Providing Therapy in a Post-Roe World: Resources for Mental Health Providers

Since Roe v. Wade was overturned, the laws about reproduction, contraception and termination of pregnancy have quickly fractured. States have rushed to protect, further restrict, or outright ban abortion, leaving a confusing landscape of what is and isn’t legal. 

For our communities, that confusion includes navigating mental health care related to abortion: Where do discussions about reproductive health care, abortion, and bodily autonomy fit into therapy now? 

UpLift believes that therapists should be able to have a trusted relationship with clients that does not require them to act as law enforcement. Being a therapist should not put you in a vulnerable position to meet clients’ needs. 

Because we operate in states with differing policies, we have put together resources to help educate you on these policies, your rights and responsibilities, and issues clients may be facing. We hope this guidance will be helpful but it is not legal advice. It is important for each provider to stay up to date about the specific laws in the state or states where they provide services.

This is an evolving document that we will update from time to time. If you have any suggested additions or questions, please email us at help@joinuplift.co. 

This guide contains resources about:

• Navigating Your Legal Risk, Rights, and Responsibilities
• What to Expect in Sessions About Reproductive Autonomy

Navigating Your Legal Risk, Rights, and Responsibilities

What the ruling means for clients’ privacy

In the aftermath of the Dobbs v. Jackson Women’s Health Organization ruling, mental health providers expressed concern about how to maintain their clients’ privacy. Will providers be forced to report on their clients? Can technology companies be trusted with client data?

UpLift takes the privacy of clients seriously. We are a HIPAA compliant platform that encrypts client and provider data. We follow the HIPAA Privacy Rule for PHI. Without a client’s signed authorization, we expect providers to maintain the privacy of clients’ PHI.

We do not record video sessions or store transcripts of video sessions. For insurance purposes, providers must fill out progress notes for clients. However, your notes—both on UpLift and off the platform—could be requested by a court. 

What does the federal government say about privacy

The Biden administration has taken steps to increase privacy protections in response to the Dobbs ruling. This includes enhancing the safety of providers who are “providing, dispensing, or delivering reproductive services” but the level of protection will vary from state-to-state, often because the practical reach of the federal government is limited. . 

The order also directs the Secretary of HHS to issue guidance under HIPAA emphasizing the protection of privacy rights and directs the Federal Trade Commission to enhance privacy protections. We still recommend providers exercise diligence in securing the digital privacy of their work and of their clients’ personal information. 

• Learn more about what the White House Executive Order addresses for reproductive health care. 

Privacy risks and your state

While the federal government has attempted to take some steps to increase legal protection for patient information related to reproductive health care, HIPAA and federal law may not supersede local laws. Aggressive law enforcement agencies in some states may take the position that federal law does not supersede local criminal law, for example. In some states, health care professionals and others may be “mandatory reporters” under child abuse statutes. In a state that has determined that a fetus is a child, this could have major legal and clinical care implications.

In other states, courts may be less sympathetic to privacy concerns in the reproductive health context and may issue orders requiring disclosure of patient information. Failure to comply with a valid court order could subject a provider to professional discipline or prosecution.

Abortion laws across the United States

This map from the Center for Reproductive Rights shows you where abortion is expanded, protected, not protected, or laws are hostile or illegal. Clicking on a state will display the status of abortion laws in the state and whether they’ll likely become more restricted, protected, or expanded. It also shows a list of the current bans, restrictions, and protections. 

• The Center for Reproductive Rights interactive map of abortion laws and policies by state

How abortion impacts each state also differs, based on who lives there and the impact of current legislation. Guttmacher Institute’s map gives a plain language explanation of each state’s current policies as well as demographic information and statistics. Demographic information gives a snapshot of who lives in the state to highlight how access may affect socioeconomic equity. Statistics show how many abortions occur in each state and how accessible abortion is based on geography and stage of pregnancy. 

• Guttmacher Institute's interactive map of abortion laws and policies by state

The White House launched a website with up to date information about people’s reproductive rights. The site includes sections on birth control, medication, abortion access, preventive health services, and what to do if you don’t have insurance. 

• Learn more about the federal government's resources on reproductive health care rights. 

Securing your digital privacy and security

The Department of Health and Human Services (HHS) also has released a guide teaching everyone how to secure their own personal health information on electronic devices, and providers should consider taking steps to increase their own data security and assisting patients who desire to do so.

• Learn more about how to protect the privacy and security of your health information on your phone or tablet.

In addition to increasing technical security, some providers could consider reducing the scope of certain records to the absolute minimum. While providers must keep accurate records for legal and clinical reasons, minimizing such information can reduce risks.

What to Expect in Sessions About Reproductive Autonomy

How the mental health community has responded

• The American Counseling Association released a statement of opposition, explaining that the ruling puts counselors in an unethical position and will have negative socio economic consequences for people who are already marginalized.
• The American Psychological Association released a statement decrying the ruling as ignoring science, endangering people, and setting a dangerous precedent for other rights.
• The American Association for Marriage and Family Therapy released a statement acknowledging that the ruling sparks strong feelings and the responsibility of therapists to support clients.
• The National Association of Social Workers released a statement condemning the ruling for rolling back rights, potentially criminalizing providers, and widening inequity.
• The American Academy of Child and Adolescent Psychiatry released a statement expressing sadness and outrage at the ruling, warning about the vulnerability of pregnant teens and youth with mental disorders. 

Counseling someone with different values

Therapists and counselors may have to work with clients whose views run counter to their own values and beliefs. Per the American Counseling Association’s Code of Ethics, we remind all of our providers to refrain from imposing your values, attitudes, beliefs, and behaviors onto clients. 

The ACA encourages professionals to seek guidance from other providers when facing personal conflict and to strive to go outside your comfort zone. 

• Learn more about the ACA’s advice on how to handle conflicts of personal values.

Expect and prepare for worse mental health outcomes and denial of care for other health conditions

• Besides their statement, the American Psychological Association also created a resource collecting and summarizing research that denying abortions worsens mental and physical health outcomes for both parent and child, and economic opportunity. Barriers to accessing care and the loss of autonomy can have the same effect, even if people can eventually receive an abortion. 
• Physicians and pharmacies are refusing care for people experiencing miscarriages or neurological conditions like sclerosis and epilepsy. 
• More on those neurological treatments: Lack of access to medication widens inequity along several lines. “The loss of bodily autonomy for pregnant women in such a scenario conscripts the dyad of mother and child to potential physical and psychological morbidity,” according to Dr. LaHue, Dr. Gano, and Dr. Bove in an article published in JAMA Neurology. 

Risks are higher for people facing multiple systemic barriers

The effects of restricted access to abortions ripples across gender identities, racial identities, disabilities, economic security, and more. These resources are nowhere near exhaustive but are a start at understanding the complex problems people with intersecting identities face. 

• Slate reported that studies show pregnant teens are most at risk, as their pregnancies are highly likely to be unplanned. They’re less prepared for parenthood, less likely to be able to access abortions for several reasons—and more vulnerable to mental health crises that can lead to self-harm and suicide.
• With the Brennan Center for Justice, Ms. Magazine discusses the religious diversity of the country.
• The two organizations also dove into the quagmire of criminalizing abortion and how incarceration is used to systemically limit rights and opportunity for individual people and for communities—especially when criminal laws tend to disproportionately target people of color and low-income communities. 
• Pregnancy and birth are more dangerous and risky than abortions, especially for Black women. The CDC reports that they face higher maternal mortality rates due to lack of access to maternal health care along with being denied good care because of provider biases and racial disparities.
• Immigrants, people earning low-income or living poverty, and people of color face double binds when it comes potentially being uninsured and less access to resources. Upon giving birth, women of color with low incomes deal with a high cost that can include long-term financial instability—especially because many states with the strictest bans have the least childcare support and maternal leave.
• People with chronic illness are finding unexpected economic strain as insurance suddenly stops covering medications to manage illness and disability because they might cause abortion. Children with juvenile arthritis also can’t get their medications anymore, until they prove they aren’t pregnant, according to MSN. 
• Pregnant people are most vulnerable to abuse and domestic violence, especially without reproductive autonomy. It’s especially important because homicide is the leading cause of death for pregnant people.
• For pregnant lesbians and bisexual people, the risk of experiencing sexual violence is higher than for heterosexual women.
• Already facing other policies attacking their rights, transgender, nonbinary, and gender-expansive people often go overlooked by the abortion conversation. Access to abortions can be important for the same reasons as it is for any pregnant person but for some, can also be necessary for gender affirmation. TransLash’s guide provides resources and education on reproductive rights for trans and gender nonconforming people.

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