Mental health in aviation: Pilots are suffering in silence, afraid to get wings clipped

Struggling, frustrated and afraid. 

There's concern about a trend today in the aviation industry: Some pilots are participating in health care avoidance behavior, particularly when it comes to mental health care.

One retired airline pilot with three decades of experience told Fox News, "It is really difficult to reach out for help." 

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In one of the most high-stress jobs in which pilots are often overworked, Capt. Reyné O’Shaughnessy told Fox News, "They’re struggling with chronic stress, anxiety, depression, use and abuse of alcohol — and in some cases, drugs."

A study on this topic was published in 2019 in the Journal of Occupational and Environmental Medicine (JOEM). 

A simple question was asked: Have you ever felt worried about seeking medical care because it may impact your career? 

Nearly 78.6% of responding pilots answered "yes."

In an even more recent study focused on military pilots and funded by the U.S. Air Force, a similar question was presented. 

Results from the 2023 study revealed that 72% of military pilots admit to participating in health care avoidance behavior over a fear of losing their wings.

Capt. O'Shaughnessy, based in the greater Pittsburgh area, said that while pilots are not encouraged to lie to their Aviation Medical Examiners (known as AMEs), she said pilots "guard the information that is so close to us, in fear that we may lose our livelihood." 

An AME is the person who evaluates and ultimately medically certifies a pilot to fly for the Federal Aviation Administration.

One AME for the FAA, Dr. William Hoffman, told Fox News that the process for pilots to get their aeromedical certificate once it is suspended can be time-consuming and expensive. 

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Without the certificate, pilots cannot fly. 

"It could take months to years, depending on how complicated their history is," he said. "During that time, the airmen can’t fly."

"So, for airline pilots, that can result in negative occupational, social and financial repercussions."

Being a pilot is a high-stress job in which anything can happen. 

Recently, a plane engine caught fire after hitting a flock of geese minutes after takeoff in Ohio. What happened is proof that anything can happen — and it shows the reality of the weight pilots carry every day. 

They have the responsibility of the lives of everyone onboard.

Facing barriers to their mental health care only adds to an already stressful lifestyle.

In a 2022 study conducted at the University of North Dakota and published in the Journal of Occupation and Environmental Medicine, Dr. Hoffman led research on the issue (he is also a faculty member). 

The results were staggering: Some 56.1% of pilots reported a history of health care avoidance behavior, while 45.7% admitted seeking informal medical care. 

Capt. O'Shaughnessy provided context on the latter statistic, saying that pilots "go underground, and they self-medicate, or they don’t medicate at all. And that is the conundrum, because regulation does nothing more than drive pilots underground."

Both Dr. Hoffman and O'Shaughnessy said the FAA does deserve credit. 

"I do believe that they are trying to make strides in changing the regulations. Now, I think the real issue is how fast," O'Shaughnessy said.

In a statement to Fox News, the FAA said that it "encourages pilots to seek help if they have a mental-health condition since most, if treated, do not disqualify a pilot from flying." 

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It said the concern does not focus on pilots simply seeking help for mental health, but rather on certain medications that could possibly be prescribed to treat anxiety or depression. 

The FAA said if certain medications are used, or conditions go untreated, that is the factor that could disqualify a pilot from flying.

Still another part of the problem, according to Dr. Hoffman, is misinformation. 

He said, "Pilots are really frustrated. There is a lot of misinformation going around about mental health in aviation. Many pilots don’t know that you can see a therapist and still fly."

In recent years, the FAA has made changes, including the creation in 2016 of the Pilot Fitness Aviation Rulemaking Committee, known as ARC.

It was created to evaluate pilot mental health after the German Wings 9525 incident, in which a co-pilot intentionally crashed a passenger plane into the French Alps, killing all 150 people onboard. 

The co-pilot had been treated for suicidal tendencies but hid the information from his employer. 

Dr. Hoffman said research is still limited, so it’s important to conduct more and find out how to better improve mental health in the aviation industry. 

"If there was an easy solution, we would have already identified it," he said.

It’s not just the FAA or even the pilots who need to help find a solution. 

Said Dr. Hoffman, "All stakeholders stand to gain by working on health care avoidance. For pilots, this is about getting the health care that they need. For airlines and companies, this is about cost savings and maintaining aviation safety. And for regulators, this is about ensuring that the aerospace system is safe."

Meanwhile, Capt. O'Shaughnessy said there needs to be a holistic way to train pilots in the future. 

"We need to look at aviation differently. We need to train differently. We need to, because if we do that, not only will our passengers be safe, not only will our pilots be safe, but our skies will be safe," said O'Shaughnessy. 

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It’s the reason she now dedicates her time to educating pilots on how to navigate aviation regulation. 

She is founder of Piloting to Wellbeing, an organization that provides mentoring and coaching.

She is also the author of the book, "This Is Your Captain Speaking: What You Should Know About Your Pilot’s Mental Health."

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If pilots need help, either with their mental health or physical health, they are encouraged to see their health care provider, experts say.