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 Reference Committee.

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.

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 out.

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 patients.

"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 investigations.

"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 security-clearance investigators.

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 posted at<www.psych.org/edu/other_res/lib_archives/archives/200602.pdf#search=%22%22personnel%20investigations%22%22.>.▪