Advocating for health care workers has become an essential part of our day-to-day. In March, we were proud to see the Dr. Lorna Breen Health Care Provider Protection Act enacted to provide $135 million for programs aimed at supporting the mental health and well-being of health workers. However, while this was a welcome first step, it’s only the beginning of the work needed to protect our clinicians.
The next crucial step falls to the states: They must remove language in their licensing and credentialing processes that stigmatizes health care professionals who have sought treatment for mental health concerns.
Our research has identified 31 states, plus the District of Columbia, that may still use invasive or stigmatizing language requiring applicants to disclose any history of mental health concerns or to explain why they have taken breaks from work. Some require applicants to disclose any past psychiatric impairment, potentially going back decades, even to adolescence. These questions might violate the Americans with Disabilities Act. They certainly violate applicants’ privacy. And there is significant evidence that they deter clinicians from seeking the care they need – at tremendous risk to their well-being and their lives.
Indeed, a survey of more than 1,500 physicians conducted this year found that 80% agree there is stigma around doctors seeking mental health care. Nearly 40% reported that either they personally or a colleague they know has been scared to seek mental health care because that treatment would need to be disclosed on their licensure, credentialing or insurance applications.
Mental health questions were often added to licensing applications out of a misplaced desire to protect the public from clinicians who might not be fit to give care. Yet there is no evidence that these questions serve that function.
On the contrary, the public interest is harmed by these questions, since we know that when doctors, nurses and other clinicians are afraid to seek the care they need, they may find themselves unable to work due to depression or burnout. Some may turn to drugs or alcohol. And tragically, some will turn to suicide. In fact, stigma associated with seeking – or even discussing – behavioral health care is a primary driver of suicide among the health care workforce.
The Dr. Lorna Breen Act is named after the sister-in-law of Corey Feist, a co-author of this piece. An emergency room physician, Lorna died by suicide in April 2020, after weeks of incredibly intense work caring for patients in the first wave of COVID-19. At one point during that surge, Lorna called her sister to confide that she was overwhelmed with exhaustion and grief – but she was fearful that she would lose her medical license or be ostracized at work if she acknowledged that she needed help.
In the years since Lorna’s death, we have heard from many families who have lost physician loved ones to suicide. We recently connected with an emergency medicine doctor in Florida who reported that four of her physician colleagues died by suicide this summer. In too many of these cases, the clinicians have acknowledged to friends or family that they are reluctant to get treatment because of the stigma around mental health issues.
One such tragedy involves Dr. Matthew Gall, a devoted oncologist who practiced medicine for 16 years in Minnesota, one of the states that until recently used invasive questions on licensing applications. In 2019, Matthew moved to North Carolina with his wife and their three children. The move to a new practice was difficult, and Matthew struggled with depression, yet he declined to seek help. His wife, Betsy, told an interviewer that her husband felt “ashamed and embarrassed” about his depression, and feared he would lose his medical license and his livelihood if he sought treatment. “He honestly thought that he’d no longer be able to be a practicing oncologist,” Betsy said. “The fear was real, and being a doctor meant everything to him.” Matthew died by suicide on Thanksgiving Day 2019.
A terrible irony in this tragedy is the fact that North Carolina does not actually ask intrusive questions about mental health treatments in its licensure process. But having just moved to the state, Matthew was not aware of that fact. Lorna, too, was unaware that New York does not use invasive questions.
These stories are painful. They are powerful reminders that we must work toward universal reform of licensure applications, as our team did in Minnesota, which updated its questions to be less stigmatizing after testimony from Lorna’s sister and brother-in-law. It’s also clear that simply changing the language on applications is not enough. We must also get the word out widely, so no clinicians ever fear they will lose their job if they seek the help they need. In addition, we must continue to change the culture inside health care systems so that physicians, nurses, pharmacists and other health care workers feel comfortable being open about their mental health concerns and their need for support.
We are fighting for those reforms through our campaign ALL IN: WellBeing First for Healthcare, which brings together more than a dozen organizations including the American Medical Association, the American Hospital Association, the American Nurses Foundation and the Physicians Foundation. Thousands of individuals have joined us in contacting state medical boards to demand change.
We are also working to address clinician burnout through common-sense reforms that we expect will eliminate some of the bureaucracy that can consume so much of a clinician’s time and remove the joy from patient care.
Ensuring that health care workers can access necessary mental health care is critical for their well-being and for the health of our entire country. Let’s do our part to support them. Together, we can show our vital health care workforce that they aren’t alone in this fight for their lives.