April 26, 2019
The stigmas associated with mental health and addiction are fading. As a result, more individuals are coming forward and receiving appropriate treatment.
Nearly half of us are diagnosed with a mental health problem sometime during our lifetime. About 20 percent of the population reports having had a depressed mood sometime during each year. Addiction – be it to alcohol or drugs – afflicts a reported 7 to 11 percent of Americans.
Unfortunately, business aviation industry professionals – pilots included – are not immune to the various mental health issues affecting the overall population. Most commonly, these can include depressive mood, full-blown depression, psychotic conditions such as bipolar disorder, addiction and thoughts of suicide.
“The aviation community is subject to the same life stressors as the general population, but pilots, in general, often have personality traits that make them reluctant to seek mental health assistance,” said Quay Snyder, MD, MPH and president & CEO of Aviation Medicine Advisory Service.
“They want to be in control and solve problems on their own,” Snyder explained. “We often see pilots who have let a situation deteriorate to the point where the problem has gotten significant. This also can be because they are concerned about possibly losing their medical certificate and possibly their career.”
According to Snyder and other aviation medical experts, the good news for pilots – the only business aviation affected by federal mental health and medical regulations – is that there is significantly less stigma than there was years ago to seeking help for mental health and addiction issues. As a result, more individuals are coming forward and receiving appropriate treatment, from family counseling to in-patient addiction treatment.
“We have learned a lot from fighting the fatigue issue and removed most of that stigma,” said Greg Farley, chairman of the Fitness for Duty Working Group of NBAA’s Safety Committee and senior global captain for Deere & Company Aviation Services. “We’ve extended the fatigue models to individuals with substance abuse or prolonged mental-health issues. The sooner it gets reported, the sooner we get it treated and hopefully get that person back in service.”
PILOTS GETTING BACK INTO COCKPITS
Other recent positive developments include a proliferation of programs designed to help aviation professionals with a suspected or diagnosed problem, such as the Human Intervention Motivation Study (HIMS) program, which provides a structure within which pilots struggling with substance abuse or dependence can be identified, referred for treatment and, if in recovery, safely returned to the cockpit. The FAA helps fund HIMS, which involves managers, pilots, healthcare professionals and the FAA working together.
According to Snyder, who manages the national HIMS program, pilots who require help are identified through a variety of ways: peer intervention, employee drug and alcohol testing, law enforcement encounters, coworker and family referrals, and, less frequently, self-disclosure. Then pilots usually are treated in an in-patient program, followed by long-term aftercare, participation in a 12-step program, frequent unannounced follow-up drug and alcohol testing, abstinence and close monitoring by supervisors, sponsors, peers, specially trained aviation medical examiners (AMEs) and other medical professionals.
“HIMS has been a highly successful program, with an 85-percent long-term sobriety rate,” said Snyder. “We now have more than 6,600 pilots in recovery flying again with their first-class medicals.” (This number includes airline, business aircraft pilots and others.)
Snyder believes pilots in successful long-term recovery make great employees. “They are extremely productive, loyal and grateful,” he said. And, with the pilot shortage and often tens of thou-sands of dollars associated with pilot training and company requirements, it is usually less expensive for employers to stick with their pilots through treatment than to let them go and try and find another qualified aviator.
LEARNING TO IDENTIFY THOSE AT RISK
Carolyn Coarsey, Ph.D., is a former flight attendant and trauma survivor. Through her Family Assistance Education and Research Foundation, and as a master trainer for the QPR (Question, Persuade and Refer) Institute founded by Dr. Paul Quinnett, she offers “gatekeeper” programs to organizations where individuals are trained to recognize risk factors, as well as warning signs, of individuals who are at risk for suicide. The training also helps identify those who may not be at risk for suicidal behaviors, but may need assistance, assessment and treatment for any number of mental health issues. With a particular interest in aviation, Coarsey works with airlines as well as the business aviation community.
“Pilots are people, too,” says Coarsey. “They also suffer losses, divorce, illnesses and all of life’s stressors. Being down about something doesn’t necessarily mean that someone is severely depressed or suicidal.”
Coarsey says that the gatekeeper training can help prevent a tragedy by having trained individuals step in and encourage help and support, including counseling, for someone who is really suffering or showing signs of mental health distress. Often, however, a colleague may just be dealing with normal life issues.
“Everyone can relate to being in a depressed mood that can occur when we deal with life’s losses,” said Coarsey. “It’s so important that we normalize this and take away the stigma associated with it, as well as the course of treatment.”
Bipolar disorder, thoughts of suicide and many depressive disorders – and the medications used to treat them – are medically disqualifying for pilots.
However, since 2010, FAA policy allows for use of four SSRIs (selective serotonin reuptake inhibitors) – Celexa, Prozac, Zoloft and Lexapro –under very specific circumstances.
These antidepressant medications are now “waiverable” once a pilot is on a single same-dosage therapy for at least six months. After a required waiting period for stabilization, cognitive testing and oversight by a psychiatrist, pilots being treated for mild to moderate depression may get a special issuance (SI) medical certificate, which allows them to continue flying. The program also involves the services of a specially trained AME who serves as the “individual medical sponsor” and conducts periodic reevaluations.
Overall, enhancing AME training regarding assessing and treating pilot mental health issues is a key goal of the Pilot Fitness Aviation Rulemaking Committee (ARC), which was chartered in 2015 by the FAA after the Malaysia Flight 370 and Germanwings Flight 9525 tragedies to discuss and provide recommendations to the FAA on pilot mental fitness for duty.
The ARC recommended restructuring AME basic and refresher curricula, with the goal of enhancing AMEs’ abilities to identify warning signs and refer pilots for evaluation and intervention. Ultimately, the ARC and medical experts agree that creating
a safe, supportive, and penalty-free environment for pilots is the best way to encourage voluntary self-disclosure.
“We have to encourage telling the truth,” said Farley. “Pilots have to see that there will be no consequences for coming forward with an issue.” Fear of losing their job is largely unfounded in the vast majority of cases.
Snyder agrees, noting there are great benefits and better results with early intervention, including counseling.
“Counseling is very effective in treating a spectrum of mental health disorders, and pilots do well with cognitive behavioral therapy,” said Snyder.
Snyder has long advocated for pilots to do their own fitness for duty check-list as outlined by the FAA, which is called “I’M SAFE.” That acronym stands for Illness, Medications, Stress, Alcohol (and other drugs), Fatigue and Eating/Hydration. He also says maintenance technicians should be part of the overall fitness-for-duty dialogue.
Including a fitness for duty checklist as part of the International Standard for Business Aircraft Operations (IS-BAO) standards for safety management systems is something Snyder thinks would be very beneficial.
IS-BAO Director Ben Walsh said that pilot mental health issues are being studied by the International Civil Aviation Organization, the worldwide standards-setting group, and that most companies with an SMS already have mechanisms in place to address risks proactively, and doing so with programs like HIMS is a proven way.
FITNESS FOR DUTY WORKING GROUP DEVELOPING TOOLS
Greg Farley and his colleagues on the Fitness for Duty Working Group, which is part of NBAA’s Safety Committee, hope to soon give operators tools to deal with mental health issues, including a proposed policy statement and a frame-work to use as part of a safety management system. The group has been pro-active on fatigue concerns, which Farley notes are related to both mental health and medical issues. “We hope to help give people the tools to start measuring fitness for duty and then help them know what to do about it,” he said.
ONE PILOT’S RECOVERY
Linda (not her real name) is a Gulf-stream V copilot in long-term recovery and back flying after having success-fully completed the Human Intervention Motivation Study (HIMS) program. She credits her company for its supportive pilot assistance program, which paid for her treatment and covered 60 percent of her pay during the 14 months it took to get her special issuance (SI) medical certificate.
Linda was monitored closely for another four years and now – eight years after acknowledging her opioid and alcohol addictions and beginning treatment – is flying again with her first-class medical.
“I consider my experience to be an asset to my company, because of the extensive monitoring program I have been through, and because I am so grateful to be flying again,” she said.
Linda now volunteers as a peer counselor with her company’s pilot-assistance program.