The Aviation Elephant In The Room, Mental Illness & Pilots

by Bob Worthington
© Copyright 2022. All rights reserved!
Published in Midwest Flyer Magazine December 2022/January 2023 Digital Issue

What We Do Not Talk About

As people gather around the office coffee pot, at happy hour after work or munching burgers at a weekend barbeque, they may discourse about their kid’s recent tonsillectomy, or a spouse’s broken toe, or how the influx of pollen has increased their allergies. But no one talks about their “mental illness.” This is the elephant in the room no one discusses.

Yet the National Institute of Mental Health states that 19% of Americans experience mental illness issues. The Hope for Depression Research Foundation says that depression is the number one cause of disability worldwide. Mental illness is a mental, behavioral, or emotional disorder. Severe mental illness is where vocational or social life activities are functionally impaired.

For pilots, this topic is taboo and best avoided. Bringing up this subject or seeking treatment may mean a loss of flying, for a long time.

Mental Illness & Pilots

Several studies find that pilots are not immune to mental health issues. The challenges and demands on professional pilots can be fierce. The responsibilities of commercial aviators and pressures placed on them by their superiors seldom diminish. One study found that up to 12% of commercial pilots encounter mental health disorders with up to 27% of those pilots experiencing heavy workloads being affected (1).

Despite the excellent physical condition of pilots, they experience mental health issues the same as the rest of our population. While workers in professional institutions, retail operations, construction sites, or any other workplace may seek help with little fear of becoming unemployed, not so much with pilots.

In 2015, Germanwings Flight 9525, slammed into the French Alps, a deliberate act of the copilot, killing all 150 onboard. The copilot was diagnosed with a psychosomatic illness, which he hid from the airlines.

In July 2022, in North Carolina, a plane used for parachute jumps had to abort a landing (the right main landing gear was torn off), flown by the copilot. During the go-around, the distressed copilot climbed out of the right seat, moved to the rear of the plane, opened the rear ramp, and excited the airplane. The National Transportation Safety Board’s (NTSB) initial report simply states the copilot exited the plane without a parachute. The pilot stated his copilot jumped out of the plane.

In September 2022, a man stole a King Air from a Mississippi airport, threatened to crash it into a local Walmart, but instead crash landed in a field after several hours of flying. Reports and details are not clear. Some news reports state he was not a pilot (but he successfully departed in a twin and flew it for a few hours?). Others said he placed a suicide note on Facebook. He claimed he never intended to harm anyone.

Clearly, there are times when mental health issues and pilots do not end well.

Mental Health & The FAA

Let me preface my remarks by stating I have a doctoral degree in psychology with extensive advanced post-doctoral education. For over 11 years, I practiced as a clinical psychologist diagnosing and treating mental illnesses (see The Making of an Army Psychologist, by McFarland Publishing, 2022). For over 40 years I was a pilot and an aviation psychologist. In my experience, hiding a mental illness from others (to include physicians) is not that hard to do.

To remain a pilot and exercise the privileges of flying, one must comply with FAA medical regulations. Herein lies some problems. The FAA prohibits piloting if certain mental illnesses are present, such as psychosis, bipolar disorder, some personality disorders, or substance abuse. Some diagnoses prohibit flying while others may allow flying if there is proof of absence of the disorder, but sometimes there must be a grace period of up to 24 months.

Therapy and medicinal treatment protocols have been successful at curbing mental illness disorders, especially anxiety and depression. Unfortunately, there are medical and behavioral clinicians who believe the FAA’s regulations are decades behind medical science because some treatment programs are still not accepted by the FAA.

Keep in mind the primary mission of the FAA is “aviation safety.” And keeping pilots with mental illnesses out of the cockpit is a sure way to ensure safety. But today, many forms of mental illness can be treated where the individual can successfully function at work, home, or in social situations without fear of harm.

One of my best friends is a schizophrenic. Decades ago, as a college student, he decided he no longer needed his medication. He became psychotic, was hospitalized, and treated. Realizing he cannot go off his meds again, he has never stopped taking them since then. Avoiding high stress jobs, he has never been hospitalized again. He understands his illness and has no problem discussing his condition with others. Like me with my Agent Orange heart condition, we both depend on medications and specific health regimes to keep us healthy.

Treatment programs may include both therapy and psychotropic medicines. Unfortunately, some are not approved by the FAA. The FAA clearly states that it encourages pilots with mental health issues to seek help, emphasizing that if properly treated, pilots are not disqualified from flying. For many pilots though, noting on a medical exam any hint of a mental illness is perceived as the kiss of death.

A study published by the Journal of Occupational and Environmental Medicine (Healthcare Avoidance in Aircraft Pilots Due to Concern for Aeromedical Certificate Loss: a survey of 3765 pilots, April 2022) reveals that 56% of the pilots surveyed did not seek healthcare to avoid any negative aspects of their medical exam.

Health care as viewed by pilots is a topic best hidden. Because of this prevalent feeling, the aviation industry has taken steps to aid this situation. American Airlines, Delta, and other airlines have programs to help all employees with mental health issues. American Airlines has its peer-to-peer care, using trained volunteers for its Project Wingman where pilots provide support to other pilots and their families. The Air Line Pilots Association has its Pilot Peer Support (PPS) program where peer pilots provide counseling and broad advice to pilots and their families. Delta has an Employee Assistance Program where a master’s-level mental health counselor can provide immediate help to employees and their families. Other airlines offer similar programs to assist employees and family members deal with mental health issues.

Around the country are a variety of private medical and mental health clinics that specifically cater to the aviation industry. Designed to treat air crew members with mental health disorders to get them back in the cockpit are specialists, such as Emerald Mental Health, Aviation Medicine Advisory Service, or Bradford Health Services. While these programs are not cheap, insurance may cover some costs. Other non-clinic programs such as HIMS (Human Intervention Motivation Study) combine a network of professionals specifically put together to detect and treat substance abuse problems to place pilots back on the flight deck.

Some collegiate aviation programs and professional pilot schools now have mental health counselors available to help students deal with the pressures of flight training.

Despite these dire comments on pilots and mental health issues, mental health breakdowns in the cockpit are extremely rare. Yes, this topic is the aviation elephant in the room, but mental health issues should not be self-treated or ignored. Feelings of depression, anxiety, panic attacks, or other emotional states are best treated by professionals. As this column has pointed out, numerous options exist for pilots to seek help from mental health professionals trained to offer support, counseling, or medical intervention, specifically for pilots.

What The FAA Is Doing

Most programs, as mentioned, are for professional pilots seeking mental health help to retain their jobs, flying. The situation for the non-professional private pilot is considerably different. In most instances a career is not at stake, but the same FAA regulations apply. A private pilot holding a Class III medical certificate faces the identical scrutiny if being honest, by declaring at the next medical exam, having sought mental health care.

Most physicians are not trained in dealing with mental illnesses, so the FAA is providing additional mental health training for its Aviation Medical Examiners (AME). Additional FAA mental health professionals are being hired. Both the FAA and the aviation industry recognize how serious mental health issues are. Together they are working on research studies examining programs and medicines, seeking improved ways to treat mental illnesses… Ways to get pilots with mental health concerns back in the cockpit, quicker!

The FAA strongly encourages all pilots with mental health issues to seek care, stating that under certain conditions, pilots can fly while taking prescribed mental health medication.

Mental illness in aviation is a serious matter. It is being addressed by the FAA, the airlines, and aviation training programs. It is a complex situation with no easy answers. Like other medical conditions, it is best if affected pilots recognize mental health symptoms and seek help. Yes, for some, it may mean leaving the cockpit for a period. But, for most pilots with a mental illness, professional assistance does lead back into the cockpit.

Reference: Mental Disorders Among Civil Aviation Pilots in Aviation, Space, and Environmental Medicine: Vol 83, No 5, May 2012 and Assessing Pilots with ‘The Wrong Stuff’: a Call for Research on Emotional Health Factors in Commercial Aviation in International Journal of Selection and Assessment: 16 April 2003.

EDITOR’S NOTE: Pilot, Viet Nam veteran and former university professor, Bob Worthington of Las Cruces, New Mexico, is the author of “Under Fire with ARVN Infantry” (, and producer of the 2019 film “Combat Advisor in Vietnam” ( Facebook: Bob Worthington Writer. Website: Bob Worthington has placed excerpts about combat flying in Vietnam (from his books) on his website. Here is a direct link to those excerpts: Every couple of months, he adds another excerpt.

DISCLAIMER: The information contained in this column is the expressed opinion of the author only. Readers are urged to seek the advice of others, including their personal flight instructor. Neither the author, Midwest Flyer Magazine, Flyer Publications, Inc., or their staffs, employees or advertisers assume any liability for the accuracy or content of this column or any other column or article in this publication.

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