‘Are You in the Green?’

Navigating the Mental-Health Continuum

By F/O Carrie Braun (JetBlue), Chair, ALPA Air Safety Organization Pilot Peer Support Group, and F/O Sonny Ruff (United), Vice Chair, Pilot Peer Support Group

With May being Mental Health Awareness Month, it’s the perfect time for ALPA to launch its “Are You in the Green?” campaign to raise the collective consciousness about the important role mental health plays in an individual’s well-being.

Spearheaded by ALPA’s Air Safety Organization Pilot Assistance Group and the Pilot Peer Support program, Are You in the Green? encourages ALPA members to self-assess their emotional states and, if necessary, seek assistance through the union’s peer support programs when they feel they need help.

ALPA members are likely familiar with the “IM SAFE” acronym, the Aeronautical Information Manual’s recommended mnemonic for pilots to use when evaluating fitness to fly. The “E” in IM SAFE stands for emotion and pertains to the need for pilots to be emotionally stable to effectively perform their duties.

Your emotional well-being is reflected in your daily life and how you process the challenges you confront. For example, while driving your car, an individual haphazardly steps into the road in front of you, causing you to swerve to avoid them. In most cases, you might feel some level of stress before returning to normal. However, if you’re preoccupied with other concerns and are already under stress, the impact of this experience may linger, affecting you in different ways.

This example demonstrates how mental health is fluid and exists on a spectrum of emotional states, again, depending upon what’s occurring. Accordingly, a mental-health continuum has been developed consisting of four levels with corresponding colors to help you gauge your mental wellness and identify characteristic behavioral responses that can impede your judgment and sensibilities if not properly addressed.

Assessing Your Feelings

As noted on ALPA’s Are You in the Green? webpage, the four stages of the mental health continuum range from the presence of to the absence of positive mental health. The green zone (“Well”) reflects normal functioning. Individuals in this category experience normal mood fluctuations, consistent performance, and a healthy balance between personal and social activities. Interactions with others are comfortable, and normal levels of confidence are present.

The yellow zone (“Reacting”) denotes a condition in which common and reversible stress is present. Those in this zone may find themselves becoming irritable or impatient and experience increased worrying or difficulties sleeping. Procrastination and forgetfulness may also occur. The key is to recognize these signs early and address them through self-care and social support.

Those in the orange zone (“Injured”) experience significant functional impairment. They likely grapple with anger, anxiety, and persistent sadness. Performance at work often declines, and sleep disturbances become more pronounced. In these cases, professional mental-health care is critical to facilitating recovery and restoring optimal functioning.

The red zone (“Ill”) signals a clinical disorder with severe and persistent functional impairment. Those affected may face overwhelming emotions, high anxiety, and clouded judgment. Suicidal behaviors can surface, requiring immediate professional intervention.

Imagine that you have a trip this evening and you’ve ordered an item you need that’s supposed to arrive no later than the afternoon. When it doesn’t show, how you respond is likely indicative of your mental state.

Are you calmly calling fellow pilots to see if you can borrow the item or considering other places you might acquire it? Are you shouting at your significant other about an unrelated concern that, when you stop and think about it, doesn’t warrant this level of behavior? Are you sweating even though you’re in a well air-conditioned room? Your reaction may suggest the steps you need to take next to move back into the green.

Hesitation Blues

“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,” according to the agency’s Pilot Mental Fitness webpage. “In fact, only about 0.1 percent of medical certificate applicants who disclose health issues are denied.”

That’s great news and a clear sign that aviation regulators in North America are beginning to view pilot mental wellness in the same way that they approach physical health. However, past mental-health diagnoses were often career-ending, and recent research suggests that many airline pilots may still be reluctant to seek help for these conditions. In addition to potential job consequences, social stigma is an ongoing concern. For others, it may be fear of the unknown.

Promoting education and awareness about this changing dynamic and our improved understanding of disorders and their appropriate treatments is the best strategy for mitigating these concerns and is the impetus for ALPA’s Are You in the Green? campaign.

ALPA members have numerous tools at their disposal, including self-care measures, assistance through the union’s Pilot Peer Support and other Pilot Assistance programs, and ALPA’s aeromedical services. Self-care often begins with simple lifestyle adjustments such as eating well, prioritizing healthy sleep patterns, regularly exercising, spending time with family and friends, and participating in hobbies or social events.

Peer Support

According to the Substance Abuse and Mental Health Services Administration, “Peer workers are emerging as important members of treatment teams.” Peer support programs have proven to be an effective way to provide a network of trained peers who offer confidential, nonjudgmental support and share their own experiences.

For more information about ALPA’s Pilot Peer Support program and the independent support lines for specific pilot groups, visit alpa.org/pps. The program is staffed with trained pilot peers who understand the challenges of your career and can speak confidentially with you about what you’re experiencing and the potential resources available.

ALPA also offers specialty peer programs such as Professional Standards, which addresses interpersonal conflicts at work; the HIMS (Human Intervention Motivation Study) program, which deals with alcoholism and substance addiction; the Critical Incident Response Program, which addresses potentially harmful stress reactions following accidents and serious incidents; and Canadian Pilot Assistance, which provides mental and physical health resources for Canadian-represented pilots.

In addition, U.S. ALPA pilots have access to the Association’s Aeromedical Office, the Aviation Medicine Advisory Service, by calling 303-341-4435 Monday–Friday 8:30 a.m. to 4:00 p.m., mountain time, to speak with staff physicians about any medical certification questions. Additional information is available on the Aeromedical Office’s website. ALPA pilots based in Canada are encouraged to contact ALPA Canada’s aeromedical consultant at 403-389-3032. Information is also available at canadianpilotassistance.com.

Early intervention is the key to maintaining mental fitness. Don’t wait until your problem escalates into a larger concern. Call Pilot Peer Support and talk with a pilot peer who personally understands the challenges of the piloting profession and can offer resources to help you address the issue and get back into the green.

Talk Early, Talk Often

This simple statement carries profound implications. Navigating the intricacies of mental well-being are just as important as safely navigating the skies. Seeking help when it’s needed isn’t a sign of weakness but a proactive step toward well-being.

Are You in the Green? isn’t just a question—it’s a call to action for ALPA pilots to foster a culture in which health, safety, and well-being take precedence, ensuring that every journey, both in the air and in our minds, is a smooth and supported one.

Coming Forward: One ALPA Member Shares His Experience

The FAA and Transport Canada continue to make progress in recognizing the treatability of many mental-health conditions, allowing pilots who meet the necessary protocols to return to an airline flight deck. However, it wasn’t too long ago that such a condition meant the permanent loss of medical certification, putting an end to numerous flying careers.

This former policy likely led some aviators, including Capt. Carlos Vilella (FedEx Express), to withhold their conditions from their carriers and federal regulators. Vilella was hired by FedEx in 2001. Five years later, he was diagnosed with generalized anxiety disorder, which, according to the Mayo Clinic, causes “excessive, ongoing worry and interferes with daily life.”

At the time of his diagnosis, Vilella had an impeccable flying record with both his carrier and as a lieutenant colonel in the U.S. Air Force Reserve. “I was struggling for a while before my diagnosis and eventually had a panic attack, which led to my seeking help,” he remarked.

Vilella soon conferred with his sister, who suffers from the same condition. She suggested a therapist, who subsequently recommended he take medication to treat this condition. However, the selective serotonin reuptake inhibitor (SSRI) she wanted to prescribe—Lexapro (or the generic, escitalopram)—wasn’t approved by the FAA.

Vilella managed as best he could until 2008 when he made the decision to take the drug without reporting it. In 2010, the FAA announced it would allow certain SSRIs, including Lexapro, but he continued to operate “under the radar,” flying for another seven years without issue.

“The medication helps you reach a point where you can begin to deal with the concerns you have,” Vilella said. However, the patient must also apply coping tools and exercises the therapist prescribes. “Taking the drug, by itself, isn’t enough. You also have to be willing to do the work,” he observed.

Everything was going well until 2015 when Vilella confronted his next health challenge, a diagnosis of cranial nerve palsy. Nerves from the cranium lead directly from the brain to parts of the head, face, and torso and can cause weakness or even paralysis in the areas served by the affected nerve or nerves. As a result, Vilella was grounded.

Further complicating his condition, he had gained nearly 30 pounds, a side effect of using Lexapro, and his blood pressure was high. Once he recovered from his cranial nerve palsy, Vilella returned to work but decided to stop taking the SSRI. Not surprisingly, he began experiencing anxiety attacks again. “Hiding was also a big source of stress for me,” he said.

Reaching a breaking point, Vilella contacted his pilot group’s Pilot Assistance Team Hotline (PATH), the pilot peer support program available for all FedEx pilots seeking physiological, psychological, or medical assistance. “I then decided to do the right thing and reveal my condition,” Vilella acknowledged.

With the help of his fellow pilots and the many resources ALPA provides, including PATH, the Aeromedical Office, and the Association’s Representation Department, the FAA approved Vilella to fly again. In 2020, after nearly three and a half years had passed, he got his license back and secured a special-issuance medical certificate.

However, FedEx Express fired Vilella because he hadn’t been open or truthful about his circumstances. It took approximately 19 months before he returned to work as ALPA and the company were unable to come to a consensus and the case went to arbitration. The arbitrator assigned to the case acknowledged Vilella had made a mistake, but that he had done the right thing in coming forward. The arbitrator subsequently ordered Vilella’s reinstatement.

He returned to FedEx in September 2021 and has since been serving as an ALPA Air Safety Organization Aeromedical Committee member and a mental-health subject-matter expert. He now consults with other pilots, sharing his experiences and helping them deal with the various challenges they face.

“None of this would have happened without ALPA’s help,” he observed, adding that he’s eternally grateful to the union. Having a confidential peer program available that let him feel comfortable talking about his concerns was a major factor. “All things considered, life is good,” Vilella remarked.

This article was originally published in the May 2024 issue of Air Line Pilot.

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