← Daniel Saddawi‑Konefka · dansaddawi.com

Talk Resources & References

Barriers to Help-Seeking for Healthcare Workers

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The argument

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.

The three papers behind the numbers above.

The paper

Saddawi-Konefka D, Moutier CY, Ehrenfeld JM. Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations. JAMA. Published online August 14, 2025. doi:10.1001/jama.2025.12587

Read the paper in JAMA

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.

Resources

These serve the whole healthcare workforce unless noted otherwise.

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. The question appears on medical, nursing, pharmacy, and dental board applications and in hospital credentialing packets, and it sits at odds with the spirit of the Americans with Disabilities Act; the Joint Commission has discouraged it.

A response that can be entered directly in the form's text box:

"Regarding questions about health conditions, [Name] has no issues with impairment. I checked 'Yes' as I do for all individuals when facing hypothetical questions like this. Asking about hypothetical impairment ('might affect') is at odds with the ADA and has been discouraged by the Joint Commission. Please revise this question."

A better question, on the model Virginia adopted (HB 1573):

"(i) Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients or clients? (ii) Are you able to perform the essential functions of a practitioner in your area of practice, with or without reasonable accommodation?"

For anyone in a position to change the form rather than answer it, the Wellbeing First Champion Challenge provides the audit checklist and the verification process, for any licensing board or credentialing body.

References

Every source cited in the talk, with links to the DOI or publisher where one exists.

All 78 references →