State of Mental Health Affairs

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Call Me Disappointed

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Does anyone else think the mental health aspect of the FAA medical system is seriously flawed? From my observations, it appears that numerous pilots may be providing inaccurate information or purposefully omitting details on their medical applications to secure approval. The regular use of marijuana and the widespread prescribing of anti-anxiety and depression medications contribute to this perception. It seems unlikely that the pilot community holding class 1, 2, or 3 medicals would reflect a disproportionate representation of individuals not using medication or marijuana compared to the general population. While I wish this were the case, statistical data likely paints a different picture.

I know an individual at my local airport who I have taken flying before. He is genuinely eager to obtain his pilot’s license and has the resources to pursue it. However, during high school, he was prescribed an anti-anxiety drug. In hindsight, he believes he probably did not need it, but it remains on his record. Now in his mid-30s and medication-free for over 15 years, he finds himself having to address past issues. He is well-informed about the medical certification process, but to him, it feels overwhelming, burdensome, and expensive. While a strict protocol is necessary to determine who can and cannot fly, should a grown adult really have to explain issues from their childhood? The current system appears to incentivize individuals, especially those relying on a pilot's paycheck, to either lie or withhold information.
 
Seriously flawed? No. Is there room for improvement? Yes.

The vast majority of applicants are approved for a medical. Generally speaking, most applicants don’t read or use the publicly available information that guides them through the application or the AME guide that gives all the answers up front.

As for marijuana specifically, it’s a Schedule I drug, no different in classification than meth, crack, or heroin that’s illegal at the federal level, despite policies that don’t enforce that status at the federal level and state laws that contradict the federal laws. Ignorance, in this case, is not bliss.
 
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There's also this:


Excerpt:

FAA to Appoint Rulemaking Committee to Examine Pilot Mental Health​

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Thursday, November 9, 2023​
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WASHINGTON — The Federal Aviation Administration will establish a Pilot Mental Health Aviation Rulemaking Committee (ARC) to provide recommendations on breaking down the barriers that prevent pilots from reporting mental health issues to the agency.​
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“Mental health care has made great strides in recent years, and we want to make sure the FAA is considering those advances when we evaluate the health of pilots,” said FAA Administrator Mike Whitaker....​
 
A direct consequent of this:
 

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  • OIG_FAA Pilot Mental Health Final Report_07.12.2023.pdf
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Thanks @bbchien for posting that report.

Page 22 and 23 has the recommendations to mitigate future mental health safety challenges. My worry is if all of the recommendations are enacted and another incident takes place what must the FAA do next?

This is the recommendation that I believe will be scrutinized the most:

In the United States, medical professional reporting responsibilities are unclear. Reporting requirements and guidelines vary by State and by licensing boards. The perceptions of adverse legal consequences of reporting appear to be greater than not reporting. AMEs are expected to report issues potentially affecting public safety, but among medical professionals at large, concerns exist about professional and legal liability for violating patient privacy.
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There is way to much money in HIMS for the faa to change their mental health policy’s. The HIMS ame’s, psychiatrists, psychologists, social workers running groups and people that facilitate the drug tests need to take their cut before you can fly again. If the faa changes the policy’s then their buddies no longer get there money. Almost forgot about the treatment centers. They take in a lot of money from HIMS too! Charging over $35,000 for a 1 month program that often times a lot of pilots are pushed into when they don’t have an actual substance abuse problem. Great business to be in though, captive customers.
 
I don’t mind a system that allows a medical issuance after someone has jumped through the usual hoops to get it. We always complain about the over diagnosis of ADHD but I can honestly say I’ve known a few through the years and I wouldn’t want to ride in the back of a car with them, let alone an aircraft. Are people going to lie to get a paycheck? Heck yeah just look at the 5,000 veterans who lied about getting disability to protect their jobs. It’s really no different than lying about flight hours to get a job. Seen a lot of people through the years with suspect experience that they’ve claimed.

There will always be those who will do anything to bypass the system if it’s in their best interest. Nothing we can do about it.
 
I know someone who asked her sister in law veterinarian to prescribe her dog Xanax...
 
George S said:
There is way to much money in HIMS for the faa to change their mental health policy’s. The HIMS ame’s, psychiatrists, psychologists, social workers running groups and people that facilitate the drug tests need to take their cut before you can fly again. If the faa changes the policy’s then their buddies no longer get there money. Almost forgot about the treatment centers. They take in a lot of money from HIMS too! Charging over $35,000 for a 1 month program that often times a lot of pilots are pushed into when they don’t have an actual substance abuse problem. Great business to be in though, captive customers.
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I think you have a gross misperception about the financial contribution that HIMS cases make to the professionals involved. There are plenty of clients needing their services not in the HIMS path. I would gather that if the HIMS program was eliminated that it would hardly make a dent in their bottom line. I am a healthcare provider and also in the HIMS program so no bias…just knowledge gained from direct and indirect experience.
 
TCABM said:
Seriously flawed? No. Is there room for improvement? Yes.

The vast majority of applicants are approved for a medical. Generally speaking, most applicants don’t read or use the publicly available information that guides them through the application or the AME guide that gives all the answers up front.

As for marijuana specifically, it’s a Schedule I drug, no different in classification than meth, crack, or heroin that’s illegal at the federal level, despite policies that don’t enforce that status at the federal level and state laws that contradict the federal laws. Ignorance, in this case, is not bliss.
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No. Seriously flawed. I'm probably not getting my SSRIs back.
We always complain about the over diagnosis of ADHD but I can honestly say I’ve known a few through the years and I wouldn’t want to ride in the back of a car with them, let alone an aircraft.
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Can't just put those sentences together. The overdiagnosis of ADHD only means a small percentage actually has it. Still no need for a full neuropsychological if driving records is clean. Funny enough, they ask for those, too.
I never had the first problem with the system
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Sounds like this thread isn't for you.
 
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Simply, this is a question that does not have a simple answer.

One side believes that no one should fly with any hint of ever having mental struggles requiring professional assistance, and another side believes that if the person claims they're OK, then that should be all that is required to clear them. Where you do draw the line?

Obviously the line is not absolutely no, since there is a process to get a medical it is just very expensive and time consuming. Unless we want to go to where we just take people at their word, there has to be a process. No way around that.

While I would love to live in a world where people can honestly appraise their condition and honestly report it, I currently do not live in that world. Humans are notoriously bad for self evaluation and have been known to lie on occasion.

I also would proceed cautiously in relaxing the current process. While I have little sympathy for people who are a danger only to themselves, pilots are usually in a position to be a danger to others at the same time. Either passengers or people on the ground.

To reiterate, there is no simple answer.
 
N_A_M_E_24 said:
No. Seriously flawed. I'm probably not getting my SSRIs back.
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The FAA neither prescribes, issues, nor controls your access to medication.

However, if medication is what’s needed for your health and that medication is not compatible with the FAA’s aeromedical disposition, then you’re making an unhealthy decision to forego treatment.
 
Yes, I think the FAA medical system is flawed. I never see this discussed, but 14 CFR 69 clearly defines conditions that are disqualifying. Depression, Anxiety, and ADHD are not included as disqualifying conditions. 67.107 (c) does state the following which I am sure is how the FAA justifies their policies:

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.

However, the law clearly states that determination is based on case history not the outcome of FAA required testing or a HIMS evaluation. It should really be as simple as a letter from the treating physician stating that the airman is able to perform the duties or exercise the privileges of the airman certificate applied for assuming the diagnosis is not specifically precluded by the other sections of the code.

That said the real issue is in order for a doctor to bill insurance they need to diagnose the patient with something. Therefore, just talking to a therapist will likely get you diagnosed simply to allow for billing. In my opinion this has led to a lot of overdiagnosis and most people who have been diagnosed do not have mental illness to a level anywhere near what would stop them from safely operating an aircraft. There are so many reasons a person may feel down or anxious and lead them to wanting to talk to someone that are normal parts of life such as the loss of a loved one, financial hardships, or divorce, just to name a few.
 
Racerx said:
I know someone who asked her sister in law veterinarian to prescribe her dog Xanax...
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And both of them could go to jail for doing what they’re doing. Not real bright.
 
TCABM said:
Seriously flawed? No. Is there room for improvement? Yes.
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Exactly this. I’m honestly tired of the whining from people who are magically cured of all that ails them the minute they realize they can’t get a medical. How many are people who happily got diagnosed with ADD for a little help studying? A lot. Now it doesn’t seem like such a good idea when you go to apply for your medical and realize you’re in a bind.

And I’m sorry but I don’t buy the argument that people break the law, so therefore it is flawed and we must change it. Nope, sorry. But I hold a particular disdain for people who got out of the military or other positions (cops, firefighters, railroad employees, etc.) with massive disability payouts and ongoing payments who then lie about it and live large on an airline career. In my opinion not only should those people go to jail, they should have to pay back every cent they got in disability with interest. And 90% of them are from the “personal responsibility” crowd. It’s disgusting.
 
mryan75 said:
But I hold a particular disdain for people who got out of the military or other positions (cops, firefighters, railroad employees, etc.) with massive disability payouts and ongoing payments who then lie about it and live large on an airline career. In my opinion not only should those people go to jail, they should have to pay back every cent they got in disability with interest.
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Well, not to rub salt in that particular wound - but it is also very possible that they had all of their training for that Part 121/135 position paid for through the GI Bill.

They didn't have that available for us who served in the early 80's. We had the VEAP program. What a farce that was.
 
The problem is, the system is heierachical, not dispersed. No Junior wants to have to deal with the inquiry if one of his approvals does something not so good..... :(
 
bbchien said:
The problem is, the system is heierachical, not dispersed. No Junior wants to have to deal with the inquiry if one of his approvals does something not so good..... :(
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This baffles me to no end.

I'll never understand why every medical that ever gets deferred has to go through OKC. Why can't the Regional offices handle 3rd and maybe 2nd class applications without having to wait for the half-dozen physicians at OKC to work through hundreds of thousands of applications? It seems like a bottleneck that doesn't need to exist.
 
laserranger said:
This baffles me to no end.

I'll never understand why every medical that ever gets deferred has to go through OKC. Why can't the Regional offices handle 3rd and maybe 2nd class applications without having to wait for the half-dozen physicians at OKC to work through hundreds of thousands of applications? It seems like a bottleneck that doesn't need to exist.
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Or why can’t the CACI list at least include everything for which any physician can approve Basic Med? That would also relieve a significant part of the bottleneck.
 
Half Fast said:
Or why can’t the CACI list at least include everything for which any physician can approve Basic Med? That would also relieve a significant part of the bottleneck.
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That would be an INCREASE in the authority of AMEs. Never gonna happen. Remember Mr. Travolta flies his 707 on a third class.
 
bbchien said:
That would be an INCREASE in the authority of AMEs.
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Yes, it would.

It seems silly that an AME can, as a physician, approve someone with diabetes to fly under Basic Med, but for a class 3 he has to defer to an OKC bureaucrat who has never even seen the pilot.

But I agree - OKC will never give up any authority unless it’s pried from their cold, dead hands by Congress.
 
mryan75 said:
Exactly this. I’m honestly tired of the whining from people who are magically cured of all that ails them the minute they realize they can’t get a medical. How many are people who happily got diagnosed with ADD for a little help studying? A lot. Now it doesn’t seem like such a good idea when you go to apply for your medical and realize you’re in a bind.
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A ridiculous bind that does nothing to enhance flight safety. If a simple diagnosis was enough to keep someone out, then a simple diagnosis should be enough to clear someone. The hoops to undo a diagnosis are orders of magnitude too expensive and complex to be justifiable. So, yes, the "mental health aspect of the FAA medical system is seriously flawed".
 
Half Fast said:
Yes, it would.

It seems silly that an AME can, as a physician, approve someone with diabetes to fly under Basic Med, but for a class 3 he has to defer to an OKC bureaucrat who has never even seen the pilot.

But I agree - OKC will never give up any authority unless it’s pried from their cold, dead hands by Congress.
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....all the while complaining consistently about how they are overworked or something.
 
I worked on the FAA Bill. My eyes were opened to a lot. Bottom line is safety is paramount, while it is apparent there is a real need for pilots to have access to mental health treatment. Popular sentiment says that you better be right with the Lord and keep your mental health in check through His grace. He is pretty much your only option.
 
Call Me Disappointed said:
Does anyone else think the mental health aspect of the FAA medical system is seriously flawed? From my observations, it appears that numerous pilots may be providing inaccurate information or purposefully omitting details on their medical applications to secure approval. The regular use of marijuana and the widespread prescribing of anti-anxiety and depression medications contribute to this perception. It seems unlikely that the pilot community holding class 1, 2, or 3 medicals would reflect a disproportionate representation of individuals not using medication or marijuana compared to the general population. While I wish this were the case, statistical data likely paints a different picture.

I know an individual at my local airport who I have taken flying before. He is genuinely eager to obtain his pilot’s license and has the resources to pursue it. However, during high school, he was prescribed an anti-anxiety drug. In hindsight, he believes he probably did not need it, but it remains on his record. Now in his mid-30s and medication-free for over 15 years, he finds himself having to address past issues. He is well-informed about the medical certification process, but to him, it feels overwhelming, burdensome, and expensive. While a strict protocol is necessary to determine who can and cannot fly, should a grown adult really have to explain issues from their childhood? The current system appears to incentivize individuals, especially those relying on a pilot's paycheck, to either lie or withhold information.
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I work as a pro pilot. I think the number of active professionals using illegal drugs to self medicate is non-zero but extremely small.

With regards to recreational pilot self medicating… well I’ll just say that I don’t think any policy of the FAA will change what those individuals choose to do.

In my anecdotal experience the only people that I know who I think were legitimately medical patients of pot were terminally ill and managing pain. The rest just wanted to smoke some weed and get high.
 
172andyou said:
If a simple diagnosis was enough to keep someone out, then a simple diagnosis should be enough to clear someone.
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Careful what you wish for. I could see the FAA now going:
"We see you had a simple diagnosis of <this>. We now need you to undergo complex and expensive testing to confirm. If you do have it, sorry. But if you don't we'll gladly give you your medical."
"But that's the same thing!" you'll yell in frustration.
"No, it is not" They'll patiently explain. "Before, you were testing to prove it wasn't a problem, now you're testing to verify it is a problem. We expect pilot's to love the new approach, just as soon as they appreciate the nuanced difference. After all we're no longer requiring you to prove it is not an issue as we're not treating it as a problem until complex and expensive testing confirms it. And we're giving you the initial opportunity to prove it isn't an issue. If it were to unfortunately prove to be an actual issue, THEN we'll have some even more complex and expensive process to address it. We're hoping you'll help us spread the news of this wonderful new structure."
 
Princesspilot206 said:
Bottom line is safety is paramount, while it is apparent there is a real need for pilots to have access to mental health treatment.
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Bottom line is that as long as they create the ILLUSION of safety everything will be fine. Wholesale weeding out of pilots who have a speck of uncertainty in their mental health history does just that.

I use my diagnosis of malignant melanoma as another illustration. The FAA insists on yearly head and neck MRIs to maintain a Special Issuance, yet the medical experts agree that it's a useless tool for monitoring the condition.
 
guest user said:
Careful what you wish for. I could see the FAA now going:
"We see you had a simple diagnosis of <this>. We now need you to undergo complex and expensive testing to confirm. If you do have it, sorry. But if you don't we'll gladly give you your medical."
"But that's the same thing!" you'll yell in frustration.
"No, it is not" They'll patiently explain. "Before, you were testing to prove it wasn't a problem, now you're testing to verify it is a problem. We expect pilot's to love the new approach, just as soon as they appreciate the nuanced difference. After all we're no longer requiring you to prove it is not an issue as we're not treating it as a problem until complex and expensive testing confirms it. And we're giving you the initial opportunity to prove it isn't an issue. If it were to unfortunately prove to be an actual issue, THEN we'll have some even more complex and expensive process to address it. We're hoping you'll help us spread the news of this wonderful new structure."
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Nice word salad, but I'm proposing to make things simpler and smarter, not dumber and more complex.
 
172andyou said:
Have you ever met someone who got a second opinion that was meaningfully different from the first?
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That’s not the question. You said the policy “does nothing to enhance flight safety”. Please explain.
 
mryan75 said:
That’s not the question. You said the policy “does nothing to enhance flight safety”. Please explain.
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I'll take that as a, "yes", you have met someone that had a second opinion that was dramatically different. And, in that case, did they then demand that the second doctor jump through dozens of hoops, costing thousands of dollars and months or years of time because they just assumed that the first doctor was correct on no other basis than that they were first? Or, did they just accept the second doctors explanation of what was going on?

At the end of the day doctors are people and they sometimes make mistakes. On top of that mental health is one of the most poorly understood branches of medicine. And, finally, mental health changes over time for a wide variety of reasons.
 
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