Talk Resources & References

Barriers to Help-Seeking for Healthcare Workers

Companion materials for the talk: the summary paper, the cross-profession evidence, practical resources, and the full reference list.

Healthcare workers experience mental health conditions at rates similar to or higher than the general population, yet they seek care far less often. The gap holds across the professions: nurses, physicians, technicians, support staff, pharmacists, therapists, and trainees. The obstacles are largely structural and cultural rather than a matter of access. Intrusive questions on licensing and credentialing applications, fears about confidentiality and career consequences, and persistent stigma all raise the cost of asking for help. These barriers are modifiable.

Risk is also not concentrated where the attention has been. In a national cohort followed through 2019, healthcare support workers, registered nurses, and health technicians each carried significantly elevated suicide risk relative to workers outside healthcare, while physicians did not (Olfson et al., JAMA 2023). Physician mental health has drawn the most study and the most reform. Several of the groups at highest measured risk have drawn the least.

The structural barriers have the same shape across licensing boards. An audit of registered nurse and advanced practice registered nurse licensure applications found only 13 states fully adherent to the recommended standard (Melnyk et al., 2023), and an earlier review found that 22 of the 30 nursing boards asking about mental illness posed questions inconsistent with the Americans with Disabilities Act (Halter et al., 2019). The physician version of this problem is simply the best documented, which is why the paper below uses it as the worked example.

This talk reviews the evidence and offers concrete recommendations for licensing boards, hospitals, training programs, and colleagues who want to make it safer for any healthcare worker to get help. The resources below are meant to be used and shared.

Start here

This summary paper lays out the barriers, why they persist, and what actually lowers them. It works the problem through in physicians because that is where the evidence base and the reform history run deepest, but the argument and the recommendations apply to the healthcare workforce as a whole.

Evidence across the workforce

Three papers showing that the risk and the barriers extend well beyond physicians.

• Suicide Risks of Health Care Workers in the US

  Olfson M, Cosgrove CM, Wall MM, Blanco C. JAMA. 2023;330(12):1161-1166. National cohort study. Elevated suicide risk for healthcare support workers, registered nurses, and health technicians; no elevated risk for physicians over the study period.

• An audit of mental health questions on U.S. nursing licensure applications

  Melnyk BM, Holod AF, Hsieh AP, Feist JC. Worldviews on Evidence-Based Nursing. 2023;20(5):422-430. Only 13 states fully adhered to the recommended checklist for RN and APRN applications.

• State Nursing Licensure Questions About Mental Illness and Compliance With the ADA

  Halter MJ, Rolin DG, Adamaszek M, Ladenheim MC, Hutchens BF. Journal of Psychosocial Nursing and Mental Health Services. 2019;57(8):17-22. Of the 30 boards asking about mental illness, 22 asked questions inconsistent with the ADA.

Resources

These serve the whole healthcare workforce unless noted otherwise.

• The Emotional PPE Project

  A nonprofit connecting healthcare workers to free, confidential mental health support from volunteer licensed therapists. Open to anyone who works in healthcare, clinical or not. No cost, no insurance, no red tape.

• Dr. Lorna Breen Heroes' Foundation

  Advocacy and practical toolkits for reducing burnout and removing intrusive mental health questions from licensing and credentialing applications.

• Improving Licensure & Credentialing Applications (Wellbeing First Champion Challenge)

  The audit toolkit and step-by-step process a board or hospital uses to review and fix its own application language. Verified boards now span medicine, nursing, pharmacy, dentistry, psychology, and counseling, along with hospitals and staffing organizations.

• Impact Wellbeing (CDC / NIOSH)

  A federal campaign giving hospital leaders evidence-informed steps to improve working conditions and mental health for their entire workforce, plus guidance for workers who want to push their institution to adopt it.

• AFSP: Suicide Prevention for Healthcare Professionals

  Resources from the American Foundation for Suicide Prevention tailored to clinicians and healthcare organizations.

• Make the Difference: Preventing Medical Trainee Suicide (APSF)

  Anesthesia Patient Safety Foundation training video on recognizing risk and intervening. Written for physician trainees, though the recognize-and-respond skills generalize.

• 988 Suicide & Crisis Lifeline

  Free and confidential, 24/7, for anyone in crisis or worried about someone else. Call or text 988.

Responding to impairment questions on forms

Licensing and credentialing applications across the health professions still ask about hypothetical impairment (whether a condition "might" or "could" affect practice). This shows up on medical, nursing, pharmacy, and dental board applications and in hospital credentialing packets alike. These questions are at odds with the spirit of the Americans with Disabilities Act and have been discouraged by the Joint Commission. Below is language you can adapt when you encounter one, both as an individual respondent and as a suggested revision for the board or institution.

Full talk references

The complete reference list from the talk.