Should your state board ask about mental illness? Need help with research hypothesis

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Specializes in Anesthesia.

I need help.

I am developing a research hypothesis for my doctoral program.

Many states, including Alabama and my nursing home state, Georgia, ask nurses as part of the licensure/renewal process whether they have been treated for mental illness (excluding substance abuse) within the past X number of years (varies from state to state). Speaking with an Alabama nurse with PTSD brought this issue to my attention. He said he would not ever answer in the affirmative on that question when renewing his license. He felt it would be punitive, were he to admit to treatment.

A member of the Alabama Board of Nursing told me that nurses answering "Yes" were required to submit further information detailing their illness and treatment, and their fitness to practice. She said that "something less than 5 percent" of Alabama nurses answer in the affirmative.

The 5-percent figure roughly corresponds with the NIMH statistic of 4.1% of adults having "serious mental illness" -- perhaps something a nurse would not be able to hide, and therefore self reports. It does not correspond with the National Institute of Mental Health statistic that 18.6% of American adults have "any mental illness" (again, excluding substance abuse on both figures).

In my estimation, this brings up several ethical issues and -- questions about stigma associated with mental illness, not only toward patients, but particularly toward coworkers in nursing and other licensed professions. The ethics, I believe, include the fact that one must maintain integrity by self-reporting. Conversely, it is unethical to stigmatize someone who is receiving effective treatment. Practically, it seems the state boards' questions are ineffective, if few are self-reporting (despite the possibility of punitive action if they are caught) their illness and treatment. Practically, also, I believe a professional might deny -- even to themselves -- that they are ill and need treatment, especially if theirs is not a serious mental condition (and thus feel no ethical remorse about not reporting).

The NIMH of the National Institute of health says about 4% with _serious_ mental illness, about 18% for lesser types, not counting any substance abuse; still seeking more numbers, but it appears 'less than 5%' would apply if only SMI sufferers self-reported (they might not have option with SMI because more obvious, objectively?)

- if only SMI sufferers don't have option not to self-report because of obvious symptoms, then non-SMI nurses with lesser mental illness will either (1) self report (which apparently they are not, at least in Alabama), (2) violate their integrity by not reporting, or (3) not seek treatment so that they don't have to report treatment (would still violate spirit of self-reporting, although I think many licensed people would deny problem, therefore not ethical problem not to seek treatment)

- think will have to be a survey with comparison to numbers reported to state board(s); would require state boards' cooperation in more ways than one

- think I should stick to a couple states (AL & and GA); might do more states if I can accomplish surveys there and if I get cooperation from state boards to get numbers (I am assuming possibility of cooperation in GA and AL b/c I can get "connections" through y'all and GA network

- I think I will have to find a way to deliver surveys or link nurses to an online survey; depending on questions and targeting, Survey Monkey could be $300 to $3,000; I can do $300; can't do $3,000

- Questions, then, may be: (1) do you suffer from mental illness, (2) pull-down menu for type/seriousness, (3) have you/are you receiving treatment, (4) do you self-report to state board? employer?, (5) pull-down menu why/why not (e.g., afraid lose license, lose insurance, job; report b/c right thing to do, because is law, because had public breakdown(?) at work/no choice, (4) ... still working on it.

So, any thoughts? Feedback? Ideas? I know there is a research hypothesis in here somewhere. Is the statistical analysis a comparison between the self-reported state board numbers and the self-reported survey numbers? I think it is. Now I'm considering where to go next.

Thanks,

Macanes

BTW, I'm a CRNA. I have no idea how I got interested in a mental health issue.

Specializes in PDN; Burn; Phone triage.

No advice but I wish you luck. "Seriousness" of the mental illness might be hard to define from an objective point of view? From the POV of someone with mental illness, I would equate seriousness with functionality but that can wax and wane over time. I feel like outsiders might categorize seriousness by diagnosis (ie. someone with a diagnosis of schizophrenia has a more serious mental illness than someone with major depression) which obviously has its own inherent faults.

Specializes in LTC, assisted living, med-surg, psych.

"Serious" mental illness does have an objective set of criteria that must be met for an MI to qualify as such. There must be a moderate to severe impact on one's functionality in different areas of life, and a required number of a list of symptoms e.g. flight of ideas, pressured speech, grandiosity, hallucinations and such. Try the APA website for better information. And good luck!

Specializes in Pediatric.

I think most people who would self report a mental illness are the ones who are sane and safe to practice. (Speaking in generalities.) Ever heard of the saying "truly crazy people don't know they're crazy?"

Do the state boards have evidence that self reporting mental illness is a valid and reliable way to assess incapcity? That is the question that I would like answered.

Specializes in PDN; Burn; Phone triage.
"Serious" mental illness does have an objective set of criteria that must be met for an MI to qualify as such. There must be a moderate to severe impact on one's functionality in different areas of life, and a required number of a list of symptoms e.g. flight of ideas, pressured speech, grandiosity, hallucinations and such. Try the APA website for better information. And good luck!

But how many people who are filling out a surveymonkey form know whether their mental illness qualifies as severe as outlined by the APA?

I really liked my research classes. Struggled but liked the structure of of the many components. Method, design, all the pieces includ. statistics. I still do problems to keep adding to what I learned in classes. Your research hypothesis is full of ways to use stats. From a novice: your seem as if you know what info you are looking for. If this is your first round with an experiment, study, critique see what other researchers in this particular area have already studied or published. (the reason for a thorough literature review). I start with the lit review to see what is known and published, analyze articles, annotated bib. For me these activities helped me take abstractions and form a cohesive statement. It began something like this: This is what I want to know, this is how I am going to get the information I want to know, ......step by step and sometimes circlular. I look back and know I have more to learn. Great start!!!

If you didn't have a mental health issue before entering, chances are you probably will become depressed or even psychotic over time. More seriously, none of us are born the blond haired, blue eyed species. Unless it affects your ability to get your job done, nobody should have to reveal or report anything to anyone but your physician. Who trusts the government anymore? That is just my opinion. I still like to believe I am entitled to having an opinion and a mind of my own, as well as a private life away from the job. The government seems to disagree. I am sure now that there are too many of us, the self righteous will chime in and disagree as well. However, I have found it truly amazing the change of opinion that occurs when something sneaks up on people like that. A profound change in attitude and opinion I see happen every time. Reminds me of an old saying "it's what you learn after you know it all that counts". Methinks that is so very true here.....

Specializes in Pediatrics, Emergency, Trauma.
Do the state boards have evidence that self reporting mental illness is a valid and reliable way to assess incapcity? That is the question that I would like answered.

I wonder that as well.

I also wonder how far can the state boards go in terms of finding out; especially if one has not been deemed incompetent and is a stellar employee with a free and clear license.

Specializes in NICU, Trauma, Oncology.
I need help.

I am developing a research hypothesis for my doctoral program.

Many states, including Alabama and my nursing home state, Georgia, ask nurses as part of the licensure/renewal process whether they have been treated for mental illness (excluding substance abuse) within the past X number of years (varies from state to state). Speaking with an Alabama nurse with PTSD brought this issue to my attention. He said he would not ever answer in the affirmative on that question when renewing his license. He felt it would be punitive, were he to admit to treatment.

A member of the Alabama Board of Nursing told me that nurses answering "Yes" were required to submit further information detailing their illness and treatment, and their fitness to practice. She said that "something less than 5 percent" of Alabama nurses answer in the affirmative.

The 5-percent figure roughly corresponds with the NIMH statistic of 4.1% of adults having "serious mental illness" -- perhaps something a nurse would not be able to hide, and therefore self reports. It does not correspond with the National Institute of Mental Health statistic that 18.6% of American adults have "any mental illness" (again, excluding substance abuse on both figures).

In my estimation, this brings up several ethical issues and -- questions about stigma associated with mental illness, not only toward patients, but particularly toward coworkers in nursing and other licensed professions. The ethics, I believe, include the fact that one must maintain integrity by self-reporting. Conversely, it is unethical to stigmatize someone who is receiving effective treatment. Practically, it seems the state boards' questions are ineffective, if few are self-reporting (despite the possibility of punitive action if they are caught) their illness and treatment. Practically, also, I believe a professional might deny -- even to themselves -- that they are ill and need treatment, especially if theirs is not a serious mental condition (and thus feel no ethical remorse about not reporting).

The NIMH of the National Institute of health says about 4% with _serious_ mental illness, about 18% for lesser types, not counting any substance abuse; still seeking more numbers, but it appears 'less than 5%' would apply if only SMI sufferers self-reported (they might not have option with SMI because more obvious, objectively?)

- if only SMI sufferers don't have option not to self-report because of obvious symptoms, then non-SMI nurses with lesser mental illness will either (1) self report (which apparently they are not, at least in Alabama), (2) violate their integrity by not reporting, or (3) not seek treatment so that they don't have to report treatment (would still violate spirit of self-reporting, although I think many licensed people would deny problem, therefore not ethical problem not to seek treatment)

- think will have to be a survey with comparison to numbers reported to state board(s); would require state boards' cooperation in more ways than one

- think I should stick to a couple states (AL & and GA); might do more states if I can accomplish surveys there and if I get cooperation from state boards to get numbers (I am assuming possibility of cooperation in GA and AL b/c I can get "connections" through y'all and GA network

- I think I will have to find a way to deliver surveys or link nurses to an online survey; depending on questions and targeting, Survey Monkey could be $300 to $3,000; I can do $300; can't do $3,000

- Questions, then, may be: (1) do you suffer from mental illness, (2) pull-down menu for type/seriousness, (3) have you/are you receiving treatment, (4) do you self-report to state board? employer?, (5) pull-down menu why/why not (e.g., afraid lose license, lose insurance, job; report b/c right thing to do, because is law, because had public breakdown(?) at work/no choice, (4) ... still working on it.

So, any thoughts? Feedback? Ideas? I know there is a research hypothesis in here somewhere. Is the statistical analysis a comparison between the self-reported state board numbers and the self-reported survey numbers? I think it is. Now I'm considering where to go next.

Thanks,

Macanes

BTW, I'm a CRNA. I have no idea how I got interested in a mental health issue.

I self reported mild anxiety and I am teretting that decision

Specializes in NICU, Trauma, Oncology.
I self reported mild anxiety and I am teretting that decision

*regretting

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