New Policies Affecting Patient Confidentiality and Privacy in Mental Health Care

Mar. 27, 2025

Background

A recent policy change requiring most federal employees to return to the office, including VA psychologists and other mental health care providers, is significantly impacting the delivery of confidential mental and behavioral health services. 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 for the delivery of mental health care services.


The VA has long used telehealth to reach isolated and rural veterans in need of mental health services, and expanded access to telehealth services during the COVID-19 pandemic allowed many more mental health care providers to deliver care from private home offices. This side effect of the return-to-office mandate could compromise access to care and confidentiality standards that are key to effective mental health treatment.


Reports indicate that some providers are facing difficult choices between violating ethical standards regarding patient confidentiality or facing disciplinary action for non-compliance with return-to-office mandates. Simultaneously, the layoffs of approximately 1,900 probationary VA employees, which began in February, are further straining the mental health workforce, particularly in services supporting unhoused veterans or veterans at risk of suicide.

APA/APASI Assessment

APA and APA Services, Inc. express serious concern regarding the implementation of return-to-office mandates and other policies that may affect mental health providers’ provision of services without adequate consideration of confidentiality and privacy. These concerns center on several key issues:


  • Ethical and practice standards: Both the APA Ethics Code and VA professional standards require that psychotherapy be conducted in private settings that protect patient confidentiality. In many facilities, the current implementation of return-to-office orders without adequate office space availability appears inconsistent with these requirements.
  • Patient confidentiality and trust: A strong therapeutic relationship depends on confidentiality. Veterans dealing with sensitive mental health issues require assurance that their disclosures remain confidential. Conducting therapy in shared spaces fundamentally compromises this trust.
  • HIPAA compliance risks: Current arrangements in some facilities may violate HIPAA privacy and security requirements if patient information can be overheard in shared spaces. This not only presents individual providers with legal liability and ethics concerns, but would also constitute a HIPAA violation by the Veterans Health Administration itself.
  • Veteran care impact: These challenges threaten to disrupt ongoing care relationships and may deter veterans from seeking or continuing needed mental health treatment in their preferred setting.
  • Workforce retention concerns: Reports indicate that some mental health professionals are considering resignation rather than practicing under conditions they view as unethical and below an acceptable standard of care. This could worsen existing staff shortages in VA mental health services.

APA’s Position

APA has long championed the importance of patient confidentiality and privacy, emphasizing its role in fostering trust and encouraging individuals to seek necessary mental health support. This principle is enshrined in APA's Ethical Principles of Psychologists and Code of Conduct, which underscores the psychologist's obligation to protect client information. Specifically, APA stresses that:


  • Confidentiality is fundamental: It is essential for building a therapeutic alliance and encouraging open communication.
  • Privacy rights must be protected: Patients have a reasonable expectation when receiving treatment that their personal information is being heard only by their treatment providers.
  • Technology must be used responsibly: Similar to standards for in-person care, the use of telehealth or other technologies requires psychologists to take precautions to ensure confidentiality, privacy, and security.


Within the VA context, where many veterans experience trauma and sensitive mental health conditions, these principles are particularly crucial. APA Services, Inc. advocates for policies that ensure the protection of patient confidentiality and privacy. This includes:


  • Adequate physical space: Ensuring that VA facilities provide private, soundproof rooms to provide mental health services.
  • Prioritizing patient needs: Emphasizing that policy decisions should prioritize the well-being and privacy of veterans seeking mental health care.

Take Action

Share your story. To strengthen APA’s advocacy and communications efforts, please share your insights and experiences regarding the impact of these policies in your work. Your firsthand knowledge is crucial for informing our advocacy and communications strategies.


About the Hatch Act

Federal employees, including VA psychologists and mental health providers, are subject to the Hatch Act. This act limits certain political activities of federal employees to maintain a nonpartisan federal workforce. In the context of advocating for patient confidentiality and privacy and ethical and practice standards, it's important to understand the Hatch Act's implications. Keep in mind that the Hatch Act generally prohibits federal employees from engaging in advocacy while on duty, in a federal facility, or using federal property. 


Federal Employee Hatch Act Information