More Assaults on Mental Health Treatment

Recent administrative mandates affect both veterans and mental health professionals

Image: Pexels/RDNE

In the rush to dismantle agencies that safeguard American citizens’ welfare and impose restrictions on research, the new administration is now targeting mental health services for military veterans.

And it is troubling for both patients and mental health professionals.

Access to mental health treatment at many VA (Veterans Administration) hospitals and outpatient clinics had been fraught with scheduling delays in the past. But with the advent of telehealth, many veterans who are injured, reside in rural areas, or lack funding for travel could finally access mental health services. And availability of private office space for mental health professionals was not a concern since they could provide therapy in the privacy of their home offices.

But the administration’s “return to office” mandate is wreaking havoc on psychotherapists and their patients at VA facilities across the country. In a recent NPR report, psychotherapists are now required to relocate from expanded telehealth options to only meet in person with patients or provide telehealth from VA facility offices.

However, not enough office space is available.

Psychotherapy offered through telehealth will still be offered through the VA; however, psychotherapists are now expected to share offices and provide telehealth in call-center-like settings.

Confidentiality and privacy are the hallmark, bare-minimum basics for psychotherapy to be effective. Without it, trust cannot be built and treatment becomes ineffective. Absent private, secure access to care, military veterans will not receive the treatment they need. Providing therapy in a make-shift office (such as a closet) or teletherapy in a call-center setting impacts the privacy these veterans deserve. It is also counter to the psychotherapists’ code of ethics. According to the NPR report:

“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.’"

Despite outcries from congressional representatives and professional organizations such as the American Psychological Association, the VA leadership is holding firm for now, characterizing therapist concerns as whiny and unfounded. Yet according to the APA, upcoming changes will significantly impact how therapy is provided. “Many VA facilities lack sufficient private spaces to accommodate the influx of mental health providers who previously worked remotely. This has resulted in providers being asked to conduct sensitive therapy sessions in open office environments, cubicles, or shared spaces that fail to meet basic confidentiality and privacy requirements.”

“This will be a nightmare,” bemoaned one of my colleagues who works for the VA (and whose name is withheld to protect their identity). “There is only room for 1/3 of the therapists who must return to the office. Yet everyone is expected to somehow make it work. It already has been demoralizing to be told we can no longer treat gender dysphoria or other ‘controversial’ conditions. Not having the space to offer confidential treatment, though, will mean many therapists may quit because of the ethical conflicts.”

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When administrators and politicians bring their political agendas into the treatment room, therapy becomes ineffective. It places psychotherapists in an ethical bind, but more importantly, devalues the needs of these military veterans who served our country and deserve so much more.

It’s time to add this inappropriate administrative overreach to your already long list of concerns when speaking with your state representatives.

This is part of an occasional series of articles about U.S. policy that impacts mental health and well-being.