State licensing reform: removing mental health barriers for healthcare workers
The problem
Forty percent of physicians report reluctance to seek mental health care specifically because of fears about licensure — the concern that disclosing mental health treatment on a licensing application could jeopardize their ability to practice. This is not an irrational fear: licensing applications in many states have historically asked about any mental health diagnosis or treatment, creating a documented chilling effect on care-seeking behavior.
The consequences are measurable and grave. Physicians die by suicide at twice the rate of the general population. The reluctance to seek care — compounded by the demands of clinical work, the culture of stoicism in medicine, and the structural barriers created by licensing questions — produces a population of clinicians who are suffering without access to the support that might interrupt the trajectory. The licensing question is not the only barrier, but it is one of the most tractable: it can be changed by regulatory action, without requiring a shift in clinical culture.
Sources
- Medscape Physician Burnout & Depression Report
- Schernhammer ES, Colditz GA. 'Suicide rates among physicians.' JAMA. 2004
- Dr. Lorna Breen Heroes Foundation
The progress
As of 2025, 70 licensure boards across medicine, nursing, pharmacy, and dental have removed intrusive mental health questions from their licensing applications — replacing them, where appropriate, with questions focused on current functional impairment rather than mental health history or prior treatment. Virginia was the first state to enact a law requiring this change, and 21 or more states have since taken legislative or regulatory action.
The legal framework for this reform is grounded in the Americans with Disabilities Act, which prohibits discrimination based on disability history and requires that licensure questions focus on current ability to perform essential functions — not past diagnoses or treatment. The ADA does not prohibit licensing boards from asking whether a clinician currently has a condition that impairs their ability to practice safely; it does prohibit asking whether they have ever been treated for a mental health condition.
Sources
- Dr. Lorna Breen Heroes Foundation, ALL IN Campaign metrics, 2025
- Virginia Code § 54.1-2929.1
- Americans with Disabilities Act, Title II
- Federation of State Medical Boards
Hospital credentialing
Licensing is only one of two main structural barriers. Hospital credentialing applications — which determine a physician's privileges to practice at a specific facility — have historically included similarly intrusive mental health questions. More than 1,194 hospitals have now removed these questions from their credentialing applications as part of the ALL IN campaign, making it possible for physicians to seek mental health care without risking their hospital privileges.
Healthcare organizations that have not yet audited their credentialing applications for intrusive mental health questions are operating under a policy that may be both legally questionable (under the ADA) and operationally harmful (by deterring the very care-seeking that could prevent workforce departures and patient safety events). The ALL IN campaign provides a certification pathway that publicly recognizes organizations that have completed this review.
Sources
- Dr. Lorna Breen Heroes Foundation, ALL IN Hospital Certification
- Joint Commission on Accreditation of Healthcare Organizations
What your organization should do
The immediate step for any healthcare organization is a review of your current credentialing applications. If they include questions about past mental health diagnoses, treatment history, or hospitalizations for mental health conditions, those questions should be replaced with questions about current functional impairment — or removed entirely. Legal counsel familiar with ADA requirements for healthcare credentialing can guide this review.
Beyond the application itself, organizations should communicate proactively to staff about the changes that have been made — and about what your organization's policy actually is regarding mental health and professional standing. Many clinicians assume the worst about what disclosure would mean; explicit communication that mental health care will not jeopardize their standing at your organization is itself a meaningful intervention. Joining the ALL IN campaign formalizes this commitment and provides a public signal to current and prospective staff that your organization takes workforce well-being seriously.
Sources
- Dr. Lorna Breen Heroes Foundation, 'ALL IN: Hospital Certification'
- Americans with Disabilities Act, Title II
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