Federal Air Surgeon Discusses Flying and Pilot Mental Wellness Policies
By ALPA Staff
Dr. Susan Northrup, the FAA federal air surgeon, leads the strategic management of the agency’s aviation medical programs. Her responsibilities include overseeing the pilot medical certification process, its application in medical decision-making, the medical appeals process, and oversight of the aviation industry drug- and alcohol-testing programs. Air Line Pilot recently spoke with Northrup about these policies as they relate to airline pilot mental wellness concerns.
Air Line Pilot: If a pilot has some difficult issues to deal with that make handling life stresses a challenge, what avenues of treatment do you recommend?
Dr. Susan Northrup: A pilot has several avenues to obtain assistance. In addition to their own medical providers and family members, peer support networks, employee assistance programs, and mental health professionals are available. Lay groups associated with many mental health conditions can also be helpful. Regardless, asking for help early is important in helping to develop the skills necessary to handle the stressors in a positive way.
If a pilot chose to speak with a peer support volunteer, should they report this to the FAA?
Northrup: There’s no need to report peer support volunteer interactions. Visits to professional mental health providers (other than family and marital counseling) should be reported, especially if a diagnosis is made or a treatment is initiated.
If a pilot has chosen to get therapy from a counselor for a marriage issue, do they need to report this?
Northrup: Only if a diagnosis is made or the therapy trends away from marriage issues.
Counseling has been helping their marriage, so a pilot decides to go see a professional therapist to discuss some other issues they’ve been struggling with for years. Is this reportable, and, if so, how should the pilot acknowledge it so that they don’t jeopardize their medical?
Northrup: The pilot should report counseling when a diagnosis is made. Pilots should be aware 14 CFR 61.53 still applies. It depends on what type of assistance they get and if there was a diagnosis made. With respect to “Visits to Health Professional Within Last 3 Years” (Form 8500 19.B on a pilot’s medical application), list all visits in the last three years to a physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for treatment, examination, or medical/mental evaluation. List visits for counseling only if related to a personal substance abuse or psychiatric condition. Give the date, name, address, and type of health professional consulted and briefly state the reason for the consultation. Multiple visits to one health professional for the same condition may be aggregated on one line. Routine dental, eye, and FAA periodic medical examinations and consultations with your employer-sponsored employee assistance program may be excluded unless the consultations were for substance abuse or the consultations resulted in referral for psychiatric evaluation or treatment.
If a pilot needs to take medications for depression, what advice would you give?
Northrup: Pilots should review the Guide for Aviation Medical Examiners sections on mental health with their treating providers. It’s important for all parties involved to understand the requirements for selective serotonin reuptake inhibitors (SSRIs), i.e., antidepressant medication, early in the process. The pilot should also engage with a HIMS [Human Intervention Motivation Study] aviation medical examiner [AME]. Some companies and unions have medical specialists who can assist with the process.
Be sure to keep track of all your records and be ready to assist the AME or pilot advocate in collecting collect your documents. Then be patient. The first special authorization can take some time, but subsequent renewals move much more quickly. In fact, your AME can do the recertification in most cases if you bring them the required documentation and it meets specific criteria. We recently simplified the process by removing the requirement for neurocognitive testing for renewals unless there are clinical indications.
Preventive mental health for pilots is very important to the industry. Routine health visits aren’t reportable on FAA Form 8500. Will visits for preventive mental health ever be treated the same as preventive health visits?
Northrup: This is an evolving issue. Again, it depends on whether a diagnosis is made. Use of online therapy is expanding because it’s readily accessible, private, flexible, and may be more affordable. Some services are essentially talk therapy or a “life coach” and may be very useful to address life stressors and to get an objective opinion. Pastoral care may also be a very effective. Use of these services would ideally include an upfront discussion of when the individual should be referred for traditional professional care.
If a pilot and their doctor think the best path forward is taking medication for mental health (such as an SSRI), what documents and tests are necessary for an initial certification for a special-issuance medical? Once the FAA has the paperwork, who reviews the documents and how long does this take (assuming all necessary information is in the original packet)?
Northrup: Visit the FAA’s website. Start with the “Airman Information–SSRI Initial Certification” page. It describes what steps to take and includes links to documents you may need. A complete list of items to bring to your AME can be found on the HIMS AME Checklist–SSRI INITIAL Certification/Clearance.
Once the FAA receives the paperwork, the Aerospace Medical Certification Division will review the package for completeness and forward it to the Office of Aerospace Medicine for review by the Behavioral Health Division. This can take several months, but we’ve added additional staff to speed up the process.
Two tips: First, make sure you have all of the items listed on the HIMS AME Checklist–SSRI INITIAL Certification/Clearance to give to your AME.
Second, if you haven’t yet received a special-issuance authorization, continue to submit your chief pilot or air traffic manager reports every three months and your HIMS AME evaluations and treating psychiatrist reports every six months. This will ensure that the FAA has the most current information and will decrease wait time. If we don’t have current information when we review your case, we’ll have to request it, which will slow down your certification review.
Many pilots we talk to still have no idea that for more than 10 years now they’ve been allowed to fly on medications for mental health. What’s the FAA doing to help promote and advertise options that are available for pilots with respect to mental health wellness?
Northrup: It’s critical that we dispel the myth that you’ll never fly again if you’re diagnosed with a mental health condition. Most pilots will return to the air once their condition is treated. However, failing to address the issue early can lead to a worsening condition. Significant cases are more difficult to resolve, but mild and moderate depression and anxiety or PTSD are relatively easy.
To help provide up-to-date and accurate information, the FAA updated the Guide for Aviation Medical Examiners with additional checklists and guidance. We’ve also recently released worksheets for AMEs and pilots on situational depression and PTSD. If a pilot meets the requirements, the AME can issue a certificate.
Additionally, FAA staff regularly engage in educational outreach and has participated in many mental health forums for pilot advocacy groups, unions, and industry as well as podcasts and articles. The message has been conveyed internationally through the International Civil Aviation Organization and several other organizations. A Pilot Minute on Mental Health was released in May 2022 during Mental Health Awareness Month, and another one is in production for this year.
Currently, there are only four SSRI medications that pilots are allowed to take and exercise their first-class medical privileges. Where does the FAA stand on expanding the list of SSRI medications for pilots to use newer generations of medications? If there’s research under way for the approval of different medications, what does the timeline for approval and implementation of this look like?
Northrup: We’re reviewing the current antidepressant medications and hope to add more to the list in the near future. Remember, anyone who switches medications or changes the dose must remain grounded while their doctor confirms that the new medication or dose is effective.
Pilot Well-Being
ALPA’s Air Safety Organization Pilot Assistance Aeromedical Committee greatly appreciates FAA Federal Air Surgeon Susan Northrup’s efforts to clarify the agency’s position and dispel the myth that airline pilots will permanently lose their medical certification when confronting and resolving mental health issues. As a reminder, the Association offers a variety of programs through Pilot Assistance—including Pilot Peer Support—to address member health and wellness concerns.
