A new report urges the Federal Aviation Administration to tweak how it addresses mental health issues among pilots and air traffic controllers, saying the current scheme can discourage workers from disclosing such problems.

But other factors – including cultural stigmas, job-culture expectations and broad misconceptions about how the FAA responds to mental health issues – also discourage full transparency, adds the report, released on 1 April by the FAA.

“Recent events have heightened awareness throughout society of the risk of untreated mental health concerns of aviation safety professionals,” it says. “The aviation industry has been calling for a major change in how the FAA manages pilot/controller mental health conditions.”

Among the most notable of the report‘s 24 recommendations: it urges the FAA to no longer require pilots to disclose having received talk therapy – known as psychotherapy.

“It is indisputable that the requirement to disclose talk therapy leads to healthcare avoidance and/or nondisclosure,” says the report. “This alone should be sufficient to support a change in FAA policy.”

cockpit-c-Unsplash Blake Guidry

Source: Unsplash/Blake Guidry

It urges the FAA not to require comprehensive neuropsychological screenings of all pilots taking mental health medications (the FAA is the only civilian aviation authority to do so), and suggests the FAA consider allowing pilots take medications for attention deficit hyperactivity disorder.

The report also says the FAA should create a system for pilots to report, without reprisal, previously undisclosed mental health issues, and urges airlines and unions to establish more peer-support groups.

“Breaking down these barriers will then reduce the risk that an untreated pilot/controller enters or remains in the workforce without needed mental health care”, it says.

The FAA says it “will determine next steps after reviewing the recommendations”.

The report comes from an FAA-commissioned committee of representatives from the National Transportation Safety Board, US aviation trade groups, labour unions, academia and the FAA. The agency tasked the panel with studying factors that dissuade pilots and air-traffic controllers from reporting and being treated for mental health issues.

The effort is part of a broader push to tweak mental health oversight following two high-profile accidents: the 2014 disappearance of a Malaysia Airlines Boeing 777 and the 2015 crash of a Germanwings Airbus A320. Investigators say the Germanwings co-pilot deliberately crashed that jet, and some experts think a pilot deliberately crashed the Malaysia jet.

“Pilots/controllers often worry that disclosing mental health concerns will jeopardise their careers or stunt career growth… or damage to their standing within the industry,” the report says.

Under the current system, the FAA’s Office of Aerospace Medicine approves, defers or denies medical certificates. It initially disqualifies about 20% of applicants who report mental health diagnoses. But such denials are not final; pilots can be approved after completing more-comprehensive reviews.

The FAA ultimately denies medical certificates to only 0.1% of applicants who disclose any health issue and complete full reviews, the report says. “Much of the distrust is fuelled by a lack of information or misinformation about FAA policies and processes.”

“The culture of the professional aviator and controller has evolved over multiple generations to be one of strength, resilience and decisiveness,” it adds. “But multiple generations of pilots/controllers have also encouraged fire-walling of information, perpetuating a culture of healthcare avoidance for new aviators.”

The US health care system also poses problems, as many health insurers cover only diagnosed illnesses, as specified by codes on patient bills. As a result, doctors sometimes “upcode” – meaning diagnose patients with illnesses they do not have. In practice, this means pilots who, for instance, receive grief counselling, might find inaccurate mental-health diagnoses on their bills.