By 29 years old, Chris Daniel felt he had it all: a wife, two beautiful children and fulfillment of his lifelong dream of becoming a U.S. airline captain. But in the spring of 2022, after years of flying, Chris knew something was not right. His past shadows were back, and they were being strained by post-COVID travel demands and long, tiring weeks on the road. Chris’s doctor had suggested years earlier that low mood and trouble sleeping could be signs of mild depression. He resisted the suggestion, as did many pilots. Chris believed he would never fly again if he was diagnosed with depression by a doctor. Because losing flying was like losing everything, Chris didn’t think it was possible to seek help. Being a pilot was his identity.
Chris is not an unusual story. While mental health symptoms are common in airline pilots, getting help can affect their ability to work in a big way. In order to fly, airline pilots must meet certain medical standards. If they disclose a new condition or symptom to the Federal Aviation Administration (FAA), they may lose their ability to work and fly, usually temporarily. This is especially true for mental Health symptoms. Pilots are prohibited from flying in the cockpit if the pilots report that they have been receiving regular talk therapy for mild anxiety or depression. This may go on for months, sometimes even years, as the FAA assumes they pose a unacceptable safety risk. Pilots are among a few professions that require disclosure about any encounter with the healthcare system, including mental health visits.
While it is sensible to ground a pilot who is in distress, the current system fails to recognize the situational and dynamic nature of mental health symptoms. This often discourages pilots from seeking treatment. Time off the job can have negative repercussions such as loss of pay and need for recurrent training, and the expenses of additional medical evaluations required by the FAA often fall onto the pilot. All of these factors lead to a large number of pilots in the fleet who suffer in silence and are afraid to seek the help they need. We need to rethink the system that prevents pilots from taking care of their mental health, and redefine what aviation means when it comes to seeking mental health care.
Data The scope of the problem is beginning to be revealed by my group and others. These findings deserve attention. In our recent study of more than 3,500 US pilots, 56 percent reported behavior that we classify as avoiding health care (for example, getting health care outside the traditional system to avoid its documentation) specifically because they feared the loss of their clearance to fly. Interestingly, 26 percent of pilots reported that they had withheld information during their FAA health checkups for the same reason: the fear of losing their medical clearance. This is sometimes called “losing your wings “.
In a sister study, more than half of pilots in our sample had something they felt needed to get checked out–maybe it was mental health related, perhaps a knee injury, or even just a rash–but waited or decided against it because they worried about their career. Although our studies were focused on overall health care, this finding could also apply to mental health.
Many pilots have reasonable access to medical care. This includes paid time off, health insurance, and sometimes other union protections. These data suggest that there is a barrier because pilots are asked how they can weigh the professional costs of seeking help against the benefits. How severe does mild anxiety have to be to justify a long absence from work? Most pilots find it very difficult.
The growing demand for pilots in a COVID-endemic, travel-hungry world will likely make this problem even more difficult. The Bureau of Labor and Statistics projects 18,100 new pilot jobs each year for the next decade, precipitated by the continued growth of air travel. As compensation has soared in 2022, more is being asked of pilots, including longer and more frequent trips to keep pace with passenger demand. This is because other airline professions (such as maintenance and administration staff) are also facing major personnel shortages, putting additional strain on an already stretched system. Pilots who are under increased demand can mean that they spend more time away from their families and friends, which can result in a greater need for mental healthcare services. Pilots’ mental health care needs will only increase in the future.
While it may seem like increasing the number of pilots would improve the situation, additional pilots will not solve the existing problems in the system. Flight training programs are expanding, and some airlines are taking the unprecedented step of establishing their own training programs. But, while class sizes are growing, they are being filled by a younger and more diverse generation of student pilots who may not be as willing as their predecessors to quietly suffer. In fact, emerging data suggest the willingness of current pilots (who are still largely in the 40-to-60 age range) to avoid health care for job security may not be as true for the next generation.
“Younger pilots are different from past generations and are more willing to identify as needing help when it comes to their mental health,” John Dulski, 21, an aviation student at the University of North Dakota and advocate for aviation mental health reform, told me during a recent phone call. Our research group is still trying to figure out why this phenomenon exists. Could it be due to social media decreasing stigma around mental health or the effects of growing up in the aftermath of the pandemic? Future research is expected to reveal the answer.
A new generation of Gen Z pilots may be more open to taking a break from flying to receive mental health care. This could only increase the pilot shortage. It should also prompt industry to reconsider what it means to be mentally fit for airline pilots and what services they should receive while still working in the fleet. All of us can agree that safety in aviation must be the foundation for meaningful changes. A pilot with severe mental illness should not fly. Pilots with mild symptoms have the chance to fly. These are highly-motivated professionals who may be facing one of the usual stressors in life, such as a divorce, a death in the family or the constant stress of their job. How can we rethink the system that allows these professionals to access mental health care services, in order to avoid a diagnosis that could lead to them being permanently disabled from flying?
One answer is clear. The FAA should make changes to allow pilots with mild symptoms to receive regular, and if necessary, prolonged, talk therapy without losing their medical certification. This would be a major benefit for both the pilot and flight deck staff. It would include treatment to prevent symptoms from getting worsened and regular assessment by a professional mental healthcare provider. Recognizing the fact that mental health is a dynamic spectrum and that many pilots could gain from speaking to a professional at some point in their careers can help keep them flying safe and healthy. Pilot unions and airlines should fuel this movement by raising awareness about the problem their pilots face and by lobbying for an alliance of stakeholder to determine how best to safely enact this change. Although the FAA has made positive policy changes regarding mental health recently, there is still much to be done and time is crucial.
Chris Daniel never did get help for his mental health symptoms, and despite an excellent flying record, he died of suicide in June 2022. While we believe suicide is relatively rare among pilots, this extreme outcome is in part why we must create positive change. The aviation safety culture must shift to mental healthcare services as an indicator of wellness and prevention, and not risk and disease. This would be a benefit not only to pilots but also to the 2 million Americans who rely on the aviation system every single day.
IF YOU NEED HELP
If you or someone you know is struggling or having thoughts of suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 or use the online Lifeline Chat.
The views expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the Department of Defense or any agencies under the U.S. government.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.