mental health day

[manu1959]

went to a day spa today and met this wonderful iranian lady....lived in iran pre-revolution....the shaw years.....i mentioned that i recall how it was refered to as the paris of the middle east....

she said those people are crazy....she grabbed my shoulders and said something must be done....she said where do you think they come form...

i said i have no idea....

she looked at me and said .... the mosques .... religion is a dangerous thing in the hands of evil men ..... and an ignorant people....

old school...

 

[waltky]

Flaws in Mental Health Care at St. Louis VA...

Report Finds Flaws in Mental Health Care at St. Louis VA
Dec 15, 2016 — St. Louis Veterans Administration health care officials insufficiently investigated the death of a mental health patient.

The OIG launched an investigation in 2014 after concerns were raised by Dr. Jose Mathews, the St. Louis VA's former chief of psychiatry. Mathews alleged in a federal whistleblower complaint that veterans often waited a month or more for mental health treatment because psychiatrists and other staff members were so lax in their work. The investigation report released Tuesday found that new patients wait about 17 days for appointments -- only about three days above the national average for all VA centers. Investigators also denied Mathews' claims that staff psychiatrists were unproductive; in fact, the report said the St. Louis psychiatrists ranked high in productivity. VA St. Louis spokeswoman Marcena Gunter said Wednesday that several recommendations suggested by the report have been implemented, and others are in the works. She said the St. Louis facility is now in the top 20 percent of all VA medical centers in providing access to mental health services.

Perhaps the most alarming finding concerned the VA's response to the suicide of a 69-year-old schizophrenic. The report said the veteran had tried to kill himself at least once before when, in 2014, he told VA medical staff he heard voices urging him to shoot himself. The man even asked for information about a suicide prevention hotline. Nearly three months after the initial visit, unable to reach the veteran by phone, VA officials sent a letter advising him that medical tests showed his kidney function was deteriorating and a prostate test result was "abnormal," especially alarming since the man had prostate cancer. The man fatally shot himself two weeks after receiving the letter.

St. Louis VA Medical Center in St. Louis.​

Soon after the death, a leadership team review member at the VA requested an internal management review, calling the case "a pretty serious miss." But the OIG report said that among other errors, a formal review of the psychiatrist or nurse was not requested until OIG investigators were on site nearly four months later. Corrective action didn't occur until eight months after the man's death, the report said. The report also found "no evidence of any administrative follow-up" of another death, a mental health patient in his mid-20s who died in a car wreck three days after hospitalization amid suicide concerns. The death was ruled accidental but the report said suicide could not be ruled out. The investigation also found that the VA failed to provide timely treatment for a woman who complained of being sexually assaulted in the military, and for a patient suffering from post-traumatic stress disorder.

The St. Louis VA has had other problems in recent years. In 2010, faulty sterilization in the dental clinic could have exposed 1,812 veterans to hepatitis and HIV. Testing eventually found no link to either disease in any of the patients. In 2011, operating rooms at the medical center were shut down after rust stains were found on surgical equipment. Surgeries resumed months later after the faulty equipment was cleaned or replaced. The VA opened a new $7 million sterile processing lab in May 2012.

Report Finds Flaws in Mental Health Care at St. Louis VA | Military.com

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Nurse Practitioners to Treat Vets Without Doctor Supervision
Dec 14, 2016 | The Veterans Affairs Department beginning next month will allow certain nurse practitioners to treat veterans without the supervision of doctors across the agency for the first time.

The move is designed in part to shorten wait times for patients who are seeking treatment in underserved areas with physician shortages, according to a rule published Wednesday in the Federal Register. The regulatory change permits three types of nurse practitioners -- certified nurse practitioner (CNP), clinical nurse specialist (CNS), and certified nurse-midwife (CNM) -- "to practice to the full extent of their education, training and certification, without the clinical supervision or mandatory collaboration of physicians," it states. While 21 states and the District of Columbia already grant nurse practitioners so-called "full practice authority," the rule marks the first time the VA established a nationwide framework for such specialists to provide direct care to vets throughout its system.

More than 5,000 nurse practitioners already provide clinical assessments, order and interpret diagnostic tests, make diagnoses and provide other treatments at VA facilities, according to the American Association of Nurse Practitioners. As it stands now, though, many states require NPs to work under a "collaborative agreement" with a physician, meaning nurses working at VA facilities without "full practice authority" don't enjoy direct access to patients. The rule, slated to take effect Jan. 13, "permits VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA," it states.

Award winning nurse practitioner Demerise "Dee" Minor checks for tenderness in Gene Abston's hand after he sustained a fracture​

Organizations representing nurses and veterans welcomed the decision, while a group representing doctors opposed it. "This is a great day for veterans and an important step forward for VA health care," Mark A. Stevenson, chief operating officer of the Air Force Sergeants Association, told Military.com. "This rule will ensure veterans high quality access to the health care they need and deserve." Dr. Cindy Cooke, president of the American Association of Nurse Practitioners, and a proponent of the regulatory change, celebrated it as a win for both nurses and veterans. "We are pleased the VA will move forward with allowing veterans throughout the country to have direct access to nurse practitioner provided health care," Cooke said in a statement. "We trust that in the near future, the VA will propose a plan to include Certified Registered Nurse Anesthetists in this provision."

The new provision doesn't cover certified registered nurse anesthetists because the VA doesn't currently face a shortage of anesthesiologists, according to the rule. But the department is requesting comment "on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking," it states. The American Medical Association, the nation's largest association of physicians, opposed the amendment in its entirety, including the exclusion of certified registered nurse anesthetists. Dr. Andrew Gurman told Forbes on Tuesday the provision sets the clock back on physician-centric care. "We are disappointed by the VA's decision today to allow most advanced practice nurses within the VA to practice independently of a physician's clinical oversight, regardless of individual state law," he said, according to the article. The regulatory change will take effect after a month of public commenting.

Nurse Practitioners to Treat Vets Without Doctor Supervision | Military.com