In late February, as the Trump administration stepped up its quest to transform the federal government, the psychiatrist treating veterans was turned to her new workstation, which was incredible.
She had to perform virtual psychotherapy with patients from any of the 13 cubicles of large open office spaces used for call centres under the Return Office Policy from the New Office. Other staff could overhear the session, appear on patient screens, or be handed over to the toilet or break room.
The psychiatrist was unsure. Her patient suffered from disorders such as schizophrenia and bipolar disorder. It took months to get their trust by dealing with them from her home office. She said the new arrangement violated a central ethical doctrine of mental health care: guarantees of privacy.
When doctors asked how they would expect to protect the privacy of their patients, the supervisor suggested buying a privacy screen and a white noise machine. “I'm ready to leave once it comes,” she wrote to her manager in a text message shared with the New York Times. “I got it,” replied the manager. “Many of us are ready to leave.”
These scenes have been unfolding at veteran affairs facilities nationwide in recent weeks as treatment and other mental health services have been disrupted amid the dramatic changes ordered by President Trump and driven by Elon Musk's government efficiency.
Among the most consequential orders is the requirement that thousands of mental health providers, including many people employed in completely remote positions, currently working full-time from federal office space. This is the reversal of the VA's harsh policy that pioneered virtual medicine practices as a way to reach isolated veterans 20 years ago, long before the pandemic made telehealth a favorable treatment for many Americans.
As the first wave of providers report to offices simply lacking room for them, many have found no way to ensure patient privacy, healthcare workers said. Some have filed complaints and warn that the arrangement violates ethical regulations and the Health Privacy Act. At the same time, layoffs of at least 1,900 probation employees are diluting the already stressful services that support homeless or suicides.
In more than three dozen interviews, current and recently terminated mental health workers at the VA described a period of rapid and chaotic behind-the-scenes changes. Many agreed to talk about terms of anonymity as they wanted to continue serving veterans, fearing retaliation from the Trump administration.
Clinicians warn that the change will break down mental health treatments in VA, saying there is already a serious staffing shortage. Some people are hoping to see a massive departure of sought-after professionals, such as psychiatrists and psychologists. They expect waiting times to increase, and veterans will ultimately seek treatment outside the agency.
“Psychotherapy is a very personal effort,” said Ira Kedson, psychologist at Coatesville VA Medical Center in Pennsylvania and president of AFGE Local 310. Veterans believe it's a secret to tell therapists.
“If they can't trust us to do that, I think a fair number of them will withdraw from treatment,” he said.
Veteran Affairs spokesman Peter Casperowitz dismissed the claim that a busy working environment compromises patient privacy as “meaningless,” saying that “we create accommodations where necessary, so employees have enough space to work with industry standards for privacy.”
“Veterans are at the heart of everything the VA does right now,” Kasperowicz added. “Under President Trump, the VA is no longer just a place where employees are currently being called from home,” White House spokesperson Anna Kelly said the president's order to return to the office was “to ensure that all Americans benefit from more efficient services, especially veterans.”
Doge Cuts is already causing confusion and confusion within a vast institution that provides care to more than 9 million veterans. The Trump administration has plans to eliminate 80,000 VA jobs, and the first round of the closing said it has halted several research studies and cut back on support staff.
For Trump, who campaigned for improving services in Virginia during his first term, Cuts promoted in sensitive districts, and agencies expanded remote work as a way to reach veterans living in socially isolated lives in rural areas where suicide risks are at increased risk. These services could now be significantly reduced.
“The end of remote work is essentially the same as cutting off mental health services,” said a clinician at the Mental Health Center Hub in Kansas, who spoke anonymously. “These remote documents are not moving and if they are forced to drive miles away every day to virtually see patients from there, there are other options.”
Veterans are also expressing concern. Sandra Fenelon, 33, said that civilian life is rocky after leaving the Navy in 2022.
It took her a year to work with the VA psychologist to say, “people on the outside will never understand” before she felt safe enough to start sharing the annoying things she saw in the development.
Now, Fenelon is worried that the VA turmoil will encourage her therapist to leave before she gets better. She shed tears during her session last week. “I feel like I'm now forced to be in a position where I have to start over with someone else,” she said in an interview. “How can you relate to a therapist who has never worked with a veteran?”
“You deserve more.”
For California's suicide prevention coordinators, the morning begins with an introduction from the Crisis Hotline. On a typical day she is given a list of 10 callers, but sometimes 20 or 30, the work is very intense, so most days there is no time for lunch or bathroom breaks.
“My job is to build trust to understand what we need to do to keep them alive. “I'm worried about you. I'm going to send someone to check on you,” the coordinator said. “I say to them, “You have served this country. You deserve better.”
The team, which covers around 800,000 veterans, was to attract three more social workers, but the new position was cancelled as a result of the administration's employment freeze, the coordinator said.
She said the stress around staff cuts is intense and that she fears she will miss something important. “I'm very scared of making mistakes,” she said. “I'm not sleeping very well and it's hard to stay focused.”
Veterans are at a much higher risk of suicide than the general population. In 2022, the suicide rate was 34.7 per 100,000 compared to the general population of 14.2 per 100,000. The main factor for this is the availability of firearms used in 73.5% of suicide deaths, according to the VA.
In Denver, Bilal Torrens was finishing his shift when he was notified via email that he had been fired.
His job, he said, was to help homeless veterans settle into living indoors after living on the streets for years. During these early months, Torrence said men often get overwhelmed by their job of collecting profits, managing their medicines and shopping for grocery. He sat with his clients and with his clients while they filled the form and bills.
The layoffs have reduced support staff at homeless service centers by a third. The burden will shift to social workers. Social workers are already phenomenal under the caseload of dozens of veterans, he said.
“They won’t have enough time to properly serve any of their veterans.
Privacy alarms
In Coatesville, Pennsylvania, mental health providers are said to provide treatment with veterans in several large office spaces sitting with laptops at tables. Spaces are familiar, he said — but they have never been used in patient care before.
“It sounds like you're watching them from the call center, because you're in a room where there are a lot of people talking at the same time,” Dr. Kedson said. “I think veterans in that position will feel their privacy is being violated.”
So far, only supervising clinicians have been affected by the office return policy. Members are expected to report to the office in the coming weeks.
Dr. Kedson said clinicians warn that the orders will undermine patient privacy, but he has seen little response from the agency's leadership. “They're doing that because these are marching orders coming out of the current administration,” he said. “People are trying to do work that they really don't accept.”
Dr. Lynn F. Bufka, Head of Practice at the American Psychological Association, said “long-standing presumed practices for the provision of psychotherapy” requires private spaces, such as rooms with doors outside the room or soundproofing.
She said HIPAA, a health privacy law, allows for “accidental disclosure” of patient information if it cannot be reasonably prevented. In this case, she said the risk of privacy can be prevented “simply by not requiring psychologists to return to the office until private space is available.”
Several VA mental health clinicians told the Times they were interviewing for their new job or filed their resignation. Their departure risks exacerbating the already severe staffing shortage at the VA, outlined in a report from its Inspector General's Office in last year's report.
said Matthew Hunnikat, 62, a social worker who retired in late February nearly 15 years later at Jesse Brown VA Medical Center in Chicago.
When staff were ordered to close the diversity initiative, Honeycutt decided to speed up his retirement. He said care at the VA was improved during that time with community outreach, shorter waiting times and same-day mental health appointments.
“It's extreme to just destroy this kind of thing,” he said.
Alain Delaquérière and Kirsten Noyes contributed to the research.
