Having trouble complying with SI

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Hi, all. I need some practical advice on complying with my SI (for a mental health condition), which states I have to be in therapy and the therapist has to submit reports for each medical and SI renewal. The problem is, I am in such remission that my original therapist has dropped me, and six other local therapists refused to see me because I am asymptomatic. None of them are even willing to drop down to quarterly check-ins, because it violates their standard of care to have someone on the books who they don't see regularly. I understand the liability, but it leaves a real hole for me.

Before anyone suggests BasicMed, know that someone with a diagnosed mental illness has to be under the care of a mental health provider to utilize it. I discovered this a few years ago after I'd done the exam and course. I now have an expired medical but still-valid SI.

Has anyone been in this situation? How did you convince a therapist to see you? I get like two sessions in with a new person, and they're like, "Yeah, not doing this." Insane that I fixed myself like the FAA wanted, and that's caused more of an issue then being screwed up in the first place.
 
Anonymous said:
Hi, all. I need some practical advice on complying with my SI (for a mental health condition), which states I have to be in therapy and the therapist has to submit reports for each medical and SI renewal. The problem is, I am in such remission that my original therapist has dropped me, and six other local therapists refused to see me because I am asymptomatic. None of them are even willing to drop down to quarterly check-ins, because it violates their standard of care to have someone on the books who they don't see regularly. I understand the liability, but it leaves a real hole for me.

Before anyone suggests BasicMed, know that someone with a diagnosed mental illness has to be under the care of a mental health provider to utilize it. I discovered this a few years ago after I'd done the exam and course. I now have an expired medical but still-valid SI.

Has anyone been in this situation? How did you convince a therapist to see you? I get like two sessions in with a new person, and they're like, "Yeah, not doing this." Insane that I fixed myself like the FAA wanted, and that's caused more of an issue then being screwed up in the first place.
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Have you asked our HIMS AME on how to handle? Seems they would be better able to guide you/ask the FAA what would work.
 
Anonymous said:
Before anyone suggests BasicMed, know that someone with a diagnosed mental illness has to be under the care of a mental health provider to utilize it. I discovered this a few years ago after I'd done the exam and course. I now have an expired medical but still-valid SI.
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I'd love to see a citation for this.....

The regulation says quite clearly it's a one-time SI. And it's a pretty limited set of mental health issues.

Pilots must obtain a one-time Authorization for Special Issuance of a Medical Certificate from the FAA if they have an established medical history or clinical diagnosis of any of the following mental health disorders:
  • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts.
  • A psychosis, defined as a case in which an individual has manifested (or may reasonably be expected to manifest) delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis.
  • A bipolar disorder.
  • Substance dependence within the previous 2 years (as defined in 14 CFR §67.307(a)(4)).
 
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jbarrass said:
I'd love to see a citation for this.....

The regulation says quite clearly it's a one-time SI. And it's a pretty limited set of mental health issues.

Pilots must obtain a one-time Authorization for Special Issuance of a Medical Certificate from the FAA if they have an established medical history or clinical diagnosis of any of the following mental health disorders:
  • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts.
  • A psychosis, defined as a case in which an individual has manifested (or may reasonably be expected to manifest) delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis.
  • A bipolar disorder.
  • Substance dependence within the previous 2 years (as defined in 14 CFR §67.307(a)(4)).
Click to expand...
At the end of the BasicMed course, when your certificate is created, you are asked to confirm various statements. One of them is that IF (emphasis is the course's) you have a mental illness, that you are under the care of a mental health provider.
 
jbarrass said:
I'd love to see a citation for this.....

The regulation says quite clearly it's a one-time SI. And it's a pretty limited set of mental health issues.

Pilots must obtain a one-time Authorization for Special Issuance of a Medical Certificate from the FAA if they have an established medical history or clinical diagnosis of any of the following mental health disorders:
  • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts.
  • A psychosis, defined as a case in which an individual has manifested (or may reasonably be expected to manifest) delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis.
  • A bipolar disorder.
  • Substance dependence within the previous 2 years (as defined in 14 CFR §67.307(a)(4)).
Click to expand...
It’s part of the attestations you click on at the end of the BasicMed course…

14 CFR 68.9(c)(2)
Subject to paragraph (c)(1) of this section, an individual clinically diagnosed with a mental health condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that mental health condition.
 
Anonymous said:
I now have an expired medical but still-valid SI.
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If your medical is expired, do you still need to comply with the SI?
Anonymous said:
At the end of the BasicMed course, when your certificate is created, you are asked to confirm various statements. One of them is that IF (emphasis is the course's) you have a mental illness, that you are under the care of a mental health provider.
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So do you still have a mental illness? Maybe one of these providers will tell you that you don't.
 
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This is the result of the faa not using medical criteria.

They want an administrative report… go find a hims shrink to do it, they are happy to overcharge you for one.
 
Lindberg said:
If your medical is expired, do you still need to comply with the SI?

So do you still have a mental illness? Maybe one of these providers will tell you that you don't.
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Yes, because the SI hasn't expired.

And yes. This condition goes into remission but is life-long.
 
My question: Is this a therapist issue or an insurance issue? If you have been using insurance, I can definitely see insurance saying "no more" if the therapist says treatment is no longer needed (that happens with non-psych conditions too). But the idea of Dr. Otto Spielvogel saying "no, I won't take your money, monitor you, and make a report from time to time so you can keep flying"" doesn't sound right.

Aside from that I agree about going to your HIMS AME for guidance.
 
Brad Z said:
It’s part of the attestations you click on at the end of the BasicMed course…

14 CFR 68.9(c)(2)
Subject to paragraph (c)(1) of this section, an individual clinically diagnosed with a mental health condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that mental health condition.
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So weird what you find when you read the regulations and find 68.9(c). "Special rule for mental health conditions."
 
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I think the OP is referring to this, which is part of the enabling legislation to Basic Med.

1770315604802.png
Many therapists and docs don't get that the federal standard exceeds that of many therrapists: "go away you're fine". You have to explain this to them.
B
 
bbchien said:
I think the OP is referring to this, which is part of the enabling legislation to Basic Med.

View attachment 149650
Many therapists and docs don't get that the federal standard exceeds that of many therrapists: "go away you're fine". You have to explain this to them.
B
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Correct. One therapist told me i was being "clingy" for insisting on continuing therapy, another said it was an indication that my disease isn't under control. I went through the same thing when I got my initial SI—"I don't believe the FAA actually cares about this."
 
bbchien said:
I think the OP is referring to this, which is part of the enabling legislation to Basic Med.

View attachment 149650
Many therapists and docs don't get that the federal standard exceeds that of many therrapists: "go away you're fine". You have to explain this to them.
B
Click to expand...
so if u go from si to basic med u still need psychiatric exam every two years?
 
Anonymous said:
Yes, because the SI hasn't expired.
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Obviously we don't know what your SI is for, but in other threads, the general consensus is that you don't have to keep the SI in force after the underlying medical expires. Yours might require some continuous action though, but what would be the consequence if you stop?
Anonymous said:
And yes. This condition goes into remission but is life-long.
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Hmm. Perhaps consult with an attorney familiar with these matters, to whom you're comfortable disclosing everything. But if the disease is truly in remission, with no treatment indicated, including medication, then I think it's reasonable to question whether you have a current diagnosis. Hard to say without knowing the details, and some of this seems contradictory based on my limited knowledge of how FAA treats mental health issues (e.g., recurring conditions usually require ongoing treatment).
 
bbchien said:
I think the OP is referring to this, which is part of the enabling legislation to Basic Med.

View attachment 149650
Many therapists and docs don't get that the federal standard exceeds that of many therrapists: "go away you're fine". You have to explain this to them.
B
Click to expand...
Yes, that is the attestation codified in 68.9(c)(2).
 
i don’t know what you fly. I have a SI for type 2 diabetes and was kinda opposed to basic med. In July they came out with Mosaic. I was thinking that’d be the bomb. Then I figured out that night flights were NOT included. Then I re looked at BasicMed, and did the paperwork. I now have basic med but haven’t let my 3rd class medical lapse yet.

Per google:
BasicMed requires
a one-time FAA special issuance for specific, established mental health conditions—psychosis, bipolar disorder, personality disorder (manifested by overt acts), or substance dependence within the last 2 years. If you have these, you must obtain a special issuance once before using BasicMed. Other mental health conditions, such as mild depression or anxiety, do not require a special issuance but must be reviewed during the 4-year Comprehensive Medical Examination Checklist (CMEC).

If that doesn’t work or if you really need to keep the 3rd class.

In that case I suggest you find a younger therapist, explain the problem in detail and work out an arrangement that keeps you on their books as an active patient and seeing them at a slower pace that keeps them in the loop as to how your doing without you sitting on their couch every week.
 
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