State of Mental Health Affairs

  • Thread starter Call Me Disappointed
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Is there even any data that shows depression, anxiety and other common mental health diagnoses are aeromedical factors?
 
Half Fast said:
en.m.wikipedia.org

Suicide by pilot - Wikipedia

en.m.wikipedia.org en.m.wikipedia.org

Perhaps the Germanwings incident is the best known:
en.m.wikipedia.org

Germanwings Flight 9525 - Wikipedia

en.m.wikipedia.org en.m.wikipedia.org
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Thank you. So, the estimated probability of suicide by pilots is 2 x 10^-8, assuming 35 million flights per year worldwide. Is this number a result of strict FAA (and other national administrations') policies, or could it be lower if mental health treatment for pilots were less discouraged? Lacking diagnoses makes attributing all instances of suicide by pilot to conditions like depression and anxiety difficult, other factors like bipolar disorder or psychosis could be involved. Essentially, my point is that existing regulations already specify disqualifying conditions. Why not simply uphold them? No overt acts, no psychosis, no bipolar disorder. For anything beyond these established conditions, a thorough evaluation should be conducted to demonstrate enhanced safety.
 
172andyou said:
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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So you still won’t answer the question. Fine with me. Carry on.
 
mryan75 said:
So you still won’t answer the question. Fine with me. Carry on.
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The answer to the question is that it's ridiculous for the FAA to put so much weight on the initial diagnosis that it takes months/years and thousands of dollars to prove it wrong. None of this enhances flight safety.
 
MFF25 said:
Thank you. So, the estimated probability of suicide by pilots is 2 x 10^-8, assuming 35 million flights per year worldwide. Is this number a result of strict FAA (and other national administrations') policies, or could it be lower if mental health treatment for pilots were less discouraged? Lacking diagnoses makes attributing all instances of suicide by pilot to conditions like depression and anxiety difficult, other factors like bipolar disorder or psychosis could be involved. Essentially, my point is that existing regulations already specify disqualifying conditions. Why not simply uphold them? No overt acts, no psychosis, no bipolar disorder. For anything beyond these established conditions, a thorough evaluation should be conducted to demonstrate enhanced safety.
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The existing regulations also include a virtual blank check in 14 CFR 67.313(b) and (c), which the Federal Air Surgeon as made extensive use of:

(b) No other organic, functional, or structural disease, defect, or limitation 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.​
​
(c) No medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the medication or other treatment 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.​
 
Palmpilot said:
The existing regulations also include a virtual blank check in 14 CFR 67.313(b) and (c), which the Federal Air Surgeon as made extensive use of:

(b) No other organic, functional, or structural disease, defect, or limitation 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.​
​
(c) No medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the medication or other treatment 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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Yes, I am aware of this, but it really makes no sense. Why even have any conditions listed at all? What "qualified medical judgment relating to the condition" are they citing? This is why I bring up the data question.
 
Boys, you can't ask the RFS offices to do more. They are all locked into the "700 emails a day" situation.

And for those who think the existing staff doesn't do anything, I got two approvals last night both well after hours from each of two different medical officers, who were both working late. One even THANKED me for answering at 7:30 PM (from an Indian Restaurant).

The problem is too many directives
Too many "there oughta be a law(s)".

I point the spotlight to our Legislative branch!

Bruce
 
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172andyou said:
The answer to the question is that it's ridiculous for the FAA to put so much weight on the initial diagnosis that it takes months/years and thousands of dollars to prove it wrong. None of this enhances flight safety.
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You’ve said that again, I understand and that’s your position. What I’m asking you to do is support this position. How does this not enhance flight safety?
 
mryan75 said:
You’ve said that again, I understand and that’s your position. What I’m asking you to do is support this position. How does this not enhance flight safety?
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There is no evidence to support that it does enhance flight safety. In the absence of that evidence, and plenty of evidence that doctors, being the humans they are, often misdiagnose mental issues, the system can only be judged as arbitrary, unfair and expensive.
 
172andyou said:
There is no evidence to support that it does enhance flight safety. In the absence of that evidence, and plenty of evidence that doctors, being the humans they are, often misdiagnose mental issues, the system can only be judged as arbitrary, unfair and expensive.
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In light of the evidence that doctors, being the humans they are, often misdiagnose mental issues; why do we even have doctors? I say do away with the doctors and take everybody's word for their conditions. After all, they know themselves best, right?/s

But, lets explore your idea a bit. So let's hypothetically say Applicant went to DoctorA and was diagnosed as Bipolar.
Under your system he could then go to DoctorB and be UNdiagnosed.
But why would we trust DoctorB over DoctorA (or vice-versa)?
<Surely you can recognize this is a valid question>

Ok, but what if we then had a tie-breaker. Applicant went to DoctorC who agreed with DoctorB so that it is now 2-1?
But then we find out that Doctors B & C are Chiropractors instead of Physicians. (In some states chiropractors qualify and can even sign BasicMed)
Now what? Do you say "OK, 2 doctors outweigh 1, good to go!"?

Or do we need to have some kind of scale or balance for the qualifications of the doctors in question? If so, what are they?
And then, do we acknowledge that 'qualifications' in and of themselves do not equal competence? There are pilots with a great number of qualifications that I would not fly with, but on paper look good.
Doctors, being the humans they are, must have some of the same people in the profession. So their diagnosis should be disregarded out of hand if you actually knew their competence. How do we account for those doctors?

So yeah, your 'simple and less complicated proposal' can actually become quite complicated if one actually tries to think it through.
 
172andyou said:
There is no evidence to support that it does enhance flight safety. In the absence of that evidence, and plenty of evidence that doctors, being the humans they are, often misdiagnose mental issues, the system can only be judged as arbitrary, unfair and expensive.
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So, what you’re saying, is that life is unfair.
Growing up, I wanted, more than anything, to be a naval aviator. Would have made it too except the movie Top Gun came out and everyone wanted to be a naval aviator. My 3.0 GPA in chemistry did not measure up against the basket Weaver 4.0 GPA and it didn’t happen. Never mind that it took 10 times the effort to get my degree than it did for the basket Weaver. Unfortunately the selection matrix did not take that into account.
If only we could have that Utopia promised us….
Flying an airplane is not a requirement or a right.
 
bbchien said:
sigh.
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Thanks for that copy of the report. According to it, Senator Feinstein's request specified airline pilots. I am I right in thinking that the resulting tightening of requirements expanded to include non-revenue airmen?
 
Palmpilot said:
Thanks for that copy of the report. According to it, Senator Feinstein's request specified airline pilots. I am I right in thinking that the resulting tightening of requirements expanded to include non-revenue airmen?
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One airspace one standard. The MAINTENENCE of such SIs are generally lesser for third class, nonrevenue pilots.
 
bbchien said:
One airspace one standard.
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Is that the FAA's justification? If so, they're not being very consistent, because I count six different standards:

Class I​
Class II​
Class III​
BasicMed plus driver's license​
Driver's License​
None (other than 61.53) for gliders and non-commercial balloon operations​

The MAINTENENCE of such SIs are generally lesser for third class, nonrevenue pilots.
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Does SI maintenance involve periods of grounding while the FAA processes it, or is that only for the initial SI for a given condition?
 
bbchien said:
sigh.
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It is interesting that this report was ordered in response to the Germanwings incident, which according to the memorandum in the report, involved a pilot that should have "receive psychiatric hospital treatment due to a possible psychosis". Psychosis is explicitly called out as a disqualifying condition in the CFR's, and I don't think any reasonable person has an issue with that. I think what people are frustrated with is having to go through a long, complicated and expensive process for something as simple as seeing a therapist a few times, no matter how long ago it was. Particularly in this day and age when mental health awareness is so prevalent and people are encouraged to "talk to someone". For example, my PcP screens everyone for depression at every appointment regardless of the reason for the visit.
 
guest user said:
So yeah, your 'simple and less complicated proposal' can actually become quite complicated if one actually tries to think it through.
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Nope. The complicated stuff was your proposal, not mine.
 
Palmpilot said:
Is that the FAA's justification? If so, they're not being very consistent, because I count six different standards:

Class I​
Class II​
Class III​
BasicMed plus driver's license​
Driver's License​
None (other than 61.53) for gliders and non-commercial balloon operations​



Does SI maintenance involve periods of grounding while the FAA processes it, or is that only for the initial SI for a given condition?
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Richard: Class 1, 2 are generally the same both for issuance and for maintenance. These involve teh public trust- they are aviaitors who are paid to fly. Unlimited A/c Weight and pax.
Class 3 -generally same to get, somewhat more relazed as to maintenance. Unlimited A/c Weight and pax.
Basic + DL is limited to 6,000 lbs, six casualties and is weight limited.
DL is limited 1320 lbs and two persons.

It's all part of the national plan that covaries "damage the pilot might do to the unsuspecting public" with weight, size, and Medical standards. That is why Mosiac is so complicated.


B
 
172andyou said:
Nope. The complicated stuff was your proposal, not mine.
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Negative, it is the result of actually considering your 'proposal' and where it would lead.

There is a saying that goes "The devil's in the details" and your responses show that you have put little to no time in actually trying to flesh out the details of your 'proposal'.

A full blown proposal has to address how issues will be addressed and how conflicts will be resolved. Your 'proposal' is predicated upon there being a conflict between two doctors' diagnosis, so you can't duck that one.
 
guest user said:
Negative, it is the result of actually considering your 'proposal' and where it would lead.

There is a saying that goes "The devil's in the details" and your responses show that you have put little to no time in actually trying to flesh out the details of your 'proposal'.

A full blown proposal has to address how issues will be addressed and how conflicts will be resolved. Your 'proposal' is predicated upon there being a conflict between two doctors' diagnosis, so you can't duck that one.
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Nope, you are inventing a process out of thin air that I never proposed. My proposal is that if the second doctor clears the applicant of medical issues, then the FAA should accept it.
 
172andyou said:
Nope, you are inventing a process out of thin air that I never proposed. My proposal is that if the second doctor clears the applicant of medical issues, then the FAA should accept it.
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And my question is why should a second opinion automatically outrank the first opinion? Its like you're not even trying to be serious here.

You are creating a situation where two doctors are saying two different things, but you're ok just categorically saying the second doctor is correct.
 
guest user said:
you're ok just categorically saying the second doctor is correct.
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Yes.
guest user said:
And my question is why should a second opinion automatically outrank the first opinion?
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Many reasons, but for one because it's more recent. Why on earth would I care what a doctor said about an adolescent brain 15 years ago when I have a doctor today examining a fully mature adult brain and saying, "nah, no ADHD here"? Or, "nah, no sign of depression".
 
172andyou said:
Many reasons, but for one because it's more recent. Why on earth would I care what a doctor said about an adolescent brain 15 years ago when I have a doctor today examining a fully mature adult brain and saying, "nah, no ADHD here"? Or, "nah, no sign of depression".
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Well, it is different to to see someone who thinks that ADHD, depression (may I presume Autism also?) are one and done kind of things. Kinda like a cold, if I'm understanding you right. (You had it, but not any more, so you're good to go)

So, I initially thought your understanding of conflict resolution was the problem. Now it seems your whole understanding of the underlying problem is in question.

At this point, I am just going to disengage from this conversation. Feel free to tally it up as a win for you if you wish.
 
guest user said:
Well, it is different to to see someone who thinks that ADHD, depression (may I presume Autism also?) are one and done kind of things. Kinda like a cold, if I'm understanding you right. (You had it, but not any more, so you're good to go)
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Brains change over time. Diagnostic tools change over time. If you think adhd and depression are static, particularly when comparing adolescent brains to fully mature ones, you've got some reading to do.
 
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guest user said:
Well, it is different to to see someone who thinks that ADHD, depression (may I presume Autism also?) are one and done kind of things. Kinda like a cold, if I'm understanding you right. (You had it, but not any more, so you're good to go)

So, I initially thought your understanding of conflict resolution was the problem. Now it seems your whole understanding of the underlying problem is in question.

At this point, I am just going to disengage from this conversation. Feel free to tally it up as a win for you if you wish.
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A "win" would be convincing the FAA.
 
172andyou said:
Brains change over time. Diagnostic tools change over time. If you think adhd and depression are static, particularly when comparing adolescent brains to fully mature ones, you've got some reading to do.
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More importantly diagnostic criteria and techniques change over time. A colleague of mine went in for an evaluation for "adult ADHD" and spent exactly 10 minutes with the therapist, emerging with an ADHD diagnosis and a ritalin prescription. In later life, he kept having sleep problems, nervousness, irritability, etc. leading to problems concentrating.... he stopped the ritalin and after about 3 weeks of stimulant withdrawal he felt perfectly normal. Diagnostic criteria back when "adult ADHD" was a media thing were very sloppy and a lot of people got diagnosed for something they didn't have.
 
Lawson_Stone said:
More importantly diagnostic criteria and techniques change over time. A colleague of mine went in for an evaluation for "adult ADHD" and spent exactly 10 minutes with the therapist, emerging with an ADHD diagnosis and a ritalin prescription. In later life, he kept having sleep problems, nervousness, irritability, etc. leading to problems concentrating.... he stopped the ritalin and after about 3 weeks of stimulant withdrawal he felt perfectly normal. Diagnostic criteria back when "adult ADHD" was a media thing were very sloppy and a lot of people got diagnosed for something they didn't have.
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Yeah, I was including all that under the giant blanket of "diagnostic tools", so we are 110% in agreement. Your friends story is extremely common.
 
Is it true that ADHD is difficult but doable to overcome (with the AME and getting 1st-class,) but OCD is near-impossible to get FAA clearance for?
 
EasternPatriot said:
Is it true that ADHD is difficult but doable to overcome (with the AME and getting 1st-class,) but OCD is near-impossible to get FAA clearance for?
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I think it's partly because ADHD has many different manifestations. Some ADHD folks have high, almost uncontrollable impulsivity/distractability. Medication is at its best in controlling these traits, but obviously someone with very low impulse control and high distractibility would be problematic in the cockpit. But some people with AD(H)D lack those issues and/or are not hyperactive. I don't know all the criteria, but families I know with kids with ADHD talk about different "kinds" some of which are obvious and some of which are not. I suspect the evaluation screening the FAA requires is designed to see if in fact the unmedicated person with the ADHD diagnosis is in fact someone capable of managing the tasks of the cockpit effectively.
 
172andyou said:
Nope, you are inventing a process out of thin air that I never proposed. My proposal is that if the second doctor clears the applicant of medical issues, then the FAA should accept it.
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Absolute gibberish. There is no pathology for these conditions. They’re quite often diagnosed based on the self-reporting of the patient. So when the patient wants adderall to help them study they tell the doc they can’t focus, can’t complete tasks, can’t keep appointments, etc. etc. etc., and then when they realize they can’t get an FAA medical they tell the second doc they have no trouble focusing, can easily multi-task and keep appointments, etc. The patient reports differing things depending on their motives. It’s not nearly as simple as you think, unless you mean simple to game the system. I have a dear friend who is bipolar, and I mean way bipolar. Lucky to be alive bipolar. Major antipsychotics bipolar. He’s also pretty much the smartest human being I know. He could easily pass any mental health screening if he wanted to, he knows what answers the docs need for a specific outcome. He just decided he didn’t want to die.

So no, it’s not simple.
 
Uh, I never argued it was simple. I argued precisely the opposite. That it is complicated and poorly understood. I've said this pretty explicitly. Try harder. I've also said that brains aren't static and that diagnostic methods themselves change and lead to different diagnoses.

Finally, your argument above could, with only changes to the order in which things occur, be used as an argument that every pilot should have to jump through the myriad of hoops needed to undo an initial diagnosis. After all, what prospective pilot would ever self report suicidal ideation when they know they would be DQ'ed from the job they are pursuing.

Seriously...

[The idea that all pilots not be subject to a comprehensive psychological screening is ] absolute gibberish. There is no pathology for these conditions. They’re quite often diagnosed based on the self-reporting of the patient. [...] When they realize they can’t get an FAA medical they tell the [...] doc they have no trouble focusing, can easily multi-task and keep appointments, etc. The patient reports differing things depending on their motives.
 
172andyou said:
Nope, you are inventing a process out of thin air that I never proposed. My proposal is that if the second doctor clears the applicant of medical issues, then the FAA should accept it.
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Why is the second doctor smarter/ better / more correct than the first doctor?
Perhaps two out of three? Three out of five?
 
172andyou said:
Uh, I never argued it was simple. I argued precisely the opposite. That it is complicated and poorly understood. I've said this pretty explicitly. Try harder. I've also said that brains aren't static and that diagnostic methods themselves change and lead to different diagnoses.

Finally, your argument above could, with only changes to the order in which things occur, be used as an argument that every pilot should have to jump through the myriad of hoops needed to undo an initial diagnosis. After all, what prospective pilot would ever self report suicidal ideation when they know they would be DQ'ed from the job they are pursuing.

Seriously...

[The idea that all pilots not be subject to a comprehensive psychological screening is ] absolute gibberish. There is no pathology for these conditions. They’re quite often diagnosed based on the self-reporting of the patient. [...] When they realize they can’t get an FAA medical they tell the [...] doc they have no trouble focusing, can easily multi-task and keep appointments, etc. The patient reports differing things depending on their motives.
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You never argued it was simple? Are you the same person that said this:

“My proposal is that if the second doctor clears the applicant of medical issues, then the FAA should accept it.”

Nonsense.
 
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