The National Transportation Safety Board (NTSB) continued the discourse regarding mental health in aviation during a round table in December 2023. Called by Chair Jennifer Homendy, the panel asked pointed questions about the barriers pilots and other safety sensitive personnel face in seeking mental healthcare and how we might build mental health into the aviation system of the future. “No one… should have to think twice about their job before seeking help,” NTSB Chair Jennifer Homendy was quoted saying in The Hill during her opening remarks. “And yet, we’re here today because that’s not currently the case in U.S. aviation.” The full-day panel occurred at NTSB headquarters in Washington, DC, with testimony from a range of voices including pilots navigating the special issuance process, aeromedical professionals, industry leaders and regulators.

A key question recurred throughout – how do we meet the unique mental healthcare needs of our aircrew and other safety sensitive personnel while maintaining aviation’s exceptional safety record? A 2023 paper showing 56% of a sample of over 5,000 pilots across the US and Canada reported a history of healthcare avoidance due to fear for loss of their ability to work and fly served as a basis of the discussion. Speakers and NTSB board members covered a range of topics including the barriers personnel face in seeking mental health care, administrative and clinical challenges surrounding certification and open questions that lack research to guide direction ahead. “Let me be clear: the safety risk comes from a culture of silence around mental health,” Homendy was quoted in The Hill. “A culture that empowers people to get the care they deserve … to be healthy in mind and in body … that will strengthen safety.”

Dr. Penny Giovanetti, FAA Medical Specialties Division Director, was the lead representative from the Federal Aviation Administration and discussed the work being done at the FAA to address the challenges ahead. “We are focused on dispelling the myths and destroying the barriers…” said Dr. Giovanetti during her testimony and was quoted on the recording of the discussion. “…it’s amazing as I travel around and talk to groups, what myths really do exist... we have a huge task in front of us to dispel those myths.” She highlighted efforts by the FAA related to mental health, including hiring additional psychiatrists and providing information in the Guides for Aeromedical Examiners. “If you have uncomplicated anxiety… and you get into remission,” she said. “You will 100% get back into the cockpit.”

Some expressed a less optimistic view. Dr. Brent Blue, a Senior AME representing AOPA expressed concern about the process pilots face when seeking a special issuance related to mental health. “A pilot could have a letter from a world-renowned psychiatrist and that would still be ignored by the FAA because they have to go through the FAA’s… process,” said Dr. Blue. “If AMEs could issue a medical certificate for certain mental health conditions, it would significantly reduce the workload at the FAA while reducing delays in the system.”

The discussion repeatedly turned to the rising generation of aviation professionals in universities and training programs across the US. “…(student pilots) are part of this generation where society tells them it’s okay to talk about your mental health,” said Harley Waters, aviation faculty at Middle Tennessee State University and Student Wellness Coordinator. “But then aviation as an industry is saying no it’s not and they want it to be.” Innovative programs aimed at addressing mental wellness in student pilots were discussed. These efforts ranged from student-led peer support programs to mental wellness instruction in freshmen aviation courses. “I spend my days with wonderful young people,” said Dr. Frank Ayers of Emry Riddle Aeronautical University. “I think this next generation is waiting for us to move forward. They’re a pretty neat bunch of folks if you have the chance to get to know them; they’re our future.”

The conference concluded with a focus on next steps and the Federal Aviation Administration Aviation Rule Making Committee (ARC) on Mental Health, which has since published their 164-page report in April 2024. The committee provided 24 recommendations to the FAA that aim to “break down the barriers that prevent pilots from reporting and seeking care for mental health issues.” Key recommendations included discontinuing the requirement for certificate holders to disclose the use of talk therapy, the development of a non-punitive pathway to report previously undisclosed mental health conditions and/or treatments, and expansion of peer-support programs. Following publication of the report, the FAA expanded the list of approved medications for the treatment of mental health conditions from five medications to eight.

There appeared to be an air of hopefulness at the end of the day, recognizing that all stakeholders are interested in wellness and safety in aviation. “We need to create a great culture, a different culture,” said Chair Homendy during an interview with me on behalf of the Aerospace Medical Association (AsMA) Communication’s Committee. “Where… everyone in the aviation industry can get the same help you and I can... freely without fear of their livelihood or their salary or losing their job… I do feel hopeful.”

This article has been edited and is being reprinted with permission from the Civil Aviation Medical Association (CAMA) publication “The Flight Physician” Volume 27, No. 1, dated February 2024. William Hoffman MD is a neurologist and an affiliated assistant professor of aviation at the University of North Dakota John D. Odegard School of Aerospace Science with an interest in aircrew brain health and pilot healthcare behavior. Follow him on LinkedIn.