More state boards and hospitals drop invasive questions on mental health, but there’s more work to do

With more doctors and nurses saying they are struggling with burnout and depression, mental health leaders have been pushing for change in the healthcare industry.

Stefanie Simmons, MD, of the Dr. Lorna Breen Heroes’ Foundation, says more hospitals and state licensing boards are dropping intrusive questions about mental health on their applications.

The Dr. Lorna Breen Heroes’ Foundation has been working with state medical boards and hospital systems to stress the importance of encouraging clinicians to take care of their mental health. But many clinicians are reluctant to get help.

In its annual report on the wellness of doctors, The Physicians’ Foundation found most doctors still perceive a stigma around mental health, with many worried about being asked about it in job or licensing applications.

The Lorna Breen foundation is focusing on encouraging medical boards and hospitals to drop invasive questions about the mental health of applicants, and those efforts are succeeding. As of this fall, 34 licensure boards and 375 hospitals have revised their applications and removed stigmatizing language.

Stefanie Simmons, MD, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation, tells Chief Healthcare Executive® that she’s heartened by the changes taking place.

“Many people have been calling for this change in recognition of the fact that both healthcare workers and patients are served better when healthcare workers can receive the care they need for conditions that are common to humans,” Simmons says.

Simmons says these efforts have been building for years, and she credits the work of the American Medical Association and the Federation of State Medical Boards for pushing for changes in applications. But she says momentum has grown since the emergence of the COVID-19 pandemic. The foundation was created and named to honor a young physician who died by suicide in April 2020.

“There was a moment early in the pandemic where I think the humanity of healthcare workers came into sharp relief, as everyone had their eyes on what was happening in medical care,” Simmons says.

“I think many people came to grips with their own frailty with regards to mental health and how the events that happen in their workplace, the events that happen in society, can impact humans, and that the healthcare workforce was going through a massive change,” she says. “So there was this beginning of realization.”

(See part of our conversation in this video. The story continues below.)

Fitness to practice

For years, state medical boards and hospitals and health systems have asked applicants about their mental health and if they’ve received treatment in the past. Out of fear of being asked those questions, or out of concern that they could be hurting their chances to advance in the organization, some doctors have opted against seeking treatment for their mental health.

However, Simmons says more state boards and hospitals are dropping outdated questions. She says most have recognized the need for a different approach.

“Most state medical boards, when you pose this issue in terms of safe patient care by safe healthy providers, get it immediately,” Simmons says. “And many of these questions are really framed from an out-of-date framing of mental health as a moral issue as opposed to a health issue.”

Licensing boards and health systems need to ensure that clinicians are currently fit to practice medicine. But as Simmons says, “The question becomes, well, does a past history predict current fitness to practice?”

Now, Simmons sees a greater awareness that treatment enables clinicians to move beyond their mental health condition.

“If I had a medical illness like diabetes, my diagnosis of diabetes becomes much less important than whether or not I'm treated for diabetes,” Simmons says. “And so the education, the framing of this issue for medical boards has been really key, particularly because medical boards are charged with the safety of the public. And so making clear that connection between the safety of the public and the willingness and ability of healthcare workers to seek care has been key.”

• Read more: Protecting the mental health of young clinicians

Persuading hospitals

More hospitals have been dropping invasive questions about mental health, and Simmons expects many more will be following suit.

Hospitals need to ensure that clinicians have adequate training and can practice safely. But doctors or nurses that have had treatment for their mental health, or are seeking help, aren’t necessarily posing a greater risk for their patients, she says.

“It really boils down to what makes a clinician safe or not safe, and so we absolutely want to know about current impairment. We absolutely need to support the state professional health programs that treat and monitor healthcare workers who may have a history of substance use disorder,” she says.

“But again, the history of a diagnosis and treatment of a mental health condition does not predict safety,” Simmons continues. “And you might even argue that someone who has a diagnosed and treated mental health condition may be safer for patient care than someone who is afraid to seek care because they're worried about losing their job or their license.”

In the past, hospitals may have been reluctant to change their questions about the mental health of applicants partly out of concern of moving too quickly or going out of step with other providers. But with more hospitals dropping invasive questions, Simmons says that should be less of an issue for health systems.

Now, Simmons says hospitals that aren’t revising their applications run the risk of being left behind other facilities, and even facing other liability questions. Simmons notes that the Department of Justice has said that for state licensing, using questions about mental health in employment decisions violates the Americans with Disabilities Act.

“If you are now one of the few hospitals or the few states that still have these questions, you're then sticking out on a different liability issue, and one that doesn't have the benefit of the argument around patient and clinician safety as well,” Simmons says.

• Read more: How hospitals can improve the well-being of their workers

The Lorna Breen foundation has recognized hospitals and medical boards that have made changes as “Wellbeing First Champions.” Organizations receiving the award get the foundation’s “champions” badge, which denotes a commitment to improving the mental health of their workforce. Simmons says the recognition serves two purposes.

“One was to help organizations understand why they need to do this, and then the other was to help organizations communicate to their healthcare workforce that they've made this change,” Simmons says.

Getting help

988 Suicide & Crisis Lifeline: Dial or text 988 to connect with someone. Help is available 24/7.

The American Foundation for Suicide Prevention offers resources for healthcare professionals.

NAMI: The National Alliance for Mental Illness offers “frontline wellness” resources for healthcare workers and public safety employees.