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The Air Up There Podcast

Mental Health

Season 4, Episode 4
Published: Friday, May 27, 2022

Mental Health Awareness Month is almost over, but our care and concern for the emotional, psychological and social well-being of pilots continues. We receive so many comments on our social media platforms regarding pilots' concerns about mental health. We see you, and in the latest episode of our podcast, we clear the air about misconceptions around mental health and flying.

The FAA continues to make improvements around policies, testing, treatments and approved medication for pilots. Tune in to hear from Dr. Susan Northrup, FAA's Federal Air Surgeon, and learn more about the transparent process pilots can expect during their individual health assessments. You'll also hear from Ellen Brinks, Air Line Pilots Association (ALPA) Aeromedical Chair, who leads ALPA's Pilot Support Program.

It is imperative for pilots to understand that it is okay to ask for help. Seeking help puts them on the right path to getting better so they can continue their passion for flying in the safest way possible.

Share this important episode with pilots in your network. In the words of Jerry Crawford, To most people, the sky is the limit. To those in aviation, the sky is home. We want to make sure pilots get the help they need and deserve so that they can always feel at home.

Mental Health

Mental Health

Transcript

Ryan (00:04):
Welcome to The Air Up There, a podcast about the wide world of aerospace. I'm Ryan Willis. Today's episode addresses mental health in our aviation community.

DaiJah:
And I'm DaiJah Metoyer. Talking about mental health is so important to remove the stigma on issues and concerns pilots may face. We see a lot of comments on our social media posts, and we hope today's episode will address misconceptions about mental health and flying.

Ryan:
That's right DaiJah! Many pilots think they will lose their medical certification as soon as they report or seek help. But that's not the case. Most mental health conditions are safely treatable, and when resolved, the pilot is cleared to return to flight. First up, we go straight to the FAA source: our Federal Air Surgeon. Our colleague Kristen Alsop spoke with Dr. Susan Northrup to learn about the transparent process pilots can expect during the individual assessment.

Kristen (01:01):
Thank you, Dr. Northrup, for being with me today as we talk about mental health month, and some of the challenges that we see with pilots in particular, maybe being apprehensive to talk about mental health and to seek help. And so I'm just wondering, what do you want pilots to know?

Dr. Northrup:
So I want pilots to know that mental health is part of a continuum. It's part of their normal health. And it is perfectly expected in United States society today that one in five individuals will deal with some form of a mental stress or illness at any given point, certainly within their life. So we need to be able to talk freely about mental health and how this affects our individual performance so that we begin to interact with pilots early on in the process. We have to destigmatize mental health conditions in the aviation community.

Kristen:
Do you want to talk a little bit about pilots' personalities, and why they might be apprehensive to talk about their mental health?

Dr. Northrup:
Certainly. So there's, there's this belief in the pilot community that once you've been diagnosed with a mental health condition that you will never fly again. And that the process for getting back to flying is expensive, onerous, and takes forever. So there's this real resistance to even talking about mental health and accepting that somebody might need help. So you look at the typical pilot, and you want them to be very strong and firm in their beliefs and execution of things. So there's, there's also this hesitancy to admit that they might have a weakness or they might have a period in their life where they're not able to respond as effectively as they would like to. And as a result, all of this, this myth and misinformation that, oh, pilots don't get this. And the fact of the matter is they do. So we have to figure out how to get the message to the individuals in such a way that they hear it, that they believe it, and that they act on obtaining the help that they need.

Kristen:
So talk to me a little bit about kind of how we're removing that stigma of mental health and what the FAA is doing.

Dr. Northrup (03:19):
Mental Health Month … This is a great time to roll it out, where we talk about how we get people back in the air after they've learned the skills they need to respond. The big thing is to just talk about it because once you start talking about it, you can recognize it. And once you recognize it, you can take positive actions to respond. There's a couple other things we're looking at. There's a great model in the commercial aviation environment, called peer support networks, where some people are actually frightened of talking to us to a certain extent that maybe they wouldn't be so frightened initially, of going to a peer, a fellow pilot, or somebody in the university or the local FBO [fixed-base operator] that can give them good advice, so people that have been trained to respond. So once we talk about and once you recognize that then we can legitimately intervene by using some of these tactics and skills that are less concerning or threatening to an airman or a young person, in general. These same concepts would work in almost any arena. It's just I'm very definitely concerned about pilots and aircrew. So when I'm when I'm talking about groups that have mental conditions, or mental diagnoses, in general, they fall into one of four groups. So the first group are the ones we know about, that are under care that are being followed with or without medication; we're least worried about them because they're getting the tools they need. The second group are those that are getting the tools, they need the interventions or the medication and they're not telling us so I don't have any way of seeing whether or not they're in adequate treatments go into remission. And then there's the bunch that refuse to get the help because they're worried that we might find out at some point and ground them. So they're dealing with their depression without any help from professional of any sort. And the last group are those that are treating themselves in some form of homeopathy to try to get to their symptoms. The ones as I said that concern us the least are the ones that are getting the help they need and obtaining the tools so that hopefully this won't happen to them in the future.

Kristen:
Do you have anything that you want to say to the pilots who are in those latter two categories, you know, not getting help?

Dr. Northrup:
Well, I would encourage them to talk with a mental health professional or their primary care physician. Those individuals can help guide them to the areas that can be the most efficient and helping them. And certainly not everybody needs to go on a medication. Sometimes it's just a little bit of, of education, of skills, and how to deal with different situations. So there's, there's a whole lot of different ways we can intervene with somebody who's feeling anxious or depressed, and get them back in the air. And some of the other really cool things about 10 years ago, we introduced Selective Serotonin Reuptake Inhibitors, or SSRIs, as antidepressants and to a certain extent anti-anxiety medications. And pilots, if they are under adequate treatment in remission, will go through a special authorization process, special issuance, and we have several hundred individuals with a history of depression or anxiety, flying right now on SSRIs. We also recognize that some people don't need to stay on it for a long time. And they just need a little bit of support for a brief period of time. We can look at that and get people back in the air there.

Kristen:
So this idea that you can't take any medicine and ever fly again, is just not true?

Dr. Northrup:
Correct. And we're actively looking at the newer medications, because we've got 10 years' experience now. And there's a whole bunch new medications and pharmaceuticals and techniques to help people through mental conditions. And I've charged my folks to take a good look at could we add to the list of medications and get the broader spectrum of interventions.

Kristen:
Talk to me a little bit about the growth within your office.

Dr. Northrup:
Right. So if you go back three, four years ago, we had a chief psychiatrist, and that was it. So any tough cases would go to the chief psychiatrist, and it might take a minute. So we have since added to that staff, we have two PhD psychologists, a neuro psychologist and three psychiatrists that are on the team employed by the FAA in a Behavioral Sciences Division. In addition, we have broadened the number of consultants we have outside of the office of aerospace medicine. So we have some folks that we can send cases to. It's not that all mental health cases go really quick, because quite frankly, some of them are very mixed and very complicated. But we do everything in our power to get to "yes" while preserving the safety of the national airspace. Because that's the most important thing is safety, making sure that we don't put somebody in a position where they could become subtly or suddenly incapacitated.

Kristen:
So we want to help pilots and we want them to know that there's a path back to flying but also know, the safety of the National Airspace System is paramount?

Dr. Northrup:
Yes, I don't want to put anybody in a position where we have an expectation that they might get into trouble. We've got to keep the safety there.

Kristen:
If I'm a pilot, and I'm going to seek help. What is that process going to be like with the FAA?

Dr. Northrup:
So we encourage pilots and other aircrew members to get help early, get help before it gets so bad that you're tempted to take an action that might cause permanent damage or hurt. And there's lots of ways to do that. It's very important that their pilot pay attention to what they need. They can talk to a mental health provider, a social worker, they can talk to their primary care physician or nurse practitioner or physician's assistant, if they are so inclined, go speak to their pastor or their priest. Many, many of the clergy also have some training in mental health intervention. If somebody's feeling like they they're even contemplating suicide, the suicide hotline [800-273-8255] is absolutely an incredible place to go get the help that they need. While they're in the throes of this they should not fly because an airman or pilot should not fly if they know they have a condition that would affect safety. But once they're adequately treated, once they've got the skills to get back to the baseline where they can handle what's going on in their lives again, then they should work with their AMEs, their aviation medical examiners, to report it to the FAA. They do need to report many of these interactions on their 8500-8 through the MedXPress. Now they don't need to report family counseling, and there's a couple other caveats if you look at the instructions, but certainly anybody that's had medications or diagnosis needs to report that if you look in the guide for aviation medical examiners under 18.m, which is the question on the form, you can see what is out there the instructions for the aviation medical examiners based on what the applicant is dealing with. So it's not a surprise, it's out there, it's in writing, there are some nuances that can be discussed with their AMEs. But once they've done that, they'll submit the documentation, in all likelihood, depending on the level of the diagnosis, the AME will probably have to differ, but not all of them, there are several the AME can handle right there on the spot with the airman. And then it comes to us. And depending on the level of diagnosis, or the mixture of diagnosis, it may be handled at the regional flight surgeon's level, or the Aeromedical Certification Division. And the really complicated ones come to Washington that come to the headquarters to our Behavioral Sciences Group.

Kristen (11:00):
So it's an individual process, basically, for every single pilot?

Dr. Northrup:
It is, we look at each pilot on the merits of their case.

Kristen:
So when we see comments on social media about reforming mental health within the FAA, and there's this notion maybe that we should be doing some blanket approvals, that's just not possible, because we're looking at every single pilot individually?

Dr. Northrup:
Correct. We're looking at every pilot individually; it's a unique decision. Now, similar cases should be treated similarly, of course. But it's still an individual assessment on each one. The most critical thing that we have to get across to the pilots is, if you have an issue, and get treated early, when it's, you know, dysthymia, or mild depression, or bereavement, or there's a whole adjustment disorder is another one of the major categories. But if you get treated early, before it becomes full-blown moderate to major depression or anxiety, it's a lot easier for us to handle the milder case. So getting the help early, so that you learn the tools, it is so much faster to get through us and so much easier to get through us. And they won't hopefully go down the pathway to moderate or recurrent, severe depression. So as you get down that end of the spectrum of disease, it does become a lot harder, because of the risk of recurrence at that level.

Kristen:
So pilots might be afraid to tell us that they have a mental health issue because they're afraid they're going to lose their license. But what you're saying is getting help early actually helps you get back potentially to flying sooner. And the longer you wait and try to deal with it yourself, or whatever the case might be, the harder it's going to be. Is that what I'm hearing?

Dr. Northrup:
Exactly. That's exactly what you're hearing. I mean, we all grow up, we all evolve. And part of that is learning. And sometimes we need a little bit of help to learn the techniques and tools to deal with life stresses. So we go back to the you got to acknowledge there's an issue, talk about it, get the help, and then come back.

Kristen:
Are you also looking at not necessarily reforming our policies and our mental health position because I think, as you've said here, you know, we really want people to get help. And I think that's the most important thing. But are you looking at ways that the FAA can improve the process or our own policies and things that we do?

Dr. Northrup:
Yes, we are. So one of the things that I have tasked my staff to look at in the next couple of years is what's the best combination of neuropsychiatric testing, we can use? What's for any given diagnosis, I get a lot of questions about ADD and ADHD, so Attention Deficit Disorder, and Attention Deficit Hyperactivity Disorder. And we're beginning to see a body of science that says for the young kids that get this diagnosis, many of them truly grow out of it. But what do we need to do? Or how do we need to determine whether individual A has grown out of it where individual B has not? And teasing those out is one of the things we hope to do in the coming years so that we're limiting the expense at the same time, we're ensuring safety, because quite frankly, the last place you want somebody with an attention deficit, or distraction issue is in the air. Because we need them to be focused on what they're doing. The medications, we're seeing more and more and then the field of science, different techniques, different medications, different treatment modalities, and can some of those work even better than what we've got now and still allow somebody to safely operate in the airspace? So we're constantly reviewing our policies and trying to improve them to the point where, one, it's no surprise to the airman or the pilot, two it's written down, and as transparent as we can make it. And then once we've got experience, so I said we've had SSRIs for 10 years, and we're beginning to really look at what the right mix of tests and what the frequency of those should be for renewals. So early on in the SSRI program, we were looking at people every six months, and then after we got some experience, we looked at him once a year, it might be time that say, Okay, we look at him once a year, but we only do the neuro psych testing this frequency. Oh, yeah, it's a constantly evolving process. I've got a really motivated team of individuals who want to get pilots back in the air safely with mental health conditions or a history of them and remissions.

Kristen:
When you hear someone say, reform mental health, what does that mean to you and to the FAA?

Dr. Northrup:
Well, to me, it means we need to constantly be looking at our standards, we need to constantly evaluate whether this policy that was formulated 10 years ago, or 15, or 20 years ago still make sense in today's world. And that's a constant iterative process. And then once we begin to get that developed, then we can look at some of the other diagnoses. It really does constantly boil right back to the safety of the individual and the National Airspace and making sure that we've got everyone who can safely operate doing so.

Kristen:
What else do you want pilots to know?

Dr. Northrup:
I encourage any pilot that's beginning to have issues to reach out and get the help they need. Do it fast, do it early. And the skills are important and something that that will help moving forward.

Kristen:
Well, thank you for talking with us today about this important topic. And I hope that pilots are listening. And, you know, if you're one of those pilots who may need help that you get that help.

DaiJah (17:09):
It is great to hear that the FAA makes continual improvements around policies, testing, treatments and approved medication. Up next, we explore a peer support program for pilots. Our colleague, Chris Troxell, interviews Ellen Brinks, Air Line Pilots Association Aeromedical Chair, who leads ALPA's Pilot Support Program.

Ryan:
Ellen has 20 years of flying experience and a passion for helping people. This program is similar to many in the aviation community, with a network of pilot volunteers who provide guidance and help to other pilots.

Chris (17:44):
Can you tell us a little bit more about your aeromedical group and its mission?

Ellen:
Our primary goal is to keep people flying, or if they've moved off the line to get them back on line flying. So it's always helping them to retain their medical certificate. And we want them to live their best life going forward, flying the line, moving into a happy and healthy direction, so that they're, you know, really making the most out of their life.

Chris:
I read that a fairly large portion of pilots with mental health conditions are reluctant, maybe fearful to seek help. Can you can you tell us why that may be?

Ellen:
Pilots have a Type A personality, they are very commanding authority. And they're the PIC [Person In Charge] of it as an aircraft. And so they're used to solving their own problems, and they don't want to appear weak to their colleagues or even to the public when they're when they're asking for help. Because, you know, back the older generations always believed that if you were asking for help, that that's a sign of weakness, and that's not the case. So we need to really kind of move that forward. We're trying to change the thought process and normalize the behavior of asking for help. It's okay. You know, another reason why pilots may not want to seek help is they're afraid that they're going to lose their livelihood if you lose your medical certificate. When pilots are in the middle of a crisis they don't really know what the first step is in seeking help. They know they need it; they just don't know what the first step is. So getting to that first initial step is really crucial. We say that the hardest phone call that a pilot will make when asking for help is that first initial phone call. Once they get past that step, then they've got somebody walking a path with them and moving them forward helping facilitate their choices; whatever it is, it's dependent on every situation what they may do.

Chris:
Once they do that, what comes next? What's step two, step three, etc.?

Ellen (19:55):
You know, it really is dependent on the situation what the next step is going to be for some people it might be, hey, like, maybe it'd be a good idea to go talk to a therapist. For others, it might be a support group. For others, it may be some time off from work while they're going through difficult situations. So there really isn't a one-size-fits-all for what the steps are for walking you through it because everybody's an individual person. So we treat each case as an individual case.

Chris:
Can you provide a few examples of how your support network has helped pilots?

Ellen:
We let a pilot know that they're not alone; that's the first step. And we guide them to a resource, we guide them, give them the support that they need going in the direction and to help them with whatever their situation may be. And no specific details or anything, but it might be for instance, like dealing with a work issue, such as failing a check ride. Or it could be a health issue where a family member or themselves have an ailing family member, could be a financial issue, whatever that reason may be, or there could be a domestic issues such as going through a divorce. I mean, there's all these different sorts of cases that happen and, and there is no one-size-fits-all to what help they may need or how they receive it. But they just need somebody to be able to talk to and listen to them. Since the inception of our pilot peer support program, we have had a steady stream of phone calls that come in with pilots needing help with and, you know, a lot of our pilots do not lose their medical. So that's one thing that I want to make sure and clarify is that they're still flying the line, they're still enjoying their life, they're really thriving, and living a fulfilling life. So the majority of our pilots that we help actually never lose their medical. But we have had a very steady stream. So you'll see that world events will also increase the amount of phone calls that we get. When we're talking about the pandemic and like the fact that now people are talking about mental health and the mental health awareness and people were seeking help. The one thing to realize is that everyone, the general public, pilots, were doing fine; they had their routine, and they had a set way that they organize their life and then all of a sudden, literally, it was like a switch flipped. And everything stopped; their lives were disrupted, and it brought a point of a part of acute stressors is what we would call that because, for instance, pilots stopped flying. Some of them were facing furlough specifically or being, you know, terminated; their airline shut down; whatever it may be. And so that's what we'd call an acute stressor. And all of their coping mechanisms that they had for normal life were that it was fine, and then it stopped. Well, now they have no way to cope. And it brought out all these other stressors because they had no way to deal with it. And so that was one thing where now you're seeing the mental health care system in general was flooded, just like the hospitals were during the peak of the pandemic. So that's, that would be the one thing and now why people are actually talking about it, and they're aware of it. And they realize, well, everybody else is getting help. Why am I not getting help? And that's the one thing that we want our pilots to realize is that common misconception is that we hear that well, I want to get help, but I can't get help. Well, there is a way for pilots to get help. All they need to do is make that phone call.

Chris:
What do you think are the keys to destigmatizing mental health?

Ellen:
I think the best way to destigmatize mental health is to talk about it. May is now Mental Health Awareness Month. So we're in having the conversation. I think that the pandemic really brought to light some of the issues with our mental health care and wellness and the system, what needed to happen and people really have it; they may not have an understanding of it yet, but they know that it's out there. You know, the more that you talk about something, the more normal it becomes. When you normalize seeking help and that it's okay, people will do it. So that's the best way to move it forward. One of our slogans is talk early and talk often and really making that effort between all the different people that a pilot will run into in their career, knowing where it's at, making it available in training centers, making it available on the line, you know, getting the word out, whatever it may be, is really the best way to promote the program. And, honestly, our pilots that have went through the program, or used it, they're our best advertisers because they can say to the to others, hey, you know, I was having a difficult time and this peer support program really helped when I was going through it. They don't need to get into details, but those the pilots that have used it tend to be our best advertisers.

Chris:
Is there anything else that we haven't touched on, that you think would be important to discuss here?

Ellen:
I think the biggest thing that I can say is to encourage pilots to seek help. And the sooner that they seek help, the faster the recovery will be; they will end up being on the line, flying, enjoying their life. And, you know, as I said previously, our motto is talk early and talk often. If you take care of a minor health concern, whether it's physical or physical or mental, just as like, you know, you don't want to wait and let that small thing turn into a large health event. So if you deal with this problem, a health problem early, it won't turn into a long event where you may not be able to recover from it. So that's the best thing that I can recommend is to just ask for help when you need it. Don't wait.

DaiJah (26:04):
Pilots: If you're experiencing mental health issues, it's okay to ask for help. Getting help doesn't mean the end of your career. It means you're taking the right steps to get better so that you can continue to serve the flying public, or continue your flying passion, in the safest way possible.

And that's our show for today.

The Air Up There is a podcast from the Federal Aviation Administration. If you liked today's episode, remember to subscribe and share it with someone else. You can find the FAA on social media. We're @FAA on Facebook, Instagram, and LinkedIn, and @FAANews on Twitter and YouTube.

Ryan:
Thanks for listening!