The agency has revised its guidance to aviation medical examiners (AMEs) on “uncomplicated anxiety, depression and related conditions” and chief among the changes is that the FAA can be left out of the process if the pilot has been off medication for two years, there are no issues raised by a questionnaire and the AME has no concerns.

The questionnaire deals with serious mental health issues like suicidal thoughts, self-harm and whether or not the pilot has been hospitalized or been under court-ordered evaluation, and it reminds the AME to be thorough and conservative in his or her judgment.

“If ALL items fall into the ‘NO’/CLEAR COLUMN, the AME may issue with notes in Block 60 which show the AME discussed the history of Uncomplicated Anxiety, Depression, and Related Conditions, found no positives to the screening questions, AND had no concerns,” the new guidance reads. “If ANY SINGLE ITEM falls into the ‘YES’/SHADED COLUMN, the AME MUST DEFER” (emphasis the FAA’s).

Editor’s Note: This article first appeared on AVweb.

The post FAA Amends Mental Health Evaluation Criteria for Pilots appeared first on FLYING Magazine.

The Horizon Air pilots’ immediate response to Emerson’s shocking act averted a serious emergency situation. They are to be commended. Conducting a dual engine failure checklist for real is not a walk in the park.

The remaining circumstances of Emerson’s exit from the cockpit and into the cabin were a head-scratcher. He admitted to his dastardly deed and insisted that he be restrained. While restrained with flex cuffs and sitting in an aft flight attendant jumpseat, he attempted to move the handle of an emergency exit door during descent. At some point, he confessed to a myriad of issues that involved consuming psychedelic mushrooms, sleep deprivation, mourning the death of his best man after six years, and suffering from depression. Yikes.

Should we be concerned that the event described could become a new threat trend among the airline pilot profession? No matter how ludicrous this incident is, do we dismiss it simply as an anomaly, or do we have a responsibility to the flying public to evaluate our medical certification protocols? Putting aside the politics of mass shootings for a moment, isn’t it a very similar mental health issue if someone uses an airplane for the same indescribable, horrific purpose?

• READ MORE: Like Copilot, Like Captain: The Importance of Left-Seat Mentoring

It’s difficult to just shrug the epaulets on our airline pilot shoulders considering other events from the past. On March 24, 2015, first officer Andreas Lubitz committed suicide with 144 passengers and five crewmembers by deliberately descending a GermanWings Airbus A320 into the French Alps. Lubitz had been suffering from diagnosed severe depression to the point that he paused his initial flight training. Numerous indications of his mental health were a road map to the tragedy, inclusive of depression medication and internet searches involving suicide methods.

And let’s not forget the bloody battle that ensued in the cockpit of a FedEx DC-10 on April 7, 1994, when Auburn Calloway attempted to murder the three-pilot crew for the purposes of crashing the airplane in order to collect on a $2.5 million insurance policy for his family. As a FedEx pilot, Calloway was an authorized jumpseat rider.

Knowing he would be facing a hearing the following day that would put his employment in jeopardy because he had lied about his flight time on the FedEx pilot application, Calloway filled a guitar case with numerous hammers and a spear gun. (Pre-9/11 freight carriers did not have the same security access restrictions as passenger carriers.) The injuries from the hammers were to be used as imitations for blunt force trauma resulting from the planned airplane crash.

Miraculously, the DC-10 crew survived the heinous attack, albeit with severe injuries. Despite skull fractures that were causing paralysis to one side of his body, the copilot executed a handful of unusual attitudes that eventually assisted in subduing Calloway while his fellow crewmembers battled the attacker outside of the cockpit. Suffice it to say, the event was an incredible display of heroism.

Even though a legal insanity defense and the motivation of suicide was utilized, it was not acknowledged by the court. Calloway was found guilty of attempted murder, air piracy, and interference with flight crew operations. That said, one certainly has to question mental health when a pilot plots to murder his fellow employees and crash a 580,000-pound airplane.

• READ MORE: Giving Your Airplane a Face-Lift and Tummy Tuck

Thankfully, in more than four decades of professional aviation, I have never been aware of sharing the cockpit with someone suffering from mental health issues that rose to the level described. But then, I wouldn’t consider myself competently trained to recognize the signs.

A few years back, a corporate pilot friend attempted suicide. He was suffering through a child custody battle with his wife and some other personal issues. Fortunately, friends were aware of an especially bad day in court, and one intervened on the scene while the other provided medical guidance after finding him unconscious inside an exhaust-filled automobile. They saved my friend’s life. Because of the suicide attempt, his medical certificate became invalid, although it has since been reinstated. A little over a year after the event, I asked my friend what brought him to such a decision. His answer: “I can’t explain it to you, but I saw no other solution.”

Even after having been trained in critical incident stress management (CISM) and understanding the dynamics of mitigating PTSD, depression is still a mystery to me. How many of us, airline pilot or not, reacted with genuine shock when we hear that someone defined as the definition of happiness has taken their own life?

Fortunately, the vast majority of airline pilots are resilient to the effects of stress external to the cockpit. We are employed by our companies because of a very scrutinized hiring process. We are stoic. We compartmentalize. We focus on the task of flying an airplane. But how many of us have actually made a sick call in the throes of divorce, in the midst of rescuing a troubled child, or in the aftermath of mourning a loved one? Have we been honest with ourselves and made that sick call when we innately sensed that a dark cloud of depression has descended into our lives?

Not only do we resist the stigma that depression implies, but we harbor trepidation that our livelihoods will be in jeopardy. Because the FAA requires us to self-disclose on our medical applications with the threat of certificate action for not doing so, some of us take the risk and don’t report. Or worse, some of us go untreated despite the relaxation of aeromedical treatment for mild forms of depression.

The solution? The FAA could require AMEs to administer some form of a more detailed mental health test. But if the test is subjective and without specific criteria, that opens up more issues. Education is probably the best solution. Educate pilots about the medical implications of reporting depression. Educate pilots to recognize signs of depression in their colleagues. Many pilot unions have active peer-to-peer mental health programs endorsed by the airlines.

I am certain that the threat posed by the Joseph Emerson of the industry is not an epidemic among airline pilots. Certainly, the world has become a chaotic place. Our consumption of information is far beyond what was available in years past. Social and mainstream media provide us with nonstop coverage of depressing events. Combine this with life’s inevitable personal challenges, and the state of our mental health can be affected.

All that said, I am confident enough to sit in the back of the airplane while my colleagues do the business of safely flying passengers from point A to point B.

Editor’s Note: FLYING offers the following resource for those who seek support from the American Foundation for Suicide Prevention.

This column first appeared in the January-February 2024/Issue 945 of FLYING’s print edition.

The post Airline Pilots Must Not Dismiss Mental Well-Being appeared first on FLYING Magazine.

This medical adventure started with The Impossible Airplane project, a custom-controlled RV-10 that will be the first purpose-built airplane in history for a pilot flying with just their feet. I’ve been flying Ercoupes for a long time, but the RV-10 does not qualify for the current light sport rules. So if I’m ever going to solo The Impossible Airplane, I’ll need to get my private pilot certificate, which also means getting at least my third-class medical.

• READ MORE: The Impossible Airplane Showcases Aviation Innovation

Even without arms, my formal application started like any nondisabled student pilot. I spoke to several pilot friends about an aviation medical examiner (AME) they would recommend. Unlike most other applicants, though, I wanted to find an AME who had experience with nonstandard applications. Over the years, I’ve heard horror stories from prospective pilots about how one poorly written statement caused months of delays and paperwork headaches. I also know that there is no established precedent for a pilot to receive a medical who is only flying with their feet. So, if we didn’t get the application right the first time, there’s no telling what other issues we would have to resolve.

Luckily, I found Dr. Douglas Little. He is an AME in my hometown of Tucson, Arizona, and has handled several other nontypical medical applications. I also felt reassured when Little explained the medical deferral process and that he would help me through the back and forth with the FAA. He must have done a good job because two months later I received a letter from the FAA that said I needed to see an orthopedic doctor for an evaluation and further documentation. 

When I first read the letter, I wondered why the FAA wanted an evaluation. I was born without arms. I’ve made it this far in life and aviation. But it was easy enough to schedule an appointment and send the evaluation back to the agency. When I sat down with the orthopedic doctor, it took a few minutes to explain the situation and what we were asking for. He wasn’t a pilot, but he was professionally curious. (I get a lot of professional curiosity from doctors, especially podiatrists who want to see how my feet have adapted.) The next day I had triplicates of his evaluation and sent two of them to the FAA. It was a pretty straightforward letter attesting to the functionality of my legs and feet with the absence of arms.

The FAA never asked for my medical history. I can see how that collection of documents would be difficult to assemble and then even harder to present to the agency in an organized manner. There are many services out there that specialize in assisting pilots with that process. Luckily for me, about two months after sending in my evaluation, the FAA approved a medical flight review. I can only guess that a combination of Little, the orthopedic doctor, and flying as a light sport pilot for several years helped the process.

The FAA gave me the option to choose the district office that would oversee the process. Naturally, I chose the Scottsdale, Arizona, FSDO. A couple of weeks after that, I got a call from an FAA representative. She informed me that I could select the examiner for my medical flight review and would have  a six-month window to complete it. That gave me pause for a moment. I know many student pilots were struggling to find examiners and take timely tests. On top of that, the Ercoupe I wanted to use was still undergoing a lot of maintenance. Plus, I needed a good refresher after a summer of not flying at all. However, the FAA official assured me that if I needed more time, then I just needed to call the office before the six-month window was up. 

And now I am waiting for the medical flight review. A CFI friend recommended an examiner who was properly qualified for these. I told him the situation, and he was happy to arrange a date toward the end of my six-month window. I’m both nervous and excited. If I fail my exam, then I will be disqualified from flying as a light sport pilot, and my days as a pilot are over. But if I pass—when I pass—many of the LSA restrictions will be lifted. There will be other restrictions, but I’ll overcome those too. 

Thanks to the light sport rules, the doors have been opened for more pilots like me to learn to fly. I’m so thankful that Able Flight is leading the charge for helping pilots with disabilities learn to fly. Able Flight gave me a scholarship for my light sport training. More and more of us are progressing on to the private pilot level and hopefully making it easier for the next pilot to follow after us. And who knows? Maybe after earning my private pilot certificate and instrument rating, I will start looking over the requirements for being a commercial pilot.

As I stand on the threshold of setting this next precedent, I’m reminded that every flight, every test, every hurdle overcome is not just for me, but for those who dream of taking to the skies regardless of the obstacles they face.

The post The Process of Obtaining a Medical Certificate appeared first on FLYING Magazine.

The Road Map to Quick Certification

We have previously discussed how to fill out your MedXPress to reduce the number of questions your AME may want to ask. No matter how well you do that, there are many times when you will still need a note from your doctor about your medical condition(s). Because the FAA doesn’t see you in person nor have access to your entire medical history, those notes are critical. Providing a Current Detailed Clinical Progress Note that meets the agency’s rigorous quality and content standards is vital to your speedy medical certification.

You have done your due diligence. You have prepared for your FAA medical exam like the test that it is. You know what you need to get through your medical exam in an expeditious manner. You know what your doctor(s) write will play a critical role in that process. Now for the hard part. How do you get a busy doctor who is set in their practice pattern to write a note to the FAA’s standard instead of their own? If what you are asking is correct, and your doctor just won’t write it to the standard the FAA is looking for, what do you do? Similarly, what if your doctor already wrote a note and you need it updated to meet the FAA requirements, but they won’t do it? Why would this even happen?

Why Won’t Some Doctors Won’t Write the Note You Need?

Most importantly, you need to set realistic expectations. Don’t ask your doctor to write something that is factually incorrect. You can’t very well ask them to say you have passed your exercise stress test if you haven’t and your labs are in normal ranges if they aren’t.

You should also recognize you are asking a busy professional to do something they are not familiar with and may not view as being relevant or necessary. Not every patient encounter note needs the level of detail the FAA expects. Writing ones that do normally require much more time than documenting only to a standard to facilitate follow-up care, justify billing, and satisfy liability concerns. 

Are you asking them to revise a note they have already completed from a visit days or weeks ago? Some medical record systems make it hard to change notes that have already been signed. At a minimum, nobody likes being asked to repeat work they have already done once. Your doctor is no different.

If you have provided your physician with your request in advance, they may also not like you “telling them what to do.” How you approach the request and how you phrase things can be important. No physician likes it when a patient comes in with a self-diagnosis and starts demanding specific treatment protocols before they even have a chance to ask what is going on. Using good communication skills and tact can go a long way toward getting what you want. 

We briefly discussed this concern in our article about Direct Primary Care Physicians. It pretty much boils down to motivation. Most doctors are paid by insurance. Insurance has their own criteria for what is required to pay a doctor within their billing system. If your doctor has already written a note, especially one that meets the insurance payment criteria, why would they do it differently or a second time? In either scenario you are asking the doctor to do more work for no more compensation. For a busy doctor, this can be difficult to overcome.

What To Do When Your Doctor Won’t Write the Note You Need for the FAA

Sometimes pilots may hit a brick wall with their physician. That doesn’t mean it is over, but it might mean it is over between you and that particular doctor. When it comes to primary care physicians, which can cover the vast majority of issues you may be dealing with, this is where we think making the switch to a Direct Primary Care (DPC) physician may be beneficial. They work directly for you and are not beholden to the insurance companies for reimbursement.

Direct Primary Care’s goal is to bring that doctor- patient relationship back to the doctor and the patient. That is exactly what you need. You want a doctor who has time to listen to you and understand what your needs are. After all, your needs may be slightly different than the average patient. Direct Primary Care physicians tend to have a significantly smaller patient panel than insurance- paid physicians. This gives them a lot of time and flexibility in comparison. If you think this will be a good option for you, then use the Direct Primary Care Coalition’s website to find one near you.

If you aren’t ready to make a change to Direct Primary Care and you just need a one- time evaluation, or your situation requires a specialist, then you still have options. Independent Medical Examiners (IMEs) are physicians of varying specialties who conduct, well, independent medical exams. They specialize in reviewing records and writing complete notes along with giving their medical opinion based on the combination of the records and their own exam. That can be useful to a pilot facing a challenging FAA medical certification.

There is a downside though. Sometimes the FAA requires things that are not covered by insurance. While the agency wants certain tests and/or specialist evaluations, they may not be medically indicated from a treatment perspective. That generally means insurance won’t pay for them. Another thing that insurance won’t pay for is an independent medical exam. Rates will vary by specialty, location, and how long the review and exam will take. But if you need a specialist evaluation and you can’t get it done properly within your insurance system, then an IME may be your best option. If you want to find an IME, you can check SEAK’s National Directory of Independent Medical Examiners and the Independent Medical Examiners Directory.

If You Commit to the Process, You’ll Likely Succeed

Most of the time when a pilot’s medical certificate is denied, it is because the FAA never received the information requested. If you are safe to fly, then it is a matter of having the right documentation. Don’t let one physician unwilling to help be what stops you from getting back in the air. And Wingman Med can help.

The post Getting the Right Doctor’s Note for the FAA appeared first on FLYING Magazine.

To be clear, that statement applies to worst-case scenarios. About 90% of pilots leave their AME appointment with a medical certificate already in their hands. Many with significant but well- controlled medical conditions will wait less than three months for the FAA to make their decision.

Worst-case scenarios are ones with multiple conditions or ones associated with significant aviation safety concerns. Recent heart attacks, previous strokes, heart valve replacements, insulin-dependent diabetes, depression or anxiety treated with medication, other conditions of similar severity, or a combination of them will fall into that category.

Even with those conditions, the FAA will generally provide a decision in less than six to twelve months. It will not always be the decision pilots want, but with a few exceptions, those who wait longer are waiting for another reason.

What’s Behind the Horror Stories?

You do not have to look far to find a story on the internet about a pilot who waited years for a medical certificate only to give up and stop trying. Often those stories include a frustrating statement to the effect that, “I sent them everything they asked for, and they kept asking for more.”

There is truth behind those stories, but there are also misconceptions. Most of the misconceptions have to do with this: the doctors at the FAA’s Aeromedical Certification Division (AMCD) never actually see pilots in person. Instead, they rely on the notes provided by the pilots’ doctors to decide if they are safe to fly an airplane. When those notes are incomplete or contradict each other, AMCD reviewers need more information to make a decision. Similarly if one of those notes adds previously unknown, and concerning, information, they will want more information on that as well. 

From the time you start your MedXPress application and especially when providing medical records about complex medical conditions, it is up to you to make sure that your application tells a complete and consistent story. One of the best tools to do that is a good current detailed clinical progress note from your physician(s).

What is a Current Detailed Clinical Progress Note?

A clinical progress note is a note that every doctor should be trained to write. They might not immediately recognize what the FAA is asking for when you first discuss it with them. If the term “progress note” does not register, try asking for a “complete history and physical” or “SOAP note.” If that doesn’t work, RUN! Find another doctor! One who does not understand what those terms mean or is unwilling to provide a document that meets that standard can only delay your medical certificate application.

[Credit: Shutterstock]

For FAA purposes, the note must be signed by a board certified physician. There are many other highly skilled health care professionals who provide excellent care. You might see a physician associate or nurse practitioner who knows more about your healthcare than any physician. It does not matter. For FAA purposes the note must come from a physician.

The progress note should ideally exist as part of your medical record. It is different from an “After Visit Summary” or “Patient Summary” which you might also see in some online patient portals. Your doctor’s administrative staff should be able to help you locate it.

Elements of a Good Note

A progress note is what doctors use to communicate with each other about your care. Formatting varies somewhat, but in order to meet the FAA’s standard, it must include the following information:

• A history of the condition being treated
• All current medications and doses
• Whether or not you experience any medication side effects
• Physical exam findings
• Results of any tests performed to evaluate the condition
• Your specific diagnosis including something called an ICD-10 code
• A clear assessment regard the status of your condition and how it affects you
• A clear plan regarding how it is treated
• A clear statement about how your doctor plans to follow-up with you or monitor the condition

Letters from your doctor DO NOT replace progress notes. Letters that amplify information contained in your medical record may help to expedite your medical certification decision. The note your doctor provides is the only way that AMCD has to evaluate your medical issues. Missing information, inaccuracies, or ambiguity will generate questions.

Fine Print and Terminology

When it comes to FAA medical certification, the word “current” means within 90-days preceding your AME or any time after it. There are several exceptions to that rule-of-thumb that are clearly spelled out in the FAA’s Guide for Aviation Medical Examiners. Unless one of those exceptions applies to you, nothing prior to 90-days before your AME appointment will be considered in support of your medical certificate.

The term “detailed” is more subjective. Its inclusion in the FAA’s guidance mostly serves to emphasize that they actually want your doctor to document their considered opinion in a way that shows they spent some effort thinking about your particular situation. As one example, an assessment for high blood pressure that says “htn controlled with prescription medication” is not detailed.

A detailed assessment should look more like this: “43-year-old male with essential hypertension and no other modifiable risk factors for cardiovascular disease. He takes 20mg of Lisinopril per day and his average blood pressure is 125/78. No concern for undiagnosed comorbid conditions or indication for work-up at this time. He should follow-up annually for routine monitoring.”   

The difference should be obvious. While obvious, the first one may be all the doctor cares about for their own reference, but the second one is vital to your certification.

Avoiding Certification Delays 

Progress notes that do not meet these standards slow things down. Visit summaries, notes by non-physicians, notes that lack sufficient detail, old notes, and letters provided in lieu of progress notes will all delay your application.

You can probably identify most deficiencies on your own. If you want to take the guesswork out of your FAA medical certification and avoid any unnecessary delays, visit our website and schedule a free consultation to find out more.  

The post Avoid Medical Certification Delays appeared first on FLYING Magazine.

Once upon a time, the world used paper. Applying for a FAA medical certificate, meant filling out FAA form 8500-8 and presenting it to your AME at your flight physical. While the use of that paper form has fallen by the wayside,14 CFR part 68.7 still mandates its use.

MedXPress is the FAA’s online medical certificate application system. The output is still a PDF version of the 8500-8 (which you should keep), but MedXPress has eliminated the use of physical paper in the application process.

Except for printing your medical certificate, AMEs do not use paper either. Instead of requiring a physical copy of your application, your AME will need your MedXPress confirmation number. You will get that after successfully submitting your application online.

Your AME will use that confirmation number to import your medical certificate application into the Aerospace Medical Certification System (AMCS). AMCS allows AMEs to electronically complete their virtual portion of the 8500-8 and (hopefully) print your medical certificate. 

Each Section has a Purpose

The FAA’s intended goal with MedXPress is to get as much medical information about you as possible. The AME wants to make an informed decision about your health as it relates to flying.

MedXPress starts by asking some basic demographic questions. The next section asks what medications you take. Those are relatively straightforward. Most questions pilots have about the medical certificate application process concern the next section, about medical conditions.

That section is straightforward as well. Most questions that come up have to do with closing the gap between what pilots want it to say and what it actually says very clearly.

At the top of the “Medical History” section, the FAA asks, “Have you ever in your life been diagnosed with, had, or do you presently have any of the following?” They even ask the question in all caps to add emphasis.

25 specific questions follow, but question 18x deserves special mention. It asks about “Other illness, disability, or surgery.” Taken together with the introductory statement above, it should be obvious that the FAA asking, “Have you ever in your life had…[any] illness, disability, or surgery.”

That is not all. The section also has several general questions about other types of medically significant events including:  

• discharge from the military for medical reasons
• rejection for military service 
• rejection for life or health insurance
• receipt of medical disability benefits

Questions about driving history, drug and alcohol- related arrests, and criminal history follow. Finally, you will round out your application by listing each medical visit you have attended in the preceding three years and authorizing the FAA to obtain your driving record from the National Driver Register. 

Tell a Consistent Story

The FAA could simply say, “please tell us about your medical history and how you are doing,” but that wouldn’t get them much information. People tend to forget certain things. By asking for details on several different, specific items, they are more likely to jog the memory of the pilot filling out the form.

When asked about their medical history, many patients of ours neglect to mention hypertension, but they do remember they take a pill every day. Asking about medical history and current medications is more likely to get the full story. The FAA wants the full story. Your goal should be to tell a consistent one.

Here are some examples:

• If you list Allegra and Flonase as medications, then you should also mark “yes” to 18e (Hay fever or allergy). Zyrtec, by the way, is disqualifying for regular use.  
• If you mark “no” to all of the medical condition questions, but then mark “yes” to a medical rejection or disability benefits, it doesn’t add up.
• If you mark “no” to 18g (heart or vascular trouble), but have had five trips to the cardiologist in the last six months, your AME will have questions.

The AME Can Update Your Answers

Inconsistency in your answers should spark questions from your AME. If everything ends up meeting the FAA requirements, then you can still get your medical. Your AME can update your answers before submitting everything to the FAA, but it is in your best interest to make their job easy. 

Wingman Med Advice

By ensuring you tell a clear and consistent story on your MedXPress application, you can expect a smoother process with your AME. Here are some tips:

• You should have a corresponding medical condition for every medication you take and disability you have.
• If there isn’t a specific question about your medical condition, then list it under “other illness, disability, or surgery.” Along these lines, you should never think, “they didn’t ask about sleep apnea” because everything not specifically asked goes here.
• Provide a brief statement about each medical condition. As a rule of thumb, if you need more than a sentence, you should bring a current detailed clinical progress note from your treating physician that explains more. 
• List a reason for all visits to health care professionals.
• “Previously reported, no change” may not help your current AME evaluate your condition (AMEs don’t have access to your past exams)— use the above guidelines and then add “previously reported, no change.” 
• Retain copies of the generated 8500-8 for future reference, as this makes it much easier to remember what you wrote last time.

Finally, if you decide that an application you have submitted needs major rework, there is a solution. Before your AME imports your exam to AMCS, MedXPress applications will be deleted after 60 days of inactivity. If you want to toss your virtual application in the virtual trash can, just wait 60 days, and it will age out.

Once you share your confirmation number with an AME, the FAA will see it, so make sure your application says what you want it to say before you schedule your appointment.    

If you would like to do a trial run at MedXPress, we have our own MedXPress Simulator. If you want more personalized advice, you can also schedule a free consultation by clicking on the “Free Consult” button that can be found on our website.

The post How to Fill Out MedXPress: Start Your Flight Physical Right. appeared first on FLYING Magazine.

That defeatist attitude is common enough in general. For pilots with a history of mental conditions, it seems to be even more pervasive. Unfortunately, many pilots form their opinions based on information from those with no actual knowledge, training, or experience related to FAA medical policies. 

We have already written about the importance of preparing for a FAA medical certification appointment like any other pass-fail examination. We have also highlighted how we can help pilots with significant medical conditions navigate the complexities of the FAA medical certification progress. 

Mental health conditions deserve special consideration. Contrary to popular opinion, having a mental health diagnosis in your medical record is not automatically disqualifying for FAA medical qualification. In many cases even those with ongoing treatment for well controlled active conditions can still continue their flying careers. It often boils down to the right preparation for the exam.

Some Conditions Are Simple

The reality is that the FAA treats mental health conditions the same way as physical health conditions. They want to know about it and they want to know how well you are doing. 

When you are filling out a new MedXPress you have to report all medications, medical conditions and any visits to medical professionals in the last three years. 

What if you broke an ankle last week? The FAA cares a lot. But what if you broke an ankle three years ago and made a full recovery? They want to know, but if you are fully recovered, then that is what matters.

If you report your broken ankle on your MedXPress application, your AME can gather all the information they need to make a medical certification decision just by conducting a good physical exam. If you broke it last week and are still limping, using crutches, or recovering from surgery, do not schedule an AME appointment. Based on your medical condition, you should not be flying and you will not leave with a medical certificate. If you broke it three years ago and walk into your AME’s office with full pain-free strides, you will be just fine.

Some Conditions Are More Complex

If your AME needs more than their own physical exam to determine your eligibility for a medical certificate, you will need to do more preparation. Consider diabetes. Diabetes is a condition that usually does not cause any symptoms. If it is bad enough for your AME to identify during your physical exam, you almost certainly should not be flying. For pilots with diabetes, the only way to evaluate whether or not you are safe to fly is by reviewing recent lab results and reports from your treating physical. 

Determining how diabetes may affect safety of flight is more difficult than it is for a broken ankle, but at least your doctors, your AME, and the FAA can still reference objective data to help make their decisions.

Mental Health Conditions Are Even More Challenging To Evaluate 

Unlike a broken ankle, which an AME can evaluate by watching you walk in from the parking lot, or diabetes, which has objective lab results the FAA can use to determine your stability, the only way anyone can evaluate a mental health condition is by what you tell them.  

During the 15-20 minutes they might spend with an AME, most pilots with mental health conditions will not look or act any differently than anyone else. It takes time, lengthy discussion, and careful consideration to understand how the condition may affect a patient’s day-to-day life, much less aviation safety. There is no way an AME can provide a responsible evaluation in the amount of time they spend with pilots and there is no way to measure depression or anxiety with a lab test. 

Like with any other medical condition, the FAA will need to see that your condition has been properly evaluated by an appropriate specialist and that it has been treated to the point it will not affect safety of flight.  

No one wants another Germanwings or China Eastern. That is why the bar is high. On the other hand, there is growing acceptance that pilots who are forthcoming about their condition and have the courage to seek treatment are likely safer than the ones suffering in silence.

Not Everything Is Reportable

If you see a personal trainer to help prevent injury or as a continuation of your rehab from an acute musculoskeletal injury, it does not need to go on your MedXPress application. The same goes if you see a massage therapist to help relieve muscle pain that does not limit your ability to safely operate an aircraft. If your symptoms are bad enough that you have been to a doctor for help, that should be reported. 

By the same token, if you are going through a rough patch in life and turn to a non-medical counselor, pastor, or other trusted advisor for help, the FAA does not care. You do not need to report the life coach helping to improve your efficiency or the marriage and family therapist working to make your family relationships more supportive. But, if your symptoms become significant enough that you have taken medication or you are working with a psychologist or psychiatrist, that is something you should disclose. 

Showing Stability Is What Matters

Reporting mental health concerns does not necessarily mean that your medical certification will be denied or even delayed. It does mean that you will need to show you are still safe to fly an airplane. Just like with a broken ankle, if your episode of depression was years ago and you have obviously been doing better since, reporting it will be unlikely to jeopardize your medical certificate. Just like with diabetes, if you have chronic depression that is well treated by an appropriate specialist with or without medication, chances are you can continue flying. 

Do you think you are safe to fly? Would your co-pilot agree with you? If the answer is yes, the FAA will probably agree as well.  

Make no mistake, there are some mental health conditions that will always be disqualifying. Bipolar disease, psychosis, and severe personality disorders are some examples. That is true for physical conditions too. Active seizure disorders and untreated coronary heart disease will get your medical certificate application rejected just as fast as schizophrenia. 

For many pilots, including those who have suffered from depression, anxiety, and post traumatic stress disorder, FAA medical certification is becoming much more commonplace. The biggest difference between those conditions and the physical ailments we discussed above is that the documentation from those who treated you will have to tell the whole story. Making sure those records will meet the FAA’s standards and knowing which information to submit can be harder than you might guess. That is where we come in. If you’re safe to fly, we keep you in the air.

The post Depression, Anxiety, and the FAA appeared first on FLYING Magazine.

But there’s an illness he must hide—and a fear that if his employer found out, it would mean the end of the career he dreamed of since he was a boy. It’s nothing that shows on the outside, nor on his aviation medical exam every six months. For his illness lies in his brain chemistry. By no fault of his own, his mind works against him. It convinces him that his success is a farce, that he’s an imposter in the life he has made. 

It’s an all-too-common hallmark of depression—striking stars everyone seems to love and perhaps envy, like Anthony Bourdain or Robin Williams—the cruel twist that when you’re at the pinnacle of success, your brain on depression tells you that you just don’t deserve it all. 

Pilots suffer from anxiety and depression just as the rest of the population does. But they seem to be even less likely than those in other careers to seek support and treatment.

At FLYING, we’re committed to probing whether this hunch is correct, and if so, why it’s the case. In doing so, we hope to shed light on mental health and offer strategies that pilots can use to preserve their own, just like they do their physical health.

The pilot we mentioned earlier is not a hypothetical person, but a real one—and a couple of decades ago, when he hit the bottom, he had to turn in his medical certificate. He was forced into retirement. He did lose a lot—but not everything.

He got help. He recovered. And today, the airline he flew for treats pilots with mental health issues differently than they did in the 1980s and ’90s. The industry is evolving. And we’re here to explore how that’s happening—and how you can help it continue to move forward when it comes to a pilot’s mental health.

The FAA and Mental Health 

To become a pilot, whether recreationally or professionally, the FAA requires a person to hold a medical certificate. The examination to get an FAA medical, no matter the class, is similar to your average doctor’s office physical. While the main focus of the aviation medical examiner (AME) performing the physical does not involve mental health, there are a few things they may ask to ensure that the pilot is not struggling with any FAA-restricted mental illnesses. 

To attain a clear medical, pilots must report any health professional visits during the previous three years and disclose all existing physical and psychological conditions and medications. Failure to do so can result in significant fines. If the AME feels more information is needed, they can order additional testing to make a determination about a pilot’s suitability for certification. 

So What Is Allowed, According to the FAA?

Certain medical conditions such as psychosis, bipolar disorder, and severe personality disorder automatically disqualify a pilot from obtaining an FAA medical certificate and prohibit them from flying. Treatable conditions may allow the pilot to obtain a medical through reporting and monitoring programs. These instances are on a case-by-case basis and have a strict list of prohibited and permitted medications. 

According to the National Institute for Mental Health, one of the most common types of mental illness today is depression. Of the six categories of depression medications, the FAA only permits one. Selective serotonin reuptake inhibitors (SSRIs), may be taken by approved pilots; but of the seven FDA-approved SSRIs, the FAA has only recognized four since 2010.

• Prozac (fluoxetine)
• Zoloft (sertraline)
• Celexa (citalopram)
• Lexapro (escitalopram)

While these medications are effective in treating depression, no other mental health medications to address other mental health issues are approved by the FAA for pilots.

What Do Mental Health Experts Say?

To explore the role of mental health for pilots, FLYING hosted a mental health roundtable on May 2. During the event, Dr. William Hoffman, a neurology resident and aeromedical researcher, spoke about his research into why pilots avoid taking care of their mental health. 

“The small role our group is hoping to play is in trying to demonstrate the degree of pilot health care avoidance,” he said. “And we recently just published our study, thanks to the help of many including multiple airlines and…the University of North Dakota, among other organizations, that demonstrate in the largest study of over 4,000 pilots across the United States that over 56 percent of them freely admitted to some sort of health care avoidance behavior.”

In the study completed by Dr. Hoffman and others, it was found that out of a total of 3,765 pilot participants, 2,111 (56.1 percent) of them reported a history of health care avoidance because they feared losing their FAA medical certificate. Even if the pilot sought care, 994 (26.8 percent) misrepresented or withheld information on a healthcare form for the same reason. 

Dr. Hoffman said he understands why pilots are hesitant to be transparent with AMEs and see a health care professional regarding mental health issues. But he believes getting care results in the best outcomes—even if there are obstacles during the journey. 

“In the circumstance of having a medical condition, 100 percent, get the care that you need as soon as possible,” he said. “While there might be short-term repercussions as it relates to your medical certificate, that’s how you can ensure that your health can be a tool for your long-term [wellness],” he said.

Mental Health and the Airlines

Because of the regulations around mental health reporting and the medications used to treat mental health illnesses, until recently, the airlines have been wary of opening a door for their employees—especially pilots—to be transparent about their mental health concerns. Now, many airlines, including major players such as American, United, and Delta, have created a “safe” space for pilots to address their mental health needs. 

For example, American Airlines hosts a well-being team that can listen and will extend support to its employees. Through the Employee Assistance Program (EAP), all American Airlines’ employees and members of their households also have free and confidential access to EAP services anytime they need them.

• LEARN MORE: FLYING’s Complete Mental Health and Aviation Coverage

When asked how American Airlines supports its pilots’ mental health, American well-being team member Kevin Reeves was hesitant to elaborate, saying, “As you know, American cares for its pilots and their families tremendously. We make sure to take care of them on life’s journey by providing various forms of support, including medical and mental health. At this time, we aren’t open to providing additional information regarding our support programs.”

Delta Air Lines has a similar well-being program available for its employees and announced the hiring of Dr. Henry Ting as its first chief health officer at the height of the pandemic. Just recently, Delta announced Dr. Ting will be staying onboard with Delta post-pandemic to focus less on physical health and more on the “wellness journey” of its employees. The details regarding Delta’s mental health program are unknown. 

For airline employees who have access to an employer’s mental health benefit but do not feel comfortable tapping into it for fear of repercussions, peer pilot support groups are available as a first step toward wellness. 

Pilots Helping Pilots

Reyne O’Shaughnessy, an airline pilot and founder of Piloting to Wellbeing, understands the pressures of being a pilot and has been advocating for mental health in the industry for years. “Over 34 years, I saw a gap in where training has stopped and what pilots need; for example, pilots are struggling out there. So I created this company called Piloting to Wellbeing and where we target pilots, especially student pilots, [to] help them…navigate the complex world of aviation to keep them flying and fly healthily and safely.”

Piloting to Wellbeing is a mentoring and coaching program for pilots to navigate the complex, regulated system of aviation, in order to keep them flying and healthy. O’Shaughnessy acknowledged that most pilots are hesitant to express mental health issues. She wants to break down the barriers that prevent them from doing so, in order to achieve a healthier industry. When speaking about why pilots are afraid to seek help for mental health issues and some of the consequences of coming forward, she said, “None of us are eager to disclose deeply personal information. Pilots believe that being vulnerable, and sharing feelings or struggles, such as anxiety, depression, and chronic stress, would be at best humiliating or embarrassing, and, at worst, the end of their flying career. They keep quiet, go underground and put off doing anything about it until they can hardly function as a crew member anymore and are forced to take action. Pilots are reluctant to talk about issues such as stress, anxiety, depression, insomnia, and behaviors.”

Feeling as though the FAA plays a significant role in why pilots stay quiet, she went on to say, “The FAA regulations and regulators are the 800-pound gorillas that may help drive pilots underground. Aviators are forced by the regulatory environment to decide whether to seek help at the risk of being grounded. And once grounded, the lawyers and FAA doctors descend as pilots work to get reinstated to flying status.”

Lending a Listening Ear

John Hackworth definitely agrees there’s a problem with pilots not stepping up to address their mental health needs. A volunteer for the Air Line Pilots Association (ALPA) Pilot Peer Support (PPS) program and for JetBlue’s Pilot Assistance Network (PAN), he takes calls from pilots who are suffering emotional and/or mental distress and lends a listening ear.

“Pilots should absolutely feel OK to go seek mental health [care], and disclosing it to the FAA doesn’t mean you’re going to lose your medical certificate,” Hackworth said in an interview with FLYING prior to the roundtable event. Anyone who is struggling should feel comfortable and confident that they can get the help that they need, he added. Based on the calls PPS and PAN receive, he said most people just need someone they can talk to and don’t need elevated medical attention. 

“We, literally, sometimes just need somebody to listen to us. And when you have somebody who first says that everything is going to be confidential, and on top of it, is a fellow brother or sister pilot… that’s hugely helpful for many people, and that takes up about 80 percent of the calls that we get.”

Calls to either program are strictly confidential and are not reported to the FAA or anyone else. 

PPS/PAN are self-directed programs, Hackworth said. In addition to providing basic peer counseling/listening services, they’re meant to arm those who are suffering more severe mental health issues with next-step resources. For example, the Aviation Medicine Advisory Service (AMAS), which provides aeromedical consultation and is a free benefit for ALPA members, is one resource that can be helpful, Hackworth said. “The goal is to empower the pilot to make their own decisions, unique or specific to their situation, and to utilize with greater knowledge and understanding the resources available to them.”

In a minority of cases, a pilot will seek elevated mental health care and have things go badly, resulting in the loss of their medical certification. Hackworth said the pilot community/rumor mill ends up exaggerating and sensationalizing these cases, which creates misconceptions and fear for those who might have legitimate mental health care needs.

“That’s how we get where we are now, where people are just like, ‘I just don’t really understand it and I’m afraid, so I’m just not going to face it’—and we have a problem,” he said during the roundtable discussion.

An Airbus A320 pilot trainer at JetBlue, and the co-founder and president of Professional Pilots of Tomorrow, a nonprofit organization that provides career information and mentoring to future pilots, Hackworth said it’s important for pilots to discuss their mental health needs openly. 

“Truth be told, it’s a very rare circumstance for a pilot who receives mental health [care] to lose their medical,” he said. 

And, even if a physician diagnoses a pilot with a mental health condition that results in a temporary no-fly ruling from the FAA, that’s better than the alternative.

“At the end of the day, seeking medical help is, ultimately, what we all need to go to first and foremost, regardless of whether our medical license is in jeopardy or even our career,” Hackworth said. “What’s the point in keeping your career and license when you yourself are going down a path of self-destruction?”

Helping Future Pilots

Universities that offer flight training are learning from ALPA’s PPS model and from similar programs offered by the airlines, and are starting their own peer support programs. Elizabeth “Beth” Bjerke, the associate dean and professor at the University of North Dakota (UND), said UND will institute a student pilot peer counseling program in the fall. 

“Right now, we’re recruiting those volunteers, and we were fortunate to sit in on some peer support training at United Airlines. It’s helping us guide our path and how we set it up to make it successful within our university,” she told FLYING during the May 2 roundtable on mental health.

The move at UND follows the devastating loss of one of its own in October 2021, when John Hauser, a 19-year-old student pilot, took his life in an apparent suicide by airplane.

A growing number of college students have reported having symptoms of depression and anxiety. According to the Substance Abuse and Mental Health Services Administration, one in three (30.6 percent) college-age adults between the ages of 18 and 25 suffered a “mental, behavioral or emotional disorder” in 2020. 

“I’ve never seen anything like we’ve had the last couple of years, especially with this subset, the 18- to 22-year-old, has been well-researched and now [and it’s] well documented that they are suffering,” Bjerke said.

Like UND, in December 2021, Embry-Riddle Aeronautical University (ERAU) in Daytona Beach, Florida, got a mental health wake-up call, when the police arrested one of its aeronautical science students. The student had a backpack containing a collapsible semi-automatic rifle and hundreds of rounds of ammunition and had allegedly threatened to perform a “Columbine”-type assault (referencing the 1999 Colorado school mass shooting) at the campus. 

Faculty, staff, and counseling professionals serving the aviation programs at UND and ERAU now meet regularly to discuss best practices to improve and promote student mental health. 

Additionally, Alan Stolzer, the dean of the ERAU College of Aviation, commissioned an Aviation Mental Health Task Force to study the problem and possible solutions at the Daytona Beach campus. The task force is developing a peer support group for College of Aviation students that will launch this fall. It’s also surveying the college’s roughly 3,000 students—in concert with the American College Health Association-National College Health Assessment—to inform future policy decisions in the area of mental health.

Stolzer said students in all of the university’s colleges may struggle with mental health issues; however, given the FAA regulation of aeronautical science, air traffic control, and aviation maintenance, aviation students face additional pressures and demands. And, the COVID-19 pandemic exacerbated the situation, he said. 

“The general pressure on students, I think, is just more acute than it has been in the past,” Stolzer said. “It’s not a new problem, I just think it’s a problem that’s gotten worse over time.” 

Dr. Teresa Michaelson-Chmelir, director of the ERAU counseling center, would agree. In a 2021-22 digital report, she recorded that the first two weeks of the fall 2021 semester, student counseling appointments were up 47 percent compared to the same time frame in 2019; and 34 percent of those seeking care (2021) indicated that they had had thoughts of suicide. 

A  2019 survey by the Association for University and College Counseling Center Directors shows that this upward trend isn’t new, nor is it solely the result of COVID-19. According to the survey, in 2019, 87 percent of collegiate counseling centers across the U.S. saw more student-patients—on average 12 percent more—compared to 2018.  

While these are discouraging statistics, Stolzer is more concerned about the students who aren’t getting the counseling services they need. One mission of the task force is to debunk myths. For example, there are student pilots who won’t go to the counseling center on campus because they fear it will be reported to the FAA and impact their future career—which is not the case at all, Stolzer said. “The counseling center [on campus] does not diagnose mental health issues. If you’re not diagnosed with a mental health problem, there’s nothing to report.” 

Another goal of the task force is to normalize the conversation around mental health. 

The concern and care for a person’s emotional and mental well being should be as non-stigmatized as the care and concern for their physical well being, Stolzer said. In an ideal world, going to a therapist or participating in meditation would be the same as going to the gym, taking a jog, or playing racquetball, he said. “It’s important that we get to that point. We’re not there yet.”

Destigmatizing Mental Health

The panelists attending FLYING’s roundtable on mental health all agreed that the stigma surrounding mental health care can be an unnecessary barrier to getting pilots—and pilots in training—the help that they need. 

Bjerke said to promote a healthier training and professional environment, it’s important to share the stories of pilots who experienced a mental health issue, took the time they needed to heal, and returned to the cockpit. 

Hackworth agreed. “What we’re talking about is normalizing the conversation, normalizing and recognizing that we all have mental health issues,” he said. “We all struggle from time to time…And I think the more we continue to talk about it and accept that, then some of these paths become more viable and attainable.”

The airlines are trying to make mental health more top-of-mind and less taboo by integrating the topic into their employee communications. JetBlue, for example, has posters in its crew rooms and training environments that promote its Peer Assistance Network and other mental health resources, Hackworth said. The airline also promotes safety as one of its core values. “And safety doesn’t just mean the safe operation of our aircraft, but also how we take care of ourselves and each other,” he said.

Remember: ‘You’re Not Alone’

The aviation industry may make opening up about mental health worrisome, but taking care of yourself should always be a priority. Keeping tabs on your mental wellness ensures your success, not only in your professional life but also in your personal life, and also helps others around you. Utilizing company support, seeing a therapist, or talking to a peer support group can be a first step for anyone struggling with mental health issues. A key point to share with any pilot who might be suffering from depression, anxiety, or another mental health issue is: “You’re not alone,” Hackworth said. “There’s many people out there that are there to help them. And there’s a lot of resources. You are not alone.”

The post Why Pilots Don’t Want To Talk About Mental Health—and Why They Should appeared first on FLYING Magazine.