Resource Toolkit: Reducing Barriers to Care for Mental Health and Substance Use Disorders

In 2023, the ADA House of Delegates passed Resolution 517H-2023 Preventing Unfair Discrimination to address these issues. This resolution also made possible the information in the toolkit you are currently reading.

PREVENTING UNFAIR DISCRIMINATION

The following resolution was submitted by the Fourteenth Trustee District and transmitted on September 13, 2023, by Molly Pereira, executive director, Colorado Dental Association.

Background: Appropriate access to, and utilization of, mental health care is a concern in our country and in our profession. A clinician’s well-being is necessary for safe and quality patient care. It not only improves the patient-doctor relationship, but it also supports the entire care team leading to a more effective workforce.

Recent discussion by healthcare organizations, famous athletes, entertainers, and even royalty have encouraged people to seek help for mental health. While there is an increasingly accepting attitude toward treatment for the mental health and wellness issues that can affect anyone, there continues to be misconceptions and discrimination in some public and private institutions against health professionals who have received mental health treatment and who are healing. This type of discrimination can, and does, prevent many health care professionals from seeking the care they need for fear of being unable to renew or receive a license, insurance, or credentials.

It is in the best interest of our profession and our patients that dentists are able to openly seek and obtain mental health care and to disclose information honestly to authorities without fear of discrimination or punitive measures. This can be accomplished with properly phrased questions and reporting mechanisms that accurately convey actual risk. Two examples are:

Option 1: Ask one question consistent with the Federation of State Medical Board’s recommended language: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice dentistry in a competent, ethical, and professional manner? (Yes/No)”

Option 2: Implement an Attestation Model that offers “safe haven” non-reporting options to those who are under treatment and in good standing with a recognized physician health program or appropriate provider.

These would allow licensing agencies and others to fulfill their obligation to protect the public while destigmatizing mental health care and avoiding inappropriate discrimination.

Utilizing the State Public Affairs program’s existing infrastructure to assist states that are ready to address these issues will benefit our dental team and our patients. The resources that are developed can then be utilized in other states and can inform their advocacy efforts. While some additional investment may be required, the return will be realized by both our profession and the public who we serve.

Resolution

17. Resolved, that the appropriate ADA agency create a pilot project to assist a limited number of states to develop and advocate for legislation or regulation that prevents discrimination in licensing, credentialing, and other matters against dentists who have received counseling, therapy, or treatment for mental health issues, and be it further

Resolved, that the resources developed by this project, including model legislation, be compiled into a toolkit for other state associations to use in their advocacy efforts, and be it further

Resolved, that a report on these activities be prepared for the 2024 House of Delegates.

The toolkit and resources you see on this webpage is designed to address the ADA House of Delegates Resolution 517H-2023 and to summarize information from states that have accomplished licensure reform or are in progress of licensure reform. It also shares information about efforts within credentialing organizations to become aware of stigmatizing questions in credentialing applications that may deter a dental provider from seeking mental health care.

ADA Preventing Mental Health and Substance Use Disorder Discrimination in Dentist Licensure and Credentialing Resources Toolkit (2024) (PDF)

Set-up an account with and watch a webinar that the Federation of State Medical Boards (FSMB) hosted in February 2023 titled “Changing the System: Removing Barriers to Treatment through Licensing Reform.” The recording is available, but Continuing Education is no longer provided for this education.

The webinar offers foundational information on the state of licensure reform in medicine, and the advancements that have been made collectively, on behalf of physicians and medical trainees. It also provides critical background for state dental association and state boards of dental examiner leaders who are interested in learning about how medicine is effectively removing barriers to mental health support and serves as a model for dentistry. This collaborative effort protects the needs of the public at the same time as removing barriers for providers to use mental health care.

Dr. Lorna Breen was an Emergency Room physician in New York who died by suicide in April 2020. In her memory, her family established the Dr. Lorna Breen Heroes' Foundation to advocate for the mental health and professional well-being of healthcare providers, and normalize help-seeking without the fear of disciplinary action.

Learn why the fear of punitive action is a main barrier for healthcare providers to seek mental health support, and to view the U.S. map showing the 27 state medical boards that have audited and changed stigmatizing language on medical license applications, as of April 1, 2024.

Dr. Lorna Breen Heroes’ Foundation created the “Remove Mental Health Questions from Licensure and Credentialing Applications" toolkit to advance licensure reform in medicine. There are an additional 11 state medical boards that are in the process of auditing their applications. Where is your state regarding medical licensure reform? Can organized dentistry in your state partner with organized medicine to accomplish licensure reform, together?

Resources:
Dr. Lorna Breen Heroes’ Foundation
“Remove Mental Health Questions from Licensure and Credentialing Applications" toolkit

In September 2023, the ADA hosted a Health and Well-Being Summit to build a coalition of dental organizations and physician organizations that support reviewing dentist licensure applications.

Presenters from national and state dental organizations, state dental boards of examiners, state dentist well-being programs, and physician organizations including the American Medical Association, Federation of State Medical Boards, Federation of State Physician Health Programs, The Joint Commission shared their expertise with over 100 attendees from across 30 different states.

Read the ADA Health and Well-Being Summit Executive Summary (PDF)

The Federation of State Physician Health Programs is a national, nonprofit membership organization of member Physician Health Programs (PHPs) established in 1991. Their mission is “to support physician health programs in improving the health of medical professionals, thereby contributing to quality patient care.”

Most importantly, state member programs provide a confidential, therapeutic alternative to discipline and have the support of organized medicine in their state or province often through legislation, exceptions to mandated reporting, or other safe haven provisions. In addition to working with participants, PHPs provide education, outreach, and advocacy to their medical communities in support of physician health and well-being.

In addition to supporting professionals, PHPs advocate for the communities they serve in support of health and well-being. Find your state on their FSPHP State Programs web page, learn about the populations they serve and whether dentists and dental team members are included, who to contact to learn more, and about the specific health issues they address. Share the information you learn with your state dental association and state board of dental examiners colleagues. PHPs are a confidential alternative to discipline.

Federation of State Physician Health Programs

Some states have their own dentist well-being programs. Determine if your state has one with this resource, and how your state dental society and/or state board of dental examiners can work collaboratively to reduce stigma and utilize confidential services.

View the Well-Being Program Directory (PDF)