In recent years, psychiatrists have been asked to consult in the security clearance process. In The Psychiatrist in the Security Clearance Process, psychiatry expert witness Brian Crowley, MD, DLFAPA, writes:
Psychiatrists are asked to participate in the security clearance process in either of two ways. First, treating psychiatrists are occasionally asked to give a professional opinion as to whether or not a patient, or former patient, is suitable for a security clearance. The doctor will receive a call or a fax from a federal investigator, usually asking to meet briefly with the doctor, and stating he has a release signed by the patient. Typically only one question is asked:
Does the person under investigation have a condition that could impair his or her judgment, reliability, or ability to properly safeguard classified national security information?
If so, describe the nature of the condition and the extent and duration of the impairment or treatment. ______________________________________________________________________
What is the prognosis?______________________________________________________________
Dates of treatment? ________________ Doctor’s Signature _____________________________
If the treating doctor answers that question “No,” that ends the inquiry and supports the patient on his way to obtain (or retain) his clearance. On occasion a psychiatrist refuses to give any reply to this question. That refusal often leads to a prolonged delay in adjudication, during which the patient/employee stays in limbo until the system makes a referral for a current evaluation by another psychiatrist or clinical psychologist. This delay, often lengthy, is a profound disservice to an individual who is able, eager, and competent to work and to safeguard classified information.
I think we should answer this question for our patients when asked. Yes, we want to be sure the patient has consented to our giving this opinion, but he/she almost invariably has done so in writing, while looking for a new job, or for advancement in an existing position. Most of the time these are folks who have been working with us in treatment, sincerely trying to improve the quality of their lives and/or reduce symptoms. They are, in my experience, most often earnest, sincere people with a high degree of dedication and patriotism. With a current patient, I make a point always to discuss the inquiry I have received, and my proposed reply, with her/him before I meet with the investigator. (Frequently my patient has told me to expect such an inquiry, and we have already discussed it.)
On the other hand, if I am asked about a patient I saw once or twice, eight years ago, with dubious treatment commitment and a then-unstable condition, I say I do know not his/her current status and suggest a more current evaluation. While the form asks for a “yes” or “no” answer, there is absolutely no barrier to writing a brief explanation.
If a colleague will not answer that question about a patient he knows well out of fear his answer might prove wrong and he will experience some backlash, he should critique himself for excessive timidity and/or lack of knowledge of how strongly the law supports a doctor using his best judgment in the service of his patients and the community.
If uncertain how to handle a given inquiry, consultation with an experienced colleague is a very good idea, as it is with other challenging practice situations.
As printed in the The Washington Psychiatrist.
Dr. Crowley‘s areas of expertise include Testamentary Capacity and Undue Influence, Fitness for Duty, Security Clearances, Independent Medical Examinations Dangerousness Assessments.