The FAA is all mixed up about pilot mental health

Airline pilots are responsible for the safety of millions of people every day, but recent events have highlighted the ways their own well-being is neglected. Pilots experience mental illness and substance misuse, just like the rest of us. Yet the Federal Aviation Administration (FAA) and its policies may stand in the way of pilots getting help when they need it — ultimately putting the flying public in danger.

With approximately 167,000 commercial airline pilots flying for major, small and regional airlines, an estimated 13,861 to 21,042 pilots have depression — 12.6 percent, 1.5 times higher than the general population. The FAA estimates the prevalence of substance misuse is 8.5 percent, while other experts note that the prevalence may be as high as 15.4 percent, consistent with the general population. That means that between 13,360 and 25,718 pilots are currently struggling with substance misuse.

Meanwhile, the FAA’s mandated annual medical screening for substance misuse leads to rates of referral at about 0.5 percent of all pilots. This arithmetic is alarming.

A flurry of news stories over the past several months illustrate the consequences of failing to identify these grave health concerns. In the latest frightening episode, an off-duty pilot who reported experiencing depression and using illegal drugs attempted to cut a commercial aircraft’s engines while riding in a jump seat. The FAA’s mission calls for “providing the safest, most efficient aerospace system in the world,” but incidents like these suggest that the agency may not be meeting its goal of safety, particularly when it comes to identifying and helping pilots address substance misuse and mental illness.

Indeed, FAA policies may actually be contributing to these problems. The agency requires pilots to undergo medical certification at least annually assessing whether the pilot is medically qualified to fly. To be compliant, pilots must meet with an Aviation Medical Examiner and disclose all visits to health professionals within the last three years, including the reason and providing the dates, names and addresses of providers.

While these requirements are taxing and invasive for pilots to provide, they are in other ways too lax and unreliable, because they rely almost entirely on self-disclosure. Underreporting is common among people with mental illness and substance misuse problems; it is hard to recognize when we need help, and can be even harder to ask for it. Pilots are no exception, and they have a lot to lose by coming forward.

For these reasons, the detailed disclosures required by the FAA are often perceived by pilots as a barrier to seeking the help they need. The fear of losing their pilot’s license and their livelihood, even temporarily, is paramount, causing them to sacrifice their well-being and the safety of the aerospace. FAA requirements are effectively encouraging pilots to stay quiet when sick.

One study reported that 26.8 percent of pilots acknowledged underreporting to their Aviation Medical Examiner and 56.1 percent avoided accessing needed health care; some even recognized that their struggles could affect flight safety. Interestingly, commercial pilots were found to be more likely to underreport than other pilot classes, and nearly 50 percent of pilots acknowledged knowing a colleague who had underreported information. This suffering in silence creates a risk to aerospace safety and to all of us as passengers.

It is time for the FAA to become more curious, more open minded and more realistic about the well-being of their workforce. They need to be more collaborative with mental health and well-being experts who understand the nuances of working with these safety-sensitive professionals, and they must incorporate mental health best practices into their policies and procedures.

Other safety-sensitive industries — e.g. health care and law — are already leading the way. They are shifting work cultures; changing laws around licensure to only inquire about current impairing conditions; increasing access and incentivizing well-being activities; and creating supportive work environments. Even aviation medical examiners recognize this need; ultimately, we all have the same goal for maintaining a safe and efficient aerospace.

Beyond these changes, the FAA needs to confidentially gather more accurate data on pilot well-being; it is clear there is a problem needing to be addressed, but without this data it is unclear how unsafe the airspace truly is. Policies and procedures must be less stigmatizing, more encouraging of self-disclosure, more supportive of preventative treatment seeking and include evidence-based approaches to identification of pilots who would benefit from support through the annual medical certification process. If passenger safety is to be maintained, the airline industry must shift from a culture of silence to loudly emphasizing that the well-being of pilots is a priority.

Richard Frank is director of the Brookings Schaeffer Initiative on Health Policy. Robyn Hacker is assistant professor of psychiatry with the Behavioral Health and Wellness Program at the University of Colorado Anschutz Medical Campus.