Illustration by Tigre Pickett
Did you know that over half of pilots admit to concealing health concerns, specifically mental health issues, fearing the loss of their medical certificate? This startling statistic exposes a significant disconnect between the needs of pilots and the current medical certification system. While maintaining the highest safety standards is paramount, fostering an environment where pilots hesitate to seek help can have detrimental consequences. This article delves into the complexities surrounding pilot mental health. It explores the challenges, potential solutions, and the need for a multifaceted approach to create a truly supportive and safe aviation industry for both passengers and crew.
The High-Stakes World of Pilots
Pilots are required to navigate the complexities of the skies with exceptional skill and composure. However, beneath their often calm exteriors lies a reality marked by significant stressors, including irregular work schedules, prolonged absences from home, and demanding responsibilities. Additionally, just like anyone else, pilots are not immune to life’s everyday challenges, such as financial pressures, relationship difficulties, or the loss of loved ones. These factors, coupled with the fear of career repercussions, create a unique set of obstacles for pilots seeking mental health support.
The Dilemma: Safety, Transparency, and Support
The Federal Aviation Administration (FAA) is pivotal in ensuring aviation safety. Their stringent regulations, shaped by past tragedies, have contributed to a remarkable record, with no major airline disasters since 2009. However, the strictness, particularly regarding mental health disclosure, poses unintended consequences.
Question 18.m. on the MedXPress application, asking about any history of mental disorders, exemplifies the broad nature of the inquiry. While aiming to identify potential risks like the Germanwings 9525 and recent Horizon Air incidents, this approach fosters a climate of fear. Pilots worry that acknowledging past mental health concerns, even if successfully managed, could lead to delayed or denied medical certificates. This fear often leads them to choose silence, hindering early intervention and potentially posing a greater risk to aviation safety.
Furthermore, the lengthy and expensive Special Issuance process for pilots seeking mental health support creates a paradox. A system designed for safety inadvertently discourages pilots from seeking help, fostering a culture of avoidance. Dr. William Hoffman’s research further explains this paradox, which found that over half of pilots reported delaying or avoiding healthcare due to the fear of losing their certification.
The Balancing Act: Pressure and Coping Mechanisms
Pilots constantly navigate a delicate balance between managing immense pressure and maintaining their mental and physical well-being. The rigorous nature of their work, coupled with irregular sleep schedules and demanding schedules, creates the perfect storm for stress and fatigue. While trained to manage stress and remain focused under pressure, pilots are not superhuman. The cumulative impact of under-addressed stress can ultimately lead to a mental or physical health crisis.
Unfortunately, the fear of career repercussions discourages many pilots from seeking professional help. This fear creates a situation where unhealthy coping mechanisms, such as self-medication or suppression of emotions, become prevalent. Pilots also feel that other interventions, such as prescribed medications or therapy, are risky to reveal and, therefore, go unreported. As one anonymous pilot shared, “Flying is wonderful, and it can also be very toxic — with stress being one of the most corrosive negative effects. Without safe outlets for mental health support, the cumulative stresses of the commute, work responsibilities, and feeling powerless to help out at home when we’re gone take their toll.” This lack of support highlights the hidden struggle faced by many.
Beyond the Regulations: The Need for Change
“Interviews with pilots have highlighted significant barriers to transparency and trust between pilots and the FAA,” conveyed Madolyn Miller, advocate and co-host of The Pilot’s Pandemic Podcast. “The costs, time, and lack of transparency surrounding the Special Issuance process discourage pilots from seeking help, perpetuating a culture of repression.”
Miller and her co-host Emma Lasko strongly advocate for a more uniform and transparent approach to the aeromedical process. They emphasize that the Special Issuance process comes with high costs and lengthy processing delays. Additionally, Miller and Lasko advocate for talk therapy as a non-reportable event.
Captain Herwin Bongers, a seasoned pilot and mental health advocate, calls for a shift in perspective. He suggests moving away from a binary approach towards mental health, recognizing that “the absence of illness doesn’t necessarily mean being fully well,” and advocating for a more nuanced understanding of mental well-being. Like how an aircraft can operate with an MEL (Minimum Equipment List), Bongers proposes exploring ways to support pilots with manageable mental health conditions while ensuring safety for all aboard.
Dr. Hoffman further emphasizes how we might rethink what mental wellness means in the aviation system of the future. Encouraging early intervention and creating a supportive environment can mitigate potential risks and foster a safer and healthier aviation industry.
Breaking the Stigma and Fostering Change
Cultural norms profoundly influence societal attitudes toward mental health. Captain Reyné O’Shaughnessy, a pilot, international speaker and author, reflects on her lengthy career: “During my 35 years, there was a pervasive belief that individuals had to ‘lie to fly.’ Discussing health and mental health was uncommon, largely due to the fear of jeopardizing one’s career.”
O’Shaughnessy continues, “The question is, how do we adapt and innovate to meet the human needs of today’s and tomorrow’s aerospace system?’” Her question echoes the central concern all stakeholders seek to address: how to ensure a safe and healthy environment for pilots and passengers alike. She suggests a groundbreaking and innovative approach, integrating “the whole pilot, not just their technical prowess” into safety management systems.
Thankfully, the tide is turning. Younger generations, like 18-year-old student pilot Zachary Friedman, are openly discussing their experiences with mental health, breaking down stigma and fostering conversations. However, Friedman’s story also serves as a stark reminder of the remaining challenges. Despite using only a topical acne medication and receiving a childhood anxiety diagnosis with a stable medication history, he was caught in the complex and opaque Special Issuance process for over a year (441 days to be exact), incurring significant financial costs and facing an uncertain future in his chosen career.
Like many others, Friedman’s story underscores the need for a comprehensive overhaul of the current system and a commitment to creating a more supportive and accessible environment for pilots seeking mental health assistance.
Voices for Change: Inspiration and Action
Thankfully, global initiatives offer valuable lessons and inspire change. In 2014, New Zealand witnessed a series of pilot suicides. In response, a collaborative effort between airlines, air traffic control groups, and flight schools led to the Peer Assistance Network (PAN) creation. PAN, named after the universal call of urgency in aviation (“PAN-PAN!”), offers peer support for mental health and has emerged as a successful case study.
Captain Bongers, who is involved with PAN, shares that most calls are handled at the volunteer level, demonstrating the effectiveness of peer support. This approach fosters a safe space for pilots to openly discuss their struggles and receive understanding from someone who empathizes with their unique challenges.
While peer support programs exist in the U.S., accessibility is often limited to specific companies or unions. PAN’s model is an example of a holistic, inclusive, and collaborative approach, funded proportionally by sponsors, making it accessible to all pilots in New Zealand. PAN’s success demonstrates the potential for broader adoption and adaptation of such programs.
The mental health narrative is also shifting within the U.S. government, driven by figures like Jennifer Homendy, Chair of the National Transportation Safety Board (NTSB). Homendy emphasizes the need for collaboration and a cultural shift within the aviation industry, one that prioritizes transparency, early intervention, and readily available support without fear of repercussions.
Grassroots movements like the Pilot Mental Health Campaign (PMHC) are crucial in advocating this cultural shift. PMHC founder Brian Bomhoff emphasizes the significance of “creating a positive message around mental health and mental hygiene” and fostering an environment where seeking help is not seen as a risk or sign of weakness but is encouraged as a sign of strength and dedication to safety.
Towards a New Horizon: A Multifaceted Approach
Moving forward requires a multi-faceted approach grounded in collaboration, research, and a commitment to supporting mental health awareness and access to treatment. Integrating mental well-being into the fabric of aviation safety can empower pilots to manage the inherent stress of their profession while fostering a healthier and safer work environment for all.
By taking inspiration from successful initiatives like New Zealand’s PAN, we can hope to establish readily accessible and confidential peer support programs to bridge the gap between regulatory requirements and the human needs of pilots. Additionally, continued research is needed to refine regulations and support systems specific to the unique pressures faced by pilots.
As the aviation industry evolves, so must its approach to pilot mental health. By fostering a culture of transparency, empathy, and proactive support, the industry can create a future where the well-being of those navigating our skies is prioritized alongside their physical safety. This inclusive approach can lead to a safer and healthier aviation industry, benefiting not just the pilots but also the millions of passengers who trust them daily.
Mental Health Resources for Pilots
Pilot’s Pandemic Podcast: Erasing stigmas around aviation
tinyurl.com/pilotspandemic
Pilot Mental Health Campaign: Advocating for holistic and
humane FAA mental health reform | PMHC.org
Captain Reyné O’: Pilot health pioneer, author, and speaker piloting2wellbeing.com
Non-Reportable Counseling: Get talk therapy without consequence listenr.io/pilots
NTSB Pilot Mental Health Roundtable 2023 | tinyurl.com/ntsb-pmhr
Mental Health Stats
Mental health By the Numbers | NAMI: National Alliance on
Mental Illness Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health
nami.org/mhstats
There’s More to the Story of Pilots Avoiding Mental Health Care
| MedPage Today by William R.Hoffman, MD | tinyurl.com/3snsdj75
Aviation Mental Health News
Aviation student takes own life | tinyurl.com/52j73nv8
Alumnus killed after stealing and crashing plane | tinyurl.com/3ytekyhn
Ex-Alaska Airlines pilot accused of attempt to cut engines mid-flight released from jail after not guilty plea | tinyurl.com/4mu5bapt
Germanwings Flight 9525 | tinyurl.com/yc3uypk2
Aviation Mental Health Advocates
Capt. Reyné O’Shaughnessy | Piloting2WellBeing.com
Emma Laczko and Madolyn Miller of The Pilot’s Pandemic Podcast
tinyurl.com/2wwhfwrh
Brian Bomhoff of Pilot Mental Health Campaign | PMHC.org, tinyurl.com/5n869w4c
New Zealand’s Peer Assistance Network | www.pan.org.nz
Capt. Herwin Bongers | LinkedIn: tinyurl.com/2y6rvn9s
Jillian Bourdage, CFII | LinkedIn: tinyurl.com/yc6jnunc
Zachary Friedman, PMHC | LinkedIn: tinyurl.com/333fcu29
Jennifer Homendy, NTSB Chair | LinkedIn: tinyurl.com/mr3fjtp6
Austen Jarboe | LinkedIn: tinyurl.com/45baypsc
Aviation Researchers
Dr. William “Billy” Hoffman | LinkedIn: tinyurl.com/zyu6by6
