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

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psy.d. 2021 said:

Imagine EVERY SC VETERAN would be required to seek therapy for MH? You think it's bad now...wow
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Seems like job security to me. Move into PP and fill any empty slot with veterans begging to treatment to keep their SC.

Honestly, I have no problem with them requiring treatment (and compliance) to remain SC. Too many folks with SC and no record of any symptoms or treatment in their clinical record outside of compensation paperwork.
 
Sanman said:
Seems like job security to me. Move into PP and fill any empty slot with veterans begging to treatment to keep their SC.

Honestly, I have no problem with them requiring treatment (and compliance) to remain SC. Too many folks with SC and no record of any symptoms or treatment in their clinical record outside of compensation paperwork.
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Hell, why not just make it official in DSM-6:

Service-Connection Deficit Disorder, Chronic, Severe, With Pseudo-Psychotic Features*

*"Doc...I see shadow people..."
 
Sanman said:
Seems like job security to me. Move into PP and fill any empty slot with veterans begging to treatment to keep their SC.

Honestly, I have no problem with them requiring treatment (and compliance) to remain SC. Too many folks with SC and no record of any symptoms or treatment in their clinical record outside of compensation paperwork.
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Job security for sure. So you can spend your days working with people that don't want to be seen. Personally I'd rather not.
 
cara susanna said:
Where does it say that?

And umm, wow, that thread is really full of misconceptions about PTSD and the active episode of care model.
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Point 2 in Gade's testimony. Not clear in that reddit post

"requiring veterans receive mental health treatment if they get disability compensation for a mental health disorder"
 
psy.d. 2021 said:
Yeah that's what I'm focused on.

It is clear there are some misconceptions in that post and comments about the episodes of care model and PTSD treatment.
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It would depend on the definition of treatment. EBP, any individual psychotherapy, groups, or see psychiatrist every 3 mths for a med refill?
 
www.sheepdogthemovie.com

Sheepdog the Movie

www.sheepdogthemovie.com www.sheepdogthemovie.com

Did you guys hear about this movie? Apparently it portrays PTSD treatment in the VA, specifically EMDR (just what EMDR needs, more mainstream publicity)
 
I swear more than half of all therapy referral requests I see on my local/state list serv are for EMDR. When I first joined years ago I def posted about the lack of research and provided citations, it was received as you'd expect. I got backchannel responses from like-minded (mostly faculty and another neuropsych) that they tried too and the "I did my own research" crowd just ignored the science. I didn't realize at the time that there were so many supporters of that trash approach. Pseudoscience is bad for the field, period.
 
Therapist4Chnge said:
I swear more than half of all therapy referral requests I see on my local/state list serv are for EMDR. When I first joined years ago I def posted about the lack of research and provided citations, it was received as you'd expect. I got backchannel responses from like-minded (mostly faculty and another neuropsych) that they tried too and the "I did my own research" crowd just ignored the science. I didn't realize at the time that there were so many supporters of that trash approach. Pseudoscience is bad for the field, period.
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The public is 'Mesmerized' (literally) with the concept of magical eye movement therapy.

Someone also needs to inform veterans that the 'Jason Bourne' movies aren't an accurate scientific portrayal of trauma- and stressor-related disorder etiopathogenesis, symptomatology, course, and prognosis.
 
Therapist4Chnge said:
I swear more than half of all therapy referral requests I see on my local/state list serv are for EMDR. When I first joined years ago I def posted about the lack of research and provided citations, it was received as you'd expect. I got backchannel responses from like-minded (mostly faculty and another neuropsych) that they tried too and the "I did my own research" crowd just ignored the science. I didn't realize at the time that there were so many supporters of that trash approach. Pseudoscience is bad for the field, period.
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Much like the new sudafed, marketing wins over science. This would be one place insurance companies would be helpful. However, they rarely are.
 
cara susanna said:
I've been trying to tell people in the VA claims subs that you don't need a diagnosis from VA MH to get SC, but no one believes me.
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Par for the course for compensation seekers. They don't tend to have the best reasoning abilities or counsel. You'd be surprised about the lies some PI claimants will tell, even when they know we have their medical records and these things are easily verifiable.
 
cara susanna said:
I've been trying to tell people in the VA claims subs that you don't need a diagnosis from VA MH to get SC, but no one believes me.
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They are being told this by VSOs, patient advocates, and fellow vets in online forums and specialized YouTube channels (e.g. (so-called) "Combat Craig," VA Claims Insider, etc.). There is an entire delusional industry around the quest to get diagnosed with (and, of course, service-connected for) PTSD specifically. I can't tell you how many cases I see these days of veterans who are already s/c for another MH disorder (MDD, adj d/o, anxiety disorder---some already at 100%) who are all aggressively trying to 'upgrade' to a PTSD dx and service-connection. PTSD is, truly, THE UNIVERSAL NEXUS, to hang multiple 'secondaries' onto and "get you into the 'Hundo' (100%) Club."

People have no idea how bad it is (and how much worse it's getting over time).

But they will, at some point.

Also, the extent to which this exacerbates MH access issues is GROSSLY underestimated / ignored by VA leadership.

I think I read the other day (may be one of the WashingtonPost Articles) that a recent year's annual budget (2025?) for military disability payments totaled 193 BILLION dollars. That same year, the total budget to fund the entire US Army was 8 billion LESS than that total.
 
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Fan_of_Meehl said:
They are being told this by VSOs, patient advocates, and fellow vets in online forums and specialized YouTube channels (e.g. (so-called) "Combat Craig," VA Claims Insider, etc.). There is an entire delusional industry around the quest to get diagnosed with (and, of course, service-connected for) PTSD specifically. I can't tell you how many cases I see these days of veterans who are already s/c for another MH disorder (MDD, adj d/o, anxiety disorder---some already at 100%) who are all aggressively trying to 'upgrade' to a PTSD dx and service-connection. PTSD is, truly, THE UNIVERSAL NEXUS, to hang multiple 'secondaries' onto and "get you into the 'Hundo' (100%) Club."

People have no idea how bad it is (and how much worse it's getting over time).

But they will, at some point.

Also, the extent to which this exacerbates MH access issues is GROSSLY underestimated / ignored by VA leadership.

I think I read the other day (may be one of the WashingtonPost Articles) that a recent year's annual budget (2024?) for military disability payments totaled 193 BILLION dollars. That same year, the total budget to fund the entire US Army was 8 billion LESS than that total.
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Right, that's why I'm trying to combat that misinformation, because we need to stop people from coming here only to get a diagnosis when they don't actually want treatment.

I actually watched one of those videos and, yeah, did not help my cynicism.
 
cara susanna said:
Right, that's why I'm trying to combat that misinformation, because we need to stop people from coming here only to get a diagnosis when they don't actually want treatment.

I actually watched one of those videos and, yeah, did not help my cynicism.
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The other thing that is ubiquitous online is the (delusional and factually-incorrect) idea that service-connected disability 'isn't a disability program--it's like worker's comp' or, essentially, a 'thank you for your service' entitlement for 'signing on the dotted line to serve' and 'putting yourself in harms way' and 'destroying your body and mind in service to your country.' This is stated with absolute conviction all over the place online even though it is directly contradicted (in the same forums, sometimes by the same posters) by the enumeration of the three required elements to establish a service-connection which are: (1) a current DISABILITY, (2) an in-service event, injury, or illness, and (3) a medical nexus between them.
Historically, the program was set up for the main purpose of compensating veterans for loss of earning potential due to military service and related injuries or illnesses.
 
Fan_of_Meehl said:
Historically, the program was set up for the main purpose of compensating veterans for loss of earning potential due to military service and related injuries or illnesses.
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Then I have questions for why people get compensated for genital herpes.

But I'm pretty sure VA disability is for loss of quality of life and loss of income potential.
 
PsyDr said:
Then I have questions for why people get compensated for genital herpes.

But I'm pretty sure VA disability is for loss of quality of life and loss of income potential.
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I know a veteran that was visiting a Vietnamese brothel when their position got overrun by Viet Cong and the prostitutes had to hide the GIs. That is to say, I can make a case of service connection.
 
Sanman said:
I know a veteran that was visiting a Vietnamese brothel when their position got overrun by Viet Cong and the prostitutes had to hide the GIs. That is to say, I can make a case of service connection.
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Did the prostitutes hide them in their vaginas?
 
cara susanna said:
I get this weird thrill out of declining neuropsych referrals when there is untreated OSA.
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For me, depends on the case, and because we have a decent waitlist for sleep medicine and tx in some systems here. Compelling signs of a lot of the dementias will shine through stuff that is likely due to untreated OSA. So, we can still see signs of some of those, and then suggest a re-eval in a year or two after they get an eval and tx. As opposed to making them wait about a year plus for eval and enough time for treatment effects. Add in to that, a certain number of people will never get the eval, and even in those that get the eval, another percentage of people will not be compliant with tx. So, better to get mildly messy data as opposed to no data.

Granted, these are for typical dementia aged folks. The 40-ish year old with mild att/mem issues can wait until after getting evaluated.
 
WisNeuro said:
For me, depends on the case, and because we have a decent waitlist for sleep medicine and tx in some systems here. Compelling signs of a lot of the dementias will shine through stuff that is likely due to untreated OSA. So, we can still see signs of some of those, and then suggest a re-eval in a year or two after they get an eval and tx. As opposed to making them wait about a year plus for eval and enough time for treatment effects. Add in to that, a certain number of people will never get the eval, and even in those that get the eval, another percentage of people will not be compliant with tx. So, better to get mildly messy data as opposed to no data.

Granted, these are for typical dementia aged folks. The 40-ish year old with mild att/mem issues can wait until after getting evaluated.
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These are always cases where the person has diagnosed OSA but is not CPAP compliant.
 
cara susanna said:
These are always cases where the person has diagnosed OSA but is not CPAP compliant.
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Ah, if they're dementia aged, I'll still take them. If it's mild, non-specific deficits, then we say, "who knows, could be your untreated OSA." But, sometimes it's pretty clear AD or something, to which we say, "looks like AD/other, and the OSA is likely making the issues worse."
 
protip: Some insurance companies have a policy not to reimburse bills that use a "descriptor diagnosis" (e.g., Mild Neurocognitive Disorder due to another medical condition).
 
WisNeuro said:
Ah, if they're dementia aged, I'll still take them. If it's mild, non-specific deficits, then we say, "who knows, could be your untreated OSA." But, sometimes it's pretty clear AD or something, to which we say, "looks like AD/other, and the OSA is likely making the issues worse."
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Yeah, these are cases where they're on the younger side and have a ton of confounding factors (usually mental health)
 
cara susanna said:
Yeah, these are cases where they're on the younger side and have a ton of confounding factors (usually mental health)
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I'm surprised people are putting in those referrals. I routinely get referrals where they are already well into the moderate stages of dementia with no diagnosis. It seems PCPs lean one way or the other.
 
cara susanna said:
Yeah, these are cases where they're on the younger side and have a ton of confounding factors (usually mental health)
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Fair enough, I usually defer these too, unless there is something compelling in the record.

Sanman said:
I'm surprised people are putting in those referrals. I routinely get referrals where they are already well into the moderate stages of dementia with no diagnosis. It seems PCPs lean one way or the other.
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Yeah, I occasionally get the case where it's obvious after 2-3 minutes that we're well into moderate dementia. I generally require a MoCA from my referral sources, but sometimes they sneak in without one, or it's a new referrer.
 
It is nice to have a dedicated day off to work on fellowship applications! It is coincidentally my busiest day of the week so it is welcomed.
 
WisNeuro said:
The beauty of private practice, I get to decide which days are holidays. Also worked today.
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Yeah, I had to move a couple of patients anyway, so I’m working tomorrow and a half day on Wednesday instead. I was supposed to do some testing, but it got delayed. At least I get some no show $$.
 
Therapist4Chnge said:
Yeah, I had to move a couple of patients anyway, so I’m working tomorrow and a half day on Wednesday instead. I was supposed to do some testing, but it got delayed. At least I get some no show $$.
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Another beautiful thing about private practice, hefty invoices for no-shows.
 
cara susanna said:
Definitely would have done that had I planned ahead enough
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Develop a sudden onset case of the Mondays and call in sick.

Working Office Space GIF
 
futureapppsy2 said:
Anyone else affected by the great MHV/SM outage today?
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It is so painful to use presently, so much wasted time. I think I've sent out one message successfully between today and yesterday. If I'm actually able to read a message and there is something time sensitive, I've had to just call the veteran instead.
 
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