Psychiatrists who are contacted as part of government security-clearance
background checks on current or former patients now have an APA document to
guide them following approval in June of a resource document by the Joint
The guidelines were requested by officials at the Defense Personnel
Security Research and Education Center (PERSEREC), a government agency whose
mission is to improve government and industry personnel-security procedures.
The agency has requested similar guidelines from the American Psychological
Association and has shared APA's guidelines with that organization.
"PERSEREC came to APA because many psychiatrists were not cooperating
with background checks or understanding how to cooperate," said Steven
Hoge, M.D., a member of APA's Council on Psychiatry and Law, which developed
The guidelines outline the approach and aims of federal security checks in
general and the specific steps such investigations follow. It also indicates
what information investigators may request from psychiatrists and suggests
what disclosures are appropriate.
Investigators seek out psychiatrists who have treated security-clearance
applicants and ask an established set of questions aimed at understanding the
scope of illness and the effectiveness of treatment provided. Psychiatrists
are not obligated to perform "any additional evaluation or specialized
assessment as part of the security investigation," the guidelines point
All discussions with investigators should begin with psychiatrists
obtaining one of two federal authorization forms signed by the applicant,
according to the guidelines. Psychiatrists should discuss the evaluation with
current patients to make sure they understand the ramifications of the release
they have signed and review the responses the physician plans to give
investigators. This step is especially important in cases in which a
psychiatrist is concerned the patient is at risk for impaired judgment or
violence—red flags in the background checks.
The background checks may not affect many psychiatrists outside of areas
with many federal or military workers but they can impact many within such
regions. Millions of Americans require security clearances as part of their
jobs in the government, the telecommunications industry, and financial
institutions, and nearly 1 million clearance requests are initiated each year,
according to the federal Office of Personnel Management. The expansion of
defense-related industries in recent years has led to a backlog of several
thousand security clearances.
The federal guidelines on background searches specify that no negative
inference is to be drawn solely from the fact that an employee or potential
employee has sought mental health care. Even the presence of major psychiatric
conditions does not prevent applicants from clearing the background check if
their condition is "readily controllable" and they have adhered to
the prescribed treatment regimen.
Brian Crowley, M.D., a Washington D.C., forensic psychiatrist who has
participated in security investigations for about 30 years, said he views his
role as providing a service requested and approved by his current or former
"I may want to discuss it with current patients to make sure they
understand the ramifications of what they are approving, but it has been a
routine part of my practice, and I've never found the investigators are
embarking upon a fishing expedition," Crowley said.
It is important, he added, that psychiatrists emphasize that their
assessments of a patient's abilities to safeguard security are limited to the
timeframe that the patient was under their care. Psychiatrists contacted to
assess former patients should specify their views only apply to their
understanding of the patient at the time of care.
The APA Council on Psychiatry and Law sought the views of many members
through forums at various APA meetings, and some psychiatrists expressed
reservations with the appropriateness of their involvement with such
"Some wanted the security checkers to check these [applicants' mental
stability] themselves," Hoge said, about psychiatrists concerned with
the fact that their treatment of a patient never focused on the patient's
trustworthiness or other questions raised by investigators.
The guidelines attempt to reflect this concern by specifying that
psychiatrists who are unable or unwilling to provide the sought-after
clearance information should not automatically respond to the questions of
Investigators arrange for a "specialized mental health
evaluation" when psychiatrists are unable to answer their questions or
when they receive responses of "no opinion."
Conversely, psychiatrists who choose to participate in investigations
authorized by their patients should provide information and judgments to
investigators that fall within the authorized disclosures. The guidelines
emphasize that it is inappropriate for psychiatrists to negotiate with
patients over what opinions they will disclose to investigators. However,
before talking to investigators it would be appropriate for psychiatrists to
discuss with their patient what central aspects of their condition would be
disclosed and whether more peripheral details should be disclosed.
"We try to be very clear in these guidelines and prevent
psychiatrists from feeling like they are out on a limb when responding to
these investigations," Hoge said.
The resource document "Psychiatrists' Responses to Requests
for Psychiatric Information in Federal Personnel Investigations" is