Late in February, as the Trump administration ramped up its quest to transform the federal government, a psychiatrist who treats veterans was directed to her new workstation — and was incredulous.

She was required, under a new return-to-office policy, to conduct virtual psychotherapy with her patients from one of 13 cubicles in a large open office space, the kind of setup used for call centers. Other staff might overhear the sessions, or appear on the patient’s screen as they passed on their way to the bathroom and break room.

The psychiatrist was stunned. Her patients suffered from disorders like schizophrenia and bipolar disorder. Treating them from her home office, it had taken many months to earn their trust. This new arrangement, she said, violated a core ethical tenet of mental health care: the guarantee of privacy.

When the doctor asked how she was expected to safeguard patient privacy, a supervisor suggested she purchase privacy screens and a white noise machine. “I’m ready to walk away if it comes to it,” she wrote to her manager, in a text message shared with The New York Times. “I get it,” the manager replied. “Many of us are ready to walk away.”

Scenes like this have been unfolding in Veterans Affairs facilities across the country in recent weeks, as therapy and other mental health services have been thrown into turmoil amid the dramatic changes ordered by President Trump and pushed by Elon Musk’s Department of Government Efficiency.

Among the most consequential orders is the requirement that thousands of mental health providers, including many who were hired for fully remote positions, now work full time from federal office space. This is a jarring policy reversal for the V.A., which pioneered the practice of virtual health care two decades ago as a way to reach isolated veterans, long before the pandemic made telehealth the preferred mode of treatment for many Americans.

As the first wave of providers reports to offices where there is simply not enough room to accommodate them, many found no way to ensure patient privacy, health workers said. Some have filed complaints, warning that the arrangement violates ethics regulations and medical privacy laws. At the same time, layoffs of at least 1,900 probationary employees are thinning out already stressed services that assist veterans who are homeless or suicidal.

In more than three dozen interviews, current and recently terminated mental health workers at the V.A. described a period of rapid, chaotic behind-the-scenes change. Many agreed to speak on the condition of anonymity because they want to continue to serve veterans, and feared retribution from the Trump administration.

Clinicians warn that the changes will degrade mental health treatment at the V.A., which already has severe staffing shortages. Some expect to see a mass exodus of sought-after specialists, like psychiatrists and psychologists. They expect wait times to increase, and veterans to eventually seek treatment outside the agency.

“Psychotherapy is a very private endeavor,” said Ira Kedson, a psychologist at the Coatesville V.A. Medical Center in Pennsylvania and president of AFGE local 310. “It’s supposed to be a safe place, where people can talk about their deepest, darkest fears and issues.” Veterans, he said, trust that what they tell therapists is confidential.

“If they can’t trust us to do that, I think that a sizable number of them will withdraw from treatment,” he said.

A Veterans Affairs spokesman, Peter Kasperowicz, dismissed the contention that a crowded working environment would compromise patient privacy as “nonsensical,” saying that the V.A. “will make accommodations as needed so employees have enough space to work and comply with industry standards for privacy.”

“Veterans are now at the center of everything V.A. does,” Mr. Kasperowicz added. “Under President Trump, V.A. is no longer a place where the status quo for employees is to simply phone it in from home.” Anna Kelly, a White House spokeswoman, said the president’s return-to-office order was “ensuring that all Americans benefit from more efficient services, especially our veterans.”

The DOGE cuts have already sparked chaos and confusion within the sprawling agency, which provides care to more than nine million veterans. The Trump administration has said it plans to eliminate 80,000 V.A. jobs, and a first round of terminations has halted some research studies and slashed support staff.

The cuts drive at a sensitive constituency for Mr. Trump, who has campaigned on improving services at the V.A. In Mr. Trump’s first term, the agency expanded remote work as a way to reach veterans who are socially isolated and living in rural areas, who are at an elevated risk for suicide. Now those services are likely to be sharply reduced.

“The end of remote work is essentially the same as cutting mental health services,” said a clinician at a mental health center hub in Kansas, who spoke on the condition of anonymity. “These remote docs aren’t moving and they have other options if they are forced to drive to some office however many miles away every day to see their patient virtually from there.”

Veterans, too, are expressing anxiety. Sandra Fenelon, 33, said she had a rocky transition back to civilian life after leaving the Navy in 2022. “I just constantly felt like I am at war,” said Ms. Fenelon, who lives in New York and is training to become a pharmacist.

It took a year, working with a V.A. psychologist, until she felt safe enough to begin sharing the troubling things she had seen on deployment, things that, she said, “people on the outside would never understand.”

Now, Ms. Fenelon is worried that the tumult at the V.A. will prompt her therapist to leave before she is better. In her session this past week, she burst into tears. “I feel like I’m now forced to be put in a position where I have to start over with someone else,” she said in an interview. “How can I relate to a therapist who never worked with veterans?”

‘You Deserve Better’

For a suicide prevention coordinator in California, mornings start with referrals from a crisis hotline. On a typical day, she said, she is given a list of 10 callers, but sometimes as many as 20 or 30. The work is so intense that, most days, there is no time for a lunch break or bathroom breaks.

“My job is to build rapport, to figure out what I need to do to keep them alive. I let them know: ‘I’m worried about you, I’m going to send someone out to check on you,’” the coordinator said. “I tell them, ‘You served this country. You deserve better.’”

The team, which is responsible for covering some 800,000 veterans, was supposed to get three more social workers, but the new positions were canceled as a result of the administration’s hiring freeze, the coordinator said.

She said the stress around the staff reductions is intense, and fears it will cause her to miss something critical. “I’m so scared I’ll make a mistake,” she said. “I’m not sleeping well, and it’s hard to stay focused.”

Veterans are at sharply higher risk for suicide than the general population; in 2022, the suicide rate was 34.7 per 100,000, compared to 14.2 per 100,000 for the general population. A major factor in this is the availability of firearms, which were used in 73.5 percent of suicide deaths, according to the V.A.

In Denver, Bilal Torrens was just finishing a shift when he was notified by email that he was being terminated.

His job, he said, was helping homeless veterans settle into life indoors after years of living on the street. During those early months, Mr. Torrens said, the men are often overwhelmed by the task of collecting benefits, managing medications, even shopping for groceries; he would sit with his clients while they filled out forms and paid bills.

The layoffs reduced the support staff at the homeless service center by a third. The burden will now shift onto social workers, who are already staggering under caseloads of dozens of veterans, he said.

“They’re not going to have enough time to serve any of the veterans properly, the way that they should be served and cared for,” Mr. Torrens said.

Alarms Over Privacy

In Coatesville, Penn., mental health providers have been told they will conduct therapy with veterans from several large office spaces, sitting with their laptops at tables, said Dr. Kedson. The spaces are familiar, he said — but they have never before been used for patient care.

“That would sound like you’re seeing them from a call center, because you’d be in a room with a bunch of people who are all talking at the same time,” Dr. Kedson said. “The veterans who are going to be in that position, I suspect they will feel very much like their privacy is being violated.”

So far, only supervisory clinicians have been affected by the return-to-office policy; unionized workers will be expected to report to the office in the coming weeks.

Dr. Kedson said clinicians have warned that the orders compromise patient privacy, but he has seen little response from the agency’s leadership. “They’re doing it because these are the marching orders coming out of the current administration,” he said. “People are trying to make something that is really untenable work.”

Dr. Lynn F. Bufka, head of practice at the American Psychological Association, said the “longstanding presumed practice for the delivery of psychotherapy” requires a private location, like a room with a door and soundproofing outside the room.

She said HIPAA, the health privacy law, allows for “incidental disclosures” of patient information if they cannot be reasonably prevented — a threshold that she said the V.A. risks not meeting. In this case, she said, the privacy risk could be prevented “by simply not requiring psychologists to return to the office until private spaces are available.”

Several V.A. mental health clinicians told The Times they were interviewing for new jobs or had submitted their resignations. Their departures risk exacerbating already severe staffing shortages at the V.A., outlined in a report last year from its inspector general’s office.

“Everybody is afraid, from the top down,” said Matthew Hunnicutt, 62, a social worker who retired in late February after nearly 15 years, much of it in supervisory positions, at the Jesse Brown V.A. Medical Center in Chicago.

When staff were ordered to shut down diversity initiatives, Mr. Hunnicutt decided to speed up his retirement, feeling that “everything I had done was just wiped away.” He said care at the V.A. had been improved during his time there, with better community outreach, shorter wait times and same-day mental health appointments.

“Just to have it be destroyed like this is extreme,” he said.

Alain Delaquérière and Kirsten Noyes contributed research.