Many pilots don’t report anxiety, depression; Experts explain why

Commercial pilots must obtain a medical certificate that covers both mental and physical health. Without that certificate, they can’t do their jobs.
Published: Oct. 25, 2023 at 6:40 PM PDT
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(KPTV) - In order to sit in the cockpit and fly a commercial airliner, you have to be in really good shape.

Unlike other professions that require a physical, pilots must obtain a medical certificate that covers both mental and physical health. Without that certificate, they can’t do their jobs.

Those fitness certificates and the requirements to keep them current are in the spotlight after court documents revealed that an off-duty pilot arrested for trying to shut down a plane mid-flight had struggled with mental health.

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We don’t know the mental health history of Joseph Emerson, the Alaska Airlines pilot now in custody, but an affidavit filed with the court by the FBI provides some insight. According to those documents, Emerson told police that he was having a “nervous breakdown” and had not slept in 40 hours. “Emerson denied taking any medication, but he stated that approximately six months ago he became depressed.

But he didn’t report that depression to his company or the FAA.

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The process of obtaining a medical certificate includes a component called “full disclosure” which means that pilots are responsible for self reporting any issues during their exam as well as anything that comes up between certifications.

“The the evolving data suggest that a large population of pilots may participate in health care avoidance,” said William Hoffman MD, neurologist and affiliated assistant professor of aviation at the University of North Dakota School with a research focus on aircrew brain health. “This includes things like not disclosing all health information on an aeromedical screening assessment, seeking informal medical care, or experiencing a symptom and not getting it fully evaluated despite flying. Over 50% of U.S. pilots in our sample reported a history of health care avoidance due to these same issues.”

Many pilots believe that if they are honest about mental health struggles, they will lose their medical certificate and be grounded. But on the FAA website it says, “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. However, certain medical conditions such as a psychosis, bipolar disorder and some types of personality disorder automatically disqualify a pilot from obtaining an FAA medical certificate.”

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Hoffman says the tension between full disclosure about health and the potential financial losses of not working weigh heavy on pilots.

“This paradigm can at times leave some pilots weighing the risks of stepping away or disclosing health information against the risks to their career,” he said. “How bad does mild anxiety need to be for the potential walking away from flying for six months or longer?”

And to complicate matters, there are cultural issues as well. Pilots are a relatively self selecting group and as such they can share some common traits that also make it less likely that they will be the first to ask for help.

“The type of person who is willing to be at 35,000 feet and have complete responsibility for 250 people over the North Atlantic, and at any moment be ready for an engine failure, a hydraulic failure, a medical emergency in a bad weather storm, may not be the same type of skill set that will easily raise their hand and say, ‘You know what? I think I might need to step away to get some help,’” Hoffman said.