Fact or Fiction: FAA Continues to Remove Barriers/Reduce Stigma for Mental Illness in Pilots

Half Fast said:
Bruce, I’m curious. We have about 80k pilots using Basic Med now. Has there been any sort of anonymous survey to determine what meds they might be taking for comparison against meds acceptable to OKC?

Given the similarity of the safety records of Basic Med and Class 3 pilots, it might be interesting to know what similarities (or dissimilarities) there are between maladies, treatments, and medications.
Click to expand...

I would expect the FAA to stick it’s head in the sand re: Basic Med. Part 68 allows them to do so, and seeing how it was rammed down their throats, it’s understandable.

I also doubt there’s any correlative value between a self-reported survey and data than can be collected thru Part 67 processes.

The only hope, in my opinion is NTSB data where tox reports are collected.
 
my take on hiding conditions is this- if its treated its much less of a safety hazard. the faa needs to know, even if it temporarilly grounds someone- a case could be made that pilot could have admitted his issues- hell his doctor said possible psychosis. he should have been grounded until he was on the right treatment regiment then maybe do the ten year consideration or whatever they reccomend - what about a pilot monitor- make sure he takes the meds and is drug tested to make sure the meds are in his system. its so tragic and could have possibly been preventable. What is safe that is the question. he had a psychotic depression and on top of that knew the standards and knew he couldnt fly again- so guys wht is the faa's solution to a situation like that? I miss dr chesanow he was nice and was kind no matter what.
 
Gator1975 said:
I’m fine with Class 1 and 2 jumping through many hoops to get certified. I don’t want someone flying a 150 pax plane (like the Germanwings guy) without proving they are fit. That is in the personal interest of everyone.
Click to expand...

Except that the Class 1 and 2 do not prove that. A friend was a regional 121 captain, with a Class 1. And had a heart attack. On final.
 
i imagine there were no warning signs- nothing was being treated im guessing
 
Jameskerr3 said:
i imagine there were no warning signs- nothing was being treated im guessing
Click to expand...
It can be really easy to miss, misinterpret, or dismiss the warning signs the first time around -- especially if you've had a clean EKG and all. An impending MI doesn't always clearly announce its intentions.
 
I defer to the professionals. Thanks for sharing. i hope hes ok now and healthy. medical issues arent fun all around
 
Salty said:
I saw an Faa flyer at sun n fun asking for volunteers to participate in a medical survey. Basic med was not one of the options. I don’t think the Faa in any way acknowledges basic med even exists.
Click to expand...
It proves the farce that class III is on the public safety outcome front, and they know it. That's why I can't break bread with those petty functionaries' penchant for defending the status quo. They act in bad faith when confronted with objective (empirical meta-outcomes in this case) refutation, to say nothing of their tyrannical impulses when you get uppity and don't speak obsequiously or ask nicely (flat billed trenty boy kerfuffle et al). But we get the bureaucracy we tolerate, so I digress.
 
Also i am not advocating that people untreated or treated or untreated psychosis should fly- or mi - but if there is a low enough risk and there are meds that can treat all of the conditions of concern then perhaps its better to be treated and fly then not. I am advocating safety. If its unsafe i am not advocating it. if certain conditions are not certifiable due to the safety risk then dont certify. I think they should test pilots as a requirement to show they are being treated for their conditions.
 
jbarrass said:
All if the "have you ever" questions should be modified to a 10 year lookback. After 10 years, it's settled. A successful 40 year old who had a rough 4th grade is not a concern.
Click to expand...
5 year look back max!
 
Jameskerr3 said:
Also i am not advocating that people untreated or treated or untreated psychosis should fly- or mi - but if there is a low enough risk and there are meds that can treat all of the conditions of concern then perhaps its better to be treated and fly then not. I am advocating safety. If its unsafe i am not advocating it. if certain conditions are not certifiable due to the safety risk then dont certify. I think they should test pilots as a requirement to show they are being treated for their conditions.
Click to expand...
This is the important point I think. Treatment is so important to any medical condition, especially mental. Right now, the FAA is pretty much telling pilots to ignore any issues they could have. Its one thing to be psychotic as you say, but some airline pilot having panic attacks or heart palpitations should not be looking at the end of their career if its treatable. I know many folks on here are focused on basic med and class III, but I think the issues with this are more severe with professional pilots who require a class I, solely because of how much they have to lose.

In the end the FAA needs to focus on not punishing pilots for treatment of medical conditions. Even if they get grounded, at least provide a clear and efficient pathway to flying again.
 
I think panic attacks can be potentially concerning but if let’s say someone is treated for a history of psychosis medically do we disallow them to fly permanently? The fear of a career ending tied with their identity is one key issue . I have that in my history so maybe I have a bias but there’s a lot to be said for medically treating all conditions.
 
Jameskerr3 said:
I think panic attacks can be potentially concerning but if let’s say someone is treated for a history of psychosis medically do we disallow them to fly permanently? The fear of a career ending tied with their identity is one key issue . I have that in my history so maybe I have a bias but there’s a lot to be said for medically treating all conditions.
Click to expand...
It can be concerning you're right, that is why it's important to allow the pilot to seek treatment. Panic attacks can be debilitating but possible to hide, so the FAA blocking treatment for them is only creating risks.

As for psychosis, that's where it's a tough question. Panic attacks can be a symptom of something severe or mild and treatable, psychosis however is a more severe symptom. I don't know much about it, but I think it should be left up to a board-certified psychiatrist. Maybe drug induced psychosis with no signs of relapse could be okay, but some genetic or other mental disorder with possible recurrence would not be okay. I'm no doctor though, so I have no clue.
 
And then there’s the faa induced panic attacks.. how does that fit?
 
There's psychosis and then there's psychosis. Someone with honest-to-goodness schizophrenia is by definition untrustworthy. When a doctor says one thing and the voices say something else, a schizophrenic may not consistently listen to the doctor.
 
TCABM said:
When you’re differentiating degrees of psychosis, aeromedical suitability is not part of the discussion.
Click to expand...
True. All pilots are on the extreme side.
 
Yea but if there not a likelihood of recurrence organic or otherwise a different cause- why not treat the condition and allow them to fly on a short leash? if its safe.
 
Jameskerr3 said:
Yea but if there not a likelihood of recurrence organic or otherwise a different cause- why not treat the condition and allow them to fly on a short leash? if its safe.
Click to expand...
That would be someone who's no longer on antipsychotics and remains asymptomatic. I'd agree that there are individual cases, which is partly what I meant by "there's psychosis and then there's psychosis."
 
OneCharlieTango said:
That would be someone who's no longer on antipsychotics and remains asymptomatic. I'd agree that there are individual cases, which is partly what I meant by "there's psychosis and then there's psychosis."
Click to expand...
Either way, even that is on the extreme end. Right now the FAA grounds anyone even with mild anxiety, unless they show signs of change in that direction procedures for psychosis are not even in the conversation.
 
It appears to me (IATM?) that the FAA is operating as if we weren’t living in a time when every disappointment is worth therapy and normal melancholy is worth medicating. Truly “mild” anxiety doesn’t require treatment by definition, yet people get therapy and medications and so bugger themselves with FAA Medical.

That said, anyone who’s been on antipsychotics is worthy of close scrutiny. Let’s not give them the benefit of the doubt created by over-diagnosis and over-treatment of depression, anxiety, or ADHD.
 
OneCharlieTango said:
That said, anyone who’s been on antipsychotics is worthy of close scrutiny. Let’s not give them the benefit of the doubt created by over-diagnosis and over-treatment of depression, anxiety, or ADHD.
Click to expand...
That's clearly the FAA's current method. The problem is that they use a fine screen but then they don't have sufficient resources to sort out the particles efficiently. Currently, most of the applicants who get denied can eventually get certified with enough time and money.
 
i dont see the big deal about anti psychotics and flying- the side effect profile isnt that bad- so why not allow it for complicated depression and psychotic disorders? yes these pilots deserve close scrutiny but so do panic attack cases.
 
GoFlightMed said:
Clearly, many pilots are frustrated with the FAA's policy on history of mental health conditions (primarily ADHD & depression/anxiety).
But there have been many changes in the last few years that seem to be removing barriers and reducing stigma in the area of mental health.

A few examples:

* 1 April 2024: FAA released a NOTAM to AME's stating they are adding 3 new antidepressants [duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq)] to the 'conditionally approved' (requires special issuance) antidepressant list. This one goes live 24 April 2024.
* 30 Aug 2023: FAA creates the new ADHD 'Fast Track' pathway
* 31 May 2023: FAA adds bupropion (Wellbutrin) to adding the 'conditionally approved' (requires special issuance) antidepressant list.
* 15 Dec 2022: FAA removes requirement for Neuropsychologist Cog Eval for Antidepressant Special Issuance Renewals

Agree or Disagree?
Click to expand...
Do you have data to support your first statement and what numeric value constitutes many? Statistically the values a quite low.

The FAA has gone far enough in this area.
 
Jameskerr3 said:
i dont see the big deal about anti psychotics and flying- the side effect profile isnt that bad- so why not allow it for complicated depression and psychotic disorders?
Click to expand...

Hoo boy.

The concern isn't so much the side effects of the meds. The concern is that psychotics have been known to stop their meds because they're "feeling much better now." A psychotic episode in the air would be a very bad thing.
 
Jameskerr3 said:
i dont see the big deal about anti psychotics and flying- the side effect profile isnt that bad- so why not allow it for complicated depression and psychotic disorders? yes these pilots deserve close scrutiny but so do panic attack cases.
Click to expand...
and panic attack cases get attention, too.....

Lotsa guys think Basic is a "Hey I've got a Driver's license so what's the problem doc?" kinda deal. It can be but it should not be.
 
Last edited:
I know the thread was aimed at the germanwings archetypes, but isn't the grievance here (numerically) the non-outlier rank and file getting ensnarled in a proverbial HEPA filter over insurance coding malfeasance, mishandled/overstated medical nothingburgers like the common cold (aka ADHD) or anything with the first syllable to the word anxiety on it, whether on purpose or by errata?

I don't mean to dismiss the nuanced conversation about the tough cases, I just think it's worth highlighting that's not where the rancor against the FAA and accusations of sclerosis ultimately originates from. All due respect to the schizophrenics, we got a utilitarian case against the FAA to pursue here, we can't get slowed down by the outliers, much as the FAA would love nothing more than to use them precisely as the justification for their penchant for oversized anchors.
 
Hindsight....consider this. The range of psychiatry is a spectrum. The pilots go to the cheapest most accessable least expert practitioner they can find- frequently it's a PCP who IMO has no business prscribing Buspirone. NONE at all: I used to train residents. They got 3.5 weeks of psychiatry. What can you teach a person in 3.5 weeks- Symptom recongition only.

How about all the nuances that suggest risk factors for future severity or recurrence? NOT A THING.

Now enter Obama care. You get now , to "see the nurse". How much can an Advanced Practice nurse know- Heck he/she has never done a residency. They claim "experience". Who oversees their training- Another Nurse!! So it's the blind leading the blind. How can one possibly know what one doesn't know?!!

So to distinguish future risk (remember FAA issues you the certificate AHEAD of the useable time). The airmen are too cheap to get the highest trained doc they can. Cheap, fast, and easy.... you can get two of them, not three. Even worse, none of the discussants here have any educated idea how to even define:

"may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior or other commonly accepted symptoms of psychosis...."

"can be reasonably be expected to make the individual unble to perform the duies or exercise the privileges described in subsection (a)(8);"

So when I get an inquiry and the pilot can't even tell me the qualfiications of their prescriber, the "master caution light comes on". He sez "my doctor...." and 60% of the time it's a nurse.

Sorry nurses, but there is at least one on this site regularly who does mental health work and he, "Gets it". And I'm going to remind the peanut gallery- I am one of the four authors of the petition for even having an ON SSRI pathway. Prior to 2010 the mre presence of Prozac, Zoloft, Celexa, Lexapro or wellbutrin....was an immediate denial. So I might know a thing or two about this.
 
Last edited:
Thanks, Bruce. I think that's a pretty realistic synopsis of the failures of the medical delivery system meeting the failures of the FAA's medical certification system.

It's just unfortunate that pilots are caught in the resulting chaos.
 
I feel like this thread has gotten a little off topic. OP asked about ADHD, anxiety, and depression, not psychosis. Besides, I cannot fathom letting someone with a history of psychosis fly an airplane without a lot of scrutiny.

But to answer OP's original question, disagree. While it is true that they are removing some barriers, they still have a long way to go to fixing the problem.

I think @dbahn said it best:
The problem is that they use a fine screen but then they don't have sufficient resources to sort out the particles efficiently. Currently, most of the applicants who get denied can eventually get certified with enough time and money.
Click to expand...
This is my situation. I am like 95% sure that I will eventually be certified, and I am fortunate that I have sufficient resources to complete the evaluations that the FAA requires of me. Even still, the whole process has been a major headache for me.

Do I really need extensive neurocognitive testing when a CFI can plainly tell that I am cognitively capable of operating an airplane (by watching me actually do it)? Do I really need a psychiatric evaluation by a doctor who I have never met before when the psychologist who I have a working relationship with can tell you I'm not at all a risk to myself or others?

The answer, in most cases, is no. Bear in mind, all I want to do is GA. Maybe if I go for ATP then I could sympathize with the extra rigor, though even then there are still issues. Additionally, the doctors in OKC don't know me. They have never met me. What makes them, from a practical perspective, better able to determine my medical airworthiness than an AME who I'm working with? I think the answer is nothing.

I'm anxiously awaiting the changes downstream of the recent ARC report. I think some of those proposals might actually do some good.

All that said, I don't claim to be an expert. I sort of just come here to vent frustration. I'm open to reasonable counterarguments.
 
The REASON you can't just rely on a CFI is that his level of "seeing the performrance" is LOWER that the FAA wants. The CFI does not wish to set up an actual real emergency, to "load you up", and see how quickly you integrate the response (VMCa rollover demo in a Twinkie, at the lowest possible altitude, comes to mind.The idea is, "no excess deaths"). After establishing the performance floor, you speical issuance will indeed include the requirement for an annual report from a CFI as to how well you train.

Can your CFI distinguish your brain efficiency when you have a BAC of 0.02? How about 0.04?
How much training does the CFI have in detecting those changes?
(I'm looking but I don't see it on the new ACS for CFI's.....can you find it?)

That's.....sadly......why.
So, Biscuit: in any regulatory system, some are qualfieid and some are excluded. Right, or wrong: where they draw that line is not up to me. That's at least eight pay grades above me. My task is to understand the line and get those I can, to qualify, over that line. And to not encourage those who are demonstrably below, that line.


B
 
Last edited:
hindsight2020 said:
I know the thread was aimed at the germanwings archetypes, but isn't the grievance here (numerically) the non-outlier rank and file getting ensnarled in a proverbial HEPA filter over insurance coding malfeasance, mishandled/overstated medical nothingburgers like the common cold (aka ADHD) or anything with the first syllable to the word anxiety on it, whether on purpose or by errata?

I don't mean to dismiss the nuanced conversation about the tough cases, I just think it's worth highlighting that's not where the rancor against the FAA and accusations of sclerosis ultimately originates from. All due respect to the schizophrenics, we got a utilitarian case against the FAA to pursue here, we can't get slowed down by the outliers, much as the FAA would love nothing more than to use them precisely as the justification for their penchant for oversized anchors.
Click to expand...
That is kind of what I was getting at.

I think others here hit the nail on the head pretty well, its the process itself, not the results, that need to change. I don't think people are expecting the FAA to look at severe cases and try to get them to fly. But the process to a yes/no answer should be simpler and more streamlined. There is absolutely no good reason for this to take over a year and cost thousands of dollars to so (this being the granting of an SI).

There needs to be solid writing, and a simple process. You talk to an AME, you see a board certified psychiatrist who writes a report of your condition. You send that in along with relevant medical history. The FAA goes, "Okay, they have this disorder, which means they need approval from the psychiatrist. Then they need to be on this type of medication and receive this amount of regular checkups. Are these criteria satisfied? Yes? Okay they can receive their SI."

Barring mistakes on the pilots part in sending information, this should be a quick and easy process, even for the FAA.
 
bbchien said:
The REASON you can't just rely on a CFI is that his level of "seeing the performrance" is LOWER that the FAA wants. The CFI does not wish to set up an actual real emergency, to "load you up", and see how quickly you integrate the response (VMCa rollover demo in a Twinkie, at the lowest possible altitude, comes to mind.The idea is, "no excess deaths"). After establishing the performance floor, you speical issuance will indeed include the requirement for an annual report from a CFI as to how well you train.

Can your CFI distinguish your brain efficiency when you have a BAC of 0.02? How about 0.04?
How much training does the CFI have in detecting those changes?
(I'm looking but I don't see it on the new ACS for CFI's.....can you find it?)

That's.....sadly......why.
So, Biscuit: in any regulatory system, some are qualfieid and some are excluded. Right, or wrong: where they draw that line is not up to me. That's at least eight pay grades above me. My task is to understand the line and get those I can, to qualify, over that line. And to not encourage those who are demonstrably below, that line.


B
Click to expand...
I admit, this makes a lot of sense. I still think there are better solutions for testing neurocognitive abilities per flight safety than what the FAA has come up with so far.
 
StraightnLevel said:
This should be the case for a whole lot of different medical conditions, not just mild mental illness.

It seems that many of these SI requirements were last reviewed 50 or more years ago, and do not align well with current medical practices and outcomes. Nobody should be tempted to lie about a history of a mis-diagnosis that is decades old. Nobody should be scared to have a mole removed because it might possibly be more than .75mm thick and trigger the SI requirement. There should be a reasonable process for getting a 2nd or 3rd opinion to offset the hazard created by a prescription-happy or simply incorrect diagnosing PCP.
Click to expand...

For those of us flying small planes, all this would be accomplished if we'd just get ride of that stupid, archaic, @$#%!^& requirement for a 3rd class before Basic Med. Basic Med physicians can apply modern medical knowledge and personal knowledge of the patient to render an appropriate decision with much better accuracy than an OKC bureaucrat who's never examined the applicant.
 
Half Fast said:
Hoo boy.

The concern isn't so much the side effects of the meds. The concern is that psychotics have been known to stop their meds because they're "feeling much better now." A psychotic episode in the air would be a very bad thing.
Click to expand...
Then test and confirm with a peer pilot that your taking the meds, if thats doable. and No disrespect to Dr . Chien- Im no expert
 
I hope i am taken seriously- the people can do a drug test in the office- but which kind or take the meds in the morning in front of the cfi or a medical personnel. they take 24-48 hours. something quicker ideally. but theres got to be a solution- report that the meds are taken to the faa if there was a hotline or something. Im just trying to think of solutions.
 
Back
Top