AOPA Pilot Magazine - December 2024 - 24

FLIGHT MD
Baby steps
The FAA is headed in the right direction
on mental health
BY DR. BRENT BLUE
YOU MAY HAVE heard at a social gathering someone casually say
they forgot their Prozac or that their ADHD kicked in that evening.
However, you will never hear that type of conversation in a pilot's
lounge-not because of the stigma of mental health issues but the
consequences on pilot medical certification.
Depression in the United States is a significant and ubiquitous
problem. The CDC states that 18.5 percent of the adult population
has had a mild, moderate, or severe depressive episode in any
two-week period, based on pre-Covid data. Gallup reports that
29 percent of Americans have been diagnosed with depression at
some point in their life, and 17.8 percent currently have or are being
treated for depression. By extrapolation, this means a significant
number of pilots have depression, almost all unreported, which is
only one of several common mental health problems.
The FAA Civil Aerospace Medical Institute (CAMI) has
responded to last December's NTSB Panel on Mental Health as
well as its own Mental Health Aviation Rulemaking Committee
recommendations made last winter concerning modernized
approaches to some pilot mental health issues. This opens a
pathway to medical certification for pilots and prospective pilots
who have experienced certain types of mental health issues.
A major impetus for these recommendations has been multiple
episodes of pilots who have not sought mental health care because
of onerous FAA certification processes, which have ranged from the
jump seat pilot event on the Alaska Airlines flight last year to at least
two student pilot suicides in aircraft. Pilots and student pilots have
been in the untenable position of not seeking care, or getting care and
not revealing it, to obtain or maintain their pilot medical certificate.
As of June 26, 2024, the FAA now allows an AME to issue
medical certificates for specific mental health issues when a checklist
of questions is met and exclusion criteria are not present. Conditions
such as situational anxiety, situational depression, and post-traumatic
stress disorder, which used to trigger a deferral to Oklahoma City,
can now be evaluated by the AME using this decision tool developed
by the FAA. One other major change is that the AME can issue a
medical to a pilot who has or is currently receiving psychotherapy.
Some examples of exclusion criteria are a history of suicide
attempts or ideation, self-harm, or homicidal thoughts. Past
hospitalizations, involuntary court order evaluations, or extreme
treatment modalities like electroconvulsive therapy will also
require deferral to Oklahoma City.
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AOPA PILOT / December 2024
The FAA is now allowing AMEs to evaluate an applicant's
history of attention-deficit/hyperactivity disorder (ADHD).
ADHD has been the " disease du jour " for years, and many
patients have been misdiagnosed and treated without any
formal testing just because they were not doing well in school.
Most patients without true ADHD will stop medications
since they do not have any effect and do not improve school
performance. Medical certificate applicants who do not have
current ADHD symptoms, have not had any symptoms in the
past four years, and have not taken ADHD meds in the past four
years must obtain a signoff from a psychologist or psychiatrist.
The AME may then issue a medical with this certification
without deferring an applicant who was over-diagnosed or
inappropriately treated for ADHD. This saves a huge amount
of time, testing, and money.
Other common problems like uncomplicated bereavement,
relationship issues with life partners or children, and phase of
life issues like a new career or being a new parent, which may
have triggered anxiety or depression, can now be evaluated by the
AME and the pilot given a certificate without deferral. These new
criteria, which are all public and available online, put a lot more
pressure on AMEs to perform a thorough evaluation and to use
the proper templates and guides. This may require a significant
amount of time over the normal pilot medical examination and
pilots should be prepared to pay extra for this work. However,
these new procedures will save significant time and money,
outweighing any additional AME fees.
AMEs should have been able to evaluate these problems in
the first place, especially as the understanding of mental health
has evolved over the past 50 years. The FAA is playing catch-up
but at least they are heading in the correct direction. Baby steps
are better than no steps. Although these changes seem small,
given the inertia of a large government agency, they are huge.
Giving AMEs more decision-making capability, in and of itself,
is a major advancement.
The federal air surgeon, Dr.
Susan Northrup, should be
commended for moving the
FAA into the twenty-first
century.
brent@brentblue.com
DR. BRENT BLUE is a
senior AME who flies out
of Driggs, Idaho, near
Jackson Hole, Wyoming.
He flies a Cessna 185.
AOPA Pilot Magazine - December 2024

Table of Contents for the Digital Edition of AOPA Pilot Magazine - December 2024
