Mental Wellness in Aviation Starts With I’M SAFE

Pilots are not immune to mental health challenges, but despite increasing awareness, mental wellness issues among pilots often go unreported or untreated.

Pilots are understandably hesitant to report mental health concerns. Fear of losing their medical certificate, facing stigma from employers and colleagues, and even lack of access to mental health professionals – specifically those with aviation experience – can prevent pilots from seeking assistance.

Monitor Your Wellness

People tend to think mental health conditions are very dramatic, acute situations that come on out of nowhere. In reality, mental health issues usually present much more subtly. The first signs a pilot, colleague or family member might notice could be very small changes, explained Dr. Greg Vanichkachorn, an aerospace medicine specialist physician at the Mayo Clinic’s ProPilot program. Some signs of mental unwellness are losing interest in normally pleasant activities; being more introverted; struggling to say the words intended; and increased irritability.

“The brain only has so much bandwidth, so people with ongoing issues might be more irritable; essentially, they lose their filter, which can result in lashing out or seeming more negative,” said Vanichkachorn.

It can be difficult to identify these behaviors in ourselves, so keep an eye on your colleagues, friends and family members. And if someone approaches you with concerns about your behavior, take it seriously.

“Mental health is a team approach. Just from the nature of mental health conditions, sometimes it takes an outside perspective,” said Vanichkachorn.

To spot mental or emotional issues in your own life, use the FAA’s I’M SAFE acronym:

I Illness

Are you sick or feeling physically unwell?

M Medication

Are you taking any medicines that might impair your judgment or make you drowsy?

S Stress

Are you under psychological pressure from the job? Do you have money, health or family problems?

A Alcohol

Have you been drinking within 8 hours? Within 24 hours?

F Fatigue

Are you tired and not adequately rested?

E Emotion

Have you recently experienced any emotionally upsetting event?

Although the I’M SAFE acronym is intended to be used before a flight, Elizabeth Bjerke, Ph.D., associate dean and professor at the University of North Dakota’s (UND) aerospace department, said it’s helpful in all daily activities.

“Every day you should be checking with the I’M SAFE checklist,” said Bjerke, adding that UND students can “I’m safe” themselves at any time, meaning they can cancel a flight without penalty or challenges simply by referring to the I’M SAFE concept.

Bjerke said that self check-in can help a pilot not only determine if they’re mentally and physically fit to fly on a given day, but also to establish their own expectations for performance in other activities.

Managing at Home

We all have stress, whether work-related or challenges dealing with aging parents, teenage children or other relationships. While the FAA is primarily concerned about sudden onset pilot incapacitation, the reality is that stress builds on a continuum. Working to mitigate the impacts of daily and ongoing stressors can benefit your mental health and even prevent big problems in the long run.

Common suggestions to reduce stress include taking a walk, getting out in nature or spending time with a furry friend.

So, you’ve tried managing your stress by getting exercise, getting some fresh air and hanging out with Fido, but you remain anxious or down. Now what?

College-Based Solutions

Aviation universities know all too well the risk of untreated stress and mental illness. Both the University of North Dakota and Auburn University have felt the trauma of student suicide. These schools, and others, are developing programs to reach students long before they’re employed as pilots.

Zach Lewis, a junior in Auburn’s aviation management program, has been instrumental in the development of a peer support program (PSP). PSPs connect peers going through challenging times with trained volunteers from their own peer group. PSPs are common in airlines and some large business aircraft operators, but are not widely available in business aviation.

Bjerke and Lewis suggest seeking out a trusted peer to talk with. If your organization has a PSP or an employee assistance program, reach out to those groups for help.

“The younger generation seems more open to talk about these things and to seeking help,” said Bjerke. This willingness to discuss mental health challenges helped UND launch its peer program, UpLift.

“Sometimes students don’t realize how many other students have similar challenges,” Lewis explained. “That’s where the PSP comes in. Just knowing you’re not alone can help.”

That advice applies not just to students, but also to well-established professionals.

Experts also recommend making sleep a priority.

Matthew McNeil, M.S., a licensed professional counselor, ATP and the founder/director of human performance at LiftAffect, suggests practicing meditation and using apps such as Headspace and Calm.

Vanichkachorn said mental wellness is really about prevention and maintenance – concepts familiar to pilots. He suggests they consider nutrition an important part of good mental health, and he tells people struggling with daily stressors and anxiety to remember to get out and have fun.

When to Seek Help

When you feel mental health symptoms are interfering with your daily life, it’s time to seek help. This can be scary for pilots, because medical conditions must be reported to the FAA during the medical certification process. Essentially, a condition is reportable if a formal diagnosis is made. Whether through a counselor, psychologist, psychiatrist or other healthcare professional, a diagnosis is often made when requesting payment from an insurance company. After that, it’s difficult to remove a diagnosis from health records. Another challenge is that aviation medical examiners who specialize in mental health are few and far between.

While mental health issues are a continuum, so too are mental health treatments. Not all treatment options require FAA notification. Vanichkachorn said counseling services can teach new ways of thinking or stress-relieving mechanisms like mindfulness and breathing exercises.

“Sadness, worry, anger, grief and stress are normal emotions that everyone experiences,” McNeil said. “When things become ‘abnormal’ and unmanageable is when these emotions begin to consistently negatively impact one’s daily ability to function. Psychotherapy (often referred to as ‘counseling’) alone works for about 90% of our clients. If you have concerns about your mental wellness, it’s best to reach out for help, as small problems untreated often become big problems.” 

Seek out medical professionals experienced in aviation issues, especially if a formal diagnosis might be made or medications might be prescribed. For example, four medications used to treat anxiety or depression can be approved for use by the FAA; however, these are only a few of the dozens of medications a mental healthcare professional unfamiliar with FAA medical requirements might prescribe.

It’s critical to safety for pilots to seek assistance before mental health concerns escalate.

“One part of professionalism is holding safety to the highest standard. Getting help for yourself is also in the interest of safety for your passengers and those around you,” said Vanichkachorn. “Taking care of your mental wellness is not a sign a weakness; it’s a sign of professionalism.”

What Organizations Can Do

It’s critical that organizations promote a culture where an individual can come forward with a mental wellness concern without the added fear of organizational retribution.

The best approach gives an individual the space to say, “I’ve got something going on today,” without having to share specifics. As appropriate, management and fellow employees should encourage individuals to prioritize mental wellness with appropriate and effective strategies and resources. Also, larger organizations should consider establishing PSPs.

“Mental wellness should be a group effort; there’s no competition when it comes to safety,” Lewis said.