If pilots have been diagnosed with one of the FAA’s 15 disqualifying medical conditions, or have a history of another psychiatric condition like a personality disorder or attention deficit disorder requiring medication, they may be denied a medical certificate that allows them to fly. In some cases, however, the FAA may grant a “special-issuance authorization” (SIA) when a pilot has passed required medical testing and been deemed “low-risk.”
The use of antidepressants is considered a disqualifying condition, though the FAA currently allows SIAs for pilots taking one of four approved medications for the treatment of depression and mood disorders. Federal aviation regulations require pilots taking these antidepressants to notify their employer, report to a specially trained aviation medical examiner, and remain grounded until they have spent six months on a stable dosage without side effects. After that time, reports must be filed by the treating physician, the pilot, and a specially trained aviation medical examiner, and the pilot must undergo neurocognitive psychological tests. Once the paperwork is done, the pilot is issued a medical waiver and must follow up with a psychiatrist every six months to maintain it.
Men and women who love to fly may understandably be disinclined to self-report when doing so would keep them from flying for at least six months, if not indefinitely. It’s an imperfect system, one that depends on the pilots to seek out the help they need.
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Antidepressants are one of the most prescribed medications in the U.S. According to the New York Times, one in 10 Americans is on one. For the vast majority of people who are managing mental-health conditions, those conditions should not affect their job status. Stigma still exists in the work place, though, and disclosing a condition could lead to judgment. A paper in Occupational Medicine found that employers may unfairly micro-manage the employee, or attribute mistakes to the condition.
Careers in medicine, law, and aviation, however, involve a contract of trust with the public. People depend on their skills, and the expectation is that they will be completely honest with themselves, and the authorities who govern them, about anything that could affect their ability to do their jobs, which could potentially include mental conditions.
The Germanwings case is an anomaly. There’s always a great deal of talk about the need for better mental-health interventions when tragedies happen, but the vast majority of people dealing with mental-health conditions are nonviolent. Whether people are dealing with their condition successfully becomes a private matter between them, their family, and doctors. It’s also important to note the conclusions drawn by the Treatment Advocacy Center, a non-profit focused on mental health, from the results of many studies of the mentally ill: “Most acts of violence committed by individuals with serious mental illness are carried out when they are not being treated.” This underscores the importance of allowing and encouraging people to seek and receive treatment.
Licensing boards and employers in highly skilled fields are balancing a difficult but necessary weight: Creating rules that protect the public, while providing an environment in which employees are confident they can get the help they need, without penalty. In professions strict about licensing, attempts to make sure people are mentally fit could currently be discouraging some from coming forward, keeping them from the help they need.