This article was co-authored by Ben Shelton and Caden Rosenbaum. Caden is the Technology and Innovation Policy Analyst at Libertas Institute.
In the US, the unacceptable reality for many professionals is that a trip to the therapist could put them out of a job.
At first glance, this sounds ridiculous. But the impact of certain professions in the lives of everyday citizens often justify this issue. After all, no one wants the mental health disorders of a police officer, a pilot, or a doctor to jeopardize the lives of the community they serve.
However, in practice, licensing boards’ use of someone’s mental health history can be influenced by stereotypes about mental health disorders. The result is needless prohibitions, restrictions, and obstacles to licensure.
Worse, the practice can cause practitioners to refrain from seeking out treatment—even when they desperately need it. It creates an incentive to ignore or hide underlying mental illnesses while on the job. That undermines the outcomes occupational licensing is intended to achieve—the health and safety of consumers.
In light of sweeping improvements in the treatment of mental health disorders, which goes against stereotypes about mental illness, these prohibitions can be unnecessary in the first place.
What’s needed now is an overhaul of the way licensing boards approach mental health and wellness.
The FAA’s application process to become a pilot requires that people submit to a medical examination and provide medical histories showing a clear bill of health. For those who have read Hatchet by Gary Paulsen—where a pilot suffers a fatal heart attack mid-flight, leaving his young passenger to crash-land in a remote forest and survive in the wilderness for many weeks before being rescued—the risk posed by a pilot who could be incapacitated mid-flight by an underlying disease is a commonsense reason for medical examinations.
However, a less straightforward component of a person’s health record is their mental health. An aviation medical examiner (AME) reviews a person’s mental health records over the past five years to determine if the person has suffered some form of mental or behavioral disorder, whether it’s ongoing, and whether that disorder has gone away within six months or is being treated with prescriptions.
In these cases, an aviation medical examiner is actually forbidden from issuing a medical certificate like they would for any other applicant. Instead, they must defer to the Aerospace Medical Certification Division (AMCD) or the Regional Flight Surgeon (RFS), pass along their findings, and inform the applicant that they must apply for a special issuance or special exemption for the FAA to review directly.
The intended result is obviously to prevent pilots from flying if they are cognitively impaired. However, the unintended effect is that pilots and applicants for a pilot’s license are far less likely to seek mental health treatment when issues arise.
If a pilot or an applicant goes to a therapist for minor mood disorders like anxiety or minor depression, for instance, they risk being diagnosed with an anxiety disorder or a depressive disorder. For active pilots, this could ground them for sixty days to six months, depending on the severity and treatment plan. For applicants, treatment could affect their chances of being certified for the next five years.
Even if the disorder is actively managed with prescription medication, the FAA has harsh do not fly standards — regardless of whether those medications produce noticeable side effects. In some cases, the FAA requires pilots to go at least six months without taking their mood stabilizing prescriptions to demonstrate airworthiness. For people with chronic cases of depression or anxiety that find success only through prescription medication, this could be a determining factor in whether they are able to fly.
These outcomes are the shameful result of this licensing practice, leading some pilots to not seek help when they need it.
Even worse, this is only one of many occupations where mental health treatment jeopardizes a person’s ability to perform a professional vocation in the US.
Medical professionals facing mental health issues, for example, risk losing their license. This was demonstrated prominently during the global COVID-19 pandemic — when doctors saw their emergency rooms overcrowded with dying patients. Many of the psychological impacts of those traumatic few years have gone unaddressed due to fear of losing their medical license.
This isn’t a new issue for medical professionals either, and unlike pilots, the problem lies with state, not federal, licensing boards. In a 2018 study, 61 percent of resident and fellow physicians felt they would have benefited from psychiatric treatment, but only 24 percent actually sought it, in part due to fear of reporting any mental health disorders to state licensing boards.
The American Medical Association actually recommends that state licensing boards refrain from prodding into a person’s prior history of depression or anxiety, but the failure to follow that recommendation — and the subsequent outcome that doctors didn’t seek help when it was needed — has already cost the lives of several doctors over the last couple years.
Going further back, the toll is likely much higher. In 2011, a survey of surgeons found that one in sixteen had thought of suicide. Of those, more than sixty percent had concerns about losing their medical license. A study published in 2016 showed that almost half of the 2,106 respondents believed they suffered from some form of mental health disorders but had not sought treatment because they did not want a diagnosis tainting their record.
It’s time to revise the way we view mental health disorders from a licensing standpoint.
While negative stigmas surrounding mental health disorders, therapy, or even basic counseling once made openly discussing mental health disorders taboo, today the stigma is fading for the broader population.
In response to the clearly counterproductive approach to mental health disorders by regulators and licensing boards, it is past time to rethink the way we approach mental health disorders in occupational licensing.
The question state and federal agencies should be asking is why occupational licensing boards still operate around the confines of mental health stigmas that penalize treatment and endanger professionals in need of help.