The FAA Got Feedback on Pilot Mental Health. Now What?

If a pilot is grounded for mental health reasons, how long should it take for them to get medical approval? Do pilots need to tell the FAA every time they go to therapy? Should pilots on ADHD medication be able to fly?

The FAA established a committee to tackle these questions and review its mental health policies in December. Last month, the committee — composed of medical experts, advocacy groups, and other voices in aviation — published its recommendations. Now, the FAA is reviewing them.

“We’re trying to break down barriers and develop pathways where pilots want to come forward with some of their issues and break down those stigmas,” said Jim Coon, a committee member and the senior VP of government affairs at the Aircraft Owners and Pilots Association.

The recent push for reform comes after an Alaska Airlines pilot almost brought down a plane last fall. But this isn’t a standalone incident in aviation history. The Germanwings crash and the death of a University of North Dakota student also made headlines.

“The FAA encourages pilots to seek help if they have a mental health condition since most, if treated, do not disqualify a pilot from flying,” said a statement from the FAA. “Only about 0.1% of medical certificate applicants who disclose health issues are denied.”

The report lays out some of the FAA’s pain points with mental health — which could lead to underreporting of conditions — and 24 recommendations.

Skift spoke with pilots affiliated with the Pilot Mental Health Campaign (PMHC). The group advocates for stronger legislation on mental health in the aviation industry. Here are a few issues some pilots found most pressing:

Observation Periods and Wait Times

According to the FAA, if pilots come forward about a mental health concern in their medical forms or during an exam, the Aviation Medical Examiner — a professional responsible for medical certification — may ask more questions. The examiner may request psychological testing or defer to the Office of Aerospace Medicine for further evaluation.

People with some conditions, like bipolar disorder, have to be denied a medical certification or deferred.

A pilot needing a medical certificate — key to flying solo in most aircraft — may have to wait for the FAA’s decision.

The FAA’s current policies affect pilots of all ages, including those among the youngest. Kallen Wachi, 22 years old, is an aviation student at the University of North Dakota. He began struggling with mental health around when he started college during the pandemic.

Wachi said it took over a year to get his medical certificate back.

“I’m in many ways 14 months behind on my flight training,” Wachi said. “From a logistical standpoint, it does push you back a lot in terms of what you need to complete in terms of the degree program as a student.” 

Wachi explained his peers are already Certified Flight Instructors and preparing for airline jobs. He won’t complete his Certified Flight Instructor training until this summer.

Those on approved single-drug antidepressants have to wait at least six months before the FAA will reconsider medical certification. Anytime that dose changes, the clock restarts.

The committee’s recommendations could address the prolonged wait times. They encourage the FAA to revisit this policy, lowering the six-month period to two months for uncomplicated depression or anxiety. According to the committee’s research, two months should be ample time to see the effects of an antidepressant.

But wait times don’t just hinge on this policy. Processing medical files can also be long and tedious, especially due to the manual scanning of mailed paperwork. The committee calls for updating the FAA’s information management system, along with posting more specific guidance on the medical certification process.

“The length of time that it takes is certainly nonstandard health care,” said Adam Banks, a commercial pilot who told Skift it took seven years to get his medical certificate back. Banks described the review process as “subjective,” with the FAA periodically coming back to request he “accomplish more items.”

ADHD

Currently, pilots aren’t allowed to be treated or medicated for ADHD, as stated in the committee report. But, between 1997 and 2016, ADHD prevalence in U.S. children increased.

PMHC Founder and Executive Director Brian Bomhoff said some medical forms do not outline the FAA’s parameters around ADHD. 

“I think the FAA has a long way to go to wrap their heads around ADHD-cynical policies and clinical understandings,” Bomhoff said.

Right now, the FAA has a fast-track option for those who have not taken ADHD medication in the prior four years. The committee advised more research on ADHD and considerations on how to include prospective pilots with a diagnosis.

“If we’re going to have the younger people be part of this industry, we’re going to have to address the fact that a lot of students, a lot of young people, were diagnosed with ADHD at a young age,” Wachi said.

Talk Therapy

The FAA requires pilots to disclose talk therapy, or psychotherapy. The current policy can sometimes deter pilots from seeking out care, the committee’s report stated.

“I think that’s kind of like a mind-your-own-business kind of thing,” Wachi said. He thinks the FAA shouldn’t have to know about scheduled appointments for some life events, like breakups, unless they have a major impact.

The recommendations prompt the FAA to reconsider its policy on mandatory disclosure of talk therapy, along with clarifying conflicting guidance on reporting medical visits.

Neurocognitive Testing

The report proposes cutting back on neurocognitive testing “as much as possible,” except for cases when it is clinically recommended.

The CogScreen-Aeromedical Edition is a computerized battery of tests specifically for those with neurological or psychiatric conditions. The testing evaluates perception and cognition, not flight knowledge, according to its website. Bomhoff said further easing up on testing requirements could be a cost-saving measure for pilots.

“If [administrators] charge market rates, insurance does not reimburse,” Bomhoff said about the evaluation.

Addressing Underreporting

The committee also recommended at least a two-year grace period for pilots to report previously undisclosed conditions. The report breaks down reasons pilots may struggle to share their mental health status. Some factors include stigma, fear, a lack of trust, and the culture around aviation. 

Pilots specifically emphasized financial concerns. For Banks, fulfilling the requirements to fly again hasn’t been easy, or cheap. 

“This process has been very, very expensive for me,” Banks said. Wachi agreed — he said he spent roughly $8,000.

Along with risking an income, variable sick leave and insurance policies may not cover the entire period a pilot needs to take off work, the report said. Mental health providers may not accept insurance, proving another challenge for pilots needing treatment to return to the air.

Banks supported himself with his second career working on a health care business but can imagine how this takes a toll on young pilots with less financial stability.

“When I get to the stage of the airlines, I’m going to have to go see a counselor or a therapist outside of the university,” Wachi said. “And the issue with that is that I don’t know how they’re going to bill me. I may have to pay that out of pocket at the end of the day.”

The committee requested that aviation stakeholders push Congress for expanded disability insurance benefits.

What’s Next

It’s important to note that some recommendations are outside of the FAA’s control, like with disability insurance. Some other parts of the report are within its scope, though.

“There’s low-hanging fruit,” Bomhoff said. “I think, some of these things that appeared in the [committee report], they were probably already aware of and were working on for some time.”

Bomhoff said changing the policy for talk therapy may be one of those recommendations. Some recommendations are aligned with international aviation authorities, which could make them easier to pass. Bomhoff thinks approving ADHD medication use could take longer.

“The FAA is particularly worried about overdiagnosis in ADHD cases,” Bomhoff said.

The recent FAA Reauthorization Act plans for a working group and task force to review medical procedures. The task force will have two years to submit a report that reviews the committee’s mental health recommendations. The overall working group will update Congress on further medical recommendations.

That means more recommendations on top of the committee’s recommendations, something that concerns Bomhoff.

“The charter of the [committee] did lay out in pretty good detail many of the things that their proposed working group also laid out,” Bomhoff said. “And so I feel like some of the efforts are being duplicated.”

But some, like Coon of the Aircraft Owners and Pilots Association, see the task force and broader working group as a much-needed push.

“I think that requiring a task force to move forward on additional mental health issues or continue to push for the recommendations that the [committee] had, I think that can only be helpful,” Coon said.

Chip Hancock — Southwest Airlines Pilots Association government affairs chair — recalled past committees and agreed the task force would be the best way to move forward.

“[Committees] will make all kinds of recommendations, and then those recommendations will just die, you know? Something else will overtake the news of the day,” Hancock said.

The working group will also consider how veterans and their VA disability ratings fit into the equation.

One impacted pilot is Shannon Cruz. He started in the Air Force before pursuing other aviation opportunities. Cruz believes the FAA has been too punitive with some veterans who did not previously disclose disabilities.

Cruz said the FAA revoked several of his skill-based certificates and type ratings.

“What’s the purpose of revoking hard-earned certificates? There should always be a reasonable way back to the cockpit,” Cruz said. “It’s like taking away your diploma.”

Ultimately, the recommendations and reauthorization serve as a starting point — not the end — for the conversation on pilot mental health.

“This is an ongoing issue. Every day, there’s going to be a pilot out there in the United States that is suffering and is hesitant to report a diagnosis,” Wachi said. “What are we going to have to change as future industry leaders, as future pilots, et cetera, in the airlines and in other areas?”