We need to change the system that keeps pilots from getting mental health care

By the age of 29, Chris Daniels felt he had everything: a wife, two beautiful children, and fulfilling his lifelong dream of becoming an American airline captain. But in the spring of 2022, after years of flying, Chris knew something wasn’t right. The shadows of her past were re-emerging, strained by the demands of COVID travel and taxing long hours on the road. Years ago, Chris’s therapist suggested that his bad moods and sleeplessness might be symptoms of mild depression. But like many pilots, he balked at the idea. If a doctor diagnosed depression or if he sought help, Chris assumed he would never be able to fly again. Asking for help seemed unthinkable because missing the flight was like losing everything; Being a pilot is who he was.

Chris’s story is not unusual. While mental health symptoms are common among airline pilots, Getting help can massively affect their ability to function. Airline pilots are required to meet certain medical standards in order to maintain active flight status, and disclosing a new symptom or condition to the Federal Aviation Administration (FAA) puts them at risk of losing it, usually temporarily. , their ability to work and fly. This is especially true for mental health symptoms. The FAA barred pilots from the cockpit if they sought routine talk therapy for minor anxiety or depression; This can go on for months and sometimes even years, based on the perception that they pose an unacceptable risk to security. In fact, pilots find themselves in only a handful of occupations that require disclosure of any encounters with the health care system, including mental health visits.

While grounding a pilot in distress makes sense, current systems often fail to recognize the dynamic and often situational nature of mental health symptoms and often prevent pilots from seeking care. Taking time off the job can have negative effects such as loss of pay and the need for repeated training, and additional medical evaluations required by the FAA often cost the pilot. All of this results in a population of fleet pilots who are suffering in silence and are afraid to get the help they need. We must rethink the system that prevents pilots from attending to their mental health and change the demand for mental health care services in aviation.

Data gathered by my group and others are beginning to reveal the extent of the problem. Our findings demand attention. In our recent study of more than 3,500 US pilots, 56 percent reported behavior that we classify as health care avoidance (eg, obtaining health care outside the traditional system to avoid its documentation). ) especially because he feared loss of clearance to fly. Interestingly, 26 percent of pilots reported that they withheld information during their FAA health screenings for the same reason: fear of losing their medical clearance. This is sometimes referred to as “losing your wings”.

In a sister study, more than half the pilots in our sample had something they felt needed to be investigated—perhaps it was related to mental health, perhaps a knee injury, or even just a rash—but waited or decided against it because they were worried about their careers. While our studies focused on holistic health care, we suspect that this finding applies to mental health as well.

Many pilots have good access to health care. This includes health insurance, paid time off, and sometimes other union protections. Instead, these data suggest that a barrier exists as pilots are asked to weigh the benefits of seeking professional help against the costs that they would have borne alone. How bad does mild anxiety have to be to warrant a prolonged absence from work? For most pilots, too bad.

The growing demand for pilots in our travel-hungry, COVID-endemic world is likely to further compound this problem. The Bureau of Labor and Statistics projects 18,100 new pilot jobs each year for the next decade, driven by the continued growth of air travel. As compensation increases through 2022, more is being demanded of pilots, including longer and more frequent trips to keep pace with passenger demand. This is in the context of other airline businesses – such as maintenance and administrative staff – facing key personnel shortages, putting further pressure on systems already operating at their limits. The high demand for pilots may lead to additional time away from family and friends, which may lead to an even greater need for mental health care services. Simply put, pilots’ need for mental health care is likely to increase in the coming years.

While on the surface it may seem that increasing the pool of pilots would ease the situation, more pilots will not fix the existing challenges in the system. Flight training programs are expanding, and some airlines are taking the unprecedented step of establishing their own training programs. But, while class sizes are growing, they are being filled by a younger and more diverse generation of student pilots who may not be as willing to suffer as quietly as their predecessors. In fact, emerging data suggest the willingness of current pilots (who are still largely in the 40 to 60 age range) to avoid health care for job security may not hold true for the next generation. Is.

“Younger pilots are different from previous generations and are more willing to recognize as needing help when it comes to their mental health,” said John Dalsky, 21, an aviation student at the University of North Dakota and an advocate for aviation mental health reform. told me during a recent phone call. “Many are willing to seek care at the risk of being turned away from flying.” The answer to why such a phenomenon is happening is an open question that our research group is trying to understand. Could it be related to the effects of social media reducing the stigma of mental health or being amplified through the pandemic? We hope that future research will reveal the answers.

A new generation of Gen Z airline pilots more open to stepping away from flying to seek mental health care services may only further exacerbate the pilot shortage. But more importantly, the industry should rethink what it means for an airline pilot to be mentally fit and what services they should be able to receive while serving in the fleet. We can all agree that safety must be the foundation for meaningful change in aviation. Certainly, a pilot with a serious mental health condition should not be flying. But the opportunity is there for pilots with mild symptoms. These are high-performing professionals who are probably coping with one of life’s common stressors – a divorce, a family death or even chronic job stress. How can we rethink a system that enables this group to seek mental health care services in hopes of warding off a diagnosis that may pull them from flying altogether?

One answer is obvious. The FAA should change the policy to allow pilots with mild symptoms to seek professional routine, and if needed over a longer period of time, talk therapy without losing their medical certification. Such a change would have major benefits for people on both sides of the flight deck door, including treatment to prevent worsening symptoms and regular pilot evaluation by a professional mental health provider. Recognizing that mental health is on a dynamic spectrum and that many pilots may benefit from speaking with a professional mental health provider at some point in their careers, the ability of pilots to fly healthy as well as the system Also increase security. Pilot unions and airlines should fuel this movement by increasing their pilots’ awareness of the issue and lobbying a coalition of stakeholders to determine how to safely implement this change. While the FAA is credited for making several positive policy changes related to mental health recently, there is still work to be done and time is of the essence.

Chris Daniels never received help for his mental health symptoms, and despite an excellent flight record, he died in June 2022 by suicide. While we recognize that suicide among pilots is relatively rare, this extreme outcome is why we must seek positive change. Aviation’s safety culture must think of mental health care services as a marker for wellness and prevention, rather than risk and illness, with the use of appropriate supervision and reevaluation. This change will benefit not only pilots, but also the two million American travelers who rely on the aviation system every day.

if you need help

If you or someone you know is struggling or having thoughts of suicide, help is available. Call or text 988 or access the 988 Suicide and Crisis Lifeline online lifeline chat,

The views expressed here are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the Department of Defense, or any agency under the US government.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily scientific American.


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