On mental health, pilots call for support not suspicion

Strict monitoring of psychological conditions is meant to protect passengers, but some aviators say it stops them seeking help

When pilot Chris Finlayson contracted Covid in late 2021, brain fog and memory lapses left him unfit to fly. The disorientation soon gave way to panic attacks and depression. Months later, still grounded by his US airline, he sought help from a doctor.

Antidepressants and talking therapy meant he “stabilised” and “became the healthiest I had ever been”, he says. But regaining his aviation medical certificate proved harder.

The Federal Aviation Administration (FAA) denied Finlayson clearance in 2023, despite him being on consistent medication. The FAA had accessed his therapy notes — permissible under the US regulator’s rules — and his comments about cutting back on alcohol and marital difficulties were interpreted as red flags. “They thought I might have a substance abuse issue and obsessive compulsive disorder,” he says.

The safe space of therapy began to feel like a trap, Finlayson recalls; a means of gathering evidence against him rather than a route back to the cockpit.

His case is not unusual. Commercial airline pilots face more rigorous mental health checks and disclosure requirements than doctors. Those who reveal conditions such as depression and anxiety to the FAA are temporarily grounded and subject to psychiatric assessments, extensive paperwork, lengthy waiting periods and monitoring that can continue long after they are stable and back in the air.

Regulators insist the system is necessary for public safety, and the FAA says it “encourages pilots to seek help if they have a mental-health condition since most, if treated, do not disqualify someone from flying”. It adds that only 0.1 per cent of medical certificate applicants who disclose health issues are denied.

However, pilots and industry experts argue the fear of losing their licence, prolonged suspensions and the broader burden around disclosure, especially of mild or treatable conditions, results in a culture of silence.

Such problems are difficult to quantify, but there are telling indicators. In one study of more than 5,000 pilots in the US and Canada, more than half “reported a history of healthcare avoidance”, which researchers concluded was due to “fear of loss of flying status”.

An anonymous French study of 1,220 airline pilots in 2022 found 25 per cent reported anxiety, 13 per cent showed signs of depression and more than 40 per cent indications of alcohol misuse. Relatively high levels of mental ill health among pilots have been documented in other research, yet according to the latest FAA data just under 1,600 US pilots were flying on approved antidepressants in 2022 — in a workforce of nearly 500,000.

Finlayson believes many pilots put on a brave face so they are “always seen as the calm, cool, collected person at the front of the aeroplane, because that’s what everybody wants us to be”.

While crashes linked to pilot mental health are extremely rare, tragic events such as the 2015 Germanwings disaster have attracted attention. Then, co-pilot Andreas Lubitz, who had a history of severe depression and suicidal ideation, deliberately crashed a plane into the French Alps, killing all 150 people on board. He had been declared unfit to fly by doctors but hid his condition from his employer; investigations by regulators uncovered dangerous gaps in protocol, particularly around disclosure.

After June’s Air India crash killed 241 individuals on board, questions were raised over intentional sabotage by one of the pilots after a preliminary report noted fuel cut-off switches were flipped moments after take-off. Indian authorities have been cautious about links to mental health but the question lingers.

There are also near-misses, including the case of Joseph Emerson. His career came to a halt in October 2023 when, flying as an off-duty Alaska Airlines pilot authorised to ride in the cockpit of a passenger flight, he attempted to shut off the engines of the plane.

Grieving the death of his best friend, he tells the FT, he had been drinking more than normal as a “coping mechanism” and was hallucinating after ingesting the psychedelic psilocybin days before. “I was feeling a sense that this isn’t real . . . In my disassociated state I took action,” he says. “My mind was so screwed up. I wanted to wake up.”

According to the criminal complaint against him, he was restrained after attempting to pull handles that would have cut off fuel to the plane’s engines. He has now been indicted on 83 counts of recklessly endangering passengers, one count of endangering the aircraft, plus a federal charge of interfering with a flight crew. His legal team are currently negotiating settlements.

The incident, Emerson says, “had a significant impact on my life”. He says he is now an alcoholic, although alcohol never previously had an impact on his work. Through his non-profit, Clear Skies Ahead, he now campaigns for a culture of wellness within aviation — including advocating for a more transparent approach to disclosure. “The idea that I had to be perfect on paper influenced my desire to not interact with healthcare providers and get proper treatment.”

Robert Bor, clinical lead at the Centre for Aviation Psychology, says: “The average pilot, like the broader population, will have ups and downs and life challenges. If you don’t address challenges at an earlier stage, this has a way of developing to a point where it leads to diminished focus and attention and that compromises safety.”

In the UK, once a pilot declares a mental health issue, the Civil Aviation Authority (CAA) typically suspends their certificate temporarily. After treatment and full recovery, a pilot may be allowed to return to the air. But only a few medications are accepted, and returning pilots remain under regular review and are often subject to conditions, such as flying with a co-pilot.

Between April 2022 and March 2024, approximately 48,000 Class 1 medical exams — required for commercial pilots — were conducted in the UK. About 700 cases involved a mental health declaration or diagnosis. In each case, the pilot’s certificate was suspended, at least temporarily, according to the CAA.

“There is always the difficult balance to strike — protecting public safety but also pilots need to feel supported rather than under the microscope,” says Andreas Schenk, a consultant psychiatrist with specialist experience in aviation. “We suspect that a lot of people aren’t disclosing, particularly for mild symptoms of depression. If you look at its disclosure among pilots, it is lower than the general population.”

In recent years, reforms have started to shift emphasis from surveillance to support. The US’s FAA has widened the pool of antidepressants available to pilots and has tried to reduce the number of medical evaluations required to fly once on medication, as part of efforts to ease mental health barriers.

Some regulators, such as the EU Aviation Safety Agency, now mandate confidential peer support programmes where trained pilots offer psychological support to colleagues. These are increasingly seen as a trusted alternative to formal reporting, resolving issues before they escalate.

Airlines are also experimenting with enhanced mental health screenings and easier access to therapy. Virgin Atlantic, for example, offers pilots confidential counselling and training on how to ward against poor mental health.

But despite this progress, pilots who speak up still face obstacles. Grounding does not just end flying careers, it can isolate individuals socially and have a detrimental financial impact.

“We’ve given so little thought to how people cope with grounding,” adds Bor. “Many new pilots are remote, they share accommodation, and lack support once they go home. Regaining a licence might require self-funding treatment, waiting for care, getting the right reports to regulators . . . It can cost hundreds or thousands of pounds to get a mental health specialist to sign you off.”

Finlayson, now director of the US-based Pilot Mental Health Campaign, is fortunate. Thanks to his seniority and benefits from his former airline, he lives comfortably on long-term disability payments. But he warns that younger or less established pilots face a different reality. “For someone at the start of their career, a disclosure like mine could ruin them.”

This story originally appeared on Financial Times.