Going to HIMS Neuropsychologist?

F

FutureFocused

Guest
I’m thinking of going to a therapist to figure out whether or not I have depression that leads to a clinical diagnosis and may require an SSRI. Currently training under sport but might want to go PP later in life, requiring a Class 3.

Would it be advisable to seek out a HIMS Neuropsychologist under the list the FAA updates on their website? Trying to think ahead and avoid any pitfalls with a future Class 3 if i) there is a diagnosis and ii) it requires an SSRI.

Thanks in advance.
 
FutureFocused said:
I’m thinking of going to a therapist to figure out whether or not I have depression that leads to a clinical diagnosis and may require an SSRI. Currently training under sport but might want to go PP later in life, requiring a Class 3.

Would it be advisable to seek out a HIMS Neuropsychologist under the list the FAA updates on their website? Trying to think ahead and avoid any pitfalls with a future Class 3 if i) there is a diagnosis and ii) it requires an SSRI.

Thanks in advance.
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Be very very careful before going down this path. The SSRI path is $$$sive annually.

Any therapist visits have to be reported on medical which could lead to expensive testing requirements.

Have anyone you could talk to that is unreportable like a Pastor first?

If you do go down this path, be awfully careful about what the diagnosis is before you leave. There are many stories in this forum of where a doctor puts down “possibly BiPolar”. If that happens, your aviation dreams meet an early grave.
 
pilot445 said:
Be very very careful before going down this path. The SSRI path is $$$sive annually.

Any therapist visits have to be reported on medical which could lead to expensive testing requirements.

Have anyone you could talk to that is unreportable like a Pastor first?

If you do go down this path, be awfully careful about what the diagnosis is before you leave. There are many stories in this forum of where a doctor puts down “possibly BiPolar”. If that happens, your aviation dreams meet an early grave.
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Based on meetings with someone who would be considered an “unreportable visit”, it was recommended I seek out a more enhanced evaluation. Understand it’s an expensive road but I’d rather be healthy than unhealthy.
 
Health first. Seriously. Do what is necessary to take care of yourself.

But, if you get the Class 3 before seeing the psychiatrist and needing an SI, you’d then have the option of going Basic Med and letting the Class 3 simply expire.
 
pilot445 said:
Any therapist visits have to be reported on medical which could lead to expensive testing requirements.
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This is not accurate. Only vists that related to a personal psychiatric diagnosis need to be reported. But agreed with the post above that if you get a Class 3 medical now, there's nothing to report.
 
bbchien said:
Do NOT confuse psychologist with psychiatrist.....in your described situation you need the LATTER.
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Thank you, Bruce. Do you recommend any type of psychiatrist? Forensic or general?

Having read this forum a lot over the years I want to make sure my next steps won't have adverse effects going forward. Focusing on "getting healthy" but weighing that with the quicksand some on this forum find themselves in by not doing it "correctly".
 
Pay close to the SSRI pathway 2.

Top two mistakes are: Dual Meds ( Don’t allow the Psychiatrist to prescribe two meds).

Stick to the 4 allowed ones: (Prozac, Zoloft, Celexa, Lexapro)
 
Why not get a class 3 medical today. Then you could get your private and fly under basic med in the future without worrying about jumping through hoops.
 
OP, it's good that you're asking questions and weighing options early. As I'm sure you're aware, the SSRI special issuance is full of landmines and nuances. Hire a good HIMS AME to consult and thoroughly understand your options along with long term implications and possibilities.

Most importantly, it's admirable that you're taking action to seek assistance and improve your mental health.

skier said:
Why not get a class 3 medical today. Then you could get your private and fly under basic med in the future without worrying about jumping through hoops.
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It's not as simple as get a single 3rd class then the airman never has to answer for anything medical. They're fine if they get a 3rd class, meet all the BasicMed conditions, and specifically don't currently have or develop any of the 1 time special issuance conditions listed in 14 CFR 68.9.

If the airman is flying under BasicMed and they develop any of those conditions then they have to go back through the special issuance process. That means re-certifying at the minimum standard as obtaining a fresh 3rd class medical for all medical conditions.

Doesn't sound like an issue for the OP, but getting a 3rd class then a subsequent bipolar diagnosis or diagnosed condition where the individual "may be reasonably expected to manifest... grossly bizarre or disorganized behavior" would be something to think about. There also may be a challenge of getting a provider to sign off on the CMEC with a diagnosed condition. Depends on the relationship with treating physicians and severity of illness.

BasicMed is still in its infancy. I suspect we'll see airmen more frequently bit by a new condition as they age and get dragged back into the AMCD meat grinder. Keep in mind heart disease is the leading killer in the US and takes out about 600k per year.
 
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ThatOtherGuy said:
It's not as simple as get a single 3rd class then the airman never has to answer for anything medical. They're fine if they get a 3rd class, meet all the BasicMed conditions, and specifically don't currently have or develop any of the 1 time special issuance conditions listed in 14 CFR 68.9.

If the airman is flying under BasicMed and they develop any of those conditions then they have to go back through the special issuance process. That means re-certifying at the minimum standard as obtaining a fresh 3rd class medical for all medical conditions.

Doesn't sound like an issue for the OP, but getting a 3rd class then a subsequent bipolar diagnosis or diagnosed condition where the individual "may be reasonably expected to manifest... grossly bizarre or disorganized behavior" would be something to think about.

BasicMed is still in its infancy. I suspect we'll see airmen more frequently bit by a new condition as they age and get dragged back into the AMCD meat grinder. Keep in mind heart disease is the leading killer in the US and takes out about 600k per year.
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All true but irrelevant to this thread. And it's true for all of us on Basic. Nothing unique for the OP.

The OP could get a 3rd class today, then go see the psychiatrist and go Basic Med.
 
Half Fast said:
And it's true for all of us on Basic.

The OP could get a 3rd class today, then go see the psychiatrist and go Basic Med.
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I agree on your above points. My point is the OP believes they have a mental health condition and they'll have to attest that they don't on the 3rd class application and the BasicMed CMEC. Sworn federal form... perjury... blah blah. The usual "the penalties for lying/omitting are severe" discussion repeated here ad nauseum. If there's motivation and desire enough to seriously consider a mental health professional and pharmaceutical intervention, then the applicant has adequate reason to believe they have a disqualifying condition. It should be disclosed on the application. If it's not disqualifying then it'll be a non-issue.

Even if they got issued a 3rd class medical or completed BasicMed requirements, a strong argument could be made that the pilot should self ground per 14 CFR 61.53(a) or 14 CFR 61.53(b).

If the subsequent psychiatric visit gave him/her a diagnosis listed in 68.9 then the BasicMed is absolutely invalid and they'll be back to the special issuance process. This would require another 3rd class medical exam in close proximity to the initial exam with this suddenly newly discovered mental health condition. Depending on the proximity of those two 3rd class exams it might not "look good" for the OP. If that happens, it will cause legal problems at worst and at a minimum cast a shadow over their mental state which will be scrutinized in the SI process for a "clean" 3rd class.

None of this should be done without a HIMS AME evaluating their specific circumstances and providing consultative guidance. For all we know they talk to a psychologist, a little CBT/talk therapy, work through a rough patch and it's a done deal. It's smart that they're considering the implications before ringing a bell that can't be un-rung. It's not what they want to hear, but it's the reality of the situation.

Half Fast said:
And it's true for all of us on Basic.
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True. My opinion is that many view BasicMed as "once I get on BasicMed I can erase all the bad stuff that happened after my last 3rd class medical". The reality is that the first subsequent 14 CFR 68.9 SI condition you get, you're going to have to re-certify the same as any other 3rd class medical exam. That means any skeletons in the closet are coming out and you'll have to satisfy AMCD as to every condition you might have.
 
ThatOtherGuy said:
It's smart that they're considering the implications before ringing a bell that can't be un-rung. It's not what they want to hear, but it's the reality of the situation.
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This is exactly why I'm here asking the question. This forum is full of people who, by no fault of their own, have a history with these "bells" that can't be un-rung. If I have one of those, then that's just the cards life has dealt me and I'll find another expensive hobby. But if I don't, and get an incorrect diagnosis/go to the wrong professional/whatever it might be, I'd like to avoid that situation.

The point of my original post was to get advice on who I should seek out to have the best informed opinion on my mental health and the path of least resistance if the practitioner has to write a letter or I have to get documentation to go through an SSRI path. It's my understanding a lot of practitioners just aren't aware of the high bar the FAA sets. Risk avoidance, plain and simple.

That being said, I do appreciate all of the clarification and background on BasiMed, etc.
 
FutureFocused said:
This is exactly why I'm here asking the question. This forum is full of people who, by no fault of their own, have a history with these "bells" that can't be un-rung. If I have one of those, then that's just the cards life has dealt me and I'll find another expensive hobby. But if I don't, and get an incorrect diagnosis/go to the wrong professional/whatever it might be, I'd like to avoid that situation.

The point of my original post was to get advice on who I should seek out to have the best informed opinion on my mental health and the path of least resistance if the practitioner has to write a letter or I have to get documentation to go through an SSRI path. It's my understanding a lot of practitioners just aren't aware of the high bar the FAA sets. Risk avoidance, plain and simple.

That being said, I do appreciate all of the clarification and background on BasiMed, etc.
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That feedback helps. You have a chicken and the egg situation. You don't know if you have a "problem" until you talk to a mental health professional, but talking to a mental health professional may create a "problem" by placing a diagnosis code on your medical record. The fact that you need someone that understands the FAA position on these issues complicates it. That's where a HIMS AME consult comes in.

Completing a MedXPress online and having an AME enter the confirmation number into the FAA's system is the first bell that you wouldn't be able to un-ring. Once the confirmation number is entered you're committed. The exam has to either end in issuance or a status that will close the door to BasicMed and Sport Pilot until it's resolved.

Your best bet on this one is to find a HIMS AME and pay them to consult on your situation. Their review of your case shouldn't produce a formal diagnosis. If they ask you to complete a MedXPress do not provide them (or their staff) the confirmation number unless they can give you a reasonable assurance of success.
 
ThatOtherGuy said:
My point is the OP believes they have a mental health condition and they'll have to attest that they don't on the 3rd class application and the BasicMed CMEC. Sworn federal form... perjury... blah blah.
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The Medxpress form is to be completed "to the best of his knowledge." And its not sworn under penalty of perjury. And his belief is irrelevant. The question he'll have to answer is if he ever had or was diagnosed with (not has he ever thought he might or might not) . . . to the best of his knowledge. So three strikes and you're out.

So not for nothing, if the OP was a buddy of mine, I'd suggest he go get that third class now, then get whatever treatment he needs, and then worry about the next step in 3-5 years. At the first appointment with whomever, tell him you're paying cash so you don't need an insurance diagnosis, and you'd like to be very circumspect about taking any medications. Go from there.
 
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:yeahthat:

What Lindberg said... get a class 3 now, assuming you have no other conditions that would prevent issuance. Then continue your SP training, and see whatever medical professionals necessary to take care of your health. Do discuss with your doctor the ramifications of any diagnosis and/or medications prescribed. If, later on, you want to go PP, and you haven't been diagnosed with or prescribed anything to prevent it, go basic med, if not, stick with SP.
 
Don’t give the FAA any quarter, if you can fit in the rules just enough and not ring the proverbial bell of getting a diagnosis until you have your medical in hand, then do it.
 
Lindberg said:
The Medxpress form is to be completed "to the best of his knowledge." And its not sworn under penalty of perjury. And his belief is irrelevant. The question he'll have to answer is if he ever had or was diagnosed with (not has he ever thought he might or might not) . . . to the best of his knowledge. So three strikes and you're out.

So not for nothing, if the OP was a buddy of mine, I'd suggest he go get that third class now, then get whatever treatment he needs, and then worry about the next step in 3-5 years. At the first appointment with whomever, tell him you're paying cash so you don't need an insurance diagnosis, and you'd like to be very circumspect about taking any medications. Go from there.
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I'm not going to comment about whether he should or should not list a condition on his application. He's capable of reading the instructions and making a decision. A lot of people like to opine on that type of situation with the luxury of not having to pay consequences for any negative repercussions.

MedXPress is just the online version of form 8500-8. To use MedXPress the applicant must electronically accept the terms and conditions and sign the form. This is directly from the form:

"Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willingly falsifies, conceals or covers up by any trick, scheme, or device a material fact, or who makes any false, fictitious or fraudulent statements or representations, or entry, may be fined up to $250,000 or imprisoned not more than 5 years, or both. (18 U.S. Code Secs. 1001; 3571)."

also the applicant's signed declarations is the NDR consent along with:

"I hereby certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge, and I agree that they are to be considered part of the basis for issuance of any FAA certificate to me. I have also read and understand the Privacy Act statement that accompanies this form."

The short version is it's illegal to "lie" regarding a matter that the federal government has jurisdiction over. Concealment of material fact is included by the statute. It may not be perjury by the strict legal definition, but misrepresentation can land you with a hefty fine or a prison sentence.
 
ThatOtherGuy said:
The short version is it's illegal to "lie" regarding a matter that the federal government has jurisdiction over. Concealment of material fact is included by the statute. It may not be perjury by the strict legal definition, but misrepresentation can land you with a hefty fine or a prison sentence.
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This would be a criminal, not administrative issue. The burden of proof is on the government to show you knew you had a condition/diagnosis. Self-diagnosis of a serious condition/disease is basically practicing medicine without a license. MedExpress is like going through customs, you don't volunteer information they didn't specifically ask.
 
Jeff Oslick said:
This would be a criminal, not administrative issue. The burden of proof is on the government to show you knew you had a condition/diagnosis. Self-diagnosis of a serious condition/disease is basically practicing medicine without a license. MedExpress is like going through customs, you don't volunteer information they didn't specifically ask.
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Volunteering this information on a public forum even anonymously could provide the government with the burden of proof they need. All they would have to do is subpoena the IP address. We’ve seen it on this forum before.
 
pilot445 said:
Volunteering this information on a public forum even anonymously could provide the government with the burden of proof they need. All they would have to do is subpoena the IP address. We’ve seen it on this forum before.
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Someone self-diagnosing on the internet does not make it reportable.
 
pilot445 said:
Volunteering this information on a public forum even anonymously could provide the government with the burden of proof they need. All they would have to do is subpoena the IP address. We’ve seen it on this forum before.
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What “information?!” Here’s what the OP wrote:

FutureFocused said:
I’m thinking of going to a therapist to figure out whether or not I have depression that leads to a clinical diagnosis and may require an SSRI.
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He has not seen anyone, has no diagnosis, knows nothing about his own condition. Simple depression is not even one of the conditions requiring an SI before Basic. At this moment, there’s nothing to report. He is certainly free to go get a class 3 right now and then Basic Med.

If, later on, a psychiatrist diagnoses him with one of the few conditions requiring an SI for Basic, he could either get the SI or go Sport. Otherwise he can just continue with Basic, even if he’s diagnosed with some other condition that would require an SI for class 3.

At the moment, the OP wants to “figure out” whether he has depression. The less risky time to learn that, as far as a flight medical is concerned, is AFTER he has the class 3.
 
does a mental diagnosis have to come from a psychologist or psychiatrist? The term ‘therapist’ is used loosely (as is counselor) and they have varying degrees of education. In my opinion, counselors and therapist really do not have the background to diagnose mental disorders, but I could be wrong.
 
FutureFocused said:
Based on meetings with someone who would be considered an “unreportable visit”, it was recommended I seek out a more enhanced evaluation. Understand it’s an expensive road but I’d rather be healthy than unhealthy.
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Yeah, honestly, do what’s best for your health. Life is more important than flying.
 
I was diagnosed with depression and placed on SSRI's.

Within a year I received a letter from OKC informing me that they became aware during a prescription database check that I was taking an SSRI. The letter "reminded me" that I was unable to exercise any privileges of my certificate other than sport pilot. The letter also stated that I was unable to use Basic Med without receiving a special issuance first.

I am curious as to why I received this letter since depression or ssri is not listed as disqualifying under basic med.

But since the FAA seems to see things that way, it is reasonable to assume that they may violate OP should they become aware he was taking an SSRI even under Basic Med.
 
Anon Pilo said:
The letter also stated that I was unable to use Basic Med without receiving a special issuance first.
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I’m no expert, so this is just personal opinion, but....

I suspect it depends on what diagnosis your doc entered into the database. You could query the doc, and if it’s not one of the listed conditions you could ask the FAA for an explanation and then seek legal help as necessary. If you’re an AOPA member you could request their assistance.
 
Anon Pilo said:
I was diagnosed with depression and placed on SSRI's.

Within a year I received a letter from OKC informing me that they became aware during a prescription database check that I was taking an SSRI. The letter "reminded me" that I was unable to exercise any privileges of my certificate other than sport pilot. The letter also stated that I was unable to use Basic Med without receiving a special issuance first.

I am curious as to why I received this letter since depression or ssri is not listed as disqualifying under basic med.

But since the FAA seems to see things that way, it is reasonable to assume that they may violate OP should they become aware he was taking an SSRI even under Basic Med.
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Wtf, Since when does the FAA do random prescription databases checks?

Were you flying under basic med at the time/was your most recent medical expired? I’m curious if the privacy authorization we give them is indefinite, or if it’s only valid during the duration of a valid medical. If said authorization is indefinite, I’m curious if it would be possible to revoke that waver in writing should the pilot in question not have a current medical.

What would be their option in such a case, revoke a expired medical?
 
I guess the National prescription database is only for controlled substances. I think it’s bs and a HIPPA violation for the FAA to access to such a database without cause. This is my problem with the medical side of the FAA.
 
ProjectInfinity1 said:
Wtf, Since when does the FAA do random prescription databases checks?

Were you flying under basic med at the time/was your most recent medical expired? I’m curious if the privacy authorization we give them is indefinite, or if it’s only valid during the duration of a valid medical. If said authorization is indefinite, I’m curious if it would be possible to revoke that waver in writing should the pilot in question not have a current medical.

What would be their option in such a case, revoke a expired medical?
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Since I was diagnosed with depression, I hadn’t been near the cockpit of any airplane. Or even applied for Basic Med. So there wasn’t even a good reason for the FAA to go fishing. My medical was never even revoked either, and is still technically valid.
 
Keithlewis1900 said:
I guess the National prescription database is only for controlled substances. I think it’s bs and a HIPPA violation for the FAA to access to such a database without cause. This is my problem with the medical side of the FAA.
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Misinformation. There’s only one P and it doesn’t stand for privacy. ;) The FAA can easily claim a “medical need to know” to obtain that information, plus you already granted them permission when you applied fo4 your medical certificate. Come on….
 
Keithlewis1900 said:
I guess the National prescription database is only for controlled substances. I think it’s bs and a HIPPA violation for the FAA to access to such a database without cause. This is my problem with the medical side of the FAA.
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HIPAA isn't the catch all that people think it is. It only applies to narrowly defined "covered entities" and there are numerous exceptions carved out which allow information disclosure. If you want the dirty details you can read 45 CFR 164. In summary the one the FAA could use to access your information is 45 CFR 164.512(d) :

"(d) Standard: Uses and disclosures for health oversight activities -

(1) Permitted disclosures. A covered entity may disclose protected health information to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight of:
...
(iii) Entities subject to government regulatory programs for which health information is necessary for determining compliance with program standards; or"

Google "Medical Information Bureau" and companies like Milliman, Optum, and Epic. A lot of this data is compiled from cloud based hospital EMRs, pharmacy benefit managers, or scraped from insurance applications and aggregated. All it takes is a pilot not reading the fine print and signing a HIPAA waiver consenting to allow their data to be provided to a 3rd party aggregator or "business associate". These waivers are so prevalent that anyone that's applied for life insurance or received medical care at a modern facility has "signed" one of these waivers.
 
GaryM said:
Really? I'd love to know the details, though I suspect there are reasons why we won't be privy to them.
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I just had someone ask me this in a PM, but it doesn’t bother me so I’ll post it here as well.


“It is a long story. But it wasn’t the FAA, it was the FBI, and I don’t know if they got a subpoena, or a admin on here voluntarily gave it, or if they found me another way.

Regardless it was this thread I made, https://www.pilotsofamerica.com/community/threads/time-for-faa-psychiatric-illness-reform.118692/“

Adding in more context for those who don’t want to scroll through pages of the thread to get full context, here is a basic summary.

I was/am diagnosed with mild ADD, Have OCD, on the autism spectrum, was depressed during school with sort of a nihilist ambivalence with suicidal ideation (I.E. we’re a small spec of dirt traveling in a vast universe, our existence was by happenstance, so what’s the point, blah blah blah). In January of 2018, I was going to be forced to go to a OCD program for 2 months to take part in exposure therapy. This would’ve been my first time away from home without family, (hell upto that point I had never even stayed over a friends house). Said no thanks, and the night before my ambivalence became action, attempted to “check out” but I got caught. Ended up staying in impatient for two weeks, went to a diagnostic program for 2 weeks, went to a step down program for 3 weeks after that, and finally ended up in the very same OCD clinic that started said “adventure” in the first place, for 3 months.

Came on here a year and a half later complaining how the FAA’s psychiatric rules are stuck in the 1950’s, and how it forces pilots to bottle up their issues rather than seek help.

I referenced the absurdity of the rules, by making a statement along the lines of “I can legally own a grenade launcher or pipe bombs, even with my history, yet the FAA thinks said history makes me a danger.”

Someone (rightfully so, as I’ll admit that history along with discussions of such items, set off every red flag imaginable) made an anonymous report to the FBI.

Got a knock at the door, and the agent and I talked for an hour and a half. We hit it off once I explained the full context of why I said what I said.

In the end I standby my point, it just sounds really bad from the outside looking “in”. I’m now a FFL out of Florida, have a CCW in RI, FL, and MA.

I legally bought/was approved for a live 60mm mortar before I was old enough to legally buy a handgun from a dealer. And now I have multiple machine guns, and am importing 2 suppressors from the Czech Republic for a well known gun Youtuber whois also a FFL.

Yet still I’d be too much of a risk for the FAA today ):

I just want to putt about in a Piper for personal transit (within 350 miles), as I hate driving more than 25 miles, (former Rhode Island native where from one corner of our state to another is an about an hour drive without traffic).
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