AOPA Pilot Magazine - August 2022 - 26

FLIGHT MD
Flying low
Pilot mental health and the FAA
BY DR. BRENT BLUE
MY COL UMN IN the June issue of AOPA Pilot ( " Flying and
Depression " ) certainly stirred up a lot of conversations about
mental health, flying, and the FAA. Just by chance on May 25,
Federal Air Surgeon Dr. Susan Northrup made one very small
step to relax the criteria for minor depression. I would love to say
it was in response to my column, but the FAA has never worked
that fast, so this had to be in the works for several months.
The new policy states that if a pilot has had a single episode of
depression in response to an event or stressor " that would cause
the average person to become depressed, " it fully resolved within
six months, and occurred more than five years ago, the AME can
issue a medical certificate without further evaluation.
If the episode of depression occurred less than five years prior,
the AME must also obtain clinical records that include a current
detailed progress note to verify the diagnosis. The AME can issue
the medical certificate, but the records must be forwarded to the
FAA for " retention in the pilot's file. " If treatment or symptoms
in either case lasted more than six months, occurred more than
one time, or did not have a specific triggering event or stressor,
the pilot will need a special issuance and all the accoutrements of
that exhaustive evaluation.
In my June column, I referred pilots to a survey, which I admit
was small and non-scientific. However, the responses were so significant,
they cannot be ignored. The first question was, " Have
you ever used an antidepressant medication while flying that was
not reported to the FAA? " Forty-nine percent said yes. That is a
striking number that reflects a lot of pilots who are flying without
informing the FAA about anti-depressant medication.
Question two was, " Have you suffered from depression or
other mental health issues and not gotten help or medications
due to the effect on your FAA pilot medical? " Sixty-three percent
said yes! Even Northrup in her federal air surgeon bulletin
acknowledged that pilots should not avoid care, highlighted by
two suicides in young aviation students in 2021. I heartily agree
with Dr. Northrup that pilots should seek care, whether it is mental
health or physical health concerns that arise. One's life is more
important than our medical certificate.
The last question is a more poignant criticism of the FAA's
medical department. Question three was, " Do you think the FAA
handles pilot mental health issues appropriately? "
26
AOPA PILOT / August 2022
Ninety-six percent of respondents said no.
This may be a hard pill to swallow, but the FAA's psychiatric
and psychological evaluation process is antiquated. Some of the
process stems from a previous FAA chief psychiatrist who was,
in my opinion, also just horrible. His legacy of antiquated evaluation
has been a difficult sea to move. In addition, the Medical
Department has a love affair with the CogScreen, a proprietary
computer screening program that the FAA uses as a yes/no test
regardless of other evaluations. The CogScreen may have utilization
with alcoholic, drug abusing, and traumatic brain-injured
pilots, but it has little to no value in depression. In fact, although
there are CogScreen standards comparing possibly impaired pilots
to non-impaired pilots, there is no evidence that it has prevented
even one accident in the real world.
The bottom line is that the survey, even if only partially valid,
shows there are many pilots flying on anti-depressants and many
who should be on anti-depressants. That fact, plus the dearth of
accidents that are attributable to mental issues, which I admit
is hard to delineate, should give the FAA pause and re-evaluate
its current processes and procedures for evaluating pilots with
mental health issues.
The FAA's reliance on a checklist of tests to be completed, FAAapproved
psychologist and psychiatrist to be seen (which are few
and far between and expensive), and then if a special issuance is
granted, to make those hoops to jump through an annual event,
certainly drives pilots to not report mental health problems.
Dr. Northrup is working hard to modernize the FAA medical
processes, but it is like moving a bureaucratic iceberg. I hope
she prevails.
As the new minor depression policy does, one easy solution
would be to let AMEs participate more in the evaluation and medical
issuance in pilots who have experienced mental issues. The
CACI program (Conditions AMEs Can Issue) has certainly been
successful streamlining the
process for pilots' physical
issues without any change in
medically related accidents.
I think it would work for
mental health issues as well.
brent@brentblue.com
DR. BRENT BLUE is a
senior AME who flies a
Noorduyn Norseman and a
Cessna 185 out of Driggs,
Idaho. He is a HIMS AME
and works with special
issuance pilots.
AOPA Pilot Magazine - August 2022

Table of Contents for the Digital Edition of AOPA Pilot Magazine - August 2022
