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Mental Health in the Field of Aviation

By: Sebastian Stoerzer

What is Mental Health and How Does it Relate to the Field of Aviation

Mental health is the term that describes a person’s emotional, psychological, and social well-being, which influences every human in every stage of their life. It affects how humans think, feel, and act. It affects how we deal with stress, relate and interact with others, as well as the decision-making which is directly connected to our mental health. One’s mental health is influenced by many forms which range from biological factors – such as how your brain is formed–and one’s family history, as well as the life experiences one encounters. There is a plethora of mental health conditions, including antisocial personality disorder, anxiety disorder, ADHD, bipolar disorder, depression, PTSD, and suicidal thoughts. Mental health conditions impact everyone differently, which is why some mental health issues are classified as Serious Mental Illnesses (SAMSHA). These cases are known to impact a person’s life and ability to function. It is important to note that these are not a weakness, choice, or character flaw. In most cases, early warning signs of mental illnesses are often quite noticeable, as the victim could exhibit symptoms such as low energy, feelings of numbness, significant use of drugs and alcohol, and mood swings (SAMSHA).

Since pilots are also human, it is not uncommon that people who work as pilots often also have to deal with mental issues, especially since the profession is known to be very stressful and demanding. However, for most of aviation history, mental health has been an issue that has not gotten much attention in the field of aviation, since it has been deliberately ignored throughout the years. There have been many federal restrictions and strict rules that have been implied by the FAA, which restrict those with severe mental disorders (such as personality disorder, psychosis, and bipolar disorder) and people with more common disorders (such as anxiety and depression) from flying (FAA).

This has stopped people throughout history from seeking help for their mental well-being and has caused a dilemma for many pilots. If someone were to be diagnosed with any disorder, it would mean that they would lose their job and be grounded. However, in recent years, the FAA has moved to make changes regarding mental health and has stated that they are committed to prioritizing the mental health of pilots (FAA, 2023). Additionally, the FAA notes that they encourage pilots to seek help for their mental well-being and it will not automatically disqualify them from flying. According to the FAA, only around 0.1% of applicants are denied if they disclose mental health concerns. To obtain a medical certificate, one must undergo a mental fitness examination with an Aviation Medical Examiner (AME), with whom one must disclose all mental health professional visits, medication taken, as well as all physical and psychological conditions and medications.

Additionally, in 2016, the Pilot Rulemaking Committee (ARC) was established to help the FAA by providing recommendations about pilot medical fitness, some of which include expanding training in mental health issues provided to AMEs and encouraging pilot peer support programs, which are organized by airlines and unions (FAA). Furthermore, the FAA actively tries to reduce the stigma of mental health and encourage pilots to receive care. They accomplish this by encouraging pilots to seek help if they have mental concerns, investing in increasing mental health training for medical examiners, and continuing the outreach to pilot groups to help them know which resources are available. However, there are still many restrictions, as the FAA states that pilots who have been diagnosed with psychosis, bipolar disorder, as well as other types of personality disorder are disqualified from becoming a pilot automatically, which means they are grounded. More common cases, like severe depression and anxiety, are not listed by the FAA, meaning that if they are treated, they do not disqualify you from flying (FAA). This underlines that many steps are being made in trying to help pilots with their mental health, yet there are still many restrictions and risks that discourage pilots from disclosing mental health concerns. In a Harvard study from 2016, researchers found that 12.6% of pilots are depressed and 6% are suicidal, underlining that many pilots suffer from severe mental health concerns, yet do not disclose them (Bayern).

September 11, 2001, and its Impact on Mental Health

Throughout history, there have been many events that have significantly impacted the field of aviation. Many of these events have also influenced how mental health has been viewed in this field, as well as forced related changes in the field. However, there have also been incidents that have greatly impacted pilots’ well-being and mental state.

One of these was the attacks on September 11, 2001. On this day, four airplanes were hijacked and crashed into the World Trade Center in New York, the Pentagon in Washington, D.C., as well as a field in Pennsylvania. After these attacks, many pilots came out and said these attacks had negatively influenced their mental health.

One of these pilots was Carl Eisen, a former airline pilot from Florida who recalls suffering from a panic attack after finding out that an airplane had crashed into the World Trade Center. “You would think that a person having a panic attack would seek help from a therapist, but I didn’t,” Eisen stated (Bayern). He decided to keep it confidential, yet in the years after the 9/11 attacks his anxiety and depression worsened, which is why he decided to get help. However, by seeking help, Eisen admits that he would be endangering his career–which it ultimately did, as his right to fly was taken away after he decided to see a therapist. All of this led to him deciding to stop flying and form a group called Mindful Aviator, an online course that uses meditation to help pilots deal with anxiety (Bayern).

Another example of how the 9/11 attacks influenced the field of aviation is revealed by a study by the International Journal of Environmental Research, which examined pilot aircraft-assisted suicide. In their study, they looked at how many pilot aircraft-assisted suicides there were five years before the events of 9/11, as well as three years after (Vuorio, 2018). They conducted that in the five years before 9/11, there had been six cases. However, in the three years after 9/11, there have been eight, showing an increase in pilot aircraft-assisted suicide in a shorter timeframe, emphasizing a potential correlation between the events on 9/11 and a decrease in mental health in pilots.

JetBlue Flight 191

Another event that illustrates how severely pilots suffer from poor mental health issues occurred on March 27, 2012. JetBlue Flight 191 was planned to fly from New York City’s John F. Kennedy International Airport to Las Vegas. However, during this flight, the captain began making disturbing comments and threats to the first officer. The first officer locked the captain out of the cockpit and diverted the aircraft to Amarillo, Texas. JetBlue originally stated that the pilot was suffering from a panic attack. However, many health officials have noted that something more significant had occurred. It is unknown what exactly caused it, yet it is indicated he was having a partial brain seizure or a psychotic disorder. Three years after the crash, the captain sued JetBlue for not making sure he was fit to fly and, therefore, endangering the lives of the passengers. The case was settled, yet the details were not made public (DeHoff and Cusick, p. 1).

Germanwings Flight 9525 - An Example of How the System Failed

On March 24, 2015, Germanwings Flight 9525 was en route from Barcelona, Spain to Düsseldorf, Germany with 150 people on board. Germanwings was a low-budget German airline that was a part of Germany’s flag carrier Lufthansa. While en route over the Alps, the aircraft was holding steady at an altitude of 35,000 ft. However, without making any contact with air traffic control, the aircraft suddenly started descending and at 9:41 am, the aircraft crashed into a mountain. Within a week of the crash, the flight data recorder was found, determining that the aircraft had been hijacked by the first officer.

While cruising over the French Alps, the captain of the aircraft, Andreas Sondenheimer, left the cockpit to use the restroom, leaving the first officer, Andreas Lubitz, alone in the cockpit. While he was away, the first officer immediately set the aircraft to a different altitude. He also locked the door which made it impossible for the captain to reenter the cockpit after returning from the restroom. The captain attempted to break into the cockpit, even using a fire axe, yet he was unsuccessful (David, 2023).

The first officer, Andreas Lubitz, was 27 years old at the time of the crash and had always been interested in flying and made it his lifelong dream to become a pilot. After graduating from high school, he joined Lufthansa’s flight academy. However, he dropped out shortly after joining due to having a depressive episode, which he treated with antidepressants and by seeing a psychiatrist. Shortly after, he received a medical submission stating he was fit to rejoin, which restored his student’s pilot’s license and medical certificate. This meant that if he were to have any additional treatment, he would be grounded from flying (David, 2023).

A few years later, he went to Arizona to fly at a Lufthansa base. To fly in Arizona, he had to go through the FAA to obtain clearance to fly. During this process, he filled out an FAA form in which he stated that he had never been diagnosed with a mental disorder, which was deliberately deceptive. In some cases, lying on an FAA document can lead to the revocation of one’s flying certificate or even result in jail time, yet the FAA granted Lubitz a second chance. He admitted after having been diagnosed with depression and then went to Arizona to do his flight training. In 2014, his depressive symptoms returned, and he believed he was going blind and experiencing delusions. For this reason, he went to visit an ophthalmologist and neurologist, who diagnosed him with hypochondriacal disorder and emergent psychosis. The
doctor urged him to visit a psychiatric clinic, yet did not. In January 2015, he was taking heavy antidepressants and received multiple sick notes, the majority of which were not forwarded to Germanwings, yet he continued to fly. Ultimately, he decided to take matters into his own hands and decided to take his life and 149 others (David, 2023).

The case of Andreas Lubitz is a prime example of how the FAA failed to provide mental health assistance and proves that systematic change needs to be made. It shows pilots have a profound fear of losing their jobs and are willing to hide their conditions to keep flying (David, 2023).

Lubitz underlines that to keep flying, candidates tend to conceal their illnesses and choose to not follow the advice given by medical professionals. If people do not receive the care they desperately need, their existing conditions can substantially worsen. Further, he shows that pilots cannot consciously receive proper care without fearing they will lose their jobs. In this case, Lubitz was in desperate need of appropriate care. Nevertheless, he decided against it, hurting himself and innocents in the process. Furthermore, it also underlines that people are willing to lie on government records rather than be transparent about their mental health conditions, accentuating that people are inclined to go to extreme measures to hide their issues. All this shows is that there is widespread paranoia among pilots when it comes to acknowledging their mental health. It underlines how many pilots take massive risks, not just criminally, but also personally, to secure their position. It also shows that pilots are not able to
receive enough care when it comes to mental health and balance their careers with their lives.

COVID-19 and Its Impact on the Mental Health of Pilots

In 2020, the World Health Organization declared a global pandemic due to the outbreak of a coronavirus disease, known as COVID-19. Almost every nation shut down its entire economy, including travel to the host country. This had significant implications for the aviation industry as flights became limited, which meant that many pilots were laid off or were not working as much as they previously did.

However, the pandemic also meant that many people had to change their lifestyles completely. Going outside, meeting people, or just generally going about life without any restrictions was made impossible. Many individuals’ mental health suffered from this sudden change, yet it also made people more aware of their mental health struggles since many people were alone more often and had more time to reflect in-depth upon themselves as a person. Multiple studies have noted, including a study from Frontiers in Public Health, that research has found an increase in mental health concerns among pilots (Quan, 2022). It can trace its causes to the pressures of managing the epidemic in flight and financial concerns due to reduced flights during COVID-19.

According to the National Library of Medicine, many studies underline how the pandemic negatively impacted people’s mental health. One study found that 13% of the total population suffered from “serious distress” (NLoM, 2023) after the pandemic. Another study found that the stressors created by the pandemic have led to significant mental health symptoms in up to 40% of general population individuals. Many studies also focused on the field of aviation specifically; one study found that 40% of pilots claimed that their mental health has worsened throughout the pandemic and another one even said that 66% of pilots’ mental health has depreciated because of the pandemic. One significant impact was that 47% of pilots were unemployed during the pandemic (Flynn, 2022).

These studies highlight that the pandemic has negatively impacted many people in society, though it hit the aviation community especially hard. This is stressed by the fact that the rate of pilots stating an increase in mental health concerns is notably higher than what general society’s rate. Besides, the aviation community went through many changes because of the pandemic as many pilots lost their jobs–domestic flights decreased by 50% and international flights by 74%. What this depicts is that it is safe to assume that more mental health complaints and the need for mental health aid will increase in subsequent years. It may imply that pilots will need to get more help concerning their mental health in recent years, making it imperative that change needs to be made regarding mental health.

How Mental Health Is Perceived by Pilots and in the Field of Aviation

Being a pilot comes with its challenges, something most pilots are extensively aware of. Pilots know it is challenging to fly, especially commercially, as one has to carry hundreds of passengers who trust the pilot with their lives. This stress is something that Terry Deitz, a pilot who has been on the reality TV show “Survivors,” flown F-14s for the Navy, and has been a commercial airline pilot, has discussed.

He claims that flying commercially is more stressful than flying for the Navy and being on a reality TV show (Kunzler, 2023). He gives the example that when you fly commercially and 150 people are sitting behind you, in reality, 15,000 people sit behind you, as 100 people will be going to each of the passenger’s funerals. Deitz emphasizes that he feels constant pressure and stress every time he flies. Stress can wear on people and impact their mental health significantly. This is why many pilots, including Deitz, advocate for change in regulations surrounding mental health. Another reason why Deitz wishes for change is that mental health has been weaponized, as it has become a topic that everyone is afraid to talk about, still, everyone knows it should.

Another pilot, Adam Lemons, a helicopter engineer who has served in the Middle East, suffered from PTSD after returning from his service. This has led him to get help for his illness and be prescribed anxiety medication; after eight years, he no longer needed anxiety medication. However, after applying for a pilot’s certificate in 2016, he faced an issue with his medical due to having had mental health concerns, despite being cleared from everything years prior. The FAA has, therefore, forced him to perform constant drug tests. These drug tests, he says, are not covered by insurance, which meant he needed to pay for the visits out of pocket. He has, therefore, ended up spending more than $30,000 on doctor visits to be able to fly and determine his air safety (Weis, 2023).

Joe LoRusso is the director of aviation at Ramos Law and a private pilot. His job requires him to deal with clients who have to deal with similar issues as Adam Lemons. LoRusso finds it cruel that pilots are not able to see a therapist or that any mental health concern comes with the constant fear and very real risk of losing one’s job. He also finds that the criteria of the FAA were curated in the 1980s and, therefore, were outdated. He supposes that the pilot shortage can be blamed on the current mental health guidelines, as these days, people are receiving mental health screenings and treatment at an earlier age. However, they are working through their problems to remedy them. Yet this medically disqualifies them from flying. There seems to be a consensus on this issue, in that Lemons, Deitz, and LoRusso share the belief that the current FAA guidelines are both outdated and causing a pilot shortage (Weis, 2023).

To get more information on this issue, I decided to speak to someone with a great deal of experience one-on-one, which is why I interviewed Keith McGill. He is a pilot who spent most of his life in the field of aviation and is a current professor and the former chief pilot at º£½ÇÉçÇø, as well as an FAA-designated pilot examiner, certified flight instructor, and former commercial pilot.

Throughout his career, he has experienced many changes in the field of aviation, specifically related to mental health. He has witnessed the impact of the stress pilots are under while training to become a pilot and the role mental health plays in becoming a pilot. McGill describes mental health as the fitness of the brain and emotions and believes that regulations regarding mental health need improvement in the field of aviation. He thinks that the FAA has an unyielding stance on mental health, which causes pilots to not pursue help for their mental health, as they have to risk getting suspended if they were to take care of their well-being.

McGill has come across many cases of people not wanting to get help due to the risk of losing their medical, yet knows that it can be beneficial to seek help for one’s mental health when one needs it. Thus, he wishes that the FAA would decide to work with the pilots to get them the help they need and keep on flying, expand upon the current regulations, and find a middle ground. McGill states that he can understand the current regulations, as it is easier to not certify someone who should be than to certify somebody who should not and make a mistake. There is a greater liability and more to lose if the FAA permits somebody with a medical issue. McGill notes that he has not noticed any changes involving mental health in the field of aviation, yet is confident that within the next five years, there will be changes made since the FAA is currently working on improvements.

Furthermore, as chief pilot, he had to deal with many cases of student pilots having issues with their medical due to being on medication. He recalls that it was an often occurrence that students take medication that would disqualify them from flying. This leaves them with the dilemma of either having to give up the medication and continue flying or giving up flying and helping themselves. He also recalls that, as a young pilot, one has to deal with more stress than when someone is a senior pilot because it is very much a seniority-driven profession. It can also be difficult for young pilots to balance work and life, due to being away from home for long periods or having long shifts to work. One positive he has noticed, though, is that the pay has gotten significantly better since he was an airline pilot in the 1990s.

Overall, Keith McGill thinks that the stigma surrounding mental health ought to change. He believes that if the FAA were to alter its approach and even just help a limited number of pilots, it would still be very beneficial. He recalls that, many years ago, one was not capable of being a commercial pilot if one had diabetes. This, however, has changed in recent years. McGill hopes that with the growing knowledge and advancement of technology, more progress like that can be made.

Regulatory Recommendations

With all of the criticisms also come recommendations for regulatory changes and changes surrounding mental health in the field of aviation. The Pilot Fitness Aviation Rulemaking Committee–commissioned by the FAA in 2015 after the Germanwings crash in 2015–proposed some recommendations for change. Some of the recommendations include that AMEs, aviation medical examiners, must prove they know how to properly assess basic mental health concerns, thus advocating for an enhancement in training for AMEs. They positioned themselves against mandatory formal psychological testing and called for commercial airlines to develop effective pilot assistance programs, as well as the implementation of mental health education programs to improve awareness and recognition of mental health. With these recommendations, the Pilot Fitness Aviation Rulemaking Committee is attempting to reduce the stigma of mental health to, ultimately, encourage an open dialogue about the issue and to be more open about one’s mental health issues (DeHoff and Cusick, p. 10).

Other regulatory recommendations include Keith McGill’s call for less punishment and more support for pilots when it comes to mental health. McGill knows that many people keep their concerns to themselves to avoid the risk of losing their ability to fly–which he finds unhealthy, as he finds it important that people get the help they need if they desire. Other regulatory suggestions come from Joe LoRusso and Adam Lemons. LoRusso believes pilots should not disclose if they are seeing a therapist and only should report if they see a psychiatrist or are on pharmaceuticals, and Lemons suggests that the FAA needs to be less strict with people who used to suffer from mental health concerns (Weis, 2023). He also calls for fewer screenings for people who have been cleared of mental health issues and that insurance was to pay for FAA mandatory screenings, as they are very costly.

Conclusion

Overall, there appears to be much agreement on the fact that changes need to be made on the issue of mental health and that the current FAA guidelines demand serious updating. This is underscored by the fact that people from different sectors of the field all seem to agree on this. There have been many events throughout history that emphasize that pilots require care for their mental health. The events on September 11, 2001, and the COVID-19 pandemic have shown to have negatively impacted pilot’s well-being and mental health. Furthermore, as with the crash of Germanwings Flight 9525 in 2015 and the incident involving JetBlue Flight 191, some pilots are in desperate need of help because of their mental health, and if they do not receive it, it could have negative consequences for passengers, people, and the aviation community.

Additionally, pilots should not have to fear for their careers or give up on their dreams if they wish to receive care for themselves. The current regulations put pilots in a dilemma that could harm them in many ways. To avoid that, the FAA must make changes to the regulations regarding mental health.

One regulatory change that needs to be made is to have AMEs receive better training, but also for pilots to be able to see a therapist without having to disclose anything or risk their careers. Additionally, there needs to be an improved integration of pilots after they have been diagnosed with a mental health concern, as well as an overall better education regarding mental health for pilots and even the integration of pilot support groups. This could lead to better self-recognition of mental health concerns and more support for pilots to know that they are not alone if they were to be diagnosed with a mental health condition. If the FAA were to implement some of these suggestions, pilots would be able to get help if they desire to do so and there would be more openness when it comes to mental health, reducing the stigma of mental health in the field of aviation.

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