We Need to Change the System That Keeps Pilots from Seeking Mental Health Care

This is not just an FAA problem. Pilot medical certification decision making by the authorities in many countries is capricious, opaque, prolonged and usually behind the science by a decade or more.

A childhood diagnosis of ADHD or asthma might be a bar to obtaining a pilot medical even though the condition was resolved over a decade ago.

That said, one pilot with mental issues deliberately crashed an airliner in Southern France several years ago.

The captain took a washroom break and was blocked from the cockpit by the hijacker proof door.

We discriminate against pilots for their health quite broadly, not just their mental health. I think what makes mental health different than say, eyesight, is that it's hard to fake having eyesight but relatively easy to fake being mentally healthy.

As such, the system doesn't effectively discriminate against the mentally healthy, it fails at such discrimination in all but the most extreme cases and instead succeeds in getting the mentally ill to seek less treatment.

Great article and absolutely right. I am a pilot in the US and I also suffer from chronic mild depression that a very low dose SSRIs seem to help with. I’ve never been suicidal and most friends probably don’t even know I’ve been less happy than I could be at times. I’ve concluded it’s just something to do with my brain chemistry, and many years ago I may not have even considered that something “medical” was wrong and there were cheap, low risk treatments that could improve my life. These issues have never stopped me from being “successful” by any conventional metric.

The FAA, unfortunately, seems have a more black and white view that reflects a worldview that is stuck in the past. While there is a process for getting “special issuance” (a quite recent change) so that one can keep flying while on certain SSRIs, it is very expensive, very intrusive (think full day battery of psych exams twice a year) and may have career implications. Many professional pilots in similar situations I’ve read about or spoken with don’t say anything at all or omit certain medications from their medicals altogether and hope they don’t get caught. Can you totally blame them?

In my case, I’ve chosen to make tech my primary career, and I scratch the flying itch with a Cessna I own. I’m able to do this with much less paperwork due to a very new program called Basic Med, which is available to private pilots. Were it not for these issues, I very well may have made different career choices though. Pilots with integrity, in the same situation and with my options would likely come to the same logical conclusions. For those who don’t have my options, it may come down to compromising their integrity or lower quality of life.

There are many out there like me, and the biggest risk to aviation safety here is failing to modernize this policy, not pilots’ mental health. As this article points out, it’s time for the FAA to take a more modern, nuanced view here that reflects our improved medical knowledge and de-stigmatizes using this knowledge to improve one’s quality of life. Specifically, it’s time to view SSRIs (in addition to talk therapy) used to treat mild depression symptoms in a similar way to how we think about statins and high cholesterol. We know more than we used to about the prevalence of these issues and standard treatments are available. This shouldn’t require a special issuance.