Mental Health and Medical Licensing: Is your state consistent with the ADA?

As we wrapped up Mental Health Awareness month in May, tens of thousands of medical students became doctors as they received their hard-earned MD and DO titles. Many of these new physicians are now headed into their first years of residency. As this achievement gives reason to celebrate, it also comes with a heavy burden. According to a 2016 meta-analysis by JAMA, there was a 27.2% overall prevalence of depression or depressive symptoms among medical students and a deeply concerning prevalence of 11.1% for suicidal ideation. Yet only 15.7% of those medical students screening positive for depression or depressive symptoms sought psychiatric treatment.

Professional licensing bodies are obligated to protect the public’s safety, which can include protection from risks posed by healthcare professionals impaired by serious mental illness. However, the line between achieving public safety and respecting the privacy of healthcare professionals is concerningly blurry. This duty of licensing bodies to protect public safety can quickly conflict with the public policy objective of the Americans with Disabilities Act (ADA), which “seeks to prevent discrimination against those with disabilities, including psychiatric disabilities” (Jones et al, 2018). More specifically, the regulations enforcing the law say that a “public entity may not administer a licensing or certification program in a manner that subjects qualified individuals with disability to discrimination on the basis of disability” nor can they “impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability… unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered” (Appelbaum, 2015).

A 2018 article published in The Journal of the American Academy of Psychiatry and the Law (JAAPL) breaks down the difference between competently functioning physicians who have lived or live with a psychiatric disorder (or who are being treated for a mental health condition) versus physicians whose professional functioning is currently impaired due to psychiatric etiology and reviews the legal precedents regarding the validity of licensure questions. The article provides a detailed outline of the psychiatric history application questions asked by each state’s medical licensing board*, only 18 of which were consistent with ADA standards. This is despite the APA and AMA consistently asking medical licensing boards to avoid asking applicants about history of mental illness.

If you are a new medical graduate, we urge you to remember this:

Your mental health does not make you less than. It does not undo the hard work you put into reaching this point. It does not invalidate your success, your potential, or your ability to provide best care to patients. In fact, seeking out professional care for any mental health concerns is pivotal for patient safety. Your health directly translates to the kind of care you provide for your patients. Stigmatizing your efforts to recognize and address any mental illness you may be suffering from is dangerous for your own health and for your patients. Medical licensing bodies transgressing the ADA standards are, in fact, putting lives at danger – the lives of medical providers and the lives of the patients they are caring for. Non-disclosure or fear in seeking out help or treatment due to the threat of disqualifying for medical licensure can be destructive to providers' safety, as well as that of their patients.

Licensing bodies must recognize this and make the necessary changes in their application processes. Stigmatizing and penalizing medical students for mental health illnesses or concerns by requiring revelation of diagnoses and treatment status inarguably must end. If you are a new medical graduate, refer to JAAPL’s table (pg. 7-11) to identify the questions you will be asked regarding mental health on your application for medical licensure and whether those questions are in accordance with ADA standards.

Talk with your psychiatrist about how to maneuver these questions safely – in a way that provides you with the mental health care you need without exposing your privacy or putting your licensing application at risk. Write letters to your local licensing board citing the data and concerns presented above.

We must band together to end the stigma of mental health, especially for healthcare providers.

*for initial medical licensure