Statement on Removing Intrusive Mental Health Questions from Hospital Credentialing Applications from the Dr. Lorna Breen Heroes' Foundation and the National Institute for Occupational Safety and Health

Washington, D.C. (May 18, 2023) – J. Corey Feist, JD, MBA, Co-Founder and President of the Dr. Lorna Breen Heroes' Foundation; and John Howard, MD, Director of the National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention, issued the following statement:

Our nation's healthcare workers are there for each of us in times of need; now it is our time to be there for them. We have made important strides in understanding and beginning to address the challenges healthcare workers face in seeking and receiving support for their own wellbeing. However, our collective efforts must go beyond encouraging self-care and personal resilience to recognizing the importance of organizational-level change and supporting hospitals as they adjust and create systems that sustain worker wellbeing. In recognition of Mental Health Action Day, we jointly invite every hospital to remove one of the most substantial organizational barriers to healthcare workers' wellbeing—intrusive mental health questions on credentialing applications.

Like everyone, healthcare workers deserve the right to pursue the mental health care they may need—without the fear of losing their job. Yet, physicians, nurse practitioners, physician associates, and other clinicians fear losing their credentials because of overly broad and invasive mental health questions that are stigmatizing and discriminatory.ⁱ According to The Physicians Foundation's 2022 Survey of America's Physicians, nearly 4 in 10 physicians were either afraid or knew another physician fearful of seeking mental health care because of questions asked in licensure, credentialing, or insurance applications.ⁱⁱ Licensure questions are also a significant source of mental health stigma among nurses.ⁱⁱⁱ

These questions were often added to credentialing applications with good intent to protect the public and mitigate risk. However, there is no data demonstrating that these questions protect the public, and it is well-documented that they often lead to healthcare workers not seeking care.^iv In fact, The Joint Commission does not require organizations to ask about a worker's mental health history and encourages them to not do so.^v

Corey Feist's late sister-in-law, Dr. Lorna Breen, experienced this barrier firsthand, confiding in her family that she was fearful of being ostracized at work if she acknowledged that she needed help. Shortly after, she died by suicide. Since then, Corey has heard similar stories from many families who also lost healthcare worker loved ones to suicide because of mental health stigma in the workplace.

We must act now. An immediate action that hospital leaders can consider taking consists of three steps identified by the Dr. Lorna Breen Heroes' Foundation to remove this barrier. This begins with auditing all credentialing applications, addendums, and peer review forms, and changing or removing questions to 1) address all mental and physical health conditions as one, with no added explanations, asterisks, or fine print; 2) refrain from asking questions about health altogether; or 3) implement an attestation model with supportive language around mental health.

ALL IN: WellBeing First for Healthcare, a coalition led by the Dr. Lorna Breen Heroes' Foundation, is recognizing hospitals for taking the three steps to remove intrusive mental health questions from credentialing applications. Hospitals that submit their credentialing applications this summer will be publicly recognized as a WellBeing First Champion in early fall. They also will receive an official badge and related resources to easily communicate to their workforce that their hospital is a safe place for them to seek the mental health care they may need.

Removing intrusive mental health questions on credentialing applications is a critical step to supporting healthcare workers' wellbeing, but it is not the only one. Our organizations are committed to continuing to identify ways to tackle these challenges and support hospitals in efforts that support and sustain worker wellbeing. We hope that every hospital across the country will take deliberate systems-change actions for improved healthcare worker wellbeing—ultimately making every hospital a safe, healthy, and sustainable workplace for all.

To learn more, visit:

Dr. Lorna Breen Heroes' Foundation, www.drlornabreen.org/removebarriers/

NIOSH, https://www.cdc.gov/niosh/topics/mentalhealth/default.html