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Open Book

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Safe Haven Programs—Alternatives to Discipline in Times of Burnout, Mental Health, and Substance Use

FSBPT Member Boards have been championing a new way of addressing mental health and substance use issues among industry professionals—safe haven programs. This article is based on a 2023 Annual Education Meeting presentation by Missy Anthony, Timothy Keck, and Katie Stuart.

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Mental health concerns, substance use, and burnout are prevalent challenges facing many individuals. These issues can significantly disrupt a person's daily life, impacting their work, relationships, and overall well-being. Witnessing a colleague struggle with mental health, substance use, or burnout can be a negative experience for others in the workplace. This can lead to decreased morale, reduced productivity, and a strained work environment.

Great strides have been made in recent years toward mental health awareness, but there’s still work to be done. The key is to raise awareness of how mental health, substance use, and burnout impact professionals. Most people are generally aware these issues exist but are not aware of how they exist in their ecosystems—where they work and live. Most people are good at hiding it, so it often is not apparent. 

However, regulatory board members are all too familiar with the challenges that mental health and substance use disorders present. Disciplinary cases involving ethical violations can sometimes reveal underlying mental health challenges, substance use issues, or burnout as contributing factors. Burnout and stress among licensees often contribute to situations that require disciplinary actions. This is not just a personal issue or an employer challenge; it’s a matter of public safety. To help licensees get back on track, boards should consider offering confidential resources as an alternative.

How Safe Haven Programs Work

Safe haven programs that offer support and resources to professionals struggling with these challenges are considered highly valuable. Such programs can encourage individuals to seek help before ethical violations occur and can ultimately promote a healthier and more ethical professional environment.

Both the Idaho Bureau of Occupational Licenses and the Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board have seen success in setting up safe haven programs, or professionals' health programs (PHPs).

Safe haven programs may differ from jurisdiction to jurisdiction, but they usually incorporate the following features:

  • A clearly defined confidential path for individuals to seek help for burnout, mental health disorders, or substance use disorders
  • A safe space for early intervention before patient safety becomes a concern
  • Access to quality clinical screening/evaluation, treatment, long-term monitoring, and support
  • A therapeutic alternative to disciplinary action for illnesses such as mental health disorders or substance use disorders

By being both free and accessible, programs address significant barriers to seeking help, such as cost and access. The objective is to get these individuals the help they need without discipline. However, there should be an understanding that if they do not comply with the program, there will be repercussions.

Encouraging Reporting

There are two ways people enter a safe haven program:

  • Self-report – An individual who has not committed a crime or had a reported work-related incident can self-report to the safe haven program.
  • Board mandated – Individuals who have been reported to the board or have a complaint filed against them may be referred to the safe haven program.

Practitioners should be educated on the signs and symptoms to look for in themselves and their colleagues. The key is to recognize the symptoms, acknowledge the duty to report, and follow facility policy and procedure. Practitioners should also ask themselves how they would feel if something went wrong, and they had an opportunity to proactively report an issue prior to any public harm. PHPs, which provide confidential help instead of just discipline, should encourage more practitioners to report.

Factors that Influence Reporting

  • Small practices with fewer healthcare professionals are less likely to report.
  • A community shortage of practitioners discourages reporting but is even more of a reason to report.
  • The closer the system/team, the more it will adapt to support an impaired individual, perhaps making them less likely to report.
  • A “none-of-my-business” philosophy is dangerous and discourages reporting.

Possible Signs of Impairment

  • Engage in the following behaviors:
    • Volunteering to inventory narcotics
    • Taking increased or prolonged breaks
    • Wearing long sleeves (to hide potential injection sites)
    • Using excessive sick time
    • Arriving or leaving unexpectedly (absence without notice or last-minute requests)
    • Taking long breaks or lunches
  • Exhibit changes in the following areas:
    • Mood (increased irritability, agitation, depression)
    • Physical appearance (shakiness, sleepiness)
    • Emotional expression (emotion loss)
    • Work performance (sloppy or illogical charting)
    • Personal hygiene (smell of alcohol on breath)
    • Communication (excessive use of mints, gum, and mouthwash to mask alcohol breath)
    • Behavior (elaborate excuses for behavior)
    • Self-awareness (denial of the problem)

How to Report

  • Contact your state PHP.
  • Anonymously contact the PHP and report a concern.
  • Anonymously submit a report to the state board.
  • Report to the Employer Wellness Committee, HR, or Director.

The key to these programs is to provide a means for the individual to get help while maintaining their confidentiality. If they fear the board will be notified, they will avoid seeking help. The confidential piece is what makes it work—people want to talk to someone who is not on the regulatory board or their employer.

Programs notice a large uptick in people coming forward and benefiting from the program, provided there is confidentiality and anonymity. For example, in Idaho, the role of Health Professionals Recovery Program is as a confidential go-between, providing the individual with access to resources in a confidential manner.

Steps Boards Can Take

FSBPT member boards can come together to help implement these safe haven programs. Together, we can advance our shared goal of public protection and keeping patients safe.

 

 

Missy Anthony has served as the 8th Executive Director of the Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board since November 2017. Prior to her service with the Board, Missy worked for the Ohio House of Representatives, Ohio Governor John Kasich, as Deputy Director of the Ohio Department of Mental Health and Addiction Services, and lobbied on behalf of individuals with developmental disabilities. A native of Akron, Ohio, she graduated from the University of Akron with a degree in political science and certificate in applied politics from the Ray C. Bliss Institute. She received her master’s degree in public administration from Ohio University. She is also a graduate of the JoAnn Davidson Leadership Institute.

 

Timothy Keck was appointed by Ohio Governor, Mike DeWine to serve as the Public Member of the Ohio Occupational Therapist, Physical Therapist and Athletic Trainers Board (“OTATPT”). The OTATPT meets to actively promote and protect the health of Ohioans through effective regulation of the professions of occupational therapy, physical therapy, and athletic training. As the sole public member, Timothy represents the consumers of the services rendered by the multiple disciplines for which the OTATPT regulates. Timothy was a strong advocate for the OTATPT’s decision to establish a Safe Harbor program to assist practitioners in getting the help they need for mental health and addiction.

 

Katie Stuart, CIP, is the Bureau Chief over the Administrative/Operations Bureau for the Division of Occupational and Professional Licenses. She also oversees the Health Professionals Recovery Program, working alongside Southworth Associates. She was born and raised in Idaho. Katie graduated from Boise State University with a degree in General Studies with an emphasis in Addiction Studies. She became a Certified Intervention Professional in 2015. This certification allowed her to conduct interventions on behalf of families and professionals, who were and are currently struggling with addiction. Katie has been working in the substance use and mental health field for the last 11 years. Her passion is to help medical professionals on their journey and path to recovery.

 

 

  • Find out if your state already has a PHP that would partner with your board.
  • Contact the state agency in charge of mental health and substance use—see if they have referral resources to offer.
  • Examine the board's disciplinary procedures to reduce stigma related to mental health and substance use.
  • Identify resources available to boards to promote wellness—the second leading cause of why people don’t get treatment is that they don’t know what options are available to them.

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