Mental health as an aviation safety consideration

Sometimes we are not the first individuals to notice we have a problem, so the obvious important thing with any medical condition is to realize that we have a problem, then seek treatment to make the problem better, or go away altogether.

Mental health issues have always been a risk factor of concern to civil aviation regulators all over the globe. In December 2016, the International Civil Aviation Organization (ICAO) issued a working paper to convene a task force that is charged with analysis of recent aviation accidents in which a mental health condition was cited as a “causal factor.” (ICAO 39th Assembly Session Working Paper 12/8/16)

This action came as a result of several high-profile losses of air carrier flights in which a flight crew member was later identified as possibly suffering from depression or a related mental health state. Notable among these accidents are Germanwings Flight 9525 in 2015 and Malaysia Flight 370 that disappeared over the Indian Ocean in 2014 and other incidents that occurred within the last 10 years or so. 

The FAA has taken an interesting path with respect to medical certification of pilots. In 2010, a significant policy change was made that allows for special issuance consideration for persons using certain antidepressant medications. With that policy, the FAA determined that the airspace is safer when pilots who are having serious mental health symptoms but who fear seeking treatment because of the risk to their job security are actually treated appropriately and followed systematically to assure their continued stability.

Sometimes we are not the first individuals to notice we have a problem, so the obvious important thing with any medical condition is to realize that we have a problem, then seek treatment to make the problem better, or go away altogether. Close friends and family members often send us signals, directly or indirectly, to recognize that something isn’t right in our “affect,” the emotional tone that we project to others based on our mood or mental state. Depression is sometimes insidious in the way it presents, which is why others often pick up on signs and symptoms before the depressed person does. Getting help sooner rather than later eases the duration and often the severity of the symptoms.

Symptoms one should look for in people who may have depression include feelings of sadness, hopelessness, or just feeling “down in the dumps”; loss of interest or inability to gain pleasure from activities that you once enjoyed; a loss of sexual drive; weight loss or even gain without dieting, or a noticeable change in appetite; insomnia or disrupted sleep habits; restlessness; fatigue; inappropriate feelings of guilt or worthlessness; problems with concentration, thinking, or decision making; and thoughts about harming oneself, including suicide.

If you are experiencing any of the above symptoms, then you should seek help. Many companies offer employee assistance programs that allow phone consultations with trained staff who can listen to your story and offer avenues of coping strategies or referrals to health care providers.

Pilots are passionate about flying, no surprise. Sometimes that passion gets in the way of sound decision making, and loss of a medical certificate is often the first thing pilots think about when they receive news that could affect that certificate. A diagnosis of depression is by no means the end of one’s flying. In fact, there are relatively few circumstances involving a diagnosis of depression that would result in permanent denial of medical certification.  

That said, though, if you are diagnosed with depression, and even if you‘re not placed on medication, you shouldn’t fly at least until you have a good understanding of the issues, and that usually requires help from a qualified health care provider. Discuss your flying with the treating physician or psychologist and heed his or her advice as to the proper time to attempt to resume flying.  Remember, we all operate under 14 CFR 61.53 when we fly, and that means we medically self assess that we are fit to fly before turning the prop.

Once treated, now what happens? The FAA policy now allows four different medications called SSRIs, selective serotonin reuptake inhibitors. Serotonin is a neurotransmitter and helps relay messages from one area of the brain to another. It is believed to affect a variety of psychological and other body functions. This includes brain cells that are associated with mood, sexual desire, appetite, sleep, memory, and learning.

There is an established protocol that allows the FAA to favorably review applicants for special issuance consideration, but each case is reviewed with respect to the specific individual case history, so although there is a “cookie cutter” protocol, the FAA treats each case independent of any other one. 

If you are placed on a SSRI short term for a “situational depression” such as death of a loved one, loss of job, divorce, or other life stressors, and the medicine is taken for no more than about six months, then discontinued, the FAA could consider your case after you have been off the medication for at least 60 days, and have no recurrence of symptoms that would require you go back on the medication. 

At a minimum, you will need a detailed narrative summary of your history, treatment, and prognosis from your treating physician, preferably a psychiatrist, to provide to the FAA. The letter will need to include the type of therapy you had, including medication name, dosage, and frequency of use, when it was started, and when it was discontinued. There also should be a statement as to your current status after being off the medication. If you were diagnosed with depression but not treated with antidepressant medication, but with counseling therapy with your psychiatrist or psychologist, you will still need to provide that same type of letter for FAA review.

For a more serious depression history that requires long-term medication therapy, the FAA will ask for a much more detailed evaluation from a psychiatrist or psychologist who is familiar with FAA certification policies. 

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.
Topics: Pilot Protection Services, Pilot Health and Medical Certification

Related Articles