Summary of "Why Pilots Don't Get Therapy" – Radio Atlantic Episode

Release Date: May 29, 2025

Introduction

In the episode titled "Why Pilots Don't Get Therapy", hosted by Hanna Rosen, Radio Atlantic delves into the intricate and often perilous relationship between pilots' mental health and aviation safety. While high-profile aviation accidents frequently make headlines, a less visible but equally critical issue persists: the mental well-being of pilots and the stringent regulations that may discourage them from seeking necessary psychological support.

The Hidden Struggle: Pilot Mental Health

Hanna Rosen opens the discussion by highlighting that beyond the dramatic plane crashes, pilots face a silent crisis concerning their mental health. The episode centers around Chris Finlayson, a first officer with over a decade of experience, who grapples with anxiety and long Covid symptoms. Finlayson shares his personal journey:

[02:43] Chris Finlayson: "I got a really bad bout of long Covid memory loss, brain fog, fatigue. That really tanked my serotonin that all of a sudden triggered every anxiety I possibly had. December 19, 2021 was my last flight."

Despite his attempts to manage his anxiety through medication, Finlayson fears that seeking mental health care could jeopardize his career, illustrating the profound personal and professional stakes involved.

FAA's Mental Health Protocols

The Federal Aviation Administration (FAA) plays a pivotal role in regulating pilots' fitness to fly, particularly concerning mental health. Thomas Jetser, an FAA medical consultant, explains the agency's approach:

[05:21] Thomas Jetser: "Some of these pilots I've seen for 35, 40 years, every six months for that long."

Jetser likens the FAA's periodic medical evaluations to routine processes in other high-responsibility fields, emphasizing the intent to maintain safety without being overly punitive. However, the stringent requirements often translate into significant barriers for pilots seeking help.

Tragic Consequences of Rigorous Regulations

The episode recounts two harrowing incidents that underscore the dire consequences of the current system:

1. John Hauser's Suicide ([08:22] - [08:47]): A 19-year-old aviation student who felt unable to seek help due to fears of losing his medical certification, ultimately leading to his tragic death.

2. Joseph Emerson's Incident ([09:35] - [10:22]): An off-duty Alaska Airlines pilot who attempted to sabotage a flight by trying to shut down the engines, citing depression as his motive.

These cases illustrate how the fear of professional repercussions can drive pilots to extreme measures rather than seeking the support they need.

Barriers to Seeking Mental Health Care

Research conducted by William Hoffman, a neurologist and aviation medical researcher, reveals that 56% of pilots have avoided seeking mental health care to protect their flying status:

[11:47] Hanna Rosen: "So that's over half of pilots avoiding care, which is a lot."

Finlayson's experience epitomizes the arduous journey pilots must undertake to seek help, often involving expensive and time-consuming processes with uncertain outcomes. The financial strain is exacerbated by the lack of insurance coverage for necessary evaluations and the potential loss of income during the grounding period.

The Application Process and Its Challenges

Finlayson's attempt to secure a special medical certificate exemplifies the bureaucratic hurdles pilots face:

• Medication Management: Finlayson hoped to stabilize his condition without long-term medication but found that persistence led him to a higher dosage, which improved his mental state but complicated his certification process.

• Extensive Testing and Paperwork: The FAA requires comprehensive medical evaluations, including neuropsychological assessments and personality screenings, costing pilots upwards of $10,000 with no assurance of approval.

• Repeated Denials: With over 75% of applications denied due to minor discrepancies, pilots like Finlayson must repeatedly navigate the cumbersome process, often without success.

[27:56] Chris Finlayson: "That's probably the most frustrating thing for me right now is the fact that, like, I kind of got hosed and now there's no recourse other than to start it all over."

Impact on Passenger Safety and System Efficacy

While the FAA's regulations aim to enhance passenger safety by ensuring pilots are mentally fit, the episode questions the efficacy of the system:

[22:15] William Hoffman: "Right now, there is this simple model that using services, mental health services, or having a diagnosis is a marker for risk. But remarkably, that is never been systematically studied in research. That's a complete assumption."

Hoffman emphasizes the lack of empirical evidence supporting the assumption that mental health treatment directly correlates with increased safety risks, suggesting that the current model may be more restrictive than necessary.

Reform Efforts and Recommendations

In response to these challenges, a panel of experts, including Hoffman, presented 24 recommendations to the FAA in April 2024 aimed at lowering barriers to mental health access for pilots. Some key changes implemented include:

• Expansion of Approved Medications ([24:15] - [24:34]): Increasing the list of conditionally approved drugs, allowing pilots more flexibility in managing their conditions.

• Streamlined Testing Requirements: Reducing the number of mandatory tests for certain medications to expedite the certification process.

• Peer Support Services ([25:18] - [26:33]): Introducing peer support mechanisms where pilots can discuss sensitive issues without formal disclosures, acting as a bridge to professional help.

[25:18] William Hoffman: "One of the key recommendations was requiring that pilots have access to peer support services."

Despite these efforts, significant barriers remain, particularly regarding the financial and emotional toll of the application process and the skepticism surrounding the necessity of stringent mental health evaluations.

Conclusion and Future Outlook

The episode concludes by highlighting that as of April 2024, the FAA has approved approximately 2,800 special issuance certificates for mental health, with an ongoing increase. However, the system's inherent delays and high denial rates suggest that many pilots may continue to avoid seeking help, perpetuating the cycle of unaddressed mental health issues and potential safety risks.

Finlayson's story serves as a poignant reminder of the human cost behind regulatory frameworks and underscores the urgent need for balanced approaches that prioritize both pilot well-being and passenger safety.

Notable Quotes:

• Chris Finlayson ([02:43]): "December 19, 2021 was my last flight."

• Hanna Rosen ([11:47]): "So that's over half of pilots avoiding care, which is a lot."

• William Hoffman ([22:15]): "That's a complete assumption."

• Chris Finlayson ([27:56]): "I kind of got hosed and now there's no recourse other than to start it all over."

This comprehensive examination sheds light on the complex interplay between mental health and professional responsibilities in aviation, advocating for reforms that support pilots without compromising safety.