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18 May 2016

A week ago last Thursday

A week ago last Thursday, I took the paperwork-- a couple of pages of instructions plus a form with questions for a mental health provider to fill out and fax back-- from my employer's human resources office to the mental health clinic at the VA hospital. This paperwork is my employer's response to my ADA accommodations request at work; in effect, it's the part of the process where my employer can say "okay, prove that you really have the disability."

A week ago last Thursday. No response.

Yesterday I hopped onto MyHealtheVet and sent a 'secure message' to the patient advocate's office at said VA Hospital indicating that it had been more than a week since I'd dropped off the paperwork and that I hadn't received a response. This morning I received a response via secure message from the patient advocate's office, who said that they'd contact mental health and try to make something happen. Cool so far.

Today at (checking phone) 1607 (this will matter in a minute) I received a call from my 'provider', the same psychiatrist pharmacist-trained-as-a-psychiatrist I saw the last time I was at the mental health clinic. The message said "I wanted to talk to you on the phone to see how we can best help you." It also said "I'm available from 8 to 4:30".

First thing: the timing of the call. This is a trick people play when they have to call someone, but they don't want to deal with them. The patient advocate responded to me at about 0930, so I'm guessing they talked to mental health at the very latest before about 1000. It doesn't take from 1000 to 1600 to call a patient back, or at least it shouldn't. Calling someone less than half an hour before you're about to leave the office in effect says "I have to call you back because you went to the patient advocate but I don't want to deal with you today."

It also, between the lines, says "F you for going to the patient advocate and making me look bad." Not my problem. You ignored me for over a week. That is bad.

Second thing: the content of the call. How can you help me? Simple. Read the form with the instructions and questions on it. Look up my records to see what I'm diagnosed with (PTSD, anxiety, depression). Fill it out and fax it to HR. The questions are intentionally simple:
  • Does this person actually have this disability?
  • Is this more than a temporary disability/is it a permanent disability?
  • Are accommodations for trouble with concentration such as requiring that he not be asked to task shift between jobs, and noise canceling headphones consistent with this disability?
  • Do you have any other suggested accommodations?
That's literally the entire form. I intentionally asked the human resources person handling all of this at work to make it as simple as possible. I went through a similar process with getting academic accommodations-- in that case my provider said "have the disability resource center tell me exactly what questions they need answered". So that's what I did here too.

How would I answer these questions as a mental health professional? Let's see.

  • Yes he has been seen at this mental health clinic for PTSD since 2008.
  • It is a continuing condition. He is not cured.
  • Yes they are.
  • No. 
I'm fine with the VA wussing out and just saying "No" to the last question. I don't expect them to come up with additional ideas, nor am I asking them to do anything extra.

So there are a couple of different ways this goes from here.

I'm going to try calling tomorrow. I fully expect to get pharmacist-psychiatrist's voice mail when I call, but either way I'll still have to explain exactly what's already on the form. Answer these specific questions about me. Sign it, stamp it, write a letter, whatever you have to do. Fax whatever form your answers are in to the fax number on the form, which goes directly to the ADA accommodations person where I work.

Another way this can go is that the VA says I have to come in for an appointment and "be seen" before they'll fill out the paperwork-- experience says that they won't have an afternoon appointment available for at least a few weeks. That puts this whole mess well into June, which is silly. At the appointment, I'm going to say, again, "look at the form, answer those questions, these are the accommodations I want, they are consistent with PTSD as a disability, sign my damn form and fax it in please." It's a waste of my time, and it's a waste of the VA's time-- they could be helping another veteran in the appointment space I'd be taking up.

Third thing: the pharmacist-turned-psychiatrist called. There's likely no record of the call, other than in my records she made a note that she called. I wasn't able to contact her directly by secure messaging, because I didn't have that option. (If you're not familiar with MyHealtheVet, the VA's online health/patient information portal-- secure messaging is a way to send something that functionally approaches an email to your providers. You can only send messages to your "teams". I used to be able to send messages directly to mental health, but now I can't choose MH as a recipient.)

The thing about secure messages is that they are recorded verbatim as part of your VA health record. Phone calls are (to my knowledge) not. So if someone didn't want the specifics of a conversation recorded for posterity, they'd call rather than use secure messaging. I've been handed the line before that "oh they don't have me set up for secure messaging" and it's bullshit.

So, since I can't contact this person back directly via secure message, I have to call. Should be a fun phone call/voice mail.

-----

There's something a lot deeper going on here.

I've been in and out of therapy for, literally, years. I've had a lot of opportunities to use what I've learned in therapy and in reading on my own, and a lot of time and practice to adapt and develop new ways to cope with PTSD. I'm lucky, in that I'm not an alcoholic-- I don't drink by choice. I'm lucky that I was able to spend the time I was homeless still actively working towards education rather than in situations where getting into drugs was a lot more likely.

Why I am that kind of lucky I can't tell you. I'd love to say it's that I have the spirit of a warrior, but there are men and women who are veterans who also have the same spirit of a warrior that will give up today.  They'll choose to die on their own terms after months or years of doing a damn good job of staying alive on battlefields.

It might not seem like a huge deal, an ADA accommodations request, but it means a lot. Every environment I'm in-- home, walking to work, at work, walking home, in class, at a restaurant, at the grocery store, on the bus, whatever-- I have to make adjustments for. Where I sit, where I stand. Where's the nearest door? Who's around me? What was that noise? Who is that person? What do they want?

Work is especially important because if I can't do something useful, and do it well, I won't have money for things like food and rent. In order to do what I do well-- write software-- I need a safe and quiet environment (or at least as close as I can get to one). It goes deeper than just money for food and shelter, though. I want to do something useful with my life. It is tremendously satisfying to see someone else using software that I wrote and being better off for the experience.

When I drop paperwork off for what should be a simple review and signature, and I don't hear anything back from the VA for over a week, it's emotionally draining. Here I am busting my ass every day to overcome PTSD, and the VA doesn't think I'm important enough to deal with. It is a slippery slope to go from "I'm going to get my ass to work today and do the very best I can" to "ah, fuck it, no one gives a shit anyway".

This is a battle I fight every day even without dealing with the VA.

I work nights (there's that "ways I cope with PTSD" again), so it'll be late afternoon before I'm up and moving around. Tomorrow I'll need to interrupt  what I normally do to get ready for work-- not just the physical part, where I shower and get dressed, but the mental part where I tell myself it's still worth it until I'm convinced enough to get out the door.

The interruption will be to try to call the person at the VA, and explain yet again why I need to ask for accommodations. I've already had to explain to my student team leads, my team leads, and human resources at work. Now I have to explain it to the VA who should already know. Depending on how that goes, I'll need to do something to get my brain focused on work by the time I get there. I'll likely be disappointed and possibly pissed off, especially if I have to make and wait for an in-person appointment.

Without the form filled out by the VA, my employer doesn't have to do anything to accommodate my disability. So I still have to deal with the noise, the people moving around, and everything else. Work without accommodations is a battle, and it's frustrating and exhausting. There are a lot of times when the PTSD tries to convince me to just say "ah, fuck it" and give up. When I'm frustrated and exhausted that voice gets louder and clearer.

I'm not giving up. I'm fighting this PTSD thing. If keep having problems getting what I need from the VA to do the very best job I can at work, I'm not going to rest. Tomorrow I'll try talking to my provider. If that doesn't work I'll talk to the patient advocate again, and if that doesn't immediately produce results I still have my U. S. Senator on speed dial.

My point here is that a lot of veterans do give up. It's not just suicide that's the result. It's a lot of things: not going to college or a trade school to learn new skills to get a better job. Staying at a job that makes you miserable. Staying in a bad relationship. Running with the wrong crowd. Crawling inside a bottle. Not taking good opportunities when they come up. Not living the life that could be lived, because when a veteran went to the VA for help with something that might have changed things for the better, all they got was shrugged off.

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