‘I cannot guarantee complete confidentiality’: VA therapists ordered to tell veterans
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Panic, fear, uncertainty, and anger.
Those are the emotions mental health clinicians who work for the US Department of Veterans Affairs describe as they prepare for the VA's mandatory return-to-office directive. Some are being summoned to offices as soon as Monday, April 14. Representatives from the VA say they are planning to have the back-to-office effort completed by May 5.
For this story, NPR interviewed ten clinicians in VA locations around the country, the majority of whom spoke on condition of anonymity because they were afraid of losing their jobs. Days before the April 14 return-to-office deadline, many were still unclear about the expectations for return dates. Some had received last minute changes or delays for reporting to an office.
In a memo obtained by NPR, regional leadership at one VA facility offered a script for its therapists to read to patients. "Before we begin our session, I want to inform you that I am currently in a shared office space," reads the script. "While I will do my utmost to maintain your privacy, I cannot guarantee complete confidentiality."
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These directives come after the VA indicated it would cut about 80,000 staff in a massive restructuring effort. A widely circulated leaked memo, first obtained by the Associated Press, outlines the effort. In a video addressing the cuts, VA Secretary Doug Collins suggested the agency would eliminate waste and that the "the days of kicking the can down the road are over." He offered reassurance that VA benefits would not be impacted and that the VA "regrets anyone who loses their job."
Telehealth hires
Many VA therapists were hired on a telehealth basis and point out that there simply is not space for them to work at VA facilities. They are anticipating confusion and congestion around issues such as parking, bathroom use and adequate kitchen facilities to reheat their lunches.
But the primary concern for therapists is whether they will be able to deliver quality care to their patients in an environment without confidentiality.
In emails and meetings, VA managers described to VA mental health staff "pod" working environments, where clinicians work with headphones in a call-center like configuration to provide telehealth. In one recording obtained by NPR, a manager in a teleconference meeting acknowledged that it was inevitable therapy sessions would be overheard and exhorted people not to share any confidential information.
Supervisors working from ‘a shower’
"We won't be able to provide private sessions," says one licensed clinical social worker, who asked to be identified by a middle initial, L., for fear of retaliation. Guaranteed privacy between patient and doctor is a fundamental tenet of quality mental health care, protected by federal law.
A group of 20 House Democrats signed a letter to VA Secretary Doug Collins vocalizing their outrage on this issue. They describe one scenario in which a social worker supervisor has been ordered to return to work "sharing a 100-foot shower with another supervisor," to provide case management and clinical supervision. "We're sure you can agree," they write, "this sort of arrangement is hardly conducive to delivering the quality of care veterans deserve."
VA response
VA representatives have repeatedly insisted that federal privacy laws will be upheld. In an email response to questions about these issues, VA spokesperson Peter Kasperowicz reiterated an accusation that employees who are sounding alarms are motivated by a desire to "phone it in."
Kasperowicz wrote that these continuing concerns are "fear mongering from the media," and wrote that "the small number of employees who are desperate to avoid returning to the office will do more to drive away staff and patients than VA's commonsense return-to-office policy ever will."
VA care, he said, would continue uninterrupted and the "VA will ensure that employees have a workspace that is appropriate for the work they do."
But therapists say they do not see logistically how this is possible.
L. worried the disclaimers therapists are being encouraged to use at the start of sessions would not withstand legal scrutiny, as consent for information sharing needs to be granted in writing.
"Therapists will either cancel the session themselves," L. says, "and risk being reprimanded, or their patients will cancel."
L. forsees longer waiting times for veterans seeking care as a result and points out that veterans are at disproportionate risk for suicide than those who have not served. Wait times are already bad. Often, he says, his clients "have been waiting months and months – many of them with severe mental health issues, including suicidal thoughts."
Dates changing at the last minute
The VA is one of the biggest providers of mental health care across the US.
In emails shared with NPR, some clinicians were told they would be returning to the office May 5, some were granted exemptions, and some were told to report to work April 14 – though these dates were also subject to change. One document obtained by NPR outlines steps for managers.
"This memo provides a framework to inform a standardized approach to terminating remote and telehealth agreements," it reads.
Many clinicians expressed bewilderment about why certain workers were on the list of mandatory returns and others are not. Others were evaluating the possibility of working from their cars or finding space in a bathroom stall to conduct therapy sessions.
Some workers were asked to participate in rearranging furniture in order to accommodate group seating arrangements. Tasks like "rolling tables to podded rooms as temporary desks," or "rolling away excess furniture," were on a to-do list, obtained by NPR.
‘Distress across the board’
The American Psychological Association issued a statement criticizing the policy and raising concerns about compliance with federal privacy laws.
"Providers are facing difficult choices between violating ethical standards regarding patient confidentiality or facing disciplinary action for non-compliance with return-to-office mandates," reads the statement. It goes on to warn that the policy "could compromise access to care and confidentiality standards that are key to effective mental health treatment."
Under President Biden, the PACT act allocated nearly $800 billion to expand VA care and benefits for veterans exposed to toxins. The current efforts aim to reduce staffing numbers to the levels VA had before this legislation. It is not clear how VA would reduce staff to 2019 levels and still fulfill its legal requirements under the PACT act.
Many clinicians described their recent experience as a kind of emotional warfare, and noted the irony of compromising their own mental health while trying to provide mental health care for others.
" I'm anticipating a good deal of distress across the board," says L. "And that we will generally fail at our mission of treating veterans."
If you or a loved one is in crisis, call, text or chat the 988 Suicide and Crisis Lifeline.
Have information you want to share about the ongoing changes across the federal government? Katia Riddle is available through encrypted communications on Signal at Katia.75
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