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The US Department of Veterans Affairs appears to be backing off a plan to send telehealth therapists back to offices that may lack privacy, according to a memo obtained by NPR.

Addressing widespread concerns over mental health clinicians' ability to conduct confidential sessions, officials from the VA have issued a memo saying that providers must have private workspaces "that foster trusted, confidential, and therapeutic relationships with Veterans," when they return to their offices in the coming weeks.

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The memo is dated April 12, and was issued to regional directors the day after NPR's latest reporting on this issue, which followedother reportsand outcry from lawmakers.

After speaking with mental health providers and clinicians all over the country — anonymously, as many fear for their jobs — NPR previously reportedthat many are afraid they will be unable to provide therapy in private spaces after a mandatory return-to-work orderthat requires them to report to a VA facility. Many are currently providing telehealth to veterans from home.

The return-to-office order comes after much consternation over an announcement from VA officials and VA Secretary Doug Collins that the agency intends to cut 80,000 jobs. Under President Biden, Congress passed the PACT act,which allocated nearly $800 billion to expand VA care and benefits. The current efforts aim to reduce staffing numbers to the levels before this legislation, though it is not clear how VA would do so and still fulfill its legal requirements under the PACT act.

A script about confidentiality

Prior to the April 12 memo, VA management in one region circulated a script for therapists working in call center-like environments to read to their patients. "I cannot guarantee complete confidentiality," read the document.

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Confidentiality is guaranteed to health care patients through federal law, and the quality of a patient's bondwith a provider is one of the key predictors of overall outcomes in clinical therapy.

The April 12 memo stipulates that "spaces used to deliver synchronous telehealth services should offer the same level of privacy and therapeutic environment applicable to an in-person visit in the same space."

Confusion remains

Several clinicians who spoke to NPR about this memo remained perplexed. The memo does not explicitly say therapists would be allowed to continue working from their homes, if private office space is unavailable. But the clinicians said they do not see how they would both meet the privacy requirements and return to work, where many say there is simply not enough space for things like parking and bathroom traffic, let alone adequate private spaces for therapy. Many staff were hired to be telehealth providers working off-site for all or part of the time.