Fact or Fiction: FAA Continues to Remove Barriers/Reduce Stigma for Mental Illness in Pilots

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GoFlightMed

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Clearly, many pilots are frustrated with the FAA's policy on history of mental health conditions (primarily ADHD & depression/anxiety).
But there have been many changes in the last few years that seem to be removing barriers and reducing stigma in the area of mental health.

A few examples:

* 1 April 2024: FAA released a NOTAM to AME's stating they are adding 3 new antidepressants [duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq)] to the 'conditionally approved' (requires special issuance) antidepressant list. This one goes live 24 April 2024.
* 30 Aug 2023: FAA creates the new ADHD 'Fast Track' pathway
* 31 May 2023: FAA adds bupropion (Wellbutrin) to adding the 'conditionally approved' (requires special issuance) antidepressant list.
* 15 Dec 2022: FAA removes requirement for Neuropsychologist Cog Eval for Antidepressant Special Issuance Renewals

Agree or Disagree?
 
dbahn said:
The FAA needs a more philosophical change, not just a few tweaks to a broken process.
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Or maybe their stance is already correct and no change is needed. Do you really want someone who is dependent on taking a drug every day to stay mentally stable or someone with a history of depression or someone who is not able to stay focused on the task at hand at random times flying an aircraft you are a passenger of? What safety purpose does it bring for the FAA to consider letting someone with a mental illness become a pilot? I’m all for it if the person has proven that their condition was a one time situational event or that they were misdiagnosed as a child but that isn’t the case for the vast majority that come on here looking for solutions to pass their medical.
 
kmacht said:
Or maybe their stance is already correct and no change is needed. Do you really want someone who is dependent on taking a drug every day to stay mentally stable or someone with a history of depression or someone who is not able to stay focused on the task at hand at random times flying an aircraft you are a passenger of? What safety purpose does it bring for the FAA to consider letting someone with a mental illness become a pilot? I’m all for it if the person has proven that their condition was a one time situational event or that they were misdiagnosed as a child but that isn’t the case for the vast majority that come on here looking for solutions to pass their medical.
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Many of the current applicants, and especially younger ones, never had mental illness and still don't.

The development and marketing of mood altering drugs created a need for a coded diagnosis for physicians to prescribe them, which they did in large numbers due at least partly to agressive marketing by the drug manufacturers. ALL of those patients are caught in the FAA's net and are forced to prove that the doctor was wrong. I look at the situation as a failure of good medical care that ended up in the FAA's bureaucratic slow moving machinery that just adds time and expense for many healthy applicants.
 
In the intial work on our ON SSRI petition, bupropion was associated with lower scores, on the "Brain efficiency evaluation" than the original 4. In 2010 when this was finally considered (it took 4 years to get it considered) Bupropion was "left out" of the origin petition beucase we simply needed to obtain an approval and put into place a mechanism for which we could confidently evalute folks on these meds.

Over time the agency has gotten more comfortable with these approvals as the downstream experience has been good.

I actually suspect the ARC report has more to do wtih the new additions comping on the 24th: (cymbalta, Effexor, Pristiq). But I don't expect many successes. These additional meds, are generally much more impactful on brain performance. But the evaluators will be able to tell us!

So it goes with public safety...
 
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GoFlightMed said:
Clearly, many pilots are frustrated with the FAA's policy on history of mental health conditions.
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Serious question I’d like you to answer.

14 CFR 67.107, .207, and .307 are identical in text.
Mental standards for a first/second/third-class airman medical certificate are:

(a) No established medical history or clinical diagnosis of any of the following:

(1) A personality disorder that is severe enough to have repeatedly manifested itself by overt acts.

(2) A psychosis. As used in this section, “psychosis” refers to a mental disorder in which—

(i) The individual has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition; or

(ii) The individual may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition.

(3) A bipolar disorder.

(4) Substance dependence, except where there is established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years. As used in this section—

(i) “Substance” includes: alcohol; other sedatives and hypnotics; anxiolytics; opioids; central nervous system stimulants such as cocaine, amphetamines, and similarly acting sympathomimetics; hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; cannabis; inhalants; and other psychoactive drugs and chemicals; and

(ii) “Substance dependence” means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by—

(A) Increased tolerance;

(B) Manifestation of withdrawal symptoms;

(C) Impaired control of use; or

(D) Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.

(b) No substance abuse within the preceding 2 years defined as:

(1) Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous;

(2) A verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S. Department of Transportation or an agency of the U.S. Department of Transportation; or

(3) Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds—

(i) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(ii) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

(c) No other personality disorder, neurosis, or other mental condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
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How would you re-write the regulation to achieve what you want, because that’s about the only way any meaningful reform is achieved.
 
kmacht said:
Or maybe their stance is already correct and no change is needed. Do you really want someone who is dependent on taking a drug every day to stay mentally stable or someone with a history of depression or someone who is not able to stay focused on the task at hand at random times flying an aircraft you are a passenger of? What safety purpose does it bring for the FAA to consider letting someone with a mental illness become a pilot? I’m all for it if the person has proven that their condition was a one time situational event or that they were misdiagnosed as a child but that isn’t the case for the vast majority that come on here looking for solutions to pass their medical.
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The most glaring issue with your post, is that you assume the current process/policies are efficient and effective at achieving the goal that you've set out.
 
jbarrass said:
All if the "have you ever" questions should be modified to a 10 year lookback. After 10 years, it's settled. A successful 40 year old who had a rough 4th grade is not a concern.
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I recall a post (don’t remember what forum) from a guy who had his medical application denied because 10 years earlier, he got a minor in possession ticket while in college, paid a fine and his license was suspended for a short time even though he was not driving (some states love to double-punish) - clean record ever since. The FAA wanted him to do the whole nine yards - go to AA, testing, HIMS, sign the pledge to never drink again. All for being at a party with a red Solo cup 10 years ago, doing exactly what college kids do.
 
jbarrass said:
All if the "have you ever" questions should be modified to a 10 year lookback. After 10 years, it's settled. A successful 40 year old who had a rough 4th grade is not a concern.
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OMG, yes please. Who here has tried to obtain medical records from 30 years ago, from when they were a child, for items that haven't been relevant to their lives for decades, but nonetheless the FAA needs to know about them?
 
Baked Potato said:
OMG, yes please. Who here has tried to obtain medical records from 30 years ago, from when they were a child, for items that haven't been relevant to their lives for decades, but nonetheless the FAA needs to know about them?
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I have hard copies of relevant medical records going back to 1981 when I was seven; luckily, my first FAA medical was in 1990 or so and I’ve kept all the relevant stuff since.
 
About 10 years ago, doing the workup on the settlement for a work injury that I had, the evaluating doctor got my medical records going back to my teenage years. A fair number of the records from the late 80s through mid 90s were faint copies of copies of copies of barely-legible handwriting, and most had minimal info - just a diagnosis with no background, and sometimes a blatantly incorrect summary of how the injury or illness occurred. A 10 year lookup limit would be a good thing.
 
I’m fine with Class 1 and 2 jumping through many hoops to get certified. I don’t want someone flying a 150 pax plane (like the Germanwings guy) without proving they are fit. That is in the personal interest of everyone.

On the other hand, for class 3 weekend solo flyers the barriers are nonsense and financially an impediment for most. Should we require the elderly to see a psychologist to renew a drivers license? or increase minimums for a DOT physical to drive a semi (good luck with that… it would seriously dent interstate commerce).

Do I want someone with psychosis or suicidal tendencies flying? Absolutely not. But the current system goes way too far to ground people who are ok.

We give military pilots pseudo Adderall for missions and that’s ok?
 
Gator1975 said:
I’m fine with Class 1 and 2 jumping through many hoops to get certified. I don’t want someone flying a 150 pax plane (like the Germanwings guy) without proving they are fit. That is in the personal interest of everyone.

On the other hand, for class 3 weekend solo flyers the barriers are nonsense and financially an impediment for most. Should we require the elderly to see a psychologist to renew a drivers license? or increase minimums for a DOT physical to drive a semi (good luck with that… it would seriously dent interstate commerce).

Do I want someone with psychosis or suicidal tendencies flying? Absolutely not. But the current system goes way too far to ground people who are ok.

We give military pilots pseudo Adderall for missions and that’s ok?
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The fallacy here is that you do NOT need a class 1 or 2 to haul 150 pax in an airliner. You can do so with a Private ticket and a class 3 so long as you aren’t compensated and pay a pro rata share. You can also fly a supersonic warbird. What you can fly with a class 3 is solely limited by your wallet.

The option that restricts pilots to small planes is Basic Med, and Basic keeps OKC out of the picture. What we need to do is eliminate that stupid &#$@* requirement for a 1-time class 3 prior to Basic.
 
Half Fast said:
The fallacy here is that you do NOT need a class 1 or 2 to haul 150 pax in an airliner. You can do so with a Private ticket and a class 3 so long as you aren’t compensated and pay a pro rata share. You can also fly a supersonic warbird. What you can fly with a class 3 is solely limited by your wallet.

The option that restricts pilots to small planes is Basic Med, and Basic keeps OKC out of the picture. What we need to do is eliminate that stupid &#$@* requirement for a 1-time class 3 prior to Basic.
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Our official definitions of class 3 are a bit different. You are totally right.

My definition of a class 3 solo weekend flyer is “Marvin” who wants to take his 1960 150 up for a 50 mile flight to get a $50 burger….
 
Gator1975 said:
I’m fine with Class 1 and 2 jumping through many hoops to get certified. I don’t want someone flying a 150 pax plane (like the Germanwings guy) without proving they are fit. That is in the personal interest of everyone.

On the other hand, for class 3 weekend solo flyers the barriers are nonsense and financially an impediment for most. Should we require the elderly to see a psychologist to renew a drivers license? or increase minimums for a DOT physical to drive a semi (good luck with that… it would seriously dent interstate commerce).

Do I want someone with psychosis or suicidal tendencies flying? Absolutely not. But the current system goes way too far to ground people who are ok.

We give military pilots pseudo Adderall for missions and that’s ok?
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What requires those with a class 3 to fly solo?
 
Gator1975 said:
My definition of a class 3 solo weekend flyer is “Marvin” who wants to take his 1960 150 up for a 50 mile flight to get a $50 burger….
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I know that's what you had in mind. Marvin doesn't need a Class 3 for that; Basic Med is perfect for his needs, and if MOSAIC ever goes through he might be able to do his burger run with only a driver's license.

OKC keeps arguing they're overloaded and they need more money, when what they really need is to shed some work. Turn everything that's not on the Basic Med big-three issues list into CACI and let the AMEs take care of it, at least for 3rd class. But no bureaucracy will ever willingly give up control.
 
Lindberg said:
The most glaring issue with your post, is that you assume the current process/policies are efficient and effective at achieving the goal that you've set out.
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Sport Pilot and Basic Med have been demonstrating that, at least for private pilots in small aircraft, the current process/policies are no more effective than a DL or a checkup with your regular doctor every four years.
 
bbchien said:
These additional meds, are generally much more impactful on brain performance.
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Bruce, you'd certainly be the person to know, so I'm sure they do indeed have a greater impact on brain performance than the other meds, but is that impact enough to matter for aviation safety? Is it statistically significant? There's nothing preventing Sport Pilots and Basic Med pilots from using these meds, yet I don't think we've seen problems.
 
Gator1975 said:
I’m fine with Class 1 and 2 jumping through many hoops to get certified. I don’t want someone flying a 150 pax plane (like the Germanwings guy) without proving they are fit.
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Yet he did. He jumped the hoops, hid the condition and committed mass murder. There are more commercial pilots out there with the same conditions dealing with it however they do. Creating a process to come forward and not destroy their life seems the right thing to do.
 
dbahn said:
The FAA needs a more philosophical change, not just a few tweaks to a broken process.
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:yeahthat: :yeahthat: :yeahthat:

Unfortunately, I believe the only way to change the philosophy will be to change the philosophers. We have an entrenched bureaucracy issuing decisions based upon unpublished, tribal knowledge "standards" that they seem to change on a whim without any meaningful statistical data to justify what they do. Basic Med is finally demonstrating that the emperor has no clothes, but don't expect OKC to change on its own.
 
Pugs said:
Yet he did. He jumped the hoops, hid the condition and committed mass murder. There are more commercial pilots out there with the same conditions dealing with it however they do. Creating a process to come forward and not destroy their life seems the right thing to do.
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This seems contradictory. If they come forward with a condition that has been shown to result in mass loss of life, it would seem that the prudent thing to do is to end their career as a pilot. I realize that this sounds harsh, but far less so than slamming an A320 into the nearest alp.

The real question is how to make the determination without ending - or even disrupting - the careers of hundreds or thousands of pilots who pose no danger.
 
Pugs said:
Yet he did. He jumped the hoops, hid the condition and committed mass murder. There are more commercial pilots out there with the same conditions dealing with it however they do. Creating a process to come forward and not destroy their life seems the right thing to do.
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If you want something that will allow them to get help and not jeopardize their careers, it’s probably going to have to happen outside of any government or insurance interference.

Self-ground, take a leave of absence, and find a place to get treatment without a formal diagnosis.
 
Half Fast said:
Bruce, you'd certainly be the person to know, so I'm sure they do indeed have a greater impact on brain performance than the other meds, but is that impact enough to matter for aviation safety? Is it statistically significant? There's nothing preventing Sport Pilots and Basic Med pilots from using these meds, yet I don't think we've seen problems.
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I think is is semi-genuine on the part of the agency and promted by the Advisory Review Committee (ARC). They have the confidence that the clinical psychological battery will pick this up. But I can tell you for sure Celexa really inhibitis problem solving flexibility and mental agility and will be the source of many application failures, in the Neurocognitive laboratory.
 
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StraightnLevel said:
This seems contradictory. If they come forward with a condition that has been shown to result in mass loss of life, it would seem that the prudent thing to do is to end their career as a pilot. I realize that this sounds harsh, but far less so than slamming an A320 into the nearest alp.

The real question is how to make the determination without ending - or even disrupting - the careers of hundreds or thousands of pilots who pose no danger.
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Not if the LTD policies are robust enough to make the conflict of interest moot. Insurers won't play ball, so hunger games it is....
 
bbchien said:
... But I can tell you for sure Celexa really inhibins broblem solgin flexibility and mental agility...
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sidetrack: I had to laugh... I thought those typos to be funny. At first I was wondering what kind of medical mumbo jumbo that was.... Of course, if those are real words, I'll be suitably chagrined.

(and, yes, I know it is really really easy to mistype when firing off a post)

(edit: and then bbchien took the fun away by correcting the typos. booo)
 
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MauleSkinner said:
If you want something that will allow them to get help and not jeopardize their careers, it’s probably going to have to happen outside of any government or insurance interference.

Self-ground, take a leave of absence, and find a place to get treatment without a formal diagnosis.
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Agreed,it’s going to take a combination of a company that understands the value of an existing employee, along with their union, to find a place for the person to work and add value until they can get past this issue. If they can’t get past the issue then it becomes a medical retirement.

However, the government can really step in and screw that process up and make it very hard for someone who has an issue that works through it and proves they can go back to the cockpit. Should it be hard? Yep, but the current process that takes folks back to their childhood doesn’t seem to be the answer.
 
bbchien said:
I think is is semi-genuine on the part of the agency and promted by the Advisory Review Committee (ARC). They have the confidence that the clinical psychological battery will pick this up. But I can tell you for sure Celexa really inhibins broblem solgin flexibility and mental agility and will be the source of many application failures, in the Neurocognitive laboratory.
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Wonder how much the average impairment for a 30 year old on Celexa is to the average 70 year old not on it…
 
AKiss20 said:
Wonder how much the average impairment for a 30 year old on Celexa is to the average 70 year old not on it…
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It (celexa) is generally much worse.....we measure that by performance score equivalents to BAC's.
What I'm saying is that the agency didn't give up much. I don't think many on pristiq are going to score well enough....to get through. Celexa- maybe.
 
Bruce, I’m curious. We have about 80k pilots using Basic Med now. Has there been any sort of anonymous survey to determine what meds they might be taking for comparison against meds acceptable to OKC?

Given the similarity of the safety records of Basic Med and Class 3 pilots, it might be interesting to know what similarities (or dissimilarities) there are between maladies, treatments, and medications.
 
I saw an Faa flyer at sun n fun asking for volunteers to participate in a medical survey. Basic med was not one of the options. I don’t think the Faa in any way acknowledges basic med even exists.
 
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