Veterans Administration therapists forced to provide mental health counseling in open cubicles

As part of the Trump administration's frenzied push to end remote work arrangements for federal government workers, the Veterans Administration (VA) is forcing therapists to provide mental health counseling in open cubicles. The therapists, who work for a network of clinical resource hubs operated by the VA, are now required to work in-person, but the facilities do not have enough private offices. The VA therapists are deeply concerned about the ethics and legality of conducting therapy sessions from a cubicle, according to internal VA chat logs obtained by Popular Information.

On President Trump's first day in office, he issued an executive memorandum requiring agencies to take "all necessary steps to terminate remote work arrangements, and require employees to return to work in-person at their respective duty stations on a full-time basis."

On February 24, VA Secretary Doug Collins announced that "all across the country VA employees are coming back to work." Collins said the VA was "phasing out remote working and teleworking and bringing everyone back in." He described the move as "common sense."

Collins claimed that the VA was "making some accommodations" but he was focused on the "mission" of serving veterans. One group that has not been afforded any accommodations or exemptions is the mental health therapists working for clinical resource hubs.

In an internal chat among clinical resource hub staff, one therapist reported they were "relocated to a VA call-center cubicle space." According to the therapist, "non-MH [mental health] VA staff around my cubicle can hear my sessions." The therapist said they were "worried about issues of licensure [and] ethics code violations related to confidentiality."

Another therapist reported that they are being told by leadership that "screen protectors, a white noise machine, and a headset is sufficient to ensure patient privacy in a large bullpen of cubicles." The therapist was skeptical and reported that "these items are not always available."

A third therapist suggested the cubicle locations put the therapists in violation of federal law. "The criminal and civil penalties for violating HIPAA [Health Insurance Portability and Accountability Act] are sobering," the therapist said. HIPAA establishes legal standards to protect against the unnecessary disclosure of patient health information.

“VA’s policy is to bring as many employees back to the office as space permits,” VA Press Secretary Pete Kasperowicz told Popular Information in response to a request for comment. “VA will make accommodations as needed to ensure employees have enough space to work and will always ensure that Veterans’ access to benefits and services remains uninterrupted as employees return to in-person work.”

The ethics and laws of remote mental health therapy

The concerns about the legality and ethics of engaging in therapy from an open cubicle are well-grounded. The National Association of Social Workers [NASW] notes that "privacy and confidentiality rules still apply to telemental health" and "[a]ll laws regarding the confidentiality of protected health information… applies to telehealth interactions."

The Department of Health and Human Services, which is responsible for enforcing HIPAA, advises that therapists engaging in telehealth must take "reasonable safeguards to protect patient health data." Specifically, the HIPAA Privacy Rule requires "individually identifiable health information should be protected with reasonable administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use, or disclosure." Holding a counseling session in an open cubicle almost certainly violates this rule.

Therapists can face criminal penalties of "$50,000 and one year of imprisonment for wrongful disclosure" of personal health information. Most states have health privacy laws that mirror HIPAA, leaving VA therapists doing work in an open cubicle vulnerable to state prosecution as well.

The arrangement also runs afoul of professional guidelines. The American Psychological Association (APA) Guidelines for the Practice of Telepsychology state that therapists should secure a "physically private space" that is "free from third-party monitoring." APA Ethics Rule 4.01 says that psychologists "have a primary obligation and take reasonable precautions to protect confidential information." Standard 1.07 of the NASW Code states social workers "should not discuss confidential information in any setting unless privacy can be ensured.” Conducting therapy sessions in an open cubicle does not meet any of these standards.

The erosion of veterans services

Trump insisted that the widespread cuts and other initiatives have not negatively impacted veterans. "[W]e're taking care of our veterans," Trump said at the White House on February 27. "We love our veterans. We're going to take good care of them." 9.1 million veterans rely on the VA for treatment.

But providing inadequate facilities for counseling sessions is only one way that veterans services have suffered during the Trump administration. The New York Times reported on Sunday that, at the VA, the Trump administration "disrupted studies involving patients awaiting experimental treatments, forced some facilities to fire support staff and created uncertainty amid the mass cancellation, and partial reinstatement, of hundreds of contracts." So far, about 2400 VA employees have been terminated, including "workers who purchase medical supplies, schedule appointments and arrange rides for patients to see their doctors."

This may just be the beginning. Collins, according to a memo obtained by the Associated Press, is planning to cut 80,000 VA jobs, about ⅕ of the agency's workforce. This will put many veterans out of work since about 25% of VA staff are veterans.

The scale and speed of the cuts at the VA have garnered criticism, even from some Congressional Republicans who have otherwise shown unwavering support for Trump and Musk's agenda.