Many healthcare professionals working in both the NHS and private sectors suffer from mental health issues, without posing any risk to patients. Mental health covers a broad range of conditions, however no mental health diagnosis is an immediate barrier to pursuing your chosen professional.
Applying for either a post as a registered professional or for a place on a degree can be a stressful time for applicants with mental health issues and the process of declaration can, in cases, can exacerbate these. This guide aims to clarify the process of declaration, and also signpost readers to appropriate sources of support should they feel that they are struggling with mental health at work or university.
For ease of writing, this guidance will refer to nurses or nursing students, but is applicable to all registered professionals, including, but not limited to, doctors, occupational therapists, physiotherapists, social workers, podiatrists and dieticians.
Declaring a Mental Health Diagnosis
It is important to note that declaration of any sort of mental health diagnosis will be held in confidence by the relevant departments. When you make a declaration, it should be clear who this information will be shared with.
As a new applicant
Prior to interview, many employers and admissions tutors will ask you to declare any medical conditions, which will include a section on mental health. Often you will not be asked to provide any details at this stage. This section of your application is not viewed by the admissions department, but is sent to a department called Occupational Health (OH).
If you are currently in a post or on a course
A new diagnosis can be a difficult thing to deal with, and declaring this to your employer or university can be something you are reluctant to do. The process is largely the same as that of new applicants, whereby an occupational health referral will be required. The process varies, however, in that you would be expected to approach your employer to disclose this, rather than being asked. It is very important that you let your employer know as soon as possible, as you have a professional responsibility to do so. Generally this would be your line manager, but if you feel uncomfortable speaking to them, you could always make an appointment with occupational health to discuss. If you find it easier during this difficult time, you could always consider telling them initially via email or a letter.
Can I avoid disclosing?
Some applicants are reluctant to disclose mental health conditions as they feel that they may be stigmatised, discriminated against or fear that there may be a lack of understanding. Most healthcare professions require a regular declaration of good health and good character, and knowingly signing this while not disclosing a mental health condition would be seen as dishonesty.
Choosing not to disclose is not a decision that should be taken lightly. Should any issues occur at any time during your employment/degree related to your mental health, there is a risk that your fitness to practice would be called into question. If this happened, questions would be raised as to why you had chosen not to disclose.
After disclosing, you should then be contacted by the OH department to arrange an appointment to discuss your declaration. Many applicants are shocked or apprehensive about attending this appointment, but be assured that it is standard procedure and certainly nothing to be concerned about.
Many applicants are daunted by the occupational health appointment, however, there is little to be concerned about. The purpose of OH is to gather information about your condition to help the university or employer put in place support for you, to ensure that your condition does not affect you at work or affect your patients. OH takes the role of an impartial assessor.
The appointment will be conducted by an OH nurse or physician. They are likely to ask you for basic information about your condition, such as how long you have had it, whether there have been any significant incidents related to your condition, and what management plan you have in place. Bear in mind that OH do not know you, and have never met you before, so do not have access to any of your past medical history, so it’s important that you give them a full picture.
The key questions OH will seek to answer are:
- Is there a significant health problem?
- Will the illness interfere with this individual’s ability to do this specific job?
- Does anything in this job pose a risk to the candidate’s mental health?
- Is there any risk to the welfare of others?
- What modifications or adaptations are needed to accommodate the candidate’s health problem/minimise the risk to them or their patients, and/or if the Disability Discrimination Act applies, what adjustments can be taken to enable the person to do the job?
Occupational health will be satisfied if you have disclosed your condition, you do not pose a risk to others, and you have your condition under control. Being in control of your condition could mean that you are currently on a course of medication, having regular reviews by your GP or mental health professional, or are no longer receiving treatment and your medical professional is happy with this. In some cases, OH may request permission to gain further information from your GP.
Can I lose my place/job?
This question comes up time and time again from worried applicants. The process of occupational health assessments is not a pass/fail one. OH do not have the power to remove you from your course or employment. All they can do is make a recommendation that your line manager or course lead reviews your capability to continue. This would only be done if it was determined following your assessment that there was a significant risk posed to patient safety.
This happens very, very rarely, however, should it happen, your first steps would be to notify the OH department that you disagree with their findings and would like to appeal the decision. If you have had contact from the course lead, also contact them too. At this point, it may be appropriate to seek a letter from your GP in support of your appeal. Be aware that there is likely to be a charge for this service.
Be assured that no employer or university wants to remove an employee/student because of a minor mental health issue. All have a responsibility to support you and put in place any reasonable adjustments to enable you to continue. Where OH finds that an individual is not suitable for a post, it should be because the nature of their mental health condition puts the individual, patients or the organisation at serious risk in spite of reasonable extra efforts to support them, or where there is no reasonable adjustment that would enable that person to do the job. Refusal of employment on health grounds cannot be made until reasonable adjustments have been exhausted.
What sort of support is available to me?
Most universities have a counselling service which students are able to access free of charge, and usually self-referrals are accepted. Universities will also have a disability service, or student support service. Many students are reluctant to access these services as they do not consider themselves to be disabled, however you can access this service with a mental health diagnosis, and depending how this affects your studies, you may be entitled to additional support, for example, a mental health mentor, assistive technology, extra time in exams, permission to leave classes early, permission to eat and drink in class. Accessing the disability service will allow the university to make a record of the reasonable adjustments put in place to support you.
The support systems in place vary by employers. Some larger health boards will offer counselling services and support, whereas smaller employers may have fewer formal support systems. Discussion with occupational health or your line manager should result in you being signposted to the appropriate supports available.
What happens if my condition gets worse or is not well controlled?
An acute exacerbation of your condition is not necessarily something to worry about with regards to risking your place on a course and you definitely should not let the fear of disclosing this stop you from seeking the help you need. Your main priority should be to take care of yourself.
Taking time off for mental health is a valid reason to be off sick, however if you find yourself needing extended periods of time off, you should be seeking advice from your GP. If you find yourself unable to cope at work/university and are seeing no improvements after speaking to your GP, you may wish to discuss the situation with either your personal tutor or line manager to see if any adjustments can be made to make things easier for you. It is possible that at this point you might be re-referred to occupational health. Again, this is no reason to panic, but just an indication that they feel a more in-depth assessment is required in order to help you.
Another important thing is to realise that you shouldn't try and self-diagnose yourself. Information on Google is often inaccurate and most people could easily self-diagnose several mental health issues after a quick search. Especially when you're not feeling in a good place after previously being in control of your condition, it can be easy to look to other diagnoses to explain why things aren't going as well for you. The recommendation is always to discuss with your GP and see what they think.
If you feel you are in crisis
If you feel that you are in crisis and require immediate support:
- Nightline services are available at most universities. You can find your service here: 
- Samaritans are available 24 hours a day, 365 days a year via phone or email. You can find contact details here: 
If you are in immediate danger and feel you may be a risk to yourself or others, please phone 999 for an ambulance.