Understanding Your Options
Security Clearances and Mental Health Treatment: What Is Actually Asked
By Dr. Stacey Forbes, DNP, APRN, PMHNP-BC
Key Takeaways
- The belief that seeking mental health care automatically jeopardises a clearance is widespread and, as a general rule, wrong.
- The security questionnaire asks a narrower question than most people assume, and several categories of counselling are explicitly carved out.
- Untreated conditions are generally the greater risk to reliability and judgement — which is the thing the process is actually assessing.
- This page is general information, not a determination. Your facility security officer is the authority on your specific situation.
In Los Alamos, at Kirtland and White Sands, around Eielson and Joint Base Elmendorf-Richardson, in the defence electronics corridor on Florida’s Space Coast — the same worry comes up in the first appointment, and often in the phone call before it. If I get treated, do I lose my clearance? The belief is widespread, it is usually based on outdated information, and it delays care by years.
What the questionnaire actually asks
The standard questionnaire used for national security positions asks about mental health consultation, but it is a narrower question than the folklore suggests, and it has been narrowed further over time specifically because the old framing discouraged people from getting care. Several categories are explicitly carved out — counselling related to grief, family or marital matters not involving violence, counselling related to adjustment from service in a military combat environment, and counselling as a victim of sexual assault among them. The form is also not a test with a single disqualifying answer: it opens a conversation, and disclosure of treatment is not itself an adverse finding.
What the process is actually assessing
The underlying question in an adjudication is whether a condition affects judgement, reliability, or trustworthiness — not whether someone has ever seen a clinician. That framing cuts the opposite way from how the fear runs: a treated, stable condition generally supports the case that judgement and reliability are intact, while an untreated condition that is affecting sleep, mood, drinking, or decision-making is the thing that actually presents a concern. Avoiding treatment to protect a clearance frequently produces the situation the process is looking for.
Why the fear persists anyway
It persists because the guidance has changed while the workplace folklore has not, and because the cost of being wrong feels catastrophic and personal. In small communities built around a single installation or laboratory, it is compounded by visibility: people are not only worried about the form, they are worried about being seen walking into the one local practice. Both concerns are real, and neither is a reason to go untreated.
What to actually do
Get the answer from someone with authority over your specific case rather than from a colleague, a forum, or this page. Your facility security officer or the appropriate security representative can tell you how disclosure works for your position — and it is a question you are allowed to ask in general terms without having already begun treatment.
- Ask your facility security officer how disclosure works for your position
- Ask in general terms, before treatment, if that is more comfortable
- Do not rely on a colleague’s account of what happened to someone else years ago
- Tell your clinician that clearance is a concern — it belongs in the conversation
Privacy in a small community
Where a town is built around one laboratory or one base, the visibility concern is separate from the clearance one and just as effective at delaying care. A telehealth visit taken from home removes it: there is no waiting room, no parking lot, and no chance of passing a colleague on the way in. For patients in Los Alamos, Alamogordo, Clovis, Palm Bay and similar communities, that is frequently the difference between starting treatment and continuing to postpone it.
Common Questions
Will seeking therapy cost me my clearance?
As a general rule, no. The questionnaire asks a narrower question than most people expect, several categories of counselling are explicitly exempt, and the adjudication is concerned with judgement and reliability rather than with whether you have seen a clinician. Your security officer is the authority for your specific case.
Do I have to disclose every appointment?
No — the form does not ask for that, and several categories of counselling are carved out entirely. What is required depends on your position and the specific form, which is why the question belongs with your facility security officer rather than with a clinician.
Can I ask about this before I start treatment?
Yes. You can ask your security officer how disclosure works in general terms without having begun treatment, and many people find that removes the obstacle entirely.
Should I tell my psychiatrist that I hold a clearance?
Yes. It is relevant context — it affects what you may be weighing, and it lets the conversation happen openly rather than sitting unspoken underneath the appointment.
Sources & Further Reading
- Defense Counterintelligence and Security Agency
- NIMH — Mental Health Information
- 988 Suicide & Crisis Lifeline
If you need help right now
Willow & Stone is an outpatient practice and is not an emergency service. If you or someone you care about is in immediate danger, call 911.
For urgent mental health support at any hour, call or text 988 to reach the Suicide & Crisis Lifeline, or text HOME to 741741 for the Crisis Text Line. Both are free, confidential, and available 24/7 nationwide.
Dr. Stacey Forbes, DNP, APRN, PMHNP-BC
Board-certified Psychiatric-Mental Health Nurse Practitioner and founder of Willow & Stone Integrative Mental Health. Nearly two decades of clinical experience; integrative, root-cause psychiatry via telehealth. Licensed in Texas, New Mexico, Florida, Alaska, Arizona & Colorado.
About Dr. Forbes →