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During a critical time in commercial aviation with a high and growing shortage of airline pilots, the Federal Aviation Administration (FAA) is neglecting an outcry for pilot mental health care, especially for simple services that address the normal stresses of our rapidly growing advanced technological and logistical aeronautical environment.
On Aug. 25, 2023, the headline of CBS News in Colorado was: “Pilots are crying out for help: Pilots criticize FAA for outdated prohibitive mental health policies.” The article goes on to comment that the FAA’s outdated mental health policies cause pilots to lie about their conditions or avoid getting help until their issues boil over.
I can attest to the above conditions because I work with pilots. Some of these individuals are seasoned advanced pilots with over 30 years of experience, while others are just beginning their careers as apprentice pilots (two thin stripes), junior pilots (three thin stripes), and senior pilots (four thin stripes).
On April 26, 2023, the heading of a Fox News report was, “Mental health in aviation: Pilots are suffering in silence, afraid to get wings clipped. Over half of the pilots surveyed (by Fox) admit to avoiding health care—including mental health care.”
On Aug. 18, 2023, a United Airlines pilot was charged with criminal mischief for allegedly using an ax to destroy a barrier gate at an employee parking lot at Denver’s airport, telling authorities he was trying to help several drivers exit the lot and stated: “He just hit his breaking point.”
A March 27, 2023, Smithsonian article, “Military Pilots Avoid Health Care to Keep Flying,” says,
“U.S. military pilots avoid health care or misrepresent and withhold health information from their flight surgeon at greater rates than civilian pilots out of fear they might lose their flying status, according to a new study conducted by Air Force and civilian medical experts … Though the population size of 264 military pilots surveyed was relatively small, the study marks one of the first attempts to scientifically analyze the widely-held belief that military pilots avoid health care, particularly mental health care, out of fear that certain medical conditions will take them off flight status.”
If a pilot decides to consult with a licensed mental health professional and has psychological concerns that might include the possibility of medication, she must consider that it will cost her a lengthy time in the absence of her career.
Additionally, if a medical or mental health practitioner is consulted, it must be reported in the pilot’s medical examinations.
At a May 18, 2023, meeting it was quoted from a 2002 study that was published in the Journal of Occupational and Environmental Medicine finding that 56.1 percent of pilots reported a history of healthcare-avoidant behavior related to fear of losing their aeromedical certificate, and nearly 27 percent indicated misrepresenting or withholding information on their aeromedical screening for the same reason.
At the Business Aviation Safety Summit, organized by the Flight Safety Foundation and National Business Aviation Association, Federal Air Surgeon Susan Northrup discussed the volume of pilots whose applications have a mental health component, aiming to “dispel the myths” about certification qualification so barriers to treatment can be destroyed.
These ideas and beliefs are slow to take hold within the pilot community and significant skepticism remains as to the safety of reporting mental health consultations.
An individual may be considered for an FAA Authorization of a Special Issuance (SI) or Special Consideration (SC) of a Medical Certificate if the applicant has one of the following diagnoses: major depressive disorder (mild to moderate), either single episode or recurrent episode, dysthymic disorder, adjustment disorder with depressed mood, any non-depression related condition for which the SSRI is used.
To return to active duty, the person for a minimum of six prior continuous months has been clinically stable, as well as on a stable dose of medication without any aeromedical significant side effects and/or an increase in symptoms.
The use of psychotropic drugs is generally disqualifying for aeromedical certification purposes. Examples include sedatives, tranquilizers, antipsychotic drugs, antidepressant drugs (including SSRIs, with some exceptions), and hallucinogens.
The medications considered viable for depression and not limiting in terms of a pilot’s career, include (single use only; not in combination): Prozac, Zoloft, Celexa, Lexapro, and Wellbutrin.
What should the FAA consider?
Proven drugs that historically help individuals return to a healthy life. Some of these drugs are “life-changing” and do not at all contribute to atypical behavioral side effects that would compromise a pilot’s capabilities.
What is a career-limiting condition?
If the applicant has symptoms or a history of psychosis, suicidal ideation, electroconvulsive therapy, treatment with multiple SSRIs concurrently, or multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with SSRIs) their careers are certainly finished.
What are pilots often forced to do?
Firstly, they seek out a therapist who is familiar with FAA guidelines. Secondly, they may pay out-of-pocket expenses since the use of insurance requires a diagnosis. The pilot is required to report that there are in psychotherapy, but given the many complex circumstances, many do not.
Many pilots seek help with ongoing marital problems, family tensions, certainly depressive symptomatology, including lack of interest in ongoing events, inability to sleep, feeling worthless or excessive/inappropriate guilt, and decreased concentration.
“Being a pilot is one of the most high-stress jobs in which pilots are often overworked, struggling with chronic strep, anxiety, depression, use and abuse of alcohol—and in some cases, drugs,” Capt. Reyné O’Shaughnessy told Fox News.
Being a commercial pilot requires facing a demanding schedule that routinely includes irregular working hours and extended periods away from home. Maintaining a healthy work-life balance can be challenging due to the unpredictable nature of the job.
Most airlines offer in-house programs in which pilots serve as coaches for each other. However, often coaches are not healthcare professionals and are not trained to recognize significant mental health complexities. These individuals bring their knowledge and expertise from their flying experience to their colleagues, which could provide a critical intervention. Yet it is important to recognize that an in-house program can be a mechanism to keep the secrets of pilot stress and mental health concerns in-house.
In conclusion, pilots deserve the best care available without repercussions from a system that admonishes advances and the readily available mental health care that we are all entitled to.
To find a therapist, visit the Psychology Today Therapy Directory.
