Mental health and your medical

I’ve been diagnosed with a mental health condition. How do I prepare for my appointment with the aviation medical examiner?

I didn’t report something on my medical application that I should have. What now?

Federal Air Surgeon Dr. Susan Northrup addressed many of those questions in a wide-ranging interview with AOPA. For Northrup, getting pilots with mental health conditions into the air safely comes down to the “three Es”: education, early intervention, and evolution of standards.

Education

Northrup counsels pilots to “preflight their medicals” to ensure they provide all the information the FAA will need to make a decision. They can find those requirements in the Guide for Aviation Medical Examiners. The FAA recently added an explanation of how to use the guide, among other resources, to the start of the MedXPress application process for first-time applicants and those with new, significant medical conditions.

Providing all necessary documentation from the start can save a pilot significant delays: Northrup said applications that reach general review take 28 days if the FAA can make a decision in the first pass, but more than 100 days if the FAA has to ask for more information.

Early intervention

“Pilots don’t like to admit that they’re having issues,” Northrup said. “And they’re afraid that if they admit it, they’re not going to get their medical. That’s not true. Most of them will get their medicals.” She said early intervention helps pilots deal with life stress before it worsens.

She encourages pilots to seek out peer support programs, where pilots can talk with fellow pilots who are trained in offering support and guidance. Northrup said pilots also can seek out support from professionals such as school counselors or pastors without reporting it to the FAA. In May, the FAA published guidance on reporting mental health therapy or counseling that clarifies that couples counseling also need not be reported unless the pilot has been referred for individual therapy, nor consultation with an employee assistance program unless it results in a referral.

Evolution of standards

Completing the requirements to earn a special issuance medical certificate can be costly and time-consuming. Northrup outlined some of her office’s efforts to reduce cost and wait times.

In 2010, the FAA began considering special issuance medical certification for pilots being treated for depression with one of four selective serotonin reuptake inhibitors (SSRIs). Qualifying criteria included being stable on the medication for 12 months, neurocognitive psychological testing, and oversight by a Human Intervention and Motivation Study (HIMS) aviation medical examiner. Since then, Northrup said, the FAA has reduced the 12-month wait time to six months and now three. The initial neuropsychological testing, which may cost $3,000 to $5,000, is still required, but annual testing is now only required if there are clinical findings, she said. The antidepressant protocol now includes nine medications of various classes.

In spite of recent improvements to the medical certification system, many pilots are still reluctant to get treatment for fear of losing their medical.

“What I typically will tell them, is sometimes you got to be more worried about living than flying,” Northrup said. “Get what’s going on treated. Take care of the issue so that you have the tools, get stable, and come see us.”

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