In early April, a committee of U.S. aviation, aeromedical and safety experts published a landmark report commissioned by the Federal Aviation Administration (FAA) related to the mental health of pilots and air traffic controllers. The 24 recommendations directed to the FAA include sweeping changes to current mental health policies, including dropping the need for pilots and controllers to inform the FAA when they see a therapist and easing the pathway to medication use for aviation workers. These recommendations and others could transform an industry whose medical fitness standards may have created barriers for certain pilots and controllers needing mental health assistance. Now, FAA and industry leaders must decide if and how to enact these recommendations.
The FAA requires airline pilots and air traffic controllers to meet certain medical standards in order to work. Pilots and controllers who disclose that they have new mental health symptoms, or that they are taking a new psychoactive medication or seeing a therapist may run the risk of what is usually a temporary loss of their medical certification. Time out of work can result in lost pay, and the evaluations required to return can be prolonged, unpredictable and expensive. For this reason, I and others have argued that pilots and controllers face a barrier to seeking mental health care due to what a change in health status might mean for their career.
Data from my colleagues and myself support this; a study of 5,170 pilots across the U.S. and Canada showed that 56 percent reported a history of health care avoidance (for example, reporting that they decided to forgo an evaluation for a symptom or not fully disclosing health information during screening) based on their fear that they would lose their flying status. While these data included all types of health concerns, it seems reasonable to also apply these data to mental health. The U.S. has employed its current approach to screening pilots and controllers for many years in hopes of ensuring they are fit to perform their high-risk and often stressful duties. That said, many voices are now calling to change a system that may inadvertently harm aviation workers while not always achieving what it aims to do.
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“No one … should have to think twice about their job before seeking help,” said National Transportation Safety Board Chair Jennifer Homendy during a December roundtable on aviation mental health, as quoted in the Web publication The Hill. “And yet, we’re here today because that’s not currently the case in U.S. aviation.”
Multiple mental health incidents in pilots, including a recent one in which an off-duty airline pilot attempted to shut down the engines of a full passenger aircraft amid a mental health crisis, and a bipartisan letter from Congress challenging the FAA to modernize its mental health protocols, fueled momentum that culminated in the committee’s report. The committee is formally known as the Mental Health and Aviation Medical Clearances Aviation Rulemaking Committee; such bodies are referred to as ARCs.
“My personal belief is that the goal of this Mental Health ARC is to better the life of all pilots and controllers both current and aspiring,” Travis Ludwig, Air Line Pilots Association representative and committee co-chair wrote in the report. “This ARC strived to save a life, a job, a family. If we accomplish this lofty goal even once, the amount of work thrown into this project will be worth it.”
Now FAA leaders will need to determine not only which recommendations they incorporate, but also how to cover the costs, while assuring the 2.5 million passengers who fly in the U.S. daily that changes are safe. In an agency responsible for overseeing one of the world’s safest aviation systems, some recommendations are likely to face obstacles. While new mental health education efforts are unlikely to face opposition, broad overhauls to computer and medical processing systems will likely be contingent on major support outside of the agency. More difficult will be decisions about what pilots and controllers can do while working and what they need to tell the FAA amid a surprising paucity of safety data. To implement the committee’s 24 recommendations, the FAA will need broad support both within and outside of the agency.
Mental health is not the only aspect of aviation facing calls for change. Incidents involving Boeing aircraft—including the death of 346 passengers in two Boeing 737 MAX 8 incidents attributed to corporate missteps in the rollout of new flight control systems and a Boeing 737 MAX 9 door plug falling off in-flight—have brought public calls for the FAA to have stricter oversight over what critics view as a decades-long slide towards lax self-regulation and concessions to quickly building aircraft. “It is time to reexamine the delegation of authority and assess associated safety risks,” FAA Administrator Mike Whitaker said in a January 2024 statement, adding that “multiple production-related issues identified in recent years require us to look at every option to reduce risk.” When it comes to building America’s aircraft, calls to increase oversight aim to bolster safety.
But despite this discourse, one critical misunderstanding must be avoided when it comes to mental health.
Government leaders and ultimately the flying public must avoid the simplistic view that the committee’s recommendations aim to reduce oversight at the cost of safety. This is simply not the case. History has taught us that turning up the dials on traditional oversight tools does not necessarily mean greater safety when it comes to mental health. Instead, these recommendations propose novel, innovative ways to address hidden risks currently existing within our national air space while acknowledging an elemental quality of every aviation worker: the normal human need for support. This should be a key part of the FAA’s messaging to the public. Further, the public should insist the FAA is provided sufficient funding and backing to implement all 24 recommendations that will ultimately bolster wellness and safety in our aviation system.
This is an opinion and analysis article, and the views expressed are those of the author or authors and not necessarily those of any other organization or Scientific American.