How Federal Restrictions Force Pilots To Hide Mental Illness

It’s more than mental illness. I’ve lost a few friends so far due to illness because they refused to see anyone due to losing their livelihood or military careers.
 
Mental illness causes people to hide mental illness, at least to try to hide it. Unfortunately that is the reality of mental illness. Also mental illness covers a very wide spectrum of maladies, the FAA actually is allowing people with some illnesses to fly. But other maladies, sadly, should not be allowed to fly.
 
Every person that has an issue, or addiction that will hinder a goal will try to hide it. Just human nature unfortunately.
 
flyingron said:
https://www.huffpost.com/entry/pilots-mental-health-depression-anxiety_n_60d391e0e4b06005129e235a
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There are standards. I have to maintain currency to fly instruments. I have to get a flight review to maintain my proficiency. I agree that denying a medical to somebody because they had a 20 year old diagnosis of ADHD is a little over the edge. But If this guy , in the article has a panic attack because of the TV news cast, I don’t want to be flying behind him. He should have self grounded. He put his career and income ahead of our safety. Flying should not be about participation ribbons. When it comes to the medical thing I’m agreeing more and more with the FAA.
I weary of looking at the medical topics And seeing people with serious mental issues who think it’s OK to go flying. But they don’t know any better, the pilot community does or should. Everybody doesn’t get to do everything they want. I grow weary about hearing how life is unfair.
 
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Beaker’s Flyin said:
It’s more than mental illness. I’ve lost a few friends so far due to illness because they refused to see anyone due to losing their livelihood or military careers.
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I bet they were all male. Men still have the burden of being the main provider for their family. The older you get the harder it is to pivot and change career, especially if you have a mortgage and kids to support, or are in the financial red zone prior to retirement, scrambling to build enough portfolio to get through old age. I really understand their dilemma, but people can greatly underestimate the danger of seemingly minor symptoms. Indigestion that turns out to be cancer, chest discomfort that turns out to be heart disease.

Ironically the more locked into a career path you get with time, the higher the odds of coming down with a career - or life - ending condition. :(
 
Morgan3820 said:
There are standards. I have to maintain currency to fly instruments. I have to get a flight review to maintain my proficiency. I agree that denying a medical to somebody because they had a 20 year old diagnosis of ADHD is a little over the edge. But If this guy , in the article has a panic attack because of the TV news cast, I don’t want to be flying behind him. He should have self grounded. He put his career and income ahead of our safety. Flying should not be about participation ribbons. When it comes to the medical thing I’m agreeing more and more with the FAA.
I weary of looking at the medical topics And seeing people with serious mental issues you think it’s OK to go flying. But they don’t know any better, the pilot community does or should. Everybody doesn’t get to do everything they want. We grow weary about hearing how life is unfair.
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Not just “the” TV news cast - 9/11! Nevertheless falling to the floor in a public place hyperventilating is a bit abnormal even for that day, unless his wife and baby were actually in the WTC at the time. He does admit to subsequently realizing he had mental disorders so I’m not disagreeing with you, just sayin’.
 
Rushie said:
Not just “the” TV news cast - 9/11! Nevertheless falling to the floor in a public place hyperventilating is a bit abnormal even for that day, unless his wife and baby were actually in the WTC at the time. He does admit to subsequently realizing he had mental disorders so I’m not disagreeing with you, just sayin’.
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I watched the whole thing unfold too with a group of people. No one came close to falling down on the ground. Just sayin’
 
Rushie said:
I bet they were all male. Men still have the burden of being the main provider for their family. The older you get the harder it is to pivot and change career, especially if you have a mortgage and kids to support, or are in the financial red zone prior to retirement, scrambling to build enough portfolio to get through old age. I really understand their dilemma, but people can greatly underestimate the danger of seemingly minor symptoms. Indigestion that turns out to be cancer, chest discomfort that turns out to be heart disease.

Ironically the more locked into a career path you get with time, the higher the odds of coming down with a career - or life - ending condition. :(
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Yup, spot on. They purposely ignored symptoms and it ended up killing them all.
 
Morgan3820 said:
I watched the whole thing unfold too with a group of people. No one came close to falling down on the ground. Just sayin’
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I have a good friend who retired from the 160th SOAR as a pilot with significant combat experience. Couple years later he watched TV as the towers come down, and has been on antidepressants ever since. Would never have expected that. I was watching with a group of engineers. One lady vomited. So reactions varied.
 
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Morgan3820 said:
There are standards. I have to maintain currency to fly instruments. I have to get a flight review to maintain my proficiency.
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You do your flight review to demonstrate proficiency and maintain compliance (I hope) :D

Stress is additive. All it can sometimes take is a single event to make it overwhelming. As Rushie notes, there are times when critical life changing events like career changes, family issues or financial stress can overwhelm anyone. I suspect most of use have felt it but it just hasn't reached the levels required for active treatment and as stressors are shed we return to our "normal" selves.

For a long time those of us with the upper levels of security clearances lived with any mental health issues being immediate clearance revocation and pretty much end of your career but in the last decade that has changed and the people in charge have emphasized early intervention and minimal additional stress. A welcome change in a stressful work environment but alas, we still have a very high suicide rate. :(
 
Morgan3820 said:
But If this guy , in the article has a panic attack because of the TV news cast, I don’t want to be flying behind him. He should have self grounded. He put his career and income ahead of our safety. Flying should not be about participation ribbons. When it comes to the medical thing I’m agreeing more and more with the FAA.
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I agree that his story doesn't come across in a way that makes you automatically want to side with him. That said, there's a few things worth considering.

For one, he managed to fly his career without treatment, and (presumably) retired with more hours than you and I will ever have, combined (which, if he flew for a major airline was probably a requirement at hire). Clearly he's still alive, so therfore he didn't auger one in. Was that luck? Maybe, but it's hard to go a bunch of hours without having something bad happen at some point that is stressful whether it's weather (often), mechanical failures, etc.

Should he have self grounded? Maybe. You and your friends who watched it unfold may not have had any issues. My friends and I who saw it first hand mostly felt differently. Watching it on a newscast, our country being attacked on our soil, and no clue what/where may have been next? Not exactly a normal event. But after it seemed to later worsen and happen more, that's another question.

It's also hard for most people to decide to do something that's going to jeopardize their family's welfare and earnings potential. Would you do that? It's easy to say he should have when it's not your paycheck.

Which really gets to the point of the article. It's not that the pilots should get some treatment, it's that the system, as designed, encourages pilots to not disclose many issues. Hard to deny that.
 
Honest question..
what are the health standards for people driving hazmat trucks, busses, trains, etc.?

Is aviation at least commensurate with medical standards for other industries?
 
Waiting for some politicians to demand a full mental health workup for ALL pilots....
 
Some of the replies to this thread illustrate how little some guys know about the topic. Two quick comments.

My GP told me of an airline pilot patient who refuses to take meds for depression. Her comment was that the pilot would be far safer on meds than not on meds. Easy to believe.

My cardiologist, also a pilot, commented to me that her son, who like many kids was prescribed ADHD meds as a kid and now was struggling with getting an FAA medical, said she believes lots of pilots are taking depression and anxiety meds without reporting them. Also easy to believe.
 
Tantalum said:
Honest question..
what are the health standards for people driving hazmat trucks, busses, trains, etc.?

Is aviation at least commensurate with medical standards for other industries?
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I've done a bit of research on this, but am by no means an expert. When I looked into it, it appeared that some of the physical standards are a bit more exacting (in particular, FAA limit for blood pressure is 155/90, where DOT is 140/90, though they allow a bit higher than that with some restrictions).

But the DOT mental health standards are much more reasonable. For example, just having a condition like anxiety or depression is not automatically disqualifying. You can even take an SSRI that doesn't cause drowsiness, and all you need is a letter from your doctor saying it won't cause problems.
 
Ted said:
I agree that his story doesn't come across in a way that makes you automatically want to side with him. That said, there's a few things worth considering.

For one, he managed to fly his career without treatment, and (presumably) retired with more hours than you and I will ever have, combined (which, if he flew for a major airline was probably a requirement at hire). Clearly he's still alive, so therfore he didn't auger one in. Was that luck? Maybe, but it's hard to go a bunch of hours without having something bad happen at some point that is stressful whether it's weather (often), mechanical failures, etc.

Should he have self grounded? Maybe. You and your friends who watched it unfold may not have had any issues. My friends and I who saw it first hand mostly felt differently. Watching it on a newscast, our country being attacked on our soil, and no clue what/where may have been next? Not exactly a normal event. But after it seemed to later worsen and happen more, that's another question.

It's also hard for most people to decide to do something that's going to jeopardize their family's welfare and earnings potential. Would you do that? It's easy to say he should have when it's not your paycheck.

Which really gets to the point of the article. It's not that the pilots should get some treatment, it's that the system, as designed, encourages pilots to not disclose many issues. Hard to deny that.
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I agree that it it would be hard to walk away. I sympathize but what about the surgeon that has mental heath issues. Should he be able to keep cutting on people if something similar happens to him/her? There are lots of high responsibility careers out there. not just pilots.

My instructor also is a captain for NetJets. I don't know how many hours he has but safe to say that he is invested in his career. Having said that, he also invests in a disability insurance plan designed just for pilots to cover him if he ever loses his medical certification. I don't know what the premiums are but I guess that they are not trivial. Meaning , he has an alternative planned.
 
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Morgan3820 said:
I sympathize but what about the surgeon that has mental heath issues. Should he be able to keep cutting on people if something similar happens to him/her? There are lots of high responsibility careers out there. not just pilots
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Depends on the mental health issue. Should a surgeon with untreated major depression and multiple personality disorder be operating? Probably not. Should a surgeon who took SSRIs for a few months after her wife died be operating? Sure.
 
Stewartb said:
Some of the replies to this thread illustrate how little some guys know about the topic. Two quick comments.

Kind of resent that comment. I am entitled to my opinion without the "You guys just don't understand. I am much more knowledgeable" angle.

My GP told me of an airline pilot patient who refuses to take meds for depression. Her comment was that the pilot would be far safer on meds than not on meds. Easy to believe.

Safer, but would he be safe enough? Safer is not good enough. when it comes to hundreds of lives, I would err on the side of caution. A anecdote from a GP would not qualify as an expert witness on the subject.

My cardiologist, also a pilot, commented to me that her son, who like many kids was prescribed ADHD meds as a kid and now was struggling with getting an FAA medical, said she believes lots of pilots are taking depression and anxiety meds without reporting them. Also easy to believe.
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As i stated originally, I think that the juvenile ADHD diagnosis is bogus. I am sure had I been in school at that time, I would have been medicated.
 
future_western_pilot said:
Depends on the mental health issue. Should a surgeon with untreated major depression and multiple personality disorder be operating? Probably not. Should a surgeon who took SSRIs for a few months after her wife died be operating? Sure.
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Agreed, perhaps. But how do you administratively, draw that line? To what margin do you draw that line? Different lines for different surgical specialties? How do you make the process fair while assuring integrity while being administered by government bureaucrats?
 
I'm not going to design a whole system for evaluating this from scratch, and don't need to, in order to assess that the FAA's system is broken. There are many model systems around the world, not least of which is the EASA, which provide a system that maintains safety comparably to the FAA, without putting such a burden on pilots.

But there is a buttload of stuff the FAA could do to improve its resource allocation.

  1. The FAA should follow its own guidance as written instead of manufacturing constant ad hoc requirements. For example, SSRI Decision Path I is a sham; the FAA does not follow their own flowcharts. You regularly see posts here and elsewhere from aviators opting for pathway I who still need to spend $6,000 on costly tests that are simply not necessary, when their treating physician/psychiatrist--the professional who knows them best--says they are perfectly healthy to fly (and, per the FAA's guidance, that should be enough).
  2. Building on the first one, identify required documentation at the beginning, instead of in a piecemeal fashion. There are posts over and over about how the FAA requests one thing; it's submitted, and takes 10 months for the FAA to review; then the FAA asks for something else, which it should have known it wanted from the very beginning. Now, of course, sometimes this piecemeal fashion is necessary, when a record that is requested raises a question elsewhere. But to request, for example, a physician letter, which is submitted and is perfect; and then, after receiving the letter which contains everything the FAA wanted, ten months later request a $3000 psychiatrist visit; is complete nonsense and a waste of time. Clear guidance on what is needed would avoid this situation where, what likely occurs, is the first reviewer thinks that all that is necessary is a physician letter, and a later reviewer of physician letter decides more is needed (even though the letter is perfect).
  3. Stop ridiculous monitoring requirements. Sleep apnea is a good example. I think it's reasonable to require aviators to be evaluated if they are high risk. But once they're diagnosed and on treatment, the FAA treats them like babies, requiring constant surveillance of their condition. If these people can't be trusted to maintain their own treatment of their condition, how can you trust them to carry a plane full of 200 people? It's really rather remarkable to me. Hell, as a young 20-something coming out of grad school, I was given more responsibility over people's lives and decisionmaking that had huge impacts on people's livelihoods than the FAA apparently trusts pilots to have. By reducing this absurd nannying, you free up resources to dedicate to the more complicated stuff and reduce the massive timelines that pilots face in getting medicals.
  4. Stop the stupid ****. There was a post from a guy a few weeks ago, I think in his 30s, who had surgery on his penis when he was a tiny baby. His penis had worked perfectly since the operation more than 30 years ago, but the FAA got upset with him and tried to start digging around in those records, which obviously no longer existed. That's just insanity. There is no reasonable connection to flying 30 years after a small, routine surgery on a penis, when your penis has worked perfectly fine in the meantime. Not only does this put pilots through hell, but it just wastes the resources that could be spent on doing important stuff.
  5. Cut the nonsense with third class medicals. There is basicmed, but it requires passing a full third class. It's absurd that someone who wants to fly himself and his family in a Cessna 172 needs to go through the same $6,000 in testing as a commercial pilot because he took SSRIs a few years back (although it's frankly nonsensical that either of them have to do it). They are part of a system, yes, but taking SSRIs is not going to negatively impact that system, as other countries who allow their usage more easily testify to.

Finally, and most importantly, realize that the goal of medical guidance is not to:
  • Make aviators do what I think they should do (e.g., "Well, I think people need to deal with their emotions, rather than taking medicines to cover everything up");
  • Make aviators more like us (e.g., "Even I could have passed out after seeing that much blood!");
  • Ensure that people like me can pass their medical;
  • Keep my buddy who I have drinks with eligible to fly; or
  • Pass some arbitrary criteria.
The goal is and always has been the safety of flight, and all guidance and regulations should be designed around that. To that end, also recognizing:
  • Punitive or otherwise poorly thought through regulations and guidance CAN and DO discourage seeking treatment and reporting;
  • Discouraging seeking treatment and reporting conditions CAN and DOES hinder the safety of flight;
  • Pilots are ******n grown adults;
  • The current system is unsustainable, damages the safety of flight, and hurts pilots and their families;
  • The system will continue to grow out of control unless there is some sort of intervention;
  • Physicians, not bureaucrats, are the experts on medical conditions.
Right now, the FAA operates on aspirational principals. We issue guidance and requirements, and aviators must comply. That's stupid and, as a professional in the field of regulation, is very outdated.

There should be a shift to the PRACTICAL principal that, in my opinion, should guide all FAA medical decisions: Medical guidance/requirements should be designed based upon evidence that issuing that guidance/requirement improves the safety of flight, rather than a mere aspiration that aviators will voluntarily disclose/comply.

People always say the regulations are written in blood, but that is ******** with respect to most of the FAA's medical guidance. The medical guidance from the FAA is largely written on the precautionary principal: if we're not 100% sure, let's not risk it.

The reality is that the system is broken. Statistically speaking, you would expect about 50,000 pilots to be on SSRIs. If you think the ~1% of that number who report to the FAA that they are taking SSRIs are really the only pilots on SSRIs, or that a good number of pilots with mental illness are being treated, I have a bridge to sell you.

So, my response is, I'm not the expert, I'm not going to design a system from scratch. I don't have all the answers. But the system is broken. Other countries do it better, faster, and with less burden on pilots, while maintaining just as high a level of safety. There's no discussion to be had: we can do better.
 
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The informed medical opinion of a doctor that actually examines you should count for far more than one of a bureaucrat in OKC that has never even met you.

A doctor in OKC that diagnoses airman without personally examining them based on paper is not different than a doctor that writes prescriptions over the internet.
 
Morgan3820 said:
I agree that it it would be hard to walk away. I sympathize but what about the surgeon that has mental heath issues. Should he be able to keep cutting on people if something similar happens to him/her? There are lots of high responsibility careers out there. not just pilots.

My instructor also is a captain for NetJets. I don't know how many hours he has but safe to say that he is invested in his career. Having said that, he also invests in a disability insurance plan designed just for pilots to cover him if he ever loses his medical certification. I don't know what the premiums are but I guess that they are not trivial. Meaning , he has an alternative planned.
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A few more thoughts to consider. You said that you agree that a childhood ADHD diagnosis is bogus and shouldn't be disqualifying (paraphrasing). But, there are some people I've known defined as having ADHD who really shouldn't be flying, even though about 99% of them (if not more) are just fine.

Depression and anxiety have a spectrum that's similar. For most people, it's minor and easily treatable. For some, it's not. But like with something like high cholesterol, you can try to treat it when it's a smaller issue and generally prevent big issues, or you can ignore it and your probability of big issues increases significantly. In this country we tend to be pretty poorly educated on mental health and tend to think that it's basically an on/off switch - either you're "normal" or you're multiple personalities/schizophrenic talking to a train/etc. When it comes to depression/anxiety at least, things aren't nearly so black and white.

So that brings us to your question about the surgeon. I didn't ask my surgeon if he suffered from depression or anxiety before my hernia surgery last month. Actually, I asked no questions about his qualifications whatsoever. And frankly, I don't care if he has any of those issues so long as they're being treated. He could have high cholesterol or diabetes, either of which could theoretically cause a problem while I'm out. Don't care, so long as it's managed. And that's how I look at it with my airline crew. I don't expect him/her to be superman, I expect him/her to have appropriately managed health conditions.

To the point about disability/loss of medical insurance for pilots, the costs are very high because the issues that can cause a loss of medical are so many. I'm rarely a fan of increased regulation, but it seems to me that part of the system to help improve the situation and change incentives around would be for the majors, i.e. when you're making enough money that you're not likely to make that much any other way, to include disability insurance as part of the compensation package to handle loss/inability to receive a Class 1/2 medical (as appropriate). If all/most of the bigger/higher paying companies did that then it would just become part of standard employment compensation. But, that's another discussion, just one way that might help encourage pilots to get help when they need it.
 
I can't read now than two paragraphs from huffpo. Does the article explain why the pilots in question are willing to lie to the FAA about their conditions but unwilling to get treatment and then just lie to the FAA about that too?

Yes, I've had other pilots advise me to lie on my medical, and I know some who avoid seeking treatment, even when they know they're sick. But their reasons for doing so are usually irrational or based on misunderstanding the actual medical requirements.
 
Anyone here spend much time on university campuses? Bright kids everywhere. Very, very few have what you’d characterize as mental illness but a significant proportion are using SSRI meds. They’re living with high pressure and high expectations and SSRIs make them perform better. I know lots of young professionals in the same boat. I know a college town doctor who says Zoloft should be in the water supply. If it would make better (air)bus drivers? Why not?
 
Lindberg said:
I can't read now than two paragraphs from huffpo. Does the article explain why the pilots in question are willing to lie to the FAA about their conditions but unwilling to get treatment and then just lie to the FAA about that too?
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I think you'll find the answer if your peruse these forums. Once you are receiving treatment and have a diagnosis, there's a paper trail that can be linked to insurance. If you suspect/know that you have an issue, but don't have the diagnosis, you may be lying about it but there's no paper trail.
 
future_western_pilot said:
Stop ridiculous monitoring requirements. Sleep apnea is a good example. I think it's reasonable to require aviators to be evaluated if they are high risk. But once they're diagnosed and on treatment, the FAA treats them like babies, requiring constant surveillance of their condition. If these people can't be trusted to maintain their own treatment of their condition, how can you trust them to carry a plane full of 200 people?
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How many airmen fail the monitoring? If it's more than zero, then the monitoring serves a purpose. How many other airmen are compliant only because they know someone is watching?

I've been fortunate that despite a few medical issues, I've had excellent AMEs that have always gotten me issued. I know there are areas where the FAA is unreasonable. But there's also a lot of OWTs spread between pilots, on this forum, and I'll bet in that article.
 
Stewartb said:
They’re living with high pressure and high expectations and SSRIs make them perform better. I know lots of young professionals in the same boat. I know a college town doctor who says Zoloft should be in the water supply.
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High pressure and high expectations aren't exactly a new phenomenon, unknown to previous generations. And I'm very glad the college town doctor you reference isn't in a position to make policy.
 
Lindberg said:
How many airmen fail the monitoring? If it's more than zero, then the monitoring serves a purpose. How many other airmen are compliant only because they know someone is watching?

I've been fortunate that despite a few medical issues, I've had excellent AMEs that have always gotten me issued. I know there are areas where the FAA is unreasonable. But there's also a lot of OWTs spread between pilots, on this forum, and I'll bet in that article.
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Do you really think that if, in the absence of monitoring, one single person out of 500,000 pilots would fail to comply with treatment, setting up a whole system to monitor every single pilot with sleep apnea (statistically more than 100,000 pilots) is worth it? That's insanity and cannot be right, particularly considering that we know, based on the numbers, that the vast majority of pilots with sleep apnea right now are not receiving any treatment at all, and it hasn't caused any big problems.

Obviously the number who would not comply is higher than that, but I'm making the point that the principal you put forth--if even one wouldn't comply, aggressive and constant monitoring is necessary--is obviously wrong. I still stand by my point. If you want to implement a rule that if they fail to comply with treatment, they must self-ground, okay. If we're trust these people's judgment enough that we're willing to throw them into the air with 200 people, presumably we should trust them to handle this **** on their own, too. Sleep apnea is just an example, since maintaining compliance and reporting is so easy on the pilot's end (though it does take up large amounts of administrative resources), but there are other SIs and monitoring requirements that are much more onerous.

The only place I think is an exception is a narrow subset of mental health disorders where the disorder itself prevents you from judging your own condition, like bipolar disorder. But the FAA tends not to certify people with those disorders in the first place.
 
future_western_pilot said:
Do you really think that if, in the absence of monitoring, one single person out of 500,000 pilots would fail to comply with treatment, setting up a whole system to monitor every single pilot with sleep apnea (statistically more than 100,000 pilots) is worth it?
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If those numbers were accurate, then I would agree with you. Are those numbers accurate?

That's insanity and cannot be right, particularly considering that we know, based on the numbers, that the vast majority of pilots with sleep apnea right now are not receiving any treatment at all, and it hasn't caused any big problems.
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Disagree that it hasn't caused any problems. And the FAA is trying to get those pilots who aren't being treated into treatment. How would you propose to accomplish that without screening?

Whether you like it or not, the FAA is charged with assessing the medical fitness of airmen. Just saying it should ignore certain conditions isn't a good argument.

Obviously the number who would not comply is higher than that, but I'm making the point that the principal you put forth--if even one wouldn't comply, aggressive and constant monitoring is necessary--is obviously wrong. I still stand by my point.
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IOW, even if your premise is false, we should accept your conclusion. Not how it works.
If we're trust these people's judgment enough that we're willing to throw them into the air with 200 people, presumably we should trust them to handle this **** on their own, too.
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That's just not how it works. We don't just trust pilots' judgment on many issues. We don't leave 121 pilots alone in the cockpit. Pilots have flight reviews, currency checks, check rides, medical exams, written tests, multiple pilot rules, drug tests, etc.

If you want to self certify, fly sport, gliders, ultralights, or balloons. If you want your own doctor to determine your fitness to fly, go Basic Med.

Congress, not the FAA, has determined that "trust" is a necessary, but insufficient, condition for most commercial air operations.

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Lindberg said:
Whether you like it or not, the FAA is charged with assessing the medical fitness of airmen. Just saying it should ignore certain conditions isn't a good argument.
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I'm not going to get into an in depth argument with you, but I want to point out where you misconstrued what I said. I never said the above. Assess. Require treatment. Don't nanny. And your whole idea of trust is a great testament to why the whole system is broken, since it relies on trust in pilot's accurately reporting things to their physicians, and reporting to the FAA in the first place, which, again, we know based upon the numbers is not happening. Thus, the core point of evidence-based regulation: will this regulation/guidance significantly increase air safety? Rather than the archaic view that no modern regulator would take: if we assume aviators will comply, will this regulation/guidance significantly increase air safety? The numbers I gave are correct, kind of weird to abstractly suggest that they're not without providing any evidence of it.
 
Interesting discussion, and worthwhile.

a couple observations... apparently 90 percent of the alcoholic pilots that exist, do so unchecked and not identified, yet no problems. Zero under the influence issues in part 121. Yet all the muss and fuss. There’s an irrational fear of a drunk pilot that drives that machine, not an actual identifiable problem. So saying it’s all driven by keeping the public safe isn’t accurate. At least in that arena, I doubt it’s the only one.

Insofar as fear of being screened for mental fitness... the FAA uses people IDENTIFIED as being on the take, ESPECIALLY in part 121. So it’s a rational fear. Saying the FAA is using shrinks who understand pilots... have you ever met these “specialists”? I have. Trust me, they ain’t special. Why would they keep that list secret?!!!! Why would a pilot (especially part 121) not have a say in the doctor that evaluates them? it’s not a stretch to say these policies discourage honesty.

Why does the FAA not use current APA guidelines? Why do they condone diagnoses by policy (outdated ones even) rather than a comprehensive current industry recognized professional?

The FAA is simply risk adverse. They do not act in the best interest. It really comes across as institutional narcissism.
 
This is PRECISELY what I’m talking about. There are other options, not cheap but possibly cheaper... if you’re interested.
 
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