Industry Attitudes About Pilot Mental Wellness May Be Shifting

Industry recommendations addressing mental wellness concerns among pilots, and revised FAA guidance to aviation medical examiners (AMEs), mark progress toward not only the proper treatment of mental health, but also greater understanding of these issues across the industry, including in business aviation.

The Mental Health & Aviation Medical Clearances Aviation Rulemaking Committee (ARC) published a comprehensive list of recommendations to the FAA last year addressing concerns about mental health from across the aviation community.

Formed in late 2023, the ARC was tasked with five primary responsibilities. Topping that list was identifying factors that discourage those in the aviation industry from disclosing mental health concerns, including stigmatization and fear over the potential loss of a pilot’s medical certification.

“One key recommendation was removal of the requirement to disclose talk therapy sessions, so folks can get in to see a professional counselor without the need to disclose a medical visit,” said Mark Larsen, CAM, NBAA’s director of safety and flight operations, who represented business aviation on the ARC.

“We’ve seen peer support programs used to great effect within the commercial airline community, where there is no disclosure requirement,” he continued. “Peers help to change the culture of the industry by actively listening, ‘walking with’ their peer on the journey and affirming to the peer seeking support that, ‘it’s OK to not be OK and here are resources that exist to help you.’”

That attitude represents a welcome change. “Professional pilots face significant challenges when seeking mental health support due to stigma in the aviation industry,” said Matt McNeil, president, clinical director and director of human performance at LiftAffect. “This can lead to underdiagnosis and undertreatment, exacerbated by a lack of initial services and inadequate disability insurance coverage.”

“The recognition that peer support has received post-pandemic is conducive to more pilots seeking help,” added Dr. Quay Snyder, aeromedical adviser and co-founder of Aviation Medicine Advisory Service (AMAS) and also a member of the ARC. “Statistics indicate approximately 85% of issues that are stressing pilots can be resolved simply by talking to the peer without further assistance.

“And for those who do need additional help,” he continued, “such conversations help ensure they’re escalated appropriately and in a timely manner.”

A Universal Concern

According to a 2023 study by the U.S. Centers for Disease Control and Prevention (CDC) roughly one in five adults experiences regular feelings of anxiety and worry, while around one in 20 experiences depression. Left untreated, these conditions may contribute to approximately 50,000 suicides every year.

“There are 6 million emergency department visits annually for mental health and behavioral issues,” McNeil added. “While professional pilots may have unique personality traits and coping mechanisms, there’s no reason to believe they are any different from the general population in their susceptibility to these illnesses.”

Additional ARC recommendations included ensuring aeromedical screening protocols and requirements are based on safety management system (SMS) principles, including relevance and risk-based criteria; developing industry mental health literacy, education and awareness campaigns; and modernizing the FAA’s Aviation Medical Certification Subsystem to reflect positive developments in mental health knowledge and treatment.

Easing the Path to Medical Certification

Within days of publication of the ARC recom-mendations, the FAA issued updated guidance to aviation AMEs approved to evaluate pilots and air traffic controllers for medical certification, giving the AMEs greater autonomy to medically certify individuals with certain mental wellness concerns.

“Unlike other medical conditions like heart disease, when dealing with mental health there are many qualitative measures that must be taken into account,” said Dr. Clayton Cowl, chief of the section of transportation medicine at Mayo Clinic and a senior AME. “I think the FAA is realizing that and attempting to not paint with too wide a brush.”

This revised approach should also shorten the timeline for FAA review – a process that may currently take a year or more – and allow faster medical clearances for pilots. The new guidance provides AMEs with what Cowl termed “an uncomplicated track” for evaluating anxiety, depression and related conditions.

In turn, AMEs may approve certain cases without deferral to the agency. “As you can imagine, with more and more medical applications coming in, the queues for review of those cases were stacking up,” Cowl said. “AMEs may now be able to issue [a medical certificate] on the spot for pilots who’ve been off their medications and deemed stable by their mental health professionals, or those benefiting from seeing a therapist regularly for anxiety disorders.”

The FAA also added three new serotonin and norepinephrine reuptake inhibitors, or SNRIs – duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq) – to its previous list of conditionally approved medications used to treat anxiety and depression, including certain selective serotonin reuptake inhibitors (SSRIs) and Wellbutrin.

Getting to Yes

While these developments mark progress toward approval for certain mental health conditions, pilots hold ultimate responsibility to seek treatment for any concerns they may have, regardless of potential career implications.

“We encourage every pilot to be honest about their situation and report,” McNeil said. “We don’t see the FAA as the obstacle; it’s the timeline involved that needs improvement. But there is a process you must understand and follow. It will only delay things further if you don’t follow that.”

“These conditions exist on a spectrum,” Larsen added. “Someone may have needed counseling or medication for a short-term condition, but they came through it well and it’s no longer a concern today. Someone else may be experiencing mental illness that needs urgent and immediate care and treatment.”

In both cases, “it’s easier to be your own advocate when you have a great team around you, including the right counselor or doctor, to address head-on whatever issue you’re facing,” he continued. “The earlier that’s addressed, the easier the resolution will be, not only for your own health and wellbeing, but also with the right AME from a medical certification standpoint. They will all work to get to a ‘yes’ to return you to the flight deck.”

Cowl also emphasized that pilots need to take control of their condition with their AME. “Write a personal statement and don’t rush through it,” he advised. “That is your chance to tell your side of the story, so it helps to be introspective and thoroughly explain your situation.”

McNeil also noted a generational distinction in those who are reaching out for guidance and treatment. “The younger generation of pilots are much more apt to reach out for help,” he said. “They don’t stigmatize mental wellness like older generations.”

The presence of mental health services among the commercial airlines, and even at aviation universities, may be the driver for that change. “These resources and programs are already as familiar to the incoming generation of business aviators as, say, SMS,” Larsen noted.

Snyder expressed appreciation over how much progress has been made, crediting FAA Federal Air Surgeon Dr. Susan Northrup for much of the agency’s movement over the past few years on mental health matters.

“The ARC recommendations provide a well-thought-out roadmap for the FAA and industry,” he said. “There may be constraints on enacting these recommendations due to personnel shortages, legal and regulatory concerns, and certainly financial considerations – but as long as the FAA has the resources needed to follow these guidelines, I believe the agency will do that to their best effect. Our industry is fully committed to making this work.”

Review NBAA resources surrounding business aviation medical issues at nbaa.org/medical.