Mental health rulemaking committee issues recommendations to FAA

The Mental Health and Aviation Medical Clearances Rulemaking Committee issued recommendations to the FAA after months of review. Now, the FAA will review the recommendations provided and determine the next steps to break down barriers preventing pilots and air traffic controllers from reporting mental health issues. The Mental Health ARC was formed on Dec. 4, 2023 to provide a forum for the U.S. aviation community to discuss the many barriers that are preventing members of the community from reporting or seeking help over mental health concerns. The ARC members cover a broad range of the industry, including aerospace medicine, psychiatric and psychological medical experts from the FAA Office of Aerospace Medicine, FAA Flight Standards Service, the NTSB, U.S. aviation industry trade associations, pilot/controller representative organizations, academia and international aviation industry associations and civil aviation authorities.RELATED STORIES:Members of Congress demand more from FAA on pilot mental healthFAA forms rulemaking committee to examine pilot mental healthMental health in aviation - how the FAA is changing views on mental illness Two working groups were established, Peer Support andamp; Operations and Medical, which provided recommendations and steps needed to reduce risks to aviation safety. The groups worked collaboratively and addressed major issues like the FAA's handling of mental health diagnoses, current aeromedical mental health screening processes, the barriers preventing pilots or controllers from reporting mental health issues and seeking appropriate care, as well as education, training and awareness of pilot/controller mental health issues.READ THE FULL REPORT HERE After multiple in-person or online meetings, the ARC issued the following recommendations: Create a non-punitive pathway for disclosing mental health conditions and treatments Revise and evaluate requirements for reporting and certification/qualification of psychotherapy (talk therapy), depression/anxiety; attention deficit hyperactivity disorder and post-traumatic stress disorder Ensure aeromedical screening protocols and requirements are based on Safety Management System principles (i.e., proportionate, relevant, and risk-based) and are appropriately communicated to applicants Expand the use and promotion of Peer Support Programs Develop mental health literacy, education and awareness campaigns Increase mental health training and improve quality assurance for Aviation Medical Examiners (AMEs) Modernize the FAA's information management system/Aviation Medical Certification Subsystem The Mental Health ARC identified barriers including culture, trust, fear, stigma, financial, process, and knowledge and information gaps. Within the industry, the culture contributes to the issue of not reporting mental health disorders. There is a stigma surrounding mental health and a lingering fear over the consequences of speaking up or seeking help. Many fear getting help will be the end of their career and will suffer without help rather than report any conditions or treatment. Consequences of reporting these issues could mean losing a job or not flying for some time. Without job stability and income, many people cannot support themselves or their families. These barriers were addressed with their recommendations. Disclose requirements The ARC intends to minimize the barriers pilots and controllers face to obtaining non-pharmacological based mental health therapy. The FAA requires disclosure for talk therapy, which the ARC feels has unintended consequences. This requirement is presumably based on the view that talk therapy is a marker for identifying operational hazards or work performance impairments. There is limited data to support this view and the ARC feels there is strong data to the contrary. Studies have shown that barriers to seeking mental health care can compound initial stressors and anxiety, ultimately creating aviation safety hazards that would not otherwise exist. If a controller or pilot wanted to engage in talk therapy after a life event, like divorce, they would be deterred from doing so as to not report it to the FAA. While the pilot or controller has recognized a need for help, they may be more concerned with the potential impact on their livelihood and career in doing so. The ARC recommends the FAA amend instructions on medical applications and exclude mental health talk therapy sessions as a required reportable medical professional visit. This recommendation addressed the barriers of trust, fear, stigma and process. Regulatory pathway To increase trust in the medical certification and clearance process, the ARC recommends establishing a non-punitive pathway so applications can report previously undisclosed conditions and medications. This process should incentivize compliance and reduce any financial or occupational threats. The ARC feels this process should encourage pilots and controllers to seek mental health care to improve the safety of the national airspace. Fear can prevent people from speaking out, seeking help and reporting conditions or medications. People may fear the consequences, such as job loss, restrictions or financial setbacks. The ARC believes a program like this would encourage people to step forward. It is recommended that the FAA create a process where controllers and pilots who whole a medical certificate/clearance are encouraged to report undisclosed mental health conditions, diagnoses and/or treatment. This recommendation addressed trust, fear, stigma and process barriers. "The person should be able to disclose without fear of immediate revocation or referral for disciplinary or administrative/criminal prosecution for falsification, misrepresentation, or omission of information on the required disclosure documents," the ARC said. "The non-revocation protections should extend to the medical certificate/clearance, as well as to any other certificates, ratings, clearances, or qualifications the person holds." Requirements for depression and anxiety, as well as ADHD The ARC recommends setting a new, reduced minimum wait time for reconsideration of medical certification after starting or changing approved monotherapy antidepressant or anxiety medications. Removing barriers that discourage the start or adjustment or pharmacological treatment with approved medications can allow pilots/controllers to function in a healthier mental state. The current six-month observation period may create financial hardships for some pilots/controllers and introduce a safety risk, leading to a reluctance to seek help. The recommendation is that the FAA adopt a new program to reduce the special issuance consideration minimum wait time from six months to two months. This two-month wait time is the typical amount of time it can take to respond to a medication or for the appearance of suicidal ideation as per the FDA black-box warnings on some medications. This approach focuses on the financial and process barriers. Another recommendation is to establish whether circumstances or conditions exist in which a person can operate while taking approved medications for the treatment of properly diagnosed ADHD. Untreated ADHD can raise concerns, but studies show that adults with active ADHD are as high as 4.4 percent of the population and the diagnosis among children is increasing, which could impact the future pilot/controller population. The ARC is recommending the FAA reexamine its ADHD certification/clearance policies and determine the potential aeromedical effects of ADHD, including a study with research experts to determine appropriate assessment methodologies and operational performance outcomes. This recommendation addressed numerous barriers including fear, process, knowledge and information gap. The ARC acknowledges that not every mental health condition and treatment requires a second look or leniency and some may prevent a person from flying altogether. The safety of the NAS and all who work and fly in it is a priority. Some mental and health conditions come with additional risks, like the increased likelihood of seizures, stroke or fatigue. Even slight risk is a reason not to fly, but as the world changes, stigma dissipates and treatment evolves, rules deserve a second look. Mental health concerns are prevalent in 21 percent of the U.S. population and rates of anxiety and depression are four times higher than before the pandemic. About 5.9 percent of Class 3 certificate holders in 2020 had at least one mental health code and currently, an estimated 30-40 percent of the general review cases have a mental health component. Conditions like psychosis, bipolar disorder, untreated recurrent major depression and ADHD either on medication or with persistent signs and symptoms are rarely waivered conditions. In 2023, 522 pilots were flying while taking SSRI antidepressants and 2,996 were flying with a history of substance dependence. Mental health does not deserve a weighty stigma, but it can pose a risk to performance and safety if unchecked or untreated. Mental health in aviation has come a long way since the first FAA Chief Psychiatrist in 1970, but it still has a long way to go.