Opinion: FAA Pivots On Mental Healthcare

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The role of a pilot has shifted substantially over the years from physical and sensory-based to cognitive, where proper supervision of systems and decision-making is critical. 

For pilots facing depression and other common mental health conditions, many fear that seeking treatment will jeopardize their medical license and career, leading numerous pilots not to seek treatment altogether.

That is changing. The FAA is making revolutionary changes in its approach to mental healthcare.

A 2023 study found that around 12% of airline pilots have mild depression. The study revealed that pilots with mild depression exhibit a higher error rate, indicating potential difficulties in problem-solving, adaptive thinking and decision-making abilities. There are segments of the pilot population who need mental healthcare and are putting passengers and themselves at risk by avoiding it.

Some organizations, such as the Air Line Pilots Association and air carriers themselves, have attempted to provide a degree of care for struggling crewmembers with peer support programs, where crews volunteer to talk fellow pilots through their stress and difficulties. However, many have called these programs a weak solution for pilots, air traffic controllers and other professionals, who would benefit from talking to licensed therapists.

It has been an ongoing issue.

The industry has long called for the normalization of mental health treatment and a modern, common-sense approach to mental healthcare.

The FAA convened an Aviation Rulemaking Committee (ARC) on Mental Health & Aviation Medical Clearances in 2023, whose findings were published in April of this year.

A month later, the FAA responded swiftly to the ARC recommendation by updating its Aviation Medical Examiners Guide with several changes.

“Uncomplicated anxiety, depression and related conditions” no longer require special FAA approvals or processes if the individual has been off medication for at least two years. The FAA has also approved three new selective serotonin reuptake inhibitor drugs (commonly known as SSRIs) to its list of conditionally accepted antidepressant medications: Effexor, Pristiq and Cymbalta. And it has added more training and guides for examiners.

These developments may be just the beginning of more changes if the FAA continues to follow the recommendations of the recent ARC. For example, a reduction in observation times when switching to new medications and the removal of neurological testing for mild conditions are a few of the standards that the FAA has held more stringently than many other international civil aviation authorities.

Employers will benefit. “This allows companies to lean on professional, external sources to support their workforces, instead of internal sources,” says David Hughes, director of human resources at GrandView Aviation. Hughes is referring to peer support programs or simply giving time off for crewmembers struggling with mental health conditions, which could not be acknowledged due to the potential impact to their license.

“I will be curious to see if this impacts a carrier’s ability to access more life insurance or loss-of-license options for flight crews in the long term,” Hughes says. Life insurance is historically difficult to obtain or cost-prohibitive for carriers to offer, as the actuarial risks are higher for pilots.

Risks are higher not only because of the dangers of flying, but also because there are many health conditions for which crews cannot seek treatment due to the potential loss of a medical certificate, such as mental health and cardiovascular issues.

While data is scarce, a study published by the Flight Safety Foundation on pilot loss-of-license disabilities and morbidity rates in the 1990s showed irregularities in the pilot population versus the general population.

This study, which was conducted when the retirement age was 60, says, “evidence indicates that mortality is higher immediately after retirement.” In fact, it exceeded general population figures significantly.

“The strongest correlation between disability and age appeared in the psychiatric category,” the study says. “This suggests that stress and other psychological factors significantly affect pilot health with advancing age.”

Depression increases the risk of heart disease, cancer risks from smoking and alcoholism. On average, depression may reduce the lifespan of men by seven years, according to Reuters Health.

For air carriers and other aviation companies, the FAA’s new approach to mental health treatment is a positive step forward to a healthier and safer workforce.

“When selecting health insurance this year, flight crews can now utilize treatments like talk therapy that they couldn’t before and will have questions on the kind of coverage they will need to have access to through their employer,” Hughes says.

The changes mean that “talk therapy has been decriminalized as a pilot,” says Austen Jarobe, a pilot advocate, in a recent post. While the outcomes of the shifts in policy by the FAA are as yet unknown, there are now tens of thousands of people who can take care of their health like never before.

For air carriers and other aviation companies, the FAA’s new approach to mental health treatment is a positive step forward to a healthier and safer workforce.

Jessie Naor is the author of the Sky Strategy column in BCA and is CEO of FlyVizor, an aviation M&A advisory and business consulting firm. She is a former founder and president of GrandView Aviation.