Should Entry-Level Psychologists and Other Mental Health Clinicians Be Screened for Job-Impairing Psychiatric Disorders?
By: Craig Wetterer, PhD, JD, MSCP
Introduction
Clinical psychologists and other mental health professionals bear significant responsibility for mental health care. Given the profound impact they have on clients’ well-being, it is critical that these professionals are free from psychiatric and personality disorders that could impair their ability to practice effectively. Despite this, no U.S. jurisdiction currently mandates screening for such conditions before licensure. Specifically, Standard 2.06 of the American Psychological Association’s Ethics Code (Personal Problems and Conflicts) requires psychologists to refrain from initiating professional activities if they know or should know that their personal problems are likely to interfere with their competence or harm those they are serving. This standard implies the need for self-awareness and self-regulation when personal issues could impact professional performance, making it essential for psychologists to be free from impairing psychological problems while practicing (APA, 2017).
The Ethical Imperative
Psychologists have an ethical obligation to prioritize client welfare. The APA’s Ethical Principles of Psychologists and Code of Conduct emphasizes competence, integrity, and avoidance of harm (APA, 2017). A psychologist with a job-impairing psychiatric disorder may have compromised judgment, leading to misdiagnosis, boundary violations, or care that falls below expected standards of care. Given that psychological testing is not required prior to licensure in any U.S. state, it is likely that some proportion of practicing psychologists are experiencing significant psychiatric conditions. Research suggests that mental health problems such as depression and anxiety are common among psychologists, with rates similar to those found in the general population. Recent Empirical studies have shown that up to 70% of faculty and nearly 90% of graduate psychology students report mental health difficulties at some point, highlighting the prevalence of psychiatric issues within the profession (Victor & Nunes, 2023).
While severe mental illnesses, such as psychotic disorders, tend to be less common, personality disorders and other serious conditions still pose a risk to professional judgment and competence (Victor & Nunes, 2023). Serious personality disorders, such as borderline or narcissistic personality disorder, can significantly affect a psychologist’s ability to maintain professional boundaries. For instance, a psychologist with unmanaged borderline personality disorder may experience mood swings or interpersonal conflicts that could disrupt therapy. Ensuring that practitioners are free from impairing conditions is imperative to safeguarding the effectiveness of mental health services (Bearse, McMinn, Seegobin, & Free, 2013).
Boundary Violations and Disciplinary Issues
A major disciplinary concern in clinical psychology practice involves inappropriate sexual relationships with clients, often linked to boundary issues (California Board of Psychology, 2023). These boundary violations frequently develop gradually, starting with minor transgressions, such as excessive self-disclosure, and escalating to more serious ethical breaches, including sexual misconduct (Simon, 1995).
In California, sexual misconduct and dual relationships are the most common reasons for disciplinary action against psychologists (California Board of Psychology, 2023). Personality disorders, such as borderline personality disorder, exacerbate this risk. Individuals with borderline personality disorder often struggle with emotional regulation and may idealize their therapists, leading to inappropriate relationships if these conditions are unmanaged (Bearse et al., 2013; Simon, 1995).
Screening in Other Professions
Psychiatric screening is mandatory in other professions such as law enforcement and air traffic control, where emotional stability and sound judgment are critical (Pilot Medical Solutions, 2023). For example, air traffic controllers undergo psychological evaluations to ensure they can handle extreme stress and maintain focus under pressure (Pilot Medical Solutions, 2023). Similarly, law enforcement officers are screened to assess emotional stability and impulse control (among other dimensions) before they are hired, ensuring they can make sound decisions in high-pressure situations (Simon, 1995). Given the responsibilities of psychologists, who make decisions that profoundly impact individuals’ lives, it seems logical to consider screening as a tool to ensure that those with serious psychopathology are identified in the licensing process – decisions about how to proceed with an applicant if they are found psychologically unsuitable would be up to the individual state’s licensing authority. In the public safety context, individuals who are determined to be unsuitable psychologically are not given a formal offer of employment.
Public Trust and Professional Credibility
Mandatory screening would enhance public trust in the psychological profession. Clients entrust psychologists with their most personal thoughts, expecting care from competent and stable professionals (APA, 2017). Knowing that psychologists have been evaluated for job-impairing psychiatric disorders can reassure clients and reduce the stigma surrounding mental health services (Bearse et al., 2013).
Risk Mitigation and Support for Applicants Entering the Profession
Screening can prevent future professional misconduct and malpractice by identifying psychological conditions that may impair an applicant’s ability to practice safely. Early identification of psychiatric disorders among licensure applicants allows for timely
intervention, reducing the risks to future clients and mitigating potential legal repercussions. Applicants for licensure can also receive the support needed to manage their conditions, which ultimately improves outcomes for both the individual and the clients they will serve (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2019). Mandatory assessments should be viewed as supportive rather than punitive. If concerns are identified, applicants can be directed to appropriate resources, such as therapy or modifications to their training, before entering full practice (Dearing, Maddux, & Tangney, 2005). This is a crucial point—identifying job-impairing mental health conditions during the application phase ensures that potential problems are addressed early, promoting both personal and professional well-being.
Recent Research
A significant number of psychology trainees report personal experiences with mental health challenges. For instance, 73% of psychology graduate students reported experiencing significant mental health symptoms during their lives (Peterson, Demerouti, Bergström, Samuelsson, Åsberg, & Nygren, 2017). While personal experience can enhance empathy, unmanaged psychiatric disorders may impair a psychologist’s ability to provide effective care. This highlights the need for proactive screening measures (Dearing et al., 2005).
Counterarguments and Balancing Concerns
Despite the compelling reasons for mandatory screening, concerns about privacy, autonomy, and stigma remain. Critics argue that mandatory psychological assessments may deter individuals from seeking help for fear of professional repercussions (Simon, 1995). Moreover, mental health is dynamic, and a one-time assessment may not capture future impairments.
A balanced approach would involve confidential assessments conducted by independent professionals, focusing on identifying those who need support rather than disqualifying individuals (Bearse et al., 2013). Promoting self-care and educating psychologists on recognizing signs of impairment could further reduce stigma (Morse et al., 2019).
Conclusion
Requiring psychiatric screening for entry-level psychologists is a proactive measure aimed at ensuring the highest standards of mental health care. Similar to screening practices in professions such as law enforcement and air traffic control, mandatory evaluations can prevent boundary violations and promote professional integrity. While challenges in implementation exist, the potential benefits to client welfare, public trust, and professional credibility are considerable. By creating screening processes that prioritize privacy and support, licensing authorities can enhance psychological practice without unduly penalizing practitioners.
The intent of this article is to initiate a critical discussion about the importance of psychological stability among mental health professionals. It is logical to consider that those responsible for delivering mental health care to the public should themselves be psychologically fit to manage the emotional and psychological demands of the job. Although the focus here is on psychologists, this issue extends to other mental health professionals, such as marriage and family therapists and social workers, who share the responsibility of providing mental health care and should similarly be considered for such screenings. Ultimately, ensuring the psychological fitness of mental health professionals not only enhances the quality of care provided but also safeguards the profession’s integrity. A thoughtful, well-structured approach to screening could foster a healthier, more resilient workforce, leading to better outcomes for both clients and practitioners
References
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code
Bearse, J. L., McMinn, M. R., Seegobin, W., & Free, K. (2013). Barriers to psychologists seeking mental health care. Professional Psychology: Research and Practice, 44(3), 150-157.
California Board of Psychology. (2023). Disciplinary actions and complaints. https://www.psychology.ca.gov/consumers/complaints.shtml
Dearing, R. L., Maddux, J. E., & Tangney, J. P. (2005). Predictors of psychological help seeking in clinical and counseling psychology graduate students. Professional Psychology: Research and Practice, 36(3), 323-329.
Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2019). Burnout in mental health services: A review of the problem and its remediation. Journal of Occupational Health Psychology, 24(3), 1-13.
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Pilot Medical Solutions. (2023). FAA evaluations for air traffic controllers. https://www.leftseat.com/air-traffic-controller-specialists-evaluations/
Simon, R. I. (1995). The slippery slope from boundary crossings to sexual boundary violations: Disciplinary and therapeutic consequences. Ethics & Behavior, 5(1), 3-20.
Victor, S., & Nunes, L. (2023). A paradox in the field: Mental-health disorders among psychologists. Association for Psychological Science.