President’s Corner December 2021

Keeping Your Mind Fit for Duty and for Family

When COVID-19 was being declared as a global pandemic early in 2020, this column addressed the uncertainties and fears that existed and were associated with the virus and the possible impact it would have on our lives. A subsequent article one year ago addressed some of the mental health impacts on pilots who were seeing a collapse of the commercial passenger aviation industry, a skyrocketing demand in the cargo aviation industry and severe social and travel restrictions. This was in the vaccine testing and pre-approval era. The article highlighted several strategies to preserve mental wellness and address personal needs. At that time, I did not anticipate writing more about the mental health toll one year later, ignorantly and blissfully thinking our world would be back to business as usual by now.

Vaccines for SARS-CoV-2 have had a positive impact on the trajectory of this potentially serious and deadly disease. However, the evolution of the virus, the presence of variants and breakout of infections, scientific and political overtones of public health strategies, federal airline/airport masking mandates, the state and city public health orders and employer vaccine mandates among many other factors, have led to continuing anxiety, fear, frustration, and anger among all elements of society.

As of this writing, we have families grieving over the staggering three-quarters of a million COVID deaths in the U.S. and over five million deaths worldwide. Many others are faced with persistent COVID symptoms or sequelae of the infection. This takes both a physical and mental toll on the victims and their loved ones as well as those struggling in critical industries. Aviation is no exception.

We all face challenges and stressors of varying degrees at different points in our lives. Most of the time, we are able to face these challenges and move on. As pilots, our personalities of being strong, confident, independent problem solvers serve us very well in the cockpit. Unfortunately, these same traits make us less able to recognize or admit when we are struggling. Even worse, we loathe to reach out for help as this could be perceived as weakness. Also, the fear of adverse consequences at our job or on our FAA medical certification keeps us from seeking professional help, even in our times of greatest need.

Fortunately, there are numerous tools pilots have to move towards the healthy end of the mental wellness spectrum. We are always moving across the mental wellness spectrum, from day-to-day and even from hour-to-hour. Not being mentally well does not necessarily mean someone is mentally ill any more than the absence of disease makes one mentally healthy. Our goal should be to use those mental wellness tools to help sustain us on the positive end of the spectrum.

Some strategies are simply common-sense behaviors that our mothers taught us. Science has demonstrated the wisdom of these behaviors in preserving mental wellness. Obtaining adequate sleep (7+ hours a night) and routine exercise, especially if it is outdoors, has repeatedly been shown to improve depressive symptoms and mood. A healthy diet and avoiding excess alcohol and other drugs also improve mood and function. Exposure to bright and/or outdoor light improves mood, especially in times of long nights and short days. These are easy strategies to adopt individually.

A growing body of evidence supports the positive impact of self-awareness practices. This could be mindfulness, meditation, spirituality, prayer, or other practices that lead to self-reflections. I say “practice” because none of these behaviors are something to be implemented immediately when a crisis arises. Rather, they require regular training and practice on a near daily basis with increasing skills. This is similar to strength building in a gym. You don’t suddenly have the capability to lift a very heavy load but build to this ability over time with regular practice. Mental wellness is similar.

The next strategy for personal involvement and agency in mental wellness involves communications with others, which can be positive or disruptive. Social media and virtual communications can fall into either category, but we can decide to involve ourselves with that which solidifies serenity and avoid or disconnect from that which causes us anger, frustration, and resentments. Contact with loved family members and trusted friends, either virtually or in-person can have a strong positive effect.

In aviation, we have an obligation to conduct a self-assessment of our fitness for duty before every flight. We are all familiar with the FAA’s “I’M SAFE” checklist: Illness, Medication, Stress, Alcohol, Fatigue and Eating/Hydration (formerly known as Emotions, but that is covered in Stress). But how many of us actually run this checklist on ourselves before every flight? We religiously run the aircraft checklist and often verify it with a fellow crewmember. Why don’t we do this on ourselves as pilots as we are the most likely element of the aviation safety chain to fail? We may not fail catastrophically like an engine or a pump, but more dangerously, we can fail in subtle ways that make us unaware of our safety compromising condition. Just as with fatigue, we are our own worst judge of our level of impairment. We should run this checklist honestly and use another person to validate our own self-assessments before every flight.

For those fortunate enough to be part of a larger aviation organization, a formal Pilot Peer Support Program (PPSP) is extremely effective. For about 80% of the stressors facing us in our lives that look to outside help to address, peer support programs can help resolve the problem. There are years of evidence of the success of these programs. Nearly every airline in the U.S. and Canada has a PPSP in place. These programs are so effective that after the Germanwings murder-suicide, the European Union Aviation Safety Agency (EASA) made them mandatory for all carriers in the EU. The FAA’s Aviation Rulemaking Committee on Fitness for Duty endorsed PPSPs as an effective strategy to enhance mental health and safety in aviation. Peer contacts are not reportable on FAA medical applications so there should be no barrier to asking for help. If formal peer support programs are not available, just talking with another pilot or hangar flying can be a great benefit.

For those who are facing problems that exceed the scope of a peer’s training and capabilities, help from aviation savvy mental health providers can be invaluable. Rather than let a situation spiral out of control, seeking help early can return a pilot to wellness quickly before more serious personal or safety consequences occur. Visits for family or marital counselling are not reportable on an FAA medical application. Even visits that are reportable usually would not ground a pilot. If the pilot still can function safely in a social and occupational role and doesn’t need medication, they generally can continue to fly and simply bring a report from the counselor at the time of the pilot’s next FAA medical exam. Having a good relationship with the AME is most helpful to continue flying while receiving professional support.

There are rare situations where the magnitude of a pilot’s mental health challenges are overwhelming and the pilot should not fly until they are improved. Medications for short-term mental health problems are generally disqualifying for the duration of use of the medication plus an observation period after discontinuing the medication, although counselling can continue.

When asked by a pilot if I think they should fly with the problems they describe to me, my response is to ask them to make an honest self-assessment. If they would not put their family on a single pilot aircraft flown by a pilot with the status they just described, they should temporarily remove themselves from a flying status. If their thoughts about their mental health challenges continually intrude while flying, they should not fly. They definitely should not self-medicate with alcohol or other medications and/or drugs to solve the issues. The good news is that most pilots are very good at compartmentalizing their non-flying from their flying emotions and can safely fly despite the everyday stressors we all experience.

The keys are to be proactive about your mental wellness, conduct an honest self-assessment, communicate concerns early and reach out for help early, if needed. Protecting your own mental health as well as your family and loved ones, and being a safe, effective pilot is best for us personally and professionally. We owe it to ourselves, our loved ones, and the aviation community.

Should you have any questions about mental health issues, please contact our aerospace medicine physicians or your AME.

Be well and fly safely,