just quit."

Of course, at the end of the day, it's the patients who lose out. Especially when they see that typically, the community providers will have nowhere near the same level of multidisciplinary care options, will be much more concerned about the bottom line, and will be much less tolerant of missed appointments, late cancellations, and jerk-ish behavior in the clinic.
 
AcronymAllergy said:
I expect them to shuffle some of the "savings" of staff salaries into the Community Care budget. I will then have zero surprise when many administration-adjacent private healthcare companies secure very large contracts to provide said community care (likely with little to no competitive bidding).

It's a win-win for them. They can feed into the ever-present narrative that VA providers are subpar, so the administration is allowing veterans to get "better" care and more choice privately, and they can ultimately blame it all on the VA providers anyway, because, "hey, we didn't fire them, they all just quit."

Of course, at the end of the day, it's the patients who lose out. Especially when they see that typically, the community providers will have nowhere near the same level of multidisciplinary care options, will be much more concerned about the bottom line, and will be much less tolerant of missed appointments, late cancellations, and jerk-ish behavior in the clinic.
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Anecdote. Just one morning last week. First appointment last-minute cancellation through VETtext without explanation. No call or anything, just disappeared from the schedule five minutes before the appointment. If I was in private practice I'd have to eat the cost. Second appointment, won't go into too many details but, basically, gave me the business for doing my job (after showing up 30+ mins late for the intake)--angry at being asked required screening questions about suicidality, no eye contact, irritable to be there ('they told me to come here'), angry at me for 'making him talk' about stuff that made him upset. The kind that make you want to say, 'Yeah...dude...it ain't working out for me either...there's the door. Therapy is 100% voluntary and the door works just fine.' Third appointment (video- VVC appointment). Appointment time comes around. Of course, no client in the room. Call client. Wife answers and says they are having tech trouble and asks me to call back in 10 mins. After 10 mins I call back and they need another 10 mins. Then after 10 mins, they need another 10 mins, lol. Finally got their computer/internet setup working 30+ mins after the appointment start time.

There is no way that private practice folks are going to put up with this crap.
 
Not to add to the list of things to worry about… but is anyone else very concerned about the proposed ACCESS Act? Particularly the part that would allow veterans to access MH community care options without approval from VA? It would be a 3 year pilot program, but it very may open Pandora’s Box of finally turning VA into an insurance company and not a provider of direct care.


Veterans Access Act: Veterans deserve the care they were promised
 
Psychologist1234 said:
Not to add to the list of things to worry about… but is anyone else very concerned about the proposed ACCESS Act? Particularly the part that would allow veterans to access MH community care options without approval from VA? It would be a 3 year pilot program, but it very may open Pandora’s Box of finally turning VA into an insurance company and not a provider of direct care.


Veterans Access Act: Veterans deserve the care they were promised
Click to expand...
I'd predict that there would be some migration of veteran patients to the community but--for many reasons--I think that most would keep coming to VA for their MH appointments. For one thing, the 'culture' of VA mental health is very much 'veteran centric' in terms of--in my experience--being very liberal with respect to the diagnostic criteria for PTSD when it is clear that a veteran wants that diagnosis and/or simply announces 'I have PTSD.' I don't think that most community providers would feel the same pressure to 'rubber stamp' PTSD diagnoses and, let me tell ya, that is going to lead to a LOT of those patients who would complain about their MH VA treatment and jump ship to the community complaining even louder about their treatment in the community and jumping right back into VA MH care where they are treated more gingerly and in a more 'veteran-centric' manner. The biggest open secret that no one ever discusses is the reality that the apparent need/demand for actual psychotherapy at VA is way in excess of the actual demand for regular, evidence-based, goal-oriented, skills-building, and responsibility-taking psychotherapy courses. Like, by a factor of about 5 to 1. Therefore, a lot of the issues that can never be discussed (symptom overreporting/misattribution/fabrication for s/c benefits) within the VA system are going to be 'aired out' in the community and it will lead to very interesting times.
 
I feel like we're having the opposite experience within our VA. Most of our therapists push EBPs pretty assertively and the veterans want community providers who will let them do forever-style supportive therapy. Our BH leadership has been trying to soothe us about the influx of patients being pulled back into the VA from the community by saying they'll get a more evidence-based, higher quality therapy. In our case, I don't think they're wrong. It's just not what a lot of the veterans are wanting.

I can smuggle you over here so you can get a different experience!
 
Shiori said:
I feel like we're having the opposite experience within our VA. Most of our therapists push EBPs pretty assertively and the veterans want community providers who will let them do forever-style supportive therapy. Our BH leadership has been trying to soothe us about the influx of patients being pulled back into the VA from the community by saying they'll get a more evidence-based, higher quality therapy. In our case, I don't think they're wrong. It's just not what a lot of the veterans are wanting.

I can smuggle you over here so you can get a different experience!
Click to expand...
I really can't fault our therapists. We have ZERO case management services so a lot of veterans who really just need MH case management get tagged with 'psychotherapy' consults to MH and we are so under-staffed that caseloads are in the hundreds and, logistically, there's no way to provide regular weekly sessions to everyone.
 
Psychologist1234 said:
Not to add to the list of things to worry about… but is anyone else very concerned about the proposed ACCESS Act? Particularly the part that would allow veterans to access MH community care options without approval from VA? It would be a 3 year pilot program, but it very may open Pandora’s Box of finally turning VA into an insurance company and not a provider of direct care.


Veterans Access Act: Veterans deserve the care they were promised
Click to expand...

Not in teh VA, but wouldn't be concerned about it, at least for specialty care. Many of us do not accept this as an insurance/payor source due to the level of pay and hassles of billing associated with the program. If the vets want longer wait lists for specialty care, let them have what they voted for.
 
The tweet threatens the firing, but the email itself doesn't.
____________________________________
Subject line: What did you do last week?

Body of email:
Please reply to this email with approx. 5 bullets of what you accomplished last week and cc your manager.

Please do not send any classified information, links, or attachments.

Deadline is this Monday at 11:59pmEST.
_________________________________
Most people did not respond to the HR test emails. Are people going to respond to this?

Also, I cannot take this email seriously with how it's written. It has all the warnings of a phishing attempt.
 
AsOneDoes said:
The tweet threatens the firing, but the email itself doesn't.
____________________________________
Subject line: What did you do last week?

Body of email:
Please reply to this email with approx. 5 bullets of what you accomplished last week and cc your manager.

Please do not send any classified information, links, or attachments.

Deadline is this Monday at 11:59pmEST.
_________________________________
Most people did not respond to the HR test emails. Are people going to respond to this?

Also, I cannot take this email seriously with how it's written. It has all the warnings of a phishing attempt.
Click to expand...
  • Consumed 14 meals and 14 cups of coffee
  • Had 10 bowel movements
  • Changed my clothes 18 times
  • Shaved my face four times
  • Trimmed my beard one time
That's what they want, right?!?
 
Oh, it looks like one agency already won't be playing along.

Ken Watanabe Godzilla GIF by Legendary Entertainment
 
If the government just gives the equivalent of 'vouchers' for mental healthcare, what is going to stop the flood of 'Better Call Saul' types of provider shops who will be--essentially--selling PTSD diagnoses (under the flimsiest of evidence/history), notes/records overflowing with documented 'proof' of 100% s/c disability status, and limitless 'letters' to support applications for increased disability compensation, full-time caregiver support for MH issues, etc., etc.?

Meanwhile, the veterans who suffer from serious MDD, PTSD, SUDS, and who want effective, evidence-based treatments with the goal of reducing symptoms/disability aren't really going to have viable options to meet those needs. As out of control as the landscape is at VA for MH providers who are actually trying to provide such care, under the 'free for all' market, it will be much worse. At present, providers don't actually get paid any more for 'rubber stamping' PTSD diagnoses or slacking on implementation of evidence-based treatments. These are maintained by other contingencies of reinforcement/punishment inherent in the system. But we all get paid the same, regardless of whether we actually focus on providing excellent, evidence-based treatments that focus on client responsibility in psychotherapy and accountability (of both client and therapist) in psychotherapy. Without serious revision of the service-connected disability aspect of the equation (where there are zero forces that exist to check/counter-balance extreme overreporting/mis-attribution of symptoms or over/mis-diagnosis of PTSD), it is going to be a wild, wild ride. For some providers, we provide evidence-based care (despite its inherent difficulty) and we strive not to blatantly over-diagnose PTSD (and say 'no' sometimes) out of principle and the desire to practice psychology in a legitimate, ethical fasion. That's the only (intrinsic) 'reward' we get at present--we don't get paid any more than providers who just 'phone it in' and call it a day but...critically...we don't get paid any less either. It's going to be challenging to be a private pay (or 'voucher') provider who is selling the service of actual psychotherapy (focused on self-evaluation, self-change, skill development, between-session assignments, accountability, etc.) when 80% of the market involves customers who are more interested in customer service related to establishing/increasing disability status.

Then, the government will start 'cracking down' on the out of control mis/over-diagnosis of PTSD. It will likely 'over-correct' and lead to a lot of harm to the veterans who have this legitimate condition.

It would be an interesting mess to behold, and sad.
 
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docloufan said:
No one should reply to an email like that. Ever. You have Performance evaluations they could look at if they wanted to and were given access.
Click to expand...
Apparently leadership at my VA is telling us to respond. I haven't seen those emails for myself yet. I'm frustrated. Everyone's just giving in.
 
They want chaos. They want to hurt people. All of it is to destroy the system & replace it with privatized, private-equity backed, mid-levels in a box who get paid $25-$40/hr and make millions for investors. Veteran lives and staff lives be damned.

Always follow the money.
 
I know the chief of mental health at my VA is afraid to push back on anything, so I know I will be told to respond...
 
AsOneDoes said:
I know the chief of mental health at my VA is afraid to push back on anything, so I know I will be told to respond...
Click to expand...
You really shouldn't though. This is not coming from anyone in your leadership chain. It from an unstable nazi autistic billionaire. That's all. Saying nothing is the safest approach by far.
 
AsOneDoes said:
But the person telling me to respond is in my leadership chain.

I'm so tired.
Click to expand...
I mean, i think HIPPA and infosec 101 say you shouldn't answer a stranger something like that in an unencrypted email. More than that, VA middle manager says you should but Director of FBI says not too... think you should probably listen to the later.
 
Therapist4Chnge said:
They want chaos. They want to hurt people. All of it is to destroy the system & replace it with privatized, private-equity backed, mid-levels in a box who get paid $25-$40/hr and make millions for investors. Veteran lives and staff lives be damned.

Always follow the money.
Click to expand...

Fan_of_Meehl said:
If the government just gives the equivalent of 'vouchers' for mental healthcare, what is going to stop the flood of 'Better Call Saul' types of provider shops who will be--essentially--selling PTSD diagnoses (under the flimsiest of evidence/history), notes/records overflowing with documented 'proof' of 100% s/c disability status, and limitless 'letters' to support applications for increased disability compensation, full-time caregiver support for MH issues, etc., etc.?

Meanwhile, the veterans who suffer from serious MDD, PTSD, SUDS, and who want effective, evidence-based treatments with the goal of reducing symptoms/disability aren't really going to have viable options to meet those needs. As out of control as the landscape is at VA for MH providers who are actually trying to provide such care, under the 'free for all' market, it will be much worse. At present, providers don't actually get paid any more for 'rubber stamping' PTSD diagnoses or slacking on implementation of evidence-based treatments. These are maintained by other contingencies of reinforcement/punishment inherent in the system. But we all get paid the same, regardless of whether we actually focus on providing excellent, evidence-based treatments that focus on client responsibility in psychotherapy and accountability (of both client and therapist) in psychotherapy. Without serious revision of the service-connected disability aspect of the equation (where there are zero forces that exist to check/counter-balance extreme overreporting/mis-attribution of symptoms or over/mis-diagnosis of PTSD), it is going to be a wild, wild ride. For some providers, we provide evidence-based care (despite its inherent difficulty) and we strive not to blatantly over-diagnose PTSD (and say 'no' sometimes) out of principle and the desire to practice psychology in a legitimate, ethical fasion. That's the only (intrinsic) 'reward' we get at present--we don't get paid any more than providers who just 'phone it in' and call it a day but...critially...we don't get paid any less either. It's going to be challenging to be a private pay (or 'voucher') provider who is selling the service of actual psychotherapy (focused on self-evaluation, self-change, skill development, between-session assignments, accountability, etc.) when 80% of the market involves customers who are more interested in customer service related to establishing/increasing disability status.

Then, the government will start 'cracking down' on the out of control mis/over-diagnosis of PTSD. It will likely 'over-correct' and lead to a lot of harm to the veterans who have this legitimate condition.

It would be an interesting mess to behold, and sad.
Click to expand...

I imagine that vouchers for BetterHelp will be the future for VA Healthcare at this point. It is the only true non-profit system left and U.S. style corporate capitalism requires growth. Where else are you going to get more patients?
 
allantois said:
Trying to force mental health clinicians all into office in this day and age is gonna result in a very quick collapse of the VA mental health system
Click to expand...
The main part of my job (research coordination) is entirely virtual…I really want to just let it all burn and run away but I also don’t want them to win…
 
docloufan said:
You really shouldn't though. This is not coming from anyone in your leadership chain. It from an unstable nazi autistic billionaire. That's all. Saying nothing is the safest approach by far.
Click to expand...
The neurodiverse don’t claim that Nazi sociopath (if you believe the stories that seem confirmed).

Elon grew up w the family’s emerald/gem fortune, around ppl who supported apartheid, and is friendly w Nazis….his ‘tism is more likely an ‘ism….as in Nazism.
 
Fan_of_Meehl said:
If the government just gives the equivalent of 'vouchers' for mental healthcare, what is going to stop the flood of 'Better Call Saul' types of provider shops who will be--essentially--selling PTSD diagnoses (under the flimsiest of evidence/history), notes/records overflowing with documented 'proof' of 100% s/c disability status, and limitless 'letters' to support applications for increased disability compensation, full-time caregiver support for MH issues, etc., etc.?

Meanwhile, the veterans who suffer from serious MDD, PTSD, SUDS, and who want effective, evidence-based treatments with the goal of reducing symptoms/disability aren't really going to have viable options to meet those needs. As out of control as the landscape is at VA for MH providers who are actually trying to provide such care, under the 'free for all' market, it will be much worse. At present, providers don't actually get paid any more for 'rubber stamping' PTSD diagnoses or slacking on implementation of evidence-based treatments. These are maintained by other contingencies of reinforcement/punishment inherent in the system. But we all get paid the same, regardless of whether we actually focus on providing excellent, evidence-based treatments that focus on client responsibility in psychotherapy and accountability (of both client and therapist) in psychotherapy. Without serious revision of the service-connected disability aspect of the equation (where there are zero forces that exist to check/counter-balance extreme overreporting/mis-attribution of symptoms or over/mis-diagnosis of PTSD), it is going to be a wild, wild ride. For some providers, we provide evidence-based care (despite its inherent difficulty) and we strive not to blatantly over-diagnose PTSD (and say 'no' sometimes) out of principle and the desire to practice psychology in a legitimate, ethical fasion. That's the only (intrinsic) 'reward' we get at present--we don't get paid any more than providers who just 'phone it in' and call it a day but...critially...we don't get paid any less either. It's going to be challenging to be a private pay (or 'voucher') provider who is selling the service of actual psychotherapy (focused on self-evaluation, self-change, skill development, between-session assignments, accountability, etc.) when 80% of the market involves customers who are more interested in customer service related to establishing/increasing disability status.

Then, the government will start 'cracking down' on the out of control mis/over-diagnosis of PTSD. It will likely 'over-correct' and lead to a lot of harm to the veterans who have this legitimate condition.

It would be an interesting mess to behold, and sad.
Click to expand...
Pretty much nothing, unless they seriously revamp the SC system, require that the evaluation be done by a VA provider/evaluator, etc. Which won't happen. Although if they curtail benefits enough, which seems possible given the way Hegseth's seemingly talked about it in the past, there may not be as much motivation to go through the motions with months of "therapy" to support a diagnosis solely for SC.
 
Ive seen it suggested that if you have to reply to the email, reply with:

Last week, consistent with my job duties, I:

• Fulfilled President Lincoln’s promise to
• Care for those who have served in our nation’s military
• And for their families
• Caregivers
• And survivors
 
psycho1391 said:
Ive seen it suggested that if you have to reply to the email, reply with:

Last week, consistent with my job duties, I:

• Fulfilled President Lincoln’s promise to
• Care for those who have served in our nation’s military
• And for their families
• Caregivers
• And survivors
Click to expand...

I think this has gotten a little ridiculous, frankly. I dont think alot of people are really getting it.

1. While some responses may be humorous when putting them together, they are not chuckling with you and cheeky responses really accomplished nothing. Anything you say can be used against you. Please just dont say anything at all.
2. Its never going to stop. Today its 5 things. Next months its 10 things. Next month its something different and more outrageous. Stop feeding it. Stop going along with it.
3. I hope its obvious that they don't actually care WHAT you say. Its phishing. No one is actually reading these. Its a "I say jump and you say how high" kinda thing. Responses give them permission to continue this. Literally.
 
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docloufan said:
I think this has gotten a little ridiculous, frankly. I dont think alot of people are really getting it.

1. While some responses may be humorous when putting them together, they are not chuckling with you and cheeky responses really accomplished nothing. Anything you say can be used against you. Please just dont say anything at all.
2. Its never going to stop. Today its 5 things. Next months its 10 things. Next month its something different and more outrageous. Stop feeding it. Stop going along with it.
3. I hope its obvious that they don't actually care WHAT you say. Its phishing. No one is actually reading these. Its a "I say jump and you say how high." Responses give them permission to continue this. Literally.
Click to expand...
Then what are you suggesting to do if your leadership is instructing you to respond?
 
cara susanna said:
Our leadership already caved and I'm soooooo angry.
Click to expand...
Same here. There is no rational reason to do this and people just keep pointing at the fact that it's a small ask. What is the purpose of this small task? They are acting completely outside of norms and have given only nonsensical answers for why they're doing it. The feigned confusion why people don't trust this is all the more annoying. This is a security nightmare and they've already proven themselves untrustworthy with any data. I have been thoroughly unimpressed with the responses from people I thought knew better.
 
cara susanna said:
Our leadership just clarified that we won't get in trouble if we don't respond. But it's "highly encouraged" for us to. What the heck does that mean?
Click to expand...

Personally, I would keep copies of all of these e-mails, off my VA drives, and do nothing. If you get canned, you now have ammo for action you'd like to take.
 
cara susanna said:
Our leadership just clarified that we won't get in trouble if we don't respond. But it's "highly encouraged" for us to. What the heck does that mean?
Click to expand...
Literal 'guidance': "we are not telling staff not to reply."
 
cara susanna said:
Our leadership just clarified that we won't get in trouble if we don't respond. But it's "highly encouraged" for us to. What the heck does that mean?
Click to expand...

It means, "we have no idea what is going on right now, but Elon Musk seems to have no problem bulldozing the rule of law recently so maybe play ball. Then again we might be wrong."
 
Sanman said:
It means, "we have no idea what is going on right now, but Elon Musk seems to have no problem bulldozing the rule of law recently so maybe play ball. Then again we might be wrong."
Click to expand...
There's a memorable scene in the excellent HBO miniseries "Band of Brothers" where the narrator (I think it was Lt. Spears) says something to the effect of, "Captain Blythe wasn't a bad leader because he made BAD decisions...he was a bad leader because he made NO decisions." (Maybe that was narrated in Major Winters' voice, not sure).

The context was a chaotic battle situation where people were getting killed left and right and leadership was paralyzed with fear.

Such a great series.
 
Last edited:
Sanman said:
It means, "we have no idea what is going on right now, but Elon Musk seems to have no problem bulldozing the rule of law recently so maybe play ball. Then again we might be wrong."
Click to expand...

Right? That's exactly it. I still have no idea what to do.
 
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