I am currently stationed at the Naval Aerospace Medical Institute (NAMI) and spend part of the day reviewing applications from aspiring aircrews, air traffic controllers, Navy flight officers, and aviators from the Navy and the Marine Corps. As part of this exam, applicants are asked about their medical history, to include any mental health assessment or treatment. The safety sensitive nature of this work requires careful review of the records.
Some providers choose to refuse to release records for review, but this practice can end a patient’s military careers.
Source: Image by Pete Linforth from Pixabay
I was reminded this week that providers are not always comfortable with these disclosures. During a review of the file of an applicant who wished to become an air traffic controller, mental health records for the period in which she claimed to have been in treatment were absent. The supplier refused to release them.
Providing mental health treatment records seems daunting both for people requesting programs and for their mental health care providers. What some people hear is “The military wants your medical records. This is not quite how it works – medical records go through medical professionals. When files come to me for review, I am still a licensed psychologist. The files and the information they contain receive the same attention to privacy and confidentiality as if they were the files of my own patients.
It may be surprising that a history of many, if not most, psychiatric disorders can be undone when certain conditions are met. Some common examples are a history of ADHD in childhood, depression in high school, or a series of alcohol-related incidents in college. When I review a file, I want to to find the mentally qualified person physically for the tasks involving theft. When this is not the case, the next question is whether a person can benefit from a waiver. The Aviation Waiver Guide is very transparent and can be found in full here.
However, military personnel often struggle to get their records disclosed by civilian mental health providers. There are a number of reasons why providers do not want to provide this level of information, the most common being the protection of individual privacy. Unfortunately, this well-intentioned practice can cause damage, resulting in delay in selection or progression, or, in the worst case, outright disqualification. For a young person who has always dreamed of becoming a pilot, it can be devastating.
What I am saying is that extreme protection of mental health records harms individuals who attempt to enlist in the military as well as those in the military who request special duty (and I would say it does. increase the stigma of seeing mental health providers). However, as a psychologist, I also understand the desire to protect an individual’s privacy. Therefore, providers may have to compromise and I encourage the following if an aspiring military member requests that their treatment records be sent for military review. (Remember that the person will always have to provide a written disclosure of the information.)
- You may or may not need to provide all documents depending on the person’s request. Sometimes a letter summarizing the problem presented, diagnosis, dates of treatment, type and course of treatment, progress of treatment, and date of remission of symptoms may be sufficient.
- You may be able to have a phone call with the case reviewer to better understand the request and see if there is an alternative to providing all records. There are times when the phone call itself may be enough.
- If neither of the first two options is viable, and for high-risk professional career areas it may not be, talk to your ex-patient about the contents of the records and make sure they understand. what the files consist of. If a patient wants their records sent to another accredited health care provider, that is their decision.
Finally, you might be wondering what happens to records once they are released. For NAMI, we read them in their entirety and then summarize them either in a report (if we assessed the person face-to-face) or in a clinical opinion (if we are reviewing a case submitted by a flight surgeon for review of a waiver). Records are usually summarized in a sentence or two and are not part of the military health record.
Selection for high-risk and safety-sensitive occupations involves a risk assessment and the introduction of risk controls, and these decisions should be informed by a careful review of relevant medical records. No one should be placed in a situation where a previous or existing problem is likely to make them vulnerable to future injury or to a worsening of current conditions. When this occurs in operational environments where “normal” levels of medical or mental health care are not available, the individual and other members of the unit are put at risk. After full reviews were completed and waivers granted, the military assumed the risk and responsibility of the individual, ensuring that the needs of the military and the national security mission were met.