Baby steps

However, you will never hear that type of conversation in a pilot’s lounge—not because of the stigma of mental health issues but the consequences on pilot medical certification.

Depression in the United States is a significant and ubiquitous problem. The CDC states that 18.5 percent of the adult population has had a mild, moderate, or severe depressive episode in any two-week period, based on pre-Covid data. Gallup reports that 29 percent of Americans have been diagnosed with depression at some point in their life, and 17.8 percent currently have or are being treated for depression. By extrapolation, this means a significant number of pilots have depression, almost all unreported, which is only one of several common mental health problems.

The FAA Civil Aerospace Medical Institute (CAMI) has responded to last December’s NTSB Panel on Mental Health as well as its own Mental Health Aviation Rulemaking Committee recommendations made last winter concerning modernized approaches to some pilot mental health issues. This opens a pathway to medical certification for pilots and prospective pilots who have experienced certain types of mental health issues.

A major impetus for these recommendations has been multiple episodes of pilots who have not sought mental health care because of onerous FAA certification processes, which have ranged from the jump seat pilot event on the Alaska Airlines flight last year to at least two student pilot suicides in aircraft. Pilots and student pilots have been in the untenable position of not seeking care, or getting care and not revealing it, to obtain or maintain their pilot medical certificate.

As of June 26, 2024, the FAA now allows an AME to issue medical certificates for specific mental health issues when a checklist of questions is met and exclusion criteria are not present. Conditions such as situational anxiety, situational depression, and post-traumatic stress disorder, which used to trigger a deferral to Oklahoma City, can now be evaluated by the AME using this decision tool developed by the FAA. One other major change is that the AME can issue a medical to a pilot who has or is currently receiving psychotherapy.

Some examples of exclusion criteria are a history of suicide attempts or ideation, self-harm, or homicidal thoughts. Past hospitalizations, involuntary court order evaluations, or extreme treatment modalities like electroconvulsive therapy will also require deferral to Oklahoma City.

The FAA is now allowing AMEs to evaluate an applicant’s history of attention-deficit/hyperactivity disorder (ADHD). ADHD has been the “disease du jour” for years, and many patients have been misdiagnosed and treated without any formal testing just because they were not doing well in school. Most patients without true ADHD will stop medications since they do not have any effect and do not improve school performance. Medical certificate applicants who do not have current ADHD symptoms, have not had any symptoms in the past four years, and have not taken ADHD meds in the past four years must obtain a signoff from a psychologist or psychiatrist. The AME may then issue a medical with this certification without deferring an applicant who was over-diagnosed or inappropriately treated for ADHD. This saves a huge amount of time, testing, and money.

Other common problems like uncomplicated bereavement, relationship issues with life partners or children, and phase of life issues like a new career or being a new parent, which may have triggered anxiety or depression, can now be evaluated by the AME and the pilot given a certificate without deferral. These new criteria, which are all public and available online, put a lot more pressure on AMEs to perform a thorough evaluation and to use the proper templates and guides. This may require a significant amount of time over the normal pilot medical examination and pilots should be prepared to pay extra for this work. However, these new procedures will save significant time and money, outweighing any additional AME fees.

AMEs should have been able to evaluate these problems in the first place, especially as the understanding of mental health has evolved over the past 50 years. The FAA is playing catch-up but at least they are heading in the correct direction. Baby steps are better than no steps. Although these changes seem small, given the inertia of a large government agency, they are huge. Giving AMEs more decision-making capability, in and of itself, is a major advancement. The federal air surgeon, Dr. Susan Northrup, should be commended for moving the FAA into the twenty-first century.

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