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Pilots Need Mental Health Care Too

During a critical time in commercial aviation with a high and growing shortage of airline pilots, the Federal Aviation Administration (FAA) is neglecting an outcry for pilot mental health care, especially for simple services that address the normal stresses of our rapidly growing advanced technological and logistical aeronautical environment.

On Aug. 25, 2023, the headline of CBS News in Colorado was: “Pilots are crying out for help: Pilots criticize FAA for outdated prohibitive mental health policies.” The article goes on to comment that the FAA’s outdated mental health policies cause pilots to lie about their conditions or avoid getting help until their issues boil over.

I can attest to the above conditions because I work with pilots. Some of these individuals are seasoned advanced pilots with over 30 years of experience, while others are just beginning their careers as apprentice pilots (two thin stripes), junior pilots (three thin stripes), and senior pilots (four thin stripes).

On April 26, 2023, the heading of a Fox News report was, “Mental health in aviation: Pilots are suffering in silence, afraid to get wings clipped. Over half of the pilots surveyed (by Fox) admit to avoiding health care—including mental health care.”

On Aug. 18, 2023, a United Airlines pilot was charged with criminal mischief for allegedly using an ax to destroy a barrier gate at an employee parking lot at Denver’s airport, telling authorities he was trying to help several drivers exit the lot and stated: “He just hit his breaking point.”

A March 27, 2023, Smithsonian article, “Military Pilots Avoid Health Care to Keep Flying,” says,

“U.S. military pilots avoid health care or misrepresent and withhold health information from their flight surgeon at greater rates than civilian pilots out of fear they might lose their flying status, according to a new study conducted by Air Force and civilian medical experts … Though the population size of 264 military pilots surveyed was relatively small, the study marks one of the first attempts to scientifically analyze the widely-held belief that military pilots avoid health care, particularly mental health care, out of fear that certain medical conditions will take them off flight status.”

If a pilot decides to consult with a licensed mental health professional and has psychological concerns that might include the possibility of medication, she must consider that it will cost her a lengthy time in the absence of her career.

Additionally, if a medical or mental health practitioner is consulted, it must be reported in the pilot’s medical examinations.

At a May 18, 2023, meeting it was quoted from a 2002 study that was published in the Journal of Occupational and Environmental Medicine finding that 56.1 percent of pilots reported a history of healthcare-avoidant behavior related to fear of losing their aeromedical certificate, and nearly 27 percent indicated misrepresenting or withholding information on their aeromedical screening for the same reason.

At the Business Aviation Safety Summit, organized by the Flight Safety Foundation and National Business Aviation Association, Federal Air Surgeon Susan Northrup discussed the volume of pilots whose applications have a mental health component, aiming to “dispel the myths” about certification qualification so barriers to treatment can be destroyed.

These ideas and beliefs are slow to take hold within the pilot community and significant skepticism remains as to the safety of reporting mental health consultations.

An individual may be considered for an FAA Authorization of a Special Issuance (SI) or Special Consideration (SC) of a Medical Certificate if the applicant has one of the following diagnoses: major depressive disorder (mild to moderate), either single episode or recurrent episode, dysthymic disorder, adjustment disorder with depressed mood, any non-depression related condition for which the SSRI is used.

To return to active duty, the person for a minimum of six prior continuous months has been clinically stable, as well as on a stable dose of medication without any aeromedical significant side effects and/or an increase in symptoms.

The use of psychotropic drugs is generally disqualifying for aeromedical certification purposes. Examples include sedatives, tranquilizers, antipsychotic drugs, antidepressant drugs (including SSRIs, with some exceptions), and hallucinogens.

The medications considered viable for depression and not limiting in terms of a pilot’s career, include (single use only; not in combination): Prozac, Zoloft, Celexa, Lexapro, and Wellbutrin.

What should the FAA consider?

Proven drugs that historically help individuals return to a healthy life. Some of these drugs are “life-changing” and do not at all contribute to atypical behavioral side effects that would compromise a pilot’s capabilities.

What is a career-limiting condition?

If the applicant has symptoms or a history of psychosis, suicidal ideation, electroconvulsive therapy, treatment with multiple SSRIs concurrently, or multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with SSRIs) their careers are certainly finished.

What are pilots often forced to do?

Firstly, they seek out a therapist who is familiar with FAA guidelines. Secondly, they may pay out-of-pocket expenses since the use of insurance requires a diagnosis. The pilot is required to report that there are in psychotherapy, but given the many complex circumstances, many do not.

Many pilots seek help with ongoing marital problems, family tensions, certainly depressive symptomatology, including lack of interest in ongoing events, inability to sleep, feeling worthless or excessive/inappropriate guilt, and decreased concentration.

“Being a pilot is one of the most high-stress jobs in which pilots are often overworked, struggling with chronic strep, anxiety, depression, use and abuse of alcohol—and in some cases, drugs,” Capt. Reyné O’Shaughnessy told Fox News.

Being a commercial pilot requires facing a demanding schedule that routinely includes irregular working hours and extended periods away from home. Maintaining a healthy work-life balance can be challenging due to the unpredictable nature of the job.

Most airlines offer in-house programs in which pilots serve as coaches for each other. However, often coaches are not healthcare professionals and are not trained to recognize significant mental health complexities. These individuals bring their knowledge and expertise from their flying experience to their colleagues, which could provide a critical intervention. Yet it is important to recognize that an in-house program can be a mechanism to keep the secrets of pilot stress and mental health concerns in-house.

In conclusion, pilots deserve the best care available without repercussions from a system that admonishes advances and the readily available mental health care that we are all entitled to.

To find a therapist, visit the Psychology Today Therapy Directory.


Your Everyday Guide to Telemedicine

With more and more medical practices offering virtual care options, you may want to check first with your primary care doctor, if you have one, or a group medical practice with which you already have a relationship, to see if they’re using phone calls, video chats, or other online methods to conduct remote patient visits.

Pediatricians are also increasingly offering telemedicine, and many specialists, such as cardiologists, neurologists, obstetricians, and oncologists, are also offering care to their existing patients via telemedicine.

You may also want to check with your health insurance plan to see whether it has its own telemedicine interface, has partnered with a telemedicine company, or has preferred services. Using a telemedicine plan that accepts your insurance is one way to keep your costs down.

Another option, if you’re employed, is to ask your human resources department if the company has a preferred telemedicine provider — and whether there’s a cost savings to you in using it.

Medicaid covers some telehealth services, although the specifics vary from state to state. You should contact your healthcare provider if you have Medicaid to ask what services are available to you.

Medicare beneficiaries also now have broader access to virtual visits, following changes to federal rules in March 2020, according to the Center for Medicare and Medicaid Services (PDF).

Some physical urgent care centers are offering telehealth, and at the very least, most will speak to you on the phone about whether or not to come to the center. If you have any upper respiratory symptoms or other symptoms suggesting possible COVID-19, they likely will have special instructions for your visit.

Telemedicine apps are another option. Many apps offer basic primary and urgent care, and some offer additional services, such as dermatology, nutrition counseling, or mental health help.What You’ll Need for a Successful Virtual Visit

Telemedicine experts recommend having these on hand for a successful virtual visit:

A Charged, Plugged-In Device With a Strong Signal You don’t want to run out of power or lose your connection during your appointment! Use Wi-Fi if your cellular data plan is limited.

Ear Buds With a Built-in Microphone It will be easier to hear the healthcare provider, and for them to hear you.

A Quiet Location With Good Lighting Turn off the TV, mute notifications on your phone, and tell others in your house you’ll be busy for the next 15 to 20 minutes before you start your visit. Make sure there’s enough light for the health professional to see your face — and any rashes or other physical problems you want to show them.

If you’re not at home during the virtual visit, find a quiet, private spot where you can shut the door. “I’ve had people try to do virtual urgent care visits while they’re driving a car. We tell them to hang up and we’ll reschedule later,” Dr. Bishop says.

A Flashlight You may need extra light to give the doctor a clear view of your sore throat, a mouth problem, or even a skin problem. “That’s a big one for our urgent care service at Mount Sinai,” says telemedicine expert Brendan Carr, MD, system chair of emergency medicine for the Mount Sinai Health System in New York City. “People often call for sore throat, but it’s hard to see back of a throat without a flashlight.”

A List of Your Medication and Supplements, Health History, and Questions A telemedicine doctor who’s seeing you for the first time can better help you if they know about any chronic health conditions or other important health issues you have, as well as the prescription and over-the-counter drugs and supplements you currently take. It’s also smart to jot down your questions ahead of time, Bishop suggests.

If you’re seeing your usual doctor via telehealth instead of in-person, be sure to mention any new symptoms you may be having, any new over-the-counter products you may be using, and any prescriptions you need to have refilled.

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