Mental Health Disclosure Questions on Medical Licensure Applications: Implications for Medical Students, Residents,...

Medical trainees and physicians experience high rates of depression, anxiety, suicidal ideation, and burnout. The stigma surrounding mental health may deter help-seeking behaviors and increase informal treatment to maintain anonymity. Invasive health history questions on state medical licensure applications regarding mental health diagnoses and treatment likely increase stigma, reduce help-seeking, and consequently may motivate some applicants to report an inaccurate history to the state medical board. Research on physician mental health, suicide rates, and lack of help-seeking have led to recommendations for changes to licensure questions. In this article, the authors review the language of health history questions, disclosure requirements for applicants, and the potential consequences of disclosing mental health or substance abuse history on state medical licensure applications. They review recent changes to some states' health history questions, using the changes to Florida's licensure application in 2021 as an example, and explore the implications of these changes for reducing stigma and encouraging help-seeking. The authors recommend that state medical boards review and refine licensure applications' health history questions regarding mental health disclosure in ways that strategically address concerns related to stigma, bias, and unwarranted scrutiny. They call for research to examine the impact of such question changes on applicant response accuracy, help-seeking behaviors, and mental health outcomes and stigma. They also recommend that medical schools offer and promote access to mental health services, encourage faculty to normalize help-seeking behaviors, and provide students with information about state licensure processes. Reducing stigma, normalizing trainee and physician experiences, and promoting help-seeking are preliminary steps to promote a culture in academic medicine that prioritizes mental health. In turn, this will encourage trainees and physicians to care for themselves and cultivate physicians who are better equipped to heal and support their patients.