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Key points
- Applying to the military involves disclosing medical, including mental health, history.
- Civilian mental health providers may be uncomfortable with these disclosures.
- Providers may not need to supply all of a patient's records and many psychiatric conditions can be waived when certain conditions are met.
I am currently stationed at the Naval Aerospace Medical Institute (NAMI) and spend a part of every day reviewing the application packages of aspiring air crew, air traffic controllers, Naval Flight Officers, and Navy and Marine Corps Aviators. As a part of this review, the applicants are asked about their medical histories, to include any mental health evaluation or treatment. The safety sensitive nature of these jobs necessitates thorough review of the records.
I was reminded this week that providers are not always comfortable with these disclosures. In the course of a record review of an applicant who wanted to become an air traffic controller, the mental health records for the period that she reported she had been in treatment were absent. The provider was refusing to release them.
Providing mental health treatment records sounds daunting to both the individuals applying for programs and for their mental health providers. What some people hear is “The military wants your medical records.” That’s not quite how this works — medical records go through medical professionals. When records come to me for review, I am still a credentialed psychologist. The records and information contained therein are given the same careful consideration regarding privacy and confidentiality as if they were my own patient’s records.
It may come as a surprise that a history of many, if not most, psychiatric conditions can be waived when certain conditions are met. Some common examples are a childhood history of ADHD, depression in high school, or a series of alcohol related incidents in college. When I review a record, I want to find the person psychiatrically physically qualified for duties involving flight. When that is not the case, the next question is whether a person can qualify for a waiver. The aviation waiver guide is highly transparent and may be found in its entirety here.
However, often service members have difficulty getting their records released from civilian mental health providers. Providers have various reasons for not wanting to provide that level of information, with the most frequent being protecting the individual's privacy. Unfortunately this well-intentioned practice can cause harm, resulting in delay in selection or progression, or, in the worst case, outright disqualification. For a young person with a lifelong dream of becoming a pilot, this can be devastating.
What I’m saying is that extreme protection of mental health records hurts individuals trying to join the military as well as service members applying for special duty (and I would argue only increases the stigma of seeing mental health providers). However, as a psychologist, I also understand the desire to protect an individual’s privacy. Consequently, providers may have to compromise and I encourage the following if an aspiring service member asks for their treatment records to be sent for military review. (Keep in mind that the individual will need in all cases to provide a written release of information.)
- You may or may not need to supply all of the records depending on what the person is applying for. Sometimes a letter summarizing the presenting problem, diagnosis, treatment dates, type and course of treatment, treatment progress, and date of symptom remission may be sufficient.
- You may be able to have a phone call with the individual doing the record review to better understand the request and to see if there is an alternative to providing all of the records. There are times when the phone call itself may be sufficient.
- If neither of the first two options is viable, and for high risk occupational career fields they may not be, talk to your prior patient about the content of the records and ensure that they understand what the records consist of. If a patient wants their records sent to another credentialed medical provider, this is their decision.
Finally, you may wonder what happens to the records once they are released. For NAMI, we read them in their entirety and then summarize them in either a report (if we have evaluated the person face-to-face) or in a clinical advisory note (if we are reviewing a case submitted by a flight surgeon for consideration of a waiver). The records typically get summarized in a sentence or two and they do not become a part of the military health record.
Selection for high-risk and safety sensitive occupations entails risk assessment and the introduction of risk controls, and these decisions must be informed by a thorough review of relevant medical records. No one should be put into a position where a prior or existing problem is likely to make them vulnerable to future injury or exacerbation of current conditions. When this happens in operational environments where “normal” levels of medical or mental health care are not available, both the individual and other members of the unit are placed in jeopardy. When full reviews are completed and waivers granted, the military has assumed the risk and responsibility for the individual, ensuring that the needs of both the service member and the national security mission are met.
