A Pilot’s Mental Health

by Dr. Bill Blank, M.D.
Published in Midwest Flyer – June/July 2019 issue

Mental health issues are common in our society. The results of serious mental illness show up in the news: mass murders, the opioid crisis. Pilots are not immune. A recent crash of an airline freighter got me thinking about this. When I heard the details, I wondered if this could have been a suicide. The most recent preliminary National Transportation Safety Board (NTSB) report on the accident talked about pilot error and the control column being pushed full forward. Apparently, no attempt to recover was made. I hope I am wrong. There have been air carrier suicides: German Wings 9525 on 3/24/15 and EgyptAir 990 on 10/31/99. There are others. That is the most likely cause of Malaysian Airlines 370 on 3/8/14. In all of these accidents, many people lost their lives.

General aviation pilots are not immune. A pilot flew a Citation into his house to try to kill his wife. For more examples, you can do an internet search. Obviously, most mental health issues do not result in this extreme, destructive behavior. By far, the most common problem is depression. Accurate incidence figures are hard to obtain. Only the more serious cases seek medical help. Most people muddle through. Some self-medicate. Many suffer. A fair number, resolve.

From a pilot’s perspective, we know that we shouldn’t fly if we are feeling depressed. If we are aware of someone who is depressed, we can try to help them get help. I don’t think notifying the FAA would be much help, at least for general aviation pilots. The wheels turn slowly. People drive all of the time with suspended driver’s licenses. In the airline world, it would lead to help.

The FAA has been struggling with this issue. If the recent airline freighter accident turns out to be a suicide, there will be more pressure on the FAA to improve their procedures. They have already been studying the problem. The problem is trying to predict which people are at risk.

The German Wings pilot held, at one time, an FAA medical. Because of German privacy laws, European certifying authorities were not aware of his problem, nor was his company. The FAA tries hard to certify everyone they possibly can without endangering public safety.

The FAA will certify people who have had minor depression or depression related to bereavement. In fact, in these situations, the Aviation Medical Examiner (AME), himself, can sometimes issue the certificate. For more severe conditions, including major depression, the decision will be made in Oklahoma City. Certain medications are sometimes approved. They are all selective serotonin reuptake inhibitors (SSRI): Prozac, Zoloft, Celexa and Lexapro. No others are permitted.

The FAA has realized that it is better for people who have problems, such as depression or substance abuse, to have a pathway to recovery and recertification. Prior to the initiation of this approach, people just hid the problem and flew. If you are interested in more detail on these FAA policies, Google “FAA psychiatric dispositions.”

Hopefully, few of us will suffer from any of these problems, but treatment is becoming more effective and recertification is sometimes possible.

EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985.

Dr. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Dr. Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII) and has given over 1200 hours of aerobatic instruction. In addition, Dr. Blank was an airshow performer through the 2014 season and held a Statement of Aerobatic Competency (SAC) since 1987.

DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.