Supporting the Next Generation of Pilots
By Dr. Susan Northrup, FAA Federal Air Surgeon
It is no secret that many pilots are hesitant to disclose a mental health condition and treatment. There is concern that if one does so, they will be grounded for an excessive period or even permanently. Frankly, there is some truth to the concern, for the practical reason that delays in required evaluations were occurring due to a huge surge in new pilot applications, mirroring the airlines’ hiring.
Compared with previous generations, many new pilots had been diagnosed with attention deficit hyperactivity disorder, anxiety, or depression, and treated with medications. At the same time, we were able to expand the list of acceptable medications one can take and still fly, which also increased the number of cases to review. I would like to share some of the steps that the FAA has taken to address these issues.
We published guidance for aviation medical examiners (AME) permitting them to issue a medical certificate despite a mental health diagnosis or use of medication when circumstances allow. This has enabled many pilots to walk out of the AME’s office with their certificate in hand rather than waiting for FAA review and approval after undergoing a mental health evaluation.
We also made several recent changes to the mental health section of the AME Guide. This is part of our ongoing effort to demystify the approval process and to encourage pilots and controllers to seek treatment early. While we have traditionally focused on the aviator’s condition and its remission status, we want to emphasize the pilot's insights, transparency in the review process, aviation safety and operational performance, and resilience to prevent/mitigate future problems.
For almost all medical conditions, the earlier treatment begins, the greater the likelihood of success and the less onerous the treatment. Unfortunately, some pilots delay treatment/help due to fear of potential grounding. We want to bridge the gap between your own self-assessment/self-grounding (14 CFR section 61.53) and an official diagnosis from a doctor. For pilots, this means that grounding might not be necessary, and when it is, the duration is minimized. On the other hand, avoidance of early treatment or disclosure of a mental health condition can often result in more time out of the cockpit, which can potentially impact flight safety. Let’s clear up some of the confusion.
Q. Is therapy always reportable?
A. Not always. Counseling from a member of the clergy or an employee assistance program counselor generally is not reportable unless that person is also a licensed counselor. Counseling is useful for many common issues, such as life stresses, divorce, family loss, work issues, etc., and can help keep a situation manageable. We encourage counseling when appropriate and do not want pilots to hesitate to seek it when it can be helpful.
Q. Can I continue to fly while I see a licensed counselor?
A. Frequently, the answer is “yes.” The underlying question is “Am I safe to fly?” If the answer is “yes,” then there is no need to ground yourself. However, a pilot should self-ground and seek evaluation if symptoms significantly impair concentration or memory, emotional regulation, decision-making, overall functioning, and sleep/energy levels.
You can find the self-assessment requirement in 14 CFR section 61.53. If you are unsure of commercial services that offer advice, checking with a trusted and reliable pilot friend can be very useful.
Q. Do I need to report counseling immediately?
A. No. There is no requirement to report this to the FAA prior to renewing your medical certificate. However, compliance with 14 CFR section 61.53 still stands.
Q. I am concerned that if I seek counseling, I will be grounded for an extended period and not be able to fly. My pilot friends tell me that I should tough it out.
A. We find this concerning for two reasons. First, if a problem requires you to be grounded, letting it fester will only make it harder to treat and prolong your time away from flying. Second, pilots who seek treatment early demonstrate good judgment, which may allow them to return to flying more quickly. We also address these concerns in an FAQ sheet (PDF) in the AME Guide.
