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Mentally Ill in a High-Stakes Job

With the crash of Germanwings Flight 9525, caused by a rogue pilot with a history of depression, people are calling for better mental-health screenings for pilots. But it’s not just in aviation where mental-health treatment is a concern.

With the crash of Germanwings Flight 9525, caused by a rogue pilot with a history of depression, people are calling for better mental-health screenings for pilots. But it’s not just in aviation where mental-health treatment is a concern.

 

Consider also doctors, dentists, lawyers. They have trained for years, passed tough exams, been licensed and deemed fit by a stringent set of regulations; they’re needed at their best. Yet many of these high-responsibility, high-risk career fields have high rates of suicide. That means many of these highly trained workers could be showing up at work in a compromised condition.

 

 

  

Seeking help for depression, anxiety, or another mental condition can be difficult for anyone. People may be embarrassed to discuss their symptoms, they might not know what kind of healthcare provider to see, or they might hope the problem will go away on its own. But in some fields, visiting a therapist for a diagnosis or starting medications can endanger the licensing and career someone has often worked a decade or more to achieve.

 

The most recent National Health and Nutrition Survey from the Centers for Disease Control and Prevention (CDC), published in 2014, found that 7.6 percent of Americans ages 12 and up fit the description for moderate or severe depression. Among people with severe depression, 35 percent reported seeking help from a mental-health professional. Only 20 percent of those with moderate symptoms sought help, and 13 percent of those with mild symptoms.

 

Those statistics account for depression. Add to them the spectrum of anxiety disorders and more severe mental-health conditions—bipolar disorder, personality disorders, schizophrenia, psychosis—and a significant percentage of people reporting symptoms are going untreated. According to the Association for Psychological Science, in 2011, 59.6 percent of people with any kind of mental illness reported receiving treatment.

 

The ramifications of untreated mental illness are bad enough for the sufferers, but in certain professional fields where people’s lives or livelihoods are at stake, the questions become more complicated. Could a lawyer with social anxiety fumble a case in the courtroom—not badly enough to get a mistrial, just enough to lose? What if a doctor hasn’t slept in days because of depression and is making decisions about dosages and specialty care?

 

Legally, there are very few instances when employers are allowed to ask employees direct questions about specific conditions or medications, and medical records are protected by HIPAA laws, but some people still fear being “found out” for not reporting a mental condition. People post questions on forums for medical students, pilots, and police officers, worrying about the consequences they could incur for their conditions.

 

Licensing boards bear a different weight of responsibility than employers. Though their mission statements vary slightly state by state, they are charged with regulating practitioners in a field; protecting consumers from unethical, incompetent, and unfit professionals. But does having ever been treated for a mental illness qualify one as forever unfit? For a lifelong condition, how long must ongoing treatment be successful before someone can stop being viewed as a potential risk? One year? Five? Ten?

 

Anyone who seeks treatment puts a great deal of trust in others. Clinical notes from therapists and psychiatrists could ultimately determine the fate of a license. The Americans with Disabilities Act should protect anyone’s job as long as he seeks out and finds successful treatment; but what qualifies as “successful” isn’t always clear, and the consequences of concealing a mental-health condition from a licensing board can be stiff. In medicine, according to the Federation of State Medical Boards, it can be up to and including loss of license if someone is found to be practicing while impaired. But different professions screen for, and approach mental illness differently.

 

Caroline Cournoyer is GOVERNING's senior web editor.
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