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.

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Self reporting is a very good idea. The worst thing that can happen is that you have to go before the board but as long as you are stable and do your best at your job it should not be a problem. What is worse then not self reporting is having your supervisors or co workers find out behind your back and then getting you fired for it, which is a form of discrimination and also happened to me.

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Specializes in Oncology/StemCell Transplant; Psychiatry.

I think the idea of requiring someone to report receiving treatment for any mental illness is an extremely bad idea.

First, it further stigmatizes mental illness. It lumps together all mental illnesses as if every mentally ill person is potentially dangerous to their patients.

Likewise, I believe it discourages nurses from receiving treatment from suspected mental illness. I, for one, have struggled with this issue in the past. I have avoided seeking help for what is probably a minor mental illness because I do not want to stand on front of the Board of Nursing and defend my license on account of being "crazy". I also don't want to lie on my license application, which could also jeopardize my license.

SOLUTION: Don't seek treatment. No stigmas,no problems. Which is sad because it would be much better for the nurse and his/her patients if he/she sought treatment.

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