In the wake of federal firings and executive orders, providers and patients at the Department of Veterans Affairs say mental health and mental health care are suffering.
They fear this struggle will get worse as the VA carries through with 80,000 promised job cuts. The agency is one of the largest providers of mental health care in the country.
"I've been really struggling with my concentration and my ability to focus when I'm at work, because I feel like I have this ax over my head all the time," says a mental health provider who asked NPR not to disclose the location of her work and to identify her only as Lynn, her middle name, for fear she could be fired for speaking out.
DEI and gender orders
Lynn is especially concerned about her clients who identify as LGBTQ, since one executive order called on federal employees to eliminate "equity related," grants or contracts and another directed them to recognize only two sexes.
Consequently employees at the VA have been directed to remove symbols such as flags that indicate support for transgender or queer rights. "We're kind of skirting around that," says Lynn. "Some people have put up art in their office that says 'Love is love,' or a rainbow. So we're all kind of being subversive."
Therapists in other locations reported similar concern that these patients — already in a marginalized population — are being singled out and targeted for discrimination. They employed strategies similar to Lynn's to silently communicate a message of solidarity to patients who identify as LGBTQ.
These rebellions come with a price.
"If I wear this stuff, am I then gonna become a target from either my patients or maybe my peers?" asks Lynn. "Because there's this culture of, 'you need to rat on people.'"
Employees at the VA have received emails encouraging them to report colleagues who are violating the new ban on diversity, equity and inclusion. There have also been high profile firings in the military of leaders who are Black or female.
Lynn says these changes are destabilizing to patients as well. " We've had patients going to the medical records and asking for their charts to be altered," she says, "to remove references to their gender identity or their sexual orientation because they're fearing that they might be put on a list or that they might be discriminated against."
Anxiety about what may come
Some patients who have post-traumatic stress disorder say the changes are especially disconcerting. One woman, who asked to be identified only as D.M., says she's been suffering from near-constant anxiety since the changes began at the VA. She served for 26 years on active duty as a nurse and was sexually assaulted by a fellow service member. She says since then, she's strictly avoided being alone in rooms with men.
"Even if you have to grab the office secretary, you make sure you are not one-on-one with that male, and that's to protect you and to protect him," says D.M.
Receiving both mental and physical health care at an all-women's clinic, she says, has been tremendously helpful. D.M. fears such spaces will be eliminated from veteran and army life." We're gonna get rid of anything that involves women, transgender, you know, all that stuff," she says.
The VA has not announced plans to cut such clinics, and the stated purpose of the executive order D.M. references on gender is to "protect women." In an emailed statement from the VA, spokesperson Peter Kasperowicz wrote, "The VA will always provide veterans, families, caregivers and survivors the health care and benefits they have earned."
Doug Collins, secretary of Veterans Affairs, has promised to preserve "mission critical" positions such as clinicians.
Research may end
But some VA employees and veterans' advocates warn that getting rid of any staff could compromise care in a system that is predicated on an integrated model of physical and mental health, including research positions.
"Having high quality research is a part of high quality care," says Rashi Romanoff, CEO of a non-profit, The National Association of Veterans' Research and Education Foundations (NAVREF). The group does advocacy for research for veterans and warns that $35 million worth of research that is underway could be lost if the VA does not indefinitely preserve between 350 and 400 clinical trials.
In an emailed statement to NPR, VA spokesperson Kasperowicz said the agency would continue to fund these programs for 90 days "while the department conducts a comprehensive assessment of ongoing research." Trials include research on topics such as suicide mitigation and treatment for substance use disorder, according to NAVREF's data collection.
Nurse practitioner Lynn says going to work everyday feels like she's working on the Titanic. "Half the people on the boat are still in the ballroom partying and 25 percent of them are actively telling me I'm hysterical," she says.
She plans to stay aboard until she has no choice but to save herself.
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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