Statistically speaking, only a very small percentage of security clearances are denied or revoked due to mental health issues. Those cases that do turn out unfavorably for the applicant often share a similar feature: failure to follow medical advice.

What Does Following Medical Advice Look Like?

I’m not a medical professional, but anecdotal evidence derived from years of defending security clearance denial and revocation cases hopefully counts for something. What I’ve observed is that many mental health conditions can be effectively managed through counseling, medication, or a combination of both. When the patient / clearance applicant is actively participating in their treatment, taking their prescribed medications, and following medical advice, that person is demonstrating precisely what the government wants to see before granting a clearance: reliability, good judgment, and self-awareness. When the patient / clearance applicant is not doing those things, the opposite is assessed to be true. That’s when what could have been a winnable case often goes off the rails.

To be clear, following medical advice doesn’t mean blind obedience to a treatment regimen that isn’t working or is causing side effects worse than the condition being treated. There are some not-so-good mental health professionals, just like there are some not-so-good attorneys.

However, if that’s the case, the clearance-holder or applicant can’t just walk away from treatment entirely and expect a favorable security decision. Instead, the individual needs to be able to credibly articulate why s/he disagreed with the treating provider and then demonstrate that s/he immediately sought out a different provider for either a second opinion or a different, medically-accepted form of treatment. “I don’t need treatment” or “I don’t have that diagnosis” simply isn’t going to cut it when a licensed medical professional is saying otherwise and you don’t have a similarly-credentialed expert to dispute it with scientific evidence.

Factoring in Your Medical Provider on the SF-86

More broadly, all clearance-holders and applicants with a mental health diagnosis should understand the importance of maintaining a frank, ongoing dialogue with their treating provider. The 2016 revisions to the SF-86 form no longer require clearance applicants to list every mental health practitioner they’ve seen in the last seven years, but the form does still ask a litany of targeted questions about certain mental health diagnoses, hospitalizations, and other issues that might demonstrate that the individual is unable to safeguard sensitive information or poses a danger to themself or others. An affirmative answer to any of those questions guarantees that background investigators will seek out the medical provider(s) for a conversation about the applicant’s fitness for duty.

Additionally, some cases and some agencies require medical clearance from a mental health professional employed by or acceptable to the agency before granting a clearance or entering onto duty. In any of these situations, the last thing an applicant or clearance-holder wants is a surprise, unfavorable assessment from his or her own provider. To the contrary, if the applicant follows medical advice and works collaboratively with the provider to advance his or her own treatment, that provider can prove to be a valuable asset in helping the individual obtain or retain a clearance.


This article is intended as general information only and should not be construed as legal advice. Consult an attorney regarding your specific situation. 



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Attorney Sean M. Bigley represents clients worldwide in security clearance denials, revocations, and the security clearance application process. He is a former investigator for the Defense Counterintelligence and Security Agency (then-U.S. Office of Personnel Management). For more information, please visit Readers will also find a low-cost, self-help option for obtaining copies of their security clearance background investigations and DISS/Scattered Castles records at