Dropping invasive questions: More boards, hospitals stop asking clinicians about mental health

More people may be comfortable with the idea of seeking help for their mental health, but some doctors and nurses won’t do it for a simple, heartbreaking reason.

They worry they will have to acknowledge that they sought help, and that it could hurt their chance of being licensed, or getting a job.

The Dr. Lorna Breen Heroes’ Foundation has been pushing hospitals and state licensing boards to drop invasive questions about mental health from their applications. More hospitals and state boards are getting rid of the questions, which is encouraging, says Stefanie Simmons, MD, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation.

“Don’t ask questions you don't need the answer to, to make sure you're keeping patients safe,” Simmons says.

“And so that's really where we're focused, as we work toward this future state where everyone is getting the care they need, and organizations are able to fully support and endorse a thriving, healthy workforce,” she says. “Let's not ask questions that impede access to care and reduce the health and the thriving of our healthcare workforce.”

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

The foundation is named in honor of Dr. Lorna Breen, a physician who died by suicide in 2020 in the early days of the COVID-19 pandemic. The foundation has seen more and more success persuading licensing boards to drop questions about mental health from applications.

To date, 50 state boards have dropped the questions from their applications, including 37 state medical boards, seven pharmacy boards, five nursing boards and a state dental board.

As of late May, 635 hospitals have dropped the questions as well, up from 521 hospitals in February, the foundation says. The foundation also recognizes hospitals and state boards as “Wellbeing First Champions.” While the progress is heartening, Simmons notes that only about 10% of hospitals have made that commitment.

• Read more: Protecting the health of young clinicians

Simmons says the increasing willingness of state boards of hospitals to rethink the questions they need to ask is encouraging. As more boards and hospitals drop the question, others become less leary about making the change.

“Whenever there's a change. I think there's a reasonable reticence that regulators have to say, we want to make sure that we're making this change in a thoughtful way,” Simmons says.

“And so there's this comfort often that will come with seeing the majority of states now have made this change,” she says. “Many hospitals have made this change. It is safe, it is well received, it is legal, it is complying with credentialing agencies, and organizations are not falling into difficulty having made that change. So there certainly is a comfort level that is increasing.”

The foundation works with boards and hospitals to review their licensing applications. In some cases, health systems and boards had assumed that the questions had already been dropped.

“We want patients to have safe care, and we want health care workers to have access to mental health care, because a healthy, thriving workforce in health care really begets patient safety and patient care,” Simmons says.

Applicants may need to disclose if certain treatment impairs their ability to do their job, such as a medication that could have physical side effects. But barring such a circumstance, there’s not a need for boards and hospitals to ask if applicants have sought help for their mental health, Simmons says.

“It doesn't impact my ability to do my job,” she says. “So why are you asking? You don't need to know that, just like you don't need to know about somebody's detailed physical health history if it doesn't impact their ability to do their job.”“Some of those details are really personal, and they don't belong with an employer or regulatory board unless they have a direct relevant impact, like there's impairment.”

Clinicians may be reluctant to seek treatment, or disclose it, since they don’t know how a licensing board or a hospital would use that information.

“There is very little knowledge or transparency about what that information is used to do,” Simmons says. “So if a healthcare worker knew exactly what disclosing that information would lead to, either in licensing or in hospital credentialing, then they would be able to make a decision, about what the possible economic impact or cost would be of them having care and needing to disclose care.

“Without that information, without transparency about what that information changes in your licensing or credentialing process, healthcare workers are left making critical decisions about their care and the disclosure of their care without key pieces of information that they need,” Simmons says.

For younger clinicians who are just out of residency and carrying heavy medical debt, they may not be willing to risk taking a chance that getting help could hurt their career or affect their ability to be licensed, she says.

“Your ability to attain and maintain a license to be credentialed and have a job in a hospital or health system is a critical economic and financial decision,” she says, adding, “So in the absence of transparency, there is a very conservative decision that's being made … to err on the side of maintaining your access to your career.”

“That's a lousy decision to have to make,” she says. “Because you are at the beginning of your career, you also are often starting your family, whatever that means for you, with a relationship, with a partner, some people are having children. And so it's like you are actually choosing to not be at your best anywhere.”

More hospitals and boards are making it clear that they won’t be asking clinicians about their mental health, and Simmons says it’s also vital for organizations to communicate that information, so staff know they can get the assistance that they need.

Simmons says more organizations are also seeing the need to make it easier for clinicians to get assistance.“One of the things that has really allowed this conversation to happen is the development and deployment of additional resources for healthcare workers,” she says. “So making sure that people do have access to resources and access to help when they need it is critical.”

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.