By 29 years old, Chris Daniel felt he had it all: a wife, two beautiful children and fulfillment of his lifelong dream of becoming a U.S. airline captain. But in the spring of 2022, after years of flying, Chris knew something was not right. Shadows from his past were reemerging, strained by post-COVID travel demand and long, taxing weeks on the road. Years earlier, Chris’s physician had suggested that his low mood and trouble sleeping might be symptoms of mild depression. But like many pilots, he balked at the idea. If a doctor diagnosed depression or if he sought help, Chris assumed he would never be able to fly again. Seeking help seemed unthinkable because losing flying was akin to losing everything; being a pilot was who he was.
Chris’s story is not unusual. While mental health symptoms are common in airline pilots, getting help can affect their ability to work in a big way. Airline pilots are required to meet certain medical standards in order to maintain an active flying status, and disclosing a new symptom or condition to the Federal Aviation Administration (FAA) puts them at risk of losing, usually temporarily, their ability to work and fly. This is particularly true for mental health symptoms. The FAA bars pilots from the cockpit if they report seeking regular talk therapy for even mild anxiety or depression; this may last for months and sometimes even years based on the assumption they pose an unacceptable risk to safety. In fact, pilots find themselves among only a handful of professions that require disclosure of any encounter with the health care system, including mental health visits.
While it makes sense to ground a pilot in distress, the current system often fails to recognize the dynamic and often situational nature of mental health symptoms and often drives pilots from seeking care. Time off the job can have negative repercussions such as loss of pay and need for recurrent training, and the expenses of additional medical evaluations required by the FAA often fall onto the pilot. All of these together result in a population of pilots working the fleet who are suffering in silence and fearful to get the help they need. We must rethink the system that drives pilots from attending to their mental health and change what seeking mental health care services means in aviation.
Data my group and others have gathered are beginning to reveal the scope of this problem. Our findings demand attention. In our recent study of more than 3,500 US pilots, 56 percent reported behavior that we classify as avoiding health care (for example, getting health care outside the traditional system to avoid its documentation) specifically because they feared the loss of their clearance to fly. Interestingly, 26 percent of pilots reported that they had withheld information during their FAA health checkups for the same reason: the fear of losing their medical clearance. This is sometimes called “losing their wings.”
In a sister study, more than half of pilots in our sample had something they felt needed to get checked out—maybe it was mental health related, perhaps a knee injury, or even just a rash—but waited or decided against it because they worried about their career. While our studies focused on overall health care, we suspect this finding also applies to mental health.
Many pilots have reasonably good access to health care. This includes health insurance, paid time off and sometimes other union protections. Instead, these data suggest a barrier exists because pilots are asked to weigh the benefits of seeking help against the professional costs that they alone bear. How bad does mild anxiety need to become to warrant a prolonged absence from work? For most pilots, very bad.
The growing demand for pilots in our travel-hungry, COVID-endemic world is likely to make this problem more complicated. The Bureau of Labor and Statistics projects 18,100 new pilot jobs each year for the next decade, precipitated by the continued growth of air travel. As compensation has soared in 2022, more is being asked of pilots, including longer and more frequent trips to keep pace with passenger demand. This is in the context of other airline professions—such as maintenance and administrative staff—facing major personnel shortages, placing further strain on a system already operating at its limits. Higher demand on pilots can lead to additional time away from family and friends, leading to an even greater need for mental health care services. Simply put, pilots’ need for mental health care is likely to only grow in the coming years.
While on the surface it might seem that increasing the pool of pilots would ease the situation, more pilots won’t fix the existing challenges in the system. Flight training programs are expanding, and some airlines are taking the unprecedented step of establishing their own training programs. But, while class sizes are growing, they are being filled by a younger and more diverse generation of student pilots who may not be as willing as their predecessors to quietly suffer. In fact, emerging data suggest the willingness of current pilots (who are still largely in the 40-to-60 age range) to avoid health care for job security may not be as true for the next generation.
“Younger pilots are different from past generations and are more willing to identify as needing help when it comes to their mental health,” John Dulski, 21, an aviation student at the University of North Dakota and advocate for aviation mental health reform, told me during a recent phone call. “Many are more willing to choose to get care at the risk of stepping away from flying.” The answers to why such a phenomenon is occurring remains an open question that our research group is trying to understand. Could it be related to social media lowering the stigma of mental health or the influences of growing up through the pandemic? We hope future research will reveal the answer.
A new generation of Gen Z airline pilots more open to stepping away from flying to seek mental health care services may only further strain the shortage of pilots. But more importantly, it should call for industry to rethink what it means for an airline pilot to be mentally fit and what services they should be able to receive while still working the fleet. We can all agree that safety in aviation should be the foundation for meaningful change. Certainly, a pilot with a severe mental health condition shouldn’t be flying. But the opportunity lies for pilots with mild symptoms. These are high-performing professionals who are perhaps facing one of life’s usual stressors—a divorce, a family death or even just the chronic stress of the job. How might we rethink a system that enables this group to seek mental health care services in hopes of sidestepping a diagnosis that could go on to fully pull them from flying?
One answer is clear. The FAA should change policy to permit pilots with mild symptoms to seek professional regular, and if needed prolonged, talk therapy without loss of their medical certification. Such a change would have major benefits for people on both sides of the flight deck door, including treatment to prevent symptom worsening, and regular pilot assessment by a professional mental health provider. Recognizing that mental health is on a dynamic spectrum and that many pilots could benefit from talking to a professional mental health provider at some point in their career has the potential to keep pilots flying healthy while also increasing safety in the system. Pilot unions and airlines should fuel this movement by raising awareness about the problem their pilots face and by lobbying for an alliance of stakeholder to determine how best to safely enact this change. While credit is due to the FAA for recently making several positive policy changes related to mental health, there is still work to do and time is of the essence.
Chris Daniel never did get help for his mental health symptoms, and despite an excellent flying record, he died of suicide in June 2022. While we believe suicide is relatively rare among pilots, this extreme outcome is in part why we must create positive change. With the use of appropriate supervision and reevaluation, aviation’s safety culture should shift to thinking of mental health care services as a marker for wellness and prevention instead of risk and disease. This change would not only benefit pilots, but also the 2 million U.S. passengers who trust the aviation system every day.
IF YOU NEED HELP
If you or someone you know is struggling or having thoughts of suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 or use the online Lifeline Chat.
The views expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the Department of Defense or any agencies under the U.S. government.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.
