By Ian Arendt*

This article was originally published in the January 2024 edition of AOPA’s Pilotmagazine. Editions and alterations from the original have been made by the author.

The mental health of pilots has been discussed frequently lately—usually not for good reasons. It’s an open secret that pilots underreport mental health issues and often refuse to seek treatment. Research supports this: a 2016 study concluded that hundreds of airline pilots could be managing depressive symptoms perhaps without treatment for fear of impact to their career. A 2019 study, although not specifically addressing mental health, found that over 60% of respondents admitted to delaying or avoiding medical care over concerns for their pilot certificate.

A recent report issued by the DOT stated that the FAA has “comprehensive procedures to evaluate pilots’ psychological health.” Few of us would dispute that FAA has an extremely thorough review process when it learns of potential mental health conditions. However, the report also found that pilots are reluctant to disclose mental health conditions, primarily due to “the stigma associated with mental health, potential impact on their careers, and fear of financial hardship.” Understandably so. After all, pilots who report mental health conditions or treatment are often required to obtain onerous and costly evaluations from the few (and expensive) FAA-approved psychiatrists and neuropsychologists. After obtaining these evaluations, the FAA may take many months to review before a certification decision is made (or even more information is requested). All the while pilots are unable to exercise any medical certificate privileges, which usually means they cannot work or build flight time. Even after receiving a medical certificate, continued evaluation and reporting requirements are the norm. It provides little solace that pilots rarely receive a final denial with no hope of future medical certification when they are out of work (according to the FAA, about 0.1% of applications are truly and finally denied).

While the FAA has made meaningful strides in its messaging and changes for certain mental health conditions (including situational depression, ADHD, and PTSD), the FAA must do more if it ever hopes to dispel the fear pilots face when experiencing a mental health challenge. Substantive revisions to the FAA medical certification policies and procedures are required before any meaningful progress in combating mental health issues can be achieved.

So, what could the FAA do to encourage pilots to seriously consider their mental health and to accurately report mental health conditions and treatment? For one thing, the FAA could grant AMEs the discretion to issue temporary medical certificates when pilots report mental health conditions or treatment. Latest reports indicate the FAA has a nine-month backlog for internal review of any psychiatric case. Temporary medical certificates would allow pilots to continue working or building flight time while the FAA reviews the file.

For another, the FAA could amend its reporting requirements so that mental health evaluations, counseling, or use of an employee assistance program (EAP) are reportable only when resulting in a clinical diagnosis or treatment for specific, aeromedically significant conditions. As it stands now, all visits to a psychiatrist or psychologist within the past three years must be reported on question 19 of the medial application even if the visit did not result in any formal diagnosis or treatment. Any counseling “related to a … psychiatric condition” must similarly be reported. On the other hand, use of an EAP is reportable only when “result[ing] in referral for psychiatric evaluation or treatment,” though FAA guidance on this point is inconsistent. This change would provide much needed clarity and give pilots more tools to address their mental wellness. For example, pilots would be more likely to seek informal counseling (peer-to-peer, life coaching, etc.) and take advantage of EAPs to stop a mental condition from developing into an illness. Further, pilots concerned for their mental wellbeing would be more willing to seek professional help if only required to report visits resulting in clinical diagnosis or treatment for select conditions.

Additionally, the FAA could improve its communications with pilots by explaining, in layman’s terms, the reasons for its decisions. Currently, when the FAA denies a medical certificate or requests additional information, the FAA uses form letters which, at best, reference the underlying conditions at issue but fail to provide any substantive explanation as to why the condition makes pilots unsafe to fly or why additional information is needed. Instead, pilots must request their medical certification file with “applicant notes” (which can take weeks) or track down a helpful FAA employee to clarify the information necessary to make a decision. Providing clear reasoning in corresponding with pilots would do much to dispel the distrust many harbor against the FAA. As a bonus, the FAA could assign individual case workers to a file, so pilots have a single point of contact when questions arise.

Finally, after making these substantive changes, the FAA should provide pilots with an opportunity to reconcile their medical certification records without fear of facing revocation. This would encourage pilots who have not reported mental health conditions or treatment to come forward and disclose important information. For now, pilots with unreported conditions risk allegations of intentional falsification and revocation of all airmen certificates.

To be clear, pilots concerned for their mental wellness should seek the care and treatment they need. Often, peer-to-peer or EAP resources may not require reporting and can prevent a situation from getting worse. Nevertheless, until the FAA makes meaningful changes to the medical certification process, airmen will hesitate to receive help and may be inclined to hide a condition from the FAA.

*Ian Arendt is an in-house attorney with AOPA’s Legal Services Plan, providing consultation and legal advice to participants in the Legal Servies Plan. Ian is the Treasurer of ALA and a private pilot who owns a heavily modified Piper PA-12 Super Cruiser.