FAA, AME's & Mental Health

lbfjrmd

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Senior AME/ATC AME
an article about pilot's mental health:

The FAA and its aviation medical examiners—physicians who evaluate commercial airline pilots every six months to one year—are considering several options to break through actual or perceived “firewalls” that prevent them from alerting airlines when they observe potential mental health issues during routine or special examinations.

The action comes as the agency moves to implement recommendations from its Pilot Fitness aviation rulemaking committee (ARC) formed in the wake of the Germanwingscrash in March 2015 to assess pilot mental health issues. The ARC did not call for new psychological testing for pilots but rather a strengthening of existing airline internal pilot help programs and self-reporting. Along with helping airlines to share best practices in that area, the FAA also initiated enhanced training for its corps of aviation medical examiners (AME), physicians who provide pilots with medical certifications, to help them spot warning signs of mental illness.



The FAA will upgrade training for its medical examiners to spot potential psychological issues in pilots, but does not plan to introduce specific testing



“We have to do more to remove the stigma around mental illness,” said FAA Administrator Michael Huerta on June 9 when discussing the FAA’s response to the ARC. “The best way to reduce risk is to encourage pilots to voluntarily report issues. Most conditions are treatable.”

In the Germanwings crash, the co-pilot locked the captain out of the cockpit during cruise flight and commanded the Airbus A320 autopilot to descend from cruise altitude into the French Alps, killing all on board despite repeated attempts by the captain to reenter the cockpit. The copilot had been suffering from severe mental health issues that—due to privacy laws and the pilot’s lack of voluntary disclosure—were known to private doctors, but not to the German civil aviation regulator or Germanwings parent company, Lufthansa Group.

In its final report on the accident, the French aviation safety agency BEA called for the World Health Organization and the European Union to develop guidelines for member countries to set “clear rules” for when doctor-patient confidentiality should be breached to inform authorities “when a specific patient’s health is very likely to impact public safety.” A European task force launched after the Germanwings crash also called for a review of national regulations to find the correct balance between patient confidentiality and protection of public safety.

In the U.S., similar confidentiality concerns and reporting requirements vary by state, and licensing and specialty boards cloud the issue. There is no national standard for physicians to follow.

Based on the recommendations of the ARC, the FAA asked the Aerospace Medical Association (ASMA), the trade group representing doctors in the aerospace field, “to consider addressing the issue of professional reporting responsibilities on a national basis.” ASMA, a member of the American Medical Association (AMA), discussed potential national mental health reporting standards for doctors during the AMA’s annual meeting June 11-15 in Chicago.

“The ARC felt that we needed something at the national level to encourage private practitioners to come forward,” says Michael Berry, the FAA’s deputy federal air surgeon. Depending on ASMA’s actions, Berry says AMA could study the issue further or ask the U.S. Congress to take action.

During their required medical examinations with AMEs, airline pilots must self-disclose mental health and other physiological issues from the past three years. While some airlines do perform certain psychological tests on pilot candidates during the hiring process, Berry says those tests are meant more for personality compatibility with the airline rather than a spot check for major psychological illnesses.

In the U.S., airline pilots under age 40 must receive a first-class medical check every year, and those age 40 or older must pass the checks every six months. Based on his or her assessment of the pilot’s self-disclosure form and the pilot’s general condition, the AME may ask for additional tests or defer the application to the FAA’s Office of Aerospace Medicine.

Berry concedes that AMEs do not administer any formal psychological testing during a pilot’s recurring medical checks, but do take note of trends nonetheless. “They get a gestalt of that individual,” he says. “If [the AME] doesn’t do that, he or she is not doing their job.”

Berry says the FAA has traditionally not shared its mental health concerns about a particular pilot with the pilot’s airline. “We think we should,” he says.

While an airline will eventually find out indirectly about a problem if a pilot fails his or her six-month or yearly medical examination, Berry says the FAA is considering processes for quicker notification.

“If we are examining a pilot’s ability to hold a medical certification in between that time, and if we find out that something [has happened], can we let the airline know that we are examining the pilot’s medical credentials? We’re looking at that and we are trying to make sure we are on firm legal underpinnings [to disclose the information],” he says.
 
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A pilot would have to be crazy to admit to having any mental health issues.
...which is more than just a funny one-liner. In order to do any good in a GermanWings-type situation, it seems to me that the result of notifying the airline would have to be the grounding of pilots who were considered (potentially?) suicidal, thus creating an incentive for the pilot to hide the condition. That's why I think the only real solutions are what is already being done in the U.S., i.e., the protocol that prevents having only one crewmember in the cockpit at any time, and the avoidance of hiring pilots with as little experience as that guy had. The latter increases the chances that the mental instability becomes known before the pilot gets into a position to murder a whole airliner full of passengers and crew.
 
Without a pilot actually disclosing that he is bonkers, unless he has fruit loops just pouring out one ear and a cuckoo popping out of the other, it is pretty much impossible to diagnose one with a mental condition in the short time that one spends with an AME.
 
Without a pilot actually disclosing that he is bonkers, unless he has fruit loops just pouring out one ear and a cuckoo popping out of the other, it is pretty much impossible to diagnose one with a mental condition in the short time that one spends with an AME.

Nice imagery. :)
 
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