Why Airline Pilots Feel Pushed to Hide Their Mental Illness

Is the F.A.A. really ensuring safety by disqualifying pilots who receive a diagnosis or treatment?

By Helen Ouyang. She is a physician and associate professor at Columbia University. From The New York Times. Excerpt:

"Every airline pilot and controller must go through the F.A.A.’s medical-certification process at least once a year. This requires that an aviation medical examiner — a physician who has completed a four-and-a-half-day training seminar with the F.A.A. — reviews a pilot’s medical history and performs a physical. Pilots age 40 and over undergo this process every six months, as do those with certain health conditions that also require additional tests and clearance from specialists. But few certification pathways, if any, are considered more complex or take longer than the one for mental illness.

Pilots are taught early — by those who went before them, by those around them — that being honest with the F.A.A. about any aspect of their medical history can jeopardize their careers. Several years ago, an investigation by the Department of Veterans Affairs that cross-checked V.A. and F.A.A. databases revealed a wide discrepancy: Around 4,800 commercial and airline pilots were receiving V.A. disability benefits without reporting these medical issues to the F.A.A. While some of those pilots may have been fraudulently collecting benefits for nonexistent or exaggerated problems, others were found to have conditions that should have grounded them. Unreported health disorders can be deadly: A study of 202 fatal aviation accidents that occurred in the United States in 2015 found that in 5 percent of the cases, pilots had not disclosed the diagnoses or medications that were later implicated in the crash, most commonly including psychiatric drugs of some sort, whether taken by prescription or recreationally.

Every pilot I interviewed for this article knew of colleagues who had hidden their medical issues from the F.A.A.; some admitted to doing so themselves — several of whom told me that their supervisors had urged them not to report a health problem. And then there are the pilots who simply do not seek medical attention: A 2022 survey of pilots in the United States found that 56 percent of them reported having avoided health care in some way.

Because pilots are often reluctant to seek medical care or disclose health concerns, the number of those who are struggling with mental illness — a condition that is often easier to hide and harder to be open about than many other ailments — remains unknown. A 2016 survey of airline pilots found that nearly 13 percent of them met the criteria for a diagnosis of depression and more than 4 percent had suicidal thoughts in the preceding two weeks. The pandemic, which forced pilots into furloughs and, upon return, into facing more unruly passengers, probably made things worse, as it has for the general population. Almost half of Americans will experience mental illness at some point in their lifetime. There’s no reason to think pilots are spared. If anything, given their schedules, their irregular sleep and all the time they spend away from home and family, it would be little surprise if they don’t fare worse."

"The worry, though, is that the F.A.A. has inadvertently created a mental-health process so burdensome and restrictive that it deters pilots like Emerson from being honest with authorities and seeking help when they need it. Homendy, the N.T.S.B. chair, told me that a system that drives pilots to hide any symptoms of mental illness is “a detriment to safety.”"