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

[Sanman]

I would really encourage the clinic to revisit this policy. We are required to offer them options, sure, but they don't have to be therapy if the patient has demonstrated they can't engage. It just takes up valuable appt slots and burns out therapists. We're a CBOC with just us, no specialty mental health clinics (unless you count my 50% PCT role), and we still manage to set boundaries.

The latest policy about rescheduling efforts helps with this, too.

I don't disagree with you but not really my problem in this case.

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[cara susanna]

I don't disagree with you. but not really my problem in this case.

Haha, touche.

For OPMH therapists in this thread, definitely find out how much control you have. Often, it's more than you think. It's not like one visit to the patient advocate is gonna get you fired (assuming your clinical rationale is sound).

 

[Fan_of_Meehl]

My patients wait 2-3 months, many have MCI/mild dementia and still show up to their appointments, and on time.

My patients (at VA) claim that their 'traumatic brain injury' (remote history of mild concussion) makes it impossible for them to remember how to distinguish left from right, up from down, or day from night. They also claim to be incapable or reading/writing well enough to complete measures while filling out (perfectly) a travel pay form printed in microscopic font.

 

[cara susanna]

They get soooo many reminders, too. I'm always suspicious when they say that they thought it was a different day/time.

 

[Fan_of_Meehl]

OK, I think I know the answer to this...

I work in a BHIP setting, general mental health clinic at a VA. How do we effectively manage chronic no showers that keep asking to get back on our panel? More or less I was told we have to deal with it. Is this something I can effectively use in my informed consents going forward or would it be largely non-enforceable because of larger VA policy that allows for Veterans to do this without any consequences?

In my experience, non-enforceable. I've had good results from simply keeping very good notes on patient responsivity (or not) to increasingly lower 'response effort' laden task demands (requests?) in the form of self-monitoring forms, worksheets, therapeutic structure, etc. Eventually, they passively drop out of your caseload after being gently confronted for the 15th time on non-completion of homework. You can't let up on making the therapy environment non-reinforcing for non-engagement type behavior.

I've enjoyed some of the most unintentionally hilarious discussions with therapy patients in the VA who try in vain to explain EXACTLY how behavioral and/or cognitive change is not only difficult but impossible for them to achieve (even the most miniscule changes) at which point I share with them the 'sad' news that therapy just ain't for them (since it's all about self-change).

 

[cara susanna]

I really don't get no shows, especially. You can cancel so easily via text without having to talk to anyone.

 

[WisNeuro]

My patients (at VA) claim that their 'traumatic brain injury' (remote history of mild concussion) makes it impossible for them to remember how to distinguish left from right, up from down, or day from night. They also claim to be incapable or reading/writing well enough to complete measures while filling out (perfectly) a travel pay form printed in microscopic font.

When I gave the feedback that, if taken at face value, a vet's performance on testing would be at the level of, if I left the room for more than 20 seconds, and came back in, he would not know who I was, or where he was. To which Fu ckles the Clown doubled down and suddenly started asking "where am I?!" Despite driving independently two hours to the appointment solo.

 

[Fan_of_Meehl]

When I gave the feedback that, if taken at face value, a vet's performance on testing would be at the level of, if I left the room for more than 20 seconds, and came back in, he would not know who I was, or where he was. To which Fu ckles the Clown doubled down and suddenly started asking "where am I?!" Despite driving independently two hours to the appointment solo.

I swear we need to publish a 'Veterans Affairs Casebook of Malingering, Shucking/Jiving, and Otherwise Non-Credible Clinical Presentations'