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

[Half Fast]

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.

I’m really not following you here. I go to my hangar, get in my plane, and take off. What office are you talking about? What peer pilot? Somehow I’m just not seeing whatever it is you’re describing. What assurance is there that I took my meds that morning?

 

[Jameskerr3]

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.

I’m really not following you here. I go to my hangar, get in my plane, and take off. What office are you talking about? What peer pilot? Somehow I’m just not seeing whatever it is you’re describing. What assurance is there that I took my meds that morning?

In other words Half Fast the pilot needs to be drug tested to make sure that it is confirmed that he is being treated for his condition. Maybe the airman or cfi calls the faa to get approval due to the fact that the drug test showed the drug in the system, and like i said if he takes the medicine in front of the cfi- it should be noted and approved by the faa that he is cleared to fly . In the office of the flight school.

 

[Half Fast]

In other words Half Fast the pilot needs to be drug tested to make sure that it is confirmed that he is being treated for his condition. Maybe the airman or cfi calls the faa to get approval due to the fact that the drug test showed the drug in the system, and like i said if he takes the medicine in front of the cfi- it should be noted and approved by the faa that he is cleared to fly . In the office of the flight school.

Okay, you’re not following me. No flight school. No CFI. No office. Just a pilot and his own personal aircraft that he can hop into and fly whenever he feels like it.

How do we know he’s taken his meds and isn’t about to do a kamikaze dive into a schoolbus full of kids? What’s going to stop him from flying?

Pulling my plane out of my hangar is no more complex than pulling my car out of my garage.

 

[Jameskerr3]

if theres no flight school then theres got to be a way to make sure hes taken his meds- check in or correspondence with an ame. Take the meds in the ames office. i really dont understand how im not making sense-

 

[Half Fast]

if theres no flight school then theres got to be a way to make sure hes taken his meds- check in or correspondence with an ame. Take the meds in the ames office. i really dont understand how im not making sense-

Because there’s NOTHING that forces the pilot to see anyone at all before getting into an airplane, anymore than before he gets into a car.

What if he doesn’t go see the AME? What if he just goes straight to his plane? There is no forcing function in your suggestion.

 

[Jameskerr3]

That’s a good point! Well it should be a requirement to be tested and an offense to not be taking the medicine - there should be a forcing function

 

[guest user]

if theres no flight school then theres got to be a way to make sure hes taken his meds- check in or correspondence with an ame. Take the meds in the ames office. i really dont understand how im not making sense-

I admire your determination to try to find a way to prove that the individual is taking their medication.
Sure, MOST people this affects would be excited to have a solution available and willing to jump through the hoops that gets them in the air.

However, you're forgetting one thing, and that is that you are dealing with humans.
Humans, as a rule do NOT like rules. Do NOT like being told they have to do something.
So, you have to factor in the "How will they try to get around this?" and you have not.

"Hello, OKC? Yeah, I've taken my meds, pinky swear!" <-- Didnt actually take them
"Dear AME, I am writing you to inform you that I have taken my meds" <-- Didnt actually take them
"And now, AME, watch as I take these pills" <-- Just palmed the meds and went on his merry way
"My friend Jerry watched me take my pills" <-- Jerry was out of town visiting family

So, lets take it even further. You now have to find the resources to monitor the pilots needing monitoring. Or do you plan to have AMEs, which are already a bit limited, scheduling nothing but pilots taking their meds? How much do they get to charge for their time? After all, time spent watching someone take a pill is time not spent conducting / issuing medical certificates.

The system is not based upon believing humans are naturally good and will want to do what is right. The system is based upon humans will try to beat the system and we need to prevent it while still allowing a system to exist.

If you wish to argue this point, I would suggest looking at the results of the places that recently underwent the "Defund The Police" experiments. Did the population turn into caring, loving, law abiding citizens with an immediate reduction in crime, or did it prove the fact that yes, law enforcement is important when dealing with humans?

tl:dr; the laws and processes are not in place to deal with those who would follow the rules. It is to address concerns about "what is the effect of those who get in the system, but do not follow the rules?"

 

[OneCharlieTango]

There’s more to this that the mechanics of flying. Someone with legit depression, anxiety, or ADHD might be inclined to skip a weather briefing, forget NOTAMs, ignore TFRs, fail to check fuel or oil, ignore a low tire or strut. In short, their illness inclines them toward less safety.

The problem we have isn’t exactly the FAA; it’s a broad culture that wants its every minor disruption medicated and a medical culture incentivized to acquiesce (whether motivated by profit, laziness, or fear of “bad reviews”), feeding into an FAA Medical obligated to take seriously words like “anxiety,” despite the fact that doctors who used to know how to use such words now lapse into colloquial rather than medical use.

On another point, tell us you’ve never seen psychosis without saying you’ve never seen psychosis:

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.

 

[Bob Noel]

I can't help but think about the fact that nothing ensures that the private pilot getting into his own airplane even has a valid medical, or a current BFR, or the airplane is unairworthy. (same kind of problem exists with cars and drivers)

Down the why-there-oughta-be-way path lies madness.

 

[Jameskerr3]

well whats a better solution? i take my meds and am safe so please dont insult me

 

[geneseib]

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.

Barriers serve a purpose. Stigma is not an FAA concern.

 

[jbarrass]

It'll be hard to fix this if we dwell on the extreme outliers. Pilots with serious schizophrenia and psychotic issues are fairly limited and that seems a consensus.

The issue is with the way the FAA treats the successful 40 YO who had a rough 4th grade and the person was proscribed an anti-depressant for a transient period of sadness.

Changing the look back to 5 or 10 years will keep the former in the system and free the latter. The have you ever in your life questions are stupid and don't help anyone.

The FAA bureaucracy won't heal themselves. Needs to be a legislative fix.

 

[Lindberg]

It'll be hard to fix this if we dwell on the extreme outliers. Pilots with serious schizophrenia and psychotic issues are fairly limited and that seems a consensus.

The issue is with the way the FAA treats the successful 40 YO who had a rough 4th grade and the person was proscribed an anti-depressant for a transient period of sadness.

Changing the look back to 5 or 10 years will keep the former in the system and free the latter. The have you ever in your life questions are stupid and don't help anyone.

The FAA bureaucracy won't heal themselves. Needs to be a legislative fix.

The FAA could make this very simple. Give the treating psychiatrist a form to complete with one question, "Would you let your child fly with this patient on his worst day?"

 

[Half Fast]

The FAA could make this very simple. Give the treating psychiatrist a form to complete with one question, "Would you let your child fly with this patient on his worst day?"

Well, that assumes the psychiatrist likes his child, and with those folks one can never be certain....

 

[Lindberg]

Well, that assumes the psychiatrist likes his child, and with those folks one can never be certain....

You found the one flaw in my idea.

 

[TCABM]

I can't help but think about the fact that nothing ensures that the private pilot getting into his own airplane even has a valid medical, or a current BFR, or the airplane is unairworthy. (same kind of problem exists with cars and drivers)…

What we forget is that honesty and integrity are at the core of aviation. I don’t fly a one day out-of-annual aircraft without the waiver. Not because the airplane magically stops producing lift, but because it’s what the procedure is.

Yes, there are people who don’t accept that principle and for each NTSB report where we see those facts come to light, it gets real easy to realize the chain or poor decisions started well before takeoff.

 

[Half Fast]

What we forget is that honesty and integrity are at the core of aviation. I don’t fly a one day out-of-annual aircraft without the waiver. Not because the airplane magically stops producing lift, but because it’s what the procedure is.

Yes, there are people who don’t accept that principle and for each NTSB report where we see those facts come to light, it gets real easy to realize the chain or poor decisions started well before takeoff.

I agree, and for health issues we're all required to make a self-assessment before flying. A problem with psychosis, though, is that it renders that judgement unreliable.

 

[Jameskerr3]

I know what it feels like - thoughts scatter confusion - I wouldn’t fly in a state like that but I am medicated so I’m safe. Take care dude!

 

[MauleSkinner]

The FAA could make this very simple. Give the treating psychiatrist a form to complete with one question, "Would you let your child fly with this patient on his worst day?"

They could replace the ACSs with that question, as well. But then, that’s pretty much WHY we have an ACS system.

 

[wellknow]

They could replace the ACSs with that question, as well. But then, that’s pretty much WHY we have an ACS system.

what makes u think a psychiatrist wants the responsibility for approving someone for flight. These are judgement calls. What dr wants to have approved someone who intentionally crashes a plane.

 

[MauleSkinner]

what makes u think a psychiatrist wants the responsibility for approving someone for flight. These are judgement calls. What dr wants to have approved someone who intentionally crashes a plane.

I’m not the one who thinks a psychiatrist wants that responsibility, so…

 

[Daleandee]

I’m not the one who thinks a psychiatrist wants that responsibility, so…

I was reading this thread and wondering why any CFI or office personnel would want to be the person responsilble for guaranteeing that a pilot with known issues was actually taking their medications required before flight. If an accident occured wouldn't that make them subject to scrutiny and/or liablilty?

 

[MauleSkinner]

I was reading this thread and wondering why any CFI or office personnel would want to be the person responsilble for guaranteeing that a pilot with known issues was actually taking their medications required before flight. If an accident occured wouldn't that make them subject to scrutiny and/or liablilty?

And given the current checkride failure rates, CFIs don’t have a great track record in saying pilots are qualified anyway.

 

[Wheresmychute]

There’s more to this that the mechanics of flying. Someone with legit depression, anxiety, or ADHD might be inclined to skip a weather briefing, forget NOTAMs, ignore TFRs, fail to check fuel or oil, ignore a low tire or strut. In short, their illness inclines them toward less safety.

The problem we have isn’t exactly the FAA; it’s a broad culture that wants its every minor disruption medicated and a medical culture incentivized to acquiesce (whether motivated by profit, laziness, or fear of “bad reviews”), feeding into an FAA Medical obligated to take seriously words like “anxiety,” despite the fact that doctors who used to know how to use such words now lapse into colloquial rather than medical use.

I believe many pilots can be safe to fly, even with things like anxiety. Instead of years of effort being required to get an SI, the FAA needs to find an efficient way to figure out if pilots are safe to fly. And then communicate clearly what is needed to go down that pathway. Right now for example, the SSRI pathways are a good framework, but they are bottlenecked by poor processes and departmentalization.

Also, pilots should be able to seek out treatment and medication. Because even if the pilot does not need the meds, at least not being afraid of the risk that they do would help pilots to seek treatment. In other words, the issue won't be fixed until on medication pathways to an SI are easy and low risk.

 

[TCABM]

I believe many pilots can be safe to fly, even with things like anxiety.

That’s nice. Do you have relevant peer-reviewed empirical data acceptable to the administrator that supports your belief?

 

[OneCharlieTango]

As I said about psychosis, there’s anxiety and then there’s anxiety. Since professionalism is all but dead, when a patient says “I feel anxious,” the NP clicks on “anxiety” and *poof* the patient has a diagnosis. Next patient, please. Unfortunately, the FAA has no way to tell the difference between this patient and one whose anxiety is crippling. They really have to assume the worst until it’s disproven.

For private pilots, the answer is to kill Class 3, including the requirement for a Class 3 before one is eligible for BasicMed.

 

[Half Fast]

For private pilots, the answer is to kill Class 3, including the requirement for a Class 3 before one is eligible for BasicMed.

DING! DING! DING! WINNER!

Exactly. Consider that a pilot already on Basic Med can develop anxiety and be approved to continue flying on Basic Med by his physician right now. So why should anxiety require a deferal to OKC and an SI Class 3 if the pilot develops anxiety before Basic Med?

I'd love the see the Class 3 requirement prior to Basic go away, but that might be too steep a hill today. So here's my compromise - for class 3, the only things that should require deferral to OKC are the "big 3" on the Basic Med list, and everything else should be CACI. No need to defer for simple anxiety, diabetes, sleep apnea, et cetera ad nauseum. Let the AME decide whether to issue, and thereafter the pilot can go to Basic Med.

This would also relieve some of the backlog in OKC.

 

[Half Fast]

Absolutely NOT, unless you are going to try to expand BasicMed to allow everything that Class 3 allows today. That seems unlikely.

Unlikely, but still prefered. Nevertheless, just killing the class 3 reqt for Basic Med would be a wonderful improvement.

 

[jbarrass]

DING! DING! DING! WINNER!

Exactly. Consider that a pilot already on Basic Med can develop anxiety and be approved to continue flying on Basic Med by his physician right now. So why should anxiety require a deferal to OKC and an SI Class 3 if the pilot develops anxiety before Basic Med?

I'd love the see the Class 3 requirement prior to Basic go away, but that might be too steep a hill today. So here's my compromise - for class 3, the only things that should require deferral to OKC are the "big 3" on the Basic Med list, and everything else should be CACI. No need to defer for simple anxiety, diabetes, sleep apnea, et cetera ad nauseum. Let the AME decide whether to issue, and thereafter the pilot can go to Basic Med.

This would also relieve some of the backlog in OKC.

Exactly. And since we know that BasicMed pilots have the same accident rate as current class 3 pilots, it seems like an easy call. Recurring class 3 exams have been proven to have no benefit to safety.

 

[OneCharlieTango]

Absolutely NOT, unless you are going to try to expand BasicMed to allow everything that Class 3 allows today. That seems unlikely.

That’s EXACTLY what I’m talking about.

 

[MauleSkinner]

What are the current checkride failure rates?

Last conversation we had here about it, 30% was pretty close.

 

[Wheresmychute]

That’s nice. Do you have relevant peer-reviewed empirical data acceptable to the administrator that supports your belief?

I sadly cannot provide links, but here are two sources:

"Mental Health in Commercial Aviation - Depression & Anxiety of Pilots," Maurice DeHoff and Stephen Cusick​

Stating in the abstract, " Ultimately, removing the stigma of mental health in the greater population and improving the understanding of mental health within the aviation medical community may be necessary to encourage more pilots who have mental health concerns to seek treatment. This approach would have the most significant effect on aviation safety."

"Depression and Anxiety in Pilots: A Qualitative Study of SSRI Usage in US Aviation and Evaluation of FAA Standards and Practices Compared to ICAO States," Jake Durham
"States which have more stringent standards may force airmen to seek alternative treatment options and not disclose crucial medical information or seek appropriate treatment options in fear of reprisal."
"The Civil Aviation Safety Authority (CASA) of Australia has concluded that pilots taking an SSRI pose no significant safety threat when compared to individuals who do not suffer from a mood disorder (Nowak, 2007)."


Besides those, just the fact that the FAA allows pilots to fly whilst diagnosed with anxiety show that they accept that fact, they don't need data from me at this point, somebody already did that work in 2010.

As I said about psychosis, there’s anxiety and then there’s anxiety. Since professionalism is all but dead, when a patient says “I feel anxious,” the NP clicks on “anxiety” and *poof* the patient has a diagnosis. Next patient, please. Unfortunately, the FAA has no way to tell the difference between this patient and one whose anxiety is crippling. They really have to assume the worst until it’s disproven.

I don't really disagree here, I just think "disproving" it is where they need to up their game. As of right now it should not take a year to decide if a pilot is safe to fly.

Also, don't misunderstand, I do not think anxiety should not require closer inspection on the medical, as I said before the SSRI pathway is a really good framework. It just need proper structure to run efficiently.

 

[TCABM]

..
Besides those, just the fact that the FAA allows pilots to fly whilst diagnosed with anxiety show that they accept that fact, they don't need data from me at this point, somebody already did that work in 2010…

I’ll break this up to address things here. One of the guys who did that work for the 2010 study is a member here. Goes by bbchien.

I sadly cannot provide links, but here are two sources:

…
"Depression and Anxiety in Pilots: A Qualitative Study of SSRI Usage in US Aviation and Evaluation of FAA Standards and Practices Compared to ICAO States," Jake Durham..​

Here you go. https://ojs.library.okstate.edu/osu/index.php/CARI/article/view/7908/7304

One of the limitations up front was the number of published research studies of pilot use of SSRIs. That’s the kind of data the FAA needs. It doesn’t exist.​

 

[Wheresmychute]

One of the limitations up front was the number of published research studies of pilot use of SSRIs. That’s the kind of data the FAA needs. It doesn’t exist.

Yes, I guess that is an issue, however, there should be plenty of data on SSRI usage in general. Its a bit of a conundrum because its hard to study pilots who fly on SSRI's when pilots are afraid to take SSRI's because the FAA doesn't want them to.

I think you do not need to specifically study pilots though. While piloting is a high-risk and high-stress job, all people who those moments in life even if it isn't their career (and many besides pilots do have careers with those traits). You can study a population and determine if some symptoms of the medication would be trouble for pilots, for example, drowsiness.

So you need a study to say, "The likelihood of experiencing X side-effect 4 months or later after date of prescription is .5%, which is outside of the confidence interval, therefore we cannot confidently say that its the result of the medication."

And all the FAA needs to do is monitor the pilot for 4-months to see if they experience drowsiness, and if they don't, they can be confident the medication is not having that effect.

Though I do not want to wade through all the papers on SSRI's for a forum discussion. I also don't particularly think thats what matters to the FAA, its not hard to tell if medication is good or not.


What the FAA has trouble with, is mental health diagnosis in general. Its a legal mess. If some pilot injures themself or others in an aircraft AND the FAA knew they had *insert mental illness here*, but still allowed them to fly, then they are in big trouble. This can be solved by the FAA figuring out which mental illness would lead to this behavior and disqualifying those, but they do not want to go through the trouble (and money).

 

[TCABM]

Yes, I guess that is an issue, however, there should be plenty of data on SSRI usage in general. …

While I appreciate your passion, there is an significant lack of understanding of the FAAs by law requirements re: medical standards to certify an applicant’s history.


Every.
Single.
Special issuance is the administrator applying an exception to the law. Risks stack, sometimes exponentially, and the only data the adjudicators have is what’s provided in the records by medical professionals. Some of whom aren’t certified to make the diagnoses they’ve made so insurers will pay for a prescription.

If you want real reform, understand the problem first.

 

[Wheresmychute]

While I appreciate your passion, there is an significant lack of understanding of the FAAs by law requirements re: medical standards to certify an applicant’s history.


Every.
Single.
Special issuance is the administrator applying an exception to the law. Risks stack, sometimes exponentially, and the only data the adjudicators have is what’s provided in the records by medical professionals. Some of whom aren’t certified to make the diagnoses they’ve made so insurers will pay for a prescription.

If you want real reform, understand the problem first.

So, require the applicant see a board-certified psychiatrist. A lot of these issues are not huge. Most of them result from FAA inefficiency, like still using physical mail, requiring cogscreens, etc...

The accept/failure rate is actually really decent. It just takes forever to get there.

The "law" also happens to be very behind.