In late February, when the Trump administration stepped up its pursuit of changing the federal government, a psychiatrist who treated veterans was targeting her new workstation — which was incredible.
Under the new return policy, she must conduct virtual psychotherapy with her patients in one of the 13 cubicles in a large open office space, a setting used in a call center. Other staff may eavesdrop on meetings or appear on patients’ screens as they pass through the bathroom and rest space.
The psychiatrist was stunned. Her patients suffer from conditions such as schizophrenia and bipolar disorder. It took months to win their trust from her home office. She said the new arrangement violates the core ethical tenet of mental health care: guarantees of privacy.
When the doctor asked her how she expected to protect her patient’s privacy, the supervisor suggested that she purchase a privacy screen and a white noise machine. “If that's what I'm going to do, I'm going to walk away,” she wrote in a text message she shared with the New York Times. “I get it,” the manager replied. “Many of us are ready to walk away.”
Such scenarios have recently unfolded in veterans’ affairs facilities across the country in recent weeks, driven by the Elon Musk administration’s Department of Efficiency.
One of the most important orders is that thousands of mental health providers, including many people employed in completely remote positions, are now working full-time from the federal office space. It was a shocking policy reversal in Virginia that led the way to achieve the practice of virtual health care two decades ago as a way to reach isolated veterans long before the pandemic made telemedicine the treatment of choice for many Americans.
Health workers say many people cannot ensure patient privacy because First Wave providers report to their offices that simply do not have enough space to accommodate them. Some filed a complaint warning that the arrangement violated ethical regulations and medical privacy laws. Meanwhile, at least 1,900 trial employees are cutting down on already powerful services to help veterans who are homeless or suicide.
In more than thirty interviews, Virginia’s current and recently terminated mental health workers described a period of rapid, chaotic behind-the-scenes change. Many agreed to speak on anonymously because they wanted to continue serving veterans and were concerned about retribution from the Trump administration.
Clinicians warn that these changes will be reduced in the mental health treatment of VA, which has already had a serious lack of staff. Some people would like to see large-scale popular experts, such as psychiatrists and psychologists. They expect waiting times to increase, and veterans will eventually seek treatment outside the agency.
“Psychotherapy is a very private effort,” said Ira Kedson, a psychologist at the Virginia Medical Center at Coatesville, Pennsylvania. “It should be a safe place where people can talk about their deepest, darkest fears and problems.” Veterans believe they told therapists that it was confidential.
“If they can’t believe we do that, I think quite a few of them will quit the treatment,” he said.
Veterans Affairs spokesman Peter Kasperowicz dismissed the argument that a crowded work environment would harm patient privacy as “absurd”, saying that the VA “will build accommodation as needed so that employees have enough space to work and comply with industry-standard privacy standards.”
“Veterans are now at the center of everything VA does,” added Mr. Casperovic. “Under President Trump, Virginia is no longer a place where employees are in their status quo is simply calling them from home.” White House spokeswoman Anna Kelly said the president’s return order was “to ensure that all Americans benefit from more efficient service, especially our veterans.”
The layoffs have caused chaos and confusion in the vast organization, providing care for more than 9 million veterans. The Trump administration said it planned to cancel 80,000 VA jobs, and the first round of termination has stopped some research and cut back on support staff.
Mr. Trump is a sensitive constituency who has run for Virginia during his first term, and the agency has expanded remote work as a way to reach out to veterans in society who are isolated and living in rural areas who are at risk of suicide. Now, these services may be greatly reduced.
“The end of remote work is essentially the same as the end of reducing mental health services,” said a clinician at the Kansas Mental Health Center hub. “These distant documents are not moved and if they are forced to drive to an office but are miles away every day, almost from there, they have other options.”
Veterans are also expressing anxiety. Sandra Fenelon, 33, said she returned to civilian life after leaving the Navy in 2022. “I just keep feeling like I’m in war,” said Ms. Fernelen, who lives in New York, who is training to become a pharmacist.
It took a year to work with the VA psychologist until she felt safe enough to start sharing the disturbing things she saw in deployment, she said, “People outside will never understand.”
Now, Ms. Fennelon is worried that the Virginia commotion will prompt her therapist to leave before her situation. She cried during the meetings last week. “I feel like I’m now forced to be put in a position where I have to start over with others,” she said in an interview. “How do I connect with the therapists who have never worked with veterans?”
'You deserve better
For California’s suicide prevention coordinator, morning starts with the recommendation from the crisis hotline. She said on a typical day, she has a list of 10 callers, but sometimes as many as 20 or 30.
“My job is to build rapport and figure out what I need to do to keep them alive. I let them know: 'I worry about you, I'm going to send someone to check you out.' “I tell them, 'You serve this country. You deserve better. '”
The team was responsible for covering about 800,000 veterans and there should have been three more social workers, but the new positions were canceled due to the government's recruitment freeze.
She said the staff was under reduced pressure and was worried that it would lead her to miss out on some key things. “I'm scared, I'll make a mistake,” she said. “I'm not sleeping well and it's hard to stay focused.”
Veterans have higher risk of suicide than the average population. In 2022, the suicide rate is 34.7 per 100,000 people, compared with 14.2 per general population. This is a major factor in the availability of guns, which are used in 73.5% of suicide deaths.
In Denver, Bilal Torrens had just completed the transition when he was terminated by email.
He said his job is helping homeless veterans settle indoors after living on the street for many years. In the early months, Torrance said, these people were often overwhelmed by tasks of collecting benefits, managing drugs and even shopping for groceries. He will sit with his clients while filling out the form and paying the bill.
The layoffs have reduced support staff at homeless service centers by one third. He said the burden would shift to social workers, who were already surprised by the cases of dozens of veterans.
“They won't have enough time to properly serve any veterans,” Torrance said.
Alerts about privacy
In Coatesville, Pennsylvania, mental health providers will be told they will be treated with veterans from several large office spaces and sit at their laptops at their desks, Dr. Kedson said. The spaces are familiar, he said—but they have never been used in patient care.
“It sounds like you're seeing them from the call center because you're going to be in a room where you're talking at the same time,” Dr. Caderson said. “The veterans who are going to hold the position, I suspect they'll feel very invading their privacy.”
So far, only overseeing clinicians have been affected by the return to school policy; union workers are expected to report to the office in the coming weeks.
Dr. Caderson said clinicians warned that the orders harmed the privacy of patients, but he could not see the response from the agency’s leadership. “They do this because these are the current government’s marching orders,” he said. “People are trying to do something that is really untenable.”
“For a long time, the supposed psychotherapy practice” requires a private location, such as a room with doors and sound insulation outside the room,” said Dr. Lynn F. Bufka, director of practice at the American Psychological Association.
She said that if the Health Privacy Act HIPAA cannot reasonably prevent patient information from being “accidental disclosure”, it is a threshold for her to say VA risks do not meet. In this case, privacy risks can be prevented “by not requiring psychologists to return to the office before available private spaces”, she said. ”
Several VA mental health clinicians told The Times they are interviewing for a new job or submitting their resignation. Their departure risks have exacerbated Virginia's already severe staff shortages, outlined last year from a report from its Inspector General's Office.
“Everyone is scared,” said Matthew Hunnicutt, 62, who retired in late February at the Jesse Brown VA Medical Center in Chicago. “Everyone is scared.”
When staff were ordered to close the diversity initiative, Mr. Hennicht decided to speed up retirement, feeling “everything I did was erased.” He said that during his time, Virginia care has improved, community advocacy has been better, waiting time is shorter and mental health appointments for the day.
“Just to destroy it is extreme,” he said.
Alain Delaquérière and Kirsten Noyes Contributed to the research.
