What Mental Health Businesses Can Be Doing Following POTUS Executive Orders
From resources to conversations
Following recent executive orders and planned law changes by the POTUS, it appears there has been a lack of discussion from mental health organizations and businesses about what happens when these changes directly affect patients receiving mental health care. It seems as though these conversations are mainly happening within private practices and therapist-to-therapist circles.
These executive orders and planned law changes affect not only patients, but the mental health professionals providing care. Professionals and patients are reporting they are feeling anxious, confused, and scared with little clarity or direction from mental health businesses.
For some of these resources and discussions in certain states, it may be prohibited or legally sensitive to display on official websites, have in emails, or implement, but can still be addressed during case consultations and among professionals.
In this article, I won’t be diving into the specifics of the POTUS executive orders or future law changes. Instead, I’ll focus on actionable steps you can take, how to stay informed, and preemptive measures to navigate the following effectively:
Re: Executive orders on immigration and arrests by Immigration and Customs Enforcement (ICE)
Re: Executive orders on Diversity, Equity and Inclusion (DEI)
Re: Changes to Medicare and the Affordable Care Act (ACA)
Re: Executive orders on Transgender rights
Re: Executive orders on immigration and arrests by Immigration and Customs Enforcement (ICE)
A gentle reminder that mental health professionals and organizations do not have a duty to report patients with undocumented status. Protected Health Information (PHI) gathered is still protected under HIPAA.
Immigration and Customs Enforcement (ICE) have begun raids in several areas already (i.e. Minneapolis, Chicago, North Carolina…)
Mental health businesses can buy or print off for FREE red cards for mental health professionals to educate clients on risks and rights. These can be given to standing patients, during intakes, and kept in offices. This is the text that is printed on the front side of the cards in Spanish:
You have constitutional rights:
• DO NOT OPEN THE DOOR if an immigration agent is knocking on the door.
• DO NOT ANSWER ANY QUESTIONS from an immigration agent if they try to talk to you. You have the right to remain silent.
• DO NOT SIGN ANYTHING without first speaking to a lawyer. You have the right to speak with a lawyer.
• If you are outside of your home, ask the agent if you are free to leave and if they say yes, leave calmly.
• GIVE THIS CARD TO THE AGENT. If you are inside of your home, show the card through the window or slide it under the door.
This is the text that is printed on the back side of the cards:
"I do not wish to speak with you, answer your questions, or sign or hand you any documents based on my 5th Amendment rights under the United States Constitution. I do not give you permission to enter my home based on my 4th Amendment rights under the United States Constitution unless you have a warrant to enter, signed by a judge or magistrate with my name on it that you slide under the door. I do not give you permission to search any of my belongings based on my 4th Amendment rights. I choose to exercise my constitutional rights. "
Other handouts includes the following:
Know what ICE vehicles look like. Sometimes they can be unmarked all black vehicles:
Have a code word or non-verbal sign between professionals or patients to notify if ICE is nearby. Can use “La Migra” (lah mee-grah) to notify Spanish speaking individuals.
Gather contact information for immigration lawyers in your area.
Connect with the local agencies and human services to collaborate, stay updated on navigating through this, and for any continuity of care. This includes schools (especially if you have school-based therapists) to know their policies regarding ICE raids.
Social media managers of businesses can join Facebook groups to learn more about where ICE raids are happening and to find additional resources, events, or trainings.
Attend events: The ALCU is having a Zoom event on January, 30th, People Power Mass Deportation Know Your Rights Training
Re: Executive orders on Diversity, Equity and Inclusion (DEI)
DEI incentives provide an equal opportunity regardless of someone’s race, age, ethnicity, religion, gender, sexual orientation, physical ability or other aspects of social identity.
Businesses can take a stance on continued commitment for DEI incentives publicly and to their workers.
Shannon Brown, M.S., LPCC, the CEO of Fernbrook Family Center recently shared to LinkedIn their stance on this:
Additionally, she shared her email sent to all Fernbrook employees further explaining their continued commitment and values:
Subject: EDI work at FFC
Good morning-
I have been reflecting and processing all of the news updates this week and I feel like it’s important I send a commitment to the work we are doing at Fernbrook.
You may have heard the federal government is no longer engaging in DEI/EDI work and those positions have been laid off with a potential to be terminated all together. There have been other reports that I have not been able to fact check completely related to potential changes to affirmative action, regulations around DEI/EDI work in business and various other things.
Fernbrook Family Center holds affirming care and creating an affirming workplace as a core value and this will not change. Fernbrook will continue to engage in DEI work, training, practices. Our positions related to this work will remain in place. We will continue to provide trainings and reflective spaces for these things. DEI work is essential and imperative to the work we do as mental health providers and our commitment to that will not be diminished. If anything- my goal is to increase these efforts and not decrease them.
This week has been difficult for many of us. I have discussed with a number of you this week and I sense a burden everyone is trying to work through. If there are things we can do to support you and the work you are doing please don’t hesitate to reach out. If you find resources please add them to the spreadsheet I emailed earlier this week.
As a CEO- this is a challenge for me. I’m going to be very honest. I have received criticism for bringing politics into the workplace and I have worked very hard to balance my messaging and be clear in how we handle this as an organization. I want to be clear that my messaging about this work is not about politics, but is about policy, our clinical work with clients, and supporting our staff.
I want to thank Shannon for sharing such an important message for others to see. These are great examples on how businesses can find the words to address these important issues and better support their staff. I do not personally work for Fernbrook Family Center, but have seen their continued hard work with statements like these, trainings, and events that keep mental health professionals informed. I highly recommend following them here.
Re: Changes to Medicare and the Affordable Care Act (ACA)
There have been talks of plans for changes to Medicare and it is important to stay up to date. Most if not all Community Mental Health Centers (CMHC) are funded by Medicare with several patients on state insurances.
It is imperative that CMHC stay up to date to any changes with these insurances and how any law or policy changes might effect this. It is as crucially important to communicate this commitment to your mental health workers as they and their patients will have worries and questions.
The billing department and mental health professionals need to keep close conversations and include patients on updates or changes.
Some CMHC are a Certified Community Behavioral Health Clinic (CCBHC) which includes care coordinators. It is vital they are informed and understand how changes or updates impact patients. This includes keeping continuity of care with any other mental health workers serving the patient such as, Adult Rehabilitative Mental Health Services (ARMHS) that relies on state insurances. It may behoove the care coordinators and or CCBHC to be closely working with the county’s human services on changes, as well. Depending on the county, some CMH are funded by and keep close contacts with the local human services.
Some CMHC and CCBHC prescribe and sometimes dispense medications. POTUS signed an executive order reversing initiatives aimed at reducing prescription drug costs for Medicare and Medicaid recipients. It is unclear on how this may change prices of psychotropic or psychoactive medications at this time. It is equally important to stay vigilant of any changes and communicate this to patients receiving them.
There are “Medicaid consultants-Medicaid eligibility” that are available and state specific for contact. Mental health professionals can have this information for patients available and work with case managers and or care coordinators to keep up to date and informed.
Medicare and Medicaid may not be completely removed all together at once, but access to these programs may get harder. For example, the POTUS reversed an executive order that extended enrollment periods. Again, it is crucially important to stay up to date with these changes and how they impact patient care.
Identify how any changes in insurance plans will impact the patient’s accessibility or costs to continue care with your business. Have available sliding scale information and applications ready including ways to generate Good Faith Estimates. Additionally identify any pro bono work.
For some businesses, like solo or group practices, this may mean charging clients using the bartering system. According to the American Counseling Association (ACA) code of ethics:
Re: Executive orders on Transgender rights
There have been executive orders and plans for future policies attacking transgender rights.
Mental health professionals can validate and inform their patients that their work and place of business will stay committed to providing gender affirming care.
Encourage mental health professionals to have conversations with their trans patients on the risks and benefits of documentation.
This may mean using “Client,” “Cl,” or “they/them” when referring to the patient in any documentation.
This may mean not including names or partner(s) names in documentation.
Diagnosis when using insurance may need to have the primary diagnosis as major depressive disorder, generalized anxiety disorder, etc., while the secondary or tertiary diagnosis is gender dysphoria.
Some patients may not want gender dysphoria in their documentation at all due to safety reasons. This may impact insurance in covering gender affirming care.
The other option is for mental health professionals to have legal notes written for insurance while having psychotherapy notes include the gender dysphoria diagnoses and correct name and pronouns. This may need to be approved when working in CMH.
In most cases, a letter is only usually requested for gender affirming care and not notes, but unfortunately it is not true in all cases.
It is important to know your resources that are safe places for patients to receive gender affirming care like Planned Parenthood. This includes finding trusted doctors and surgeons. In Minnesota, I recommend Marie-Claire Buckley, MD.
Mental health businesses can redact documentation that includes gender affirming care when records are requested.
Some individuals have reported their passports have been confiscated when attempting to apply for it to accurately match their gender. It may be important to have conversations like these, as well.
It is important to make sure your business is staying up to date and informed of these changes and have information and resources for your patients.
In all of these situations, it can be helpful for mental health businesses to issue a statement, in some form, affirming their commitment to ensuring accessible care for everyone and creating an environment where all individuals feel welcome. This includes assuring that updates will be provided as they become available, along with information on how these changes may impact patient care.
Final Thoughts
In an era of rapid changes in policies and mandates, mental health businesses can remain proactive in adapting their standards of care for their patients. The recent executive orders present an opportunity to align operations with broader goals of equity, accessibility, and education in mental health care.
It's crucial to view these changes not as burdens or politics, but as chances to refine your practice, strengthen your team, and better serve your community. Community between services, businesses, and mental health professionals are vital during these times. I ask that we can lean on each other. Remember, staying informed, flexible, and educating others is key. Together, we can meet these challenges head-on.
"Where there's hope, there's life. It fills us with fresh courage and makes us strong again"—Anne Frank
Please feel free to add any insights, ideas, or additional resources. Let’s make this a collaborative space for learning and growth. Please remember to keep your comments respectful and constructive so we can maintain a supportive and professional environment.