Pilot's 'breakdown' is a reminder: Many fear seeking mental health help, advocates say

CORRECTS SPELLING OF FIRST NAME TO PETE, NOT PET - American Airlines pilot captain Pete Gamble, left, and first officer John Konstanzer conduct a pre-flight check in the cockpit of a Boeing 737 Max jet before taking off from Dallas Fort Worth airport in Grapevine, Texas, Wednesday, Dec. 2, 2020. American Airlines took its long-grounded Boeing 737 Max jets out of storage, updating key flight-control software, and flying the planes in preparation for the first flights with paying passengers later this month. (AP Photo/LM Otero)
Pilots in the cockpit of a Boeing 737 Max jet. (LM Otero / Associated Press)

After an off-duty pilot who said he had struggled with depression for months tried to shut off fuel to a plane's engines midair, industry advocates are drawing renewed attention to the difficulties pilots face dealing with mental health issues.

The Federal Aviation Administration's tight regulations and reliance on pilot "self-reporting," advocates say, create a culture in which aviators bottle up their problems instead of reporting them and seeking treatment.

"If you mention that you have a mental health issue or problem, you have basically lost your job," said Ross Aimer, chief executive of Aero Consulting Experts and a former United Airlines pilot. "Although we are supposed to self-disclose any mental issues, any drugs that we take to fix our mental issues, the minute you report that, you are basically off flying status and you may lose your job."

The focus on pilot mental health follows the arrest of off-duty pilot Joseph Emerson, 44, who was charged in federal and state court in Oregon this week after he attempted to pull a Horizon Air plane's red fire handles while sitting in the jump seat in the cockpit.

“I am not OK,” Emerson said after he had been casually engaging the two pilots in conversation, according to the FBI in a criminal complaint unsealed Tuesday.

Read more: Off-duty pilot took psychedelic mushrooms 48 hours before flight, prosecutor says

Then he grabbed onto the fire handles, which are used to extinguish engine fires and will shut off all fuel to the engines, essentially turning the plane into a glider, the pilots told investigators. The flight's pilots wrestled with Emerson and kicked him out of the cockpit. He was cuffed by flight attendants and arrested when the plane landed.

Emerson, who is due to be arraigned in federal court Thursday, told police he had been suffering from depression for six months and took psychedelic mushrooms 48 hours before the flight. He also told investigators that he was in the midst of a “nervous breakdown” and that he had not slept in 40 hours, according to the complaint.

Though Alaska Airlines said Emerson had completed all mandated FAA medical evaluations and was never suspended, researchers believe that pilots like Emerson underreport issues such as depression.

"Underreporting of mental health symptoms and diagnoses is probable among airline pilots due to the public stigma of mental illness and fear among pilots of being 'grounded' or not fit for duty," wrote researchers with Harvard University's T.H. Chan School of Public Health in a 2016 study.

The study followed the 2015 Germanwings crash that killed 150 in France. The pilot in that crash, Andreas Lubitz, also suffered from depression. He intentionally crashed the plane into a mountain after locking his co-pilot out of the cockpit.

Although it occurred in Europe, the Germanwings crash led the FAA to establish a committee to reevaluate the way it assesses pilot mental health, which led to a few changes, but not a substantial overhaul of the way the industry treats mental health issues, according to researchers.

Read more: Unruly airplane passengers disrupting more flights, despite FAA's zero-tolerance policy

"We thought more would be done at that time. We thought more resources would become available to pilots," said Deborah Donnelly-McLay, a pilot and researcher with Harvard University who contributed to the 2016 Pilot Health Study.

"Nothing was being done that really changed the landscape of mental health treatment," Donnelly-McLay said.

The study Donnelly-McLay co-authored focused on data compiled from 2,000 anonymous pilots' responses to a survey. It found that 12.4% of pilots may be clinically depressed. Even more alarmingly, the survey found that about 4% of pilots had suicidal ideations at times. In Europe, about 17% of pilots suffer from depression, according to a Trinity College survey spearheaded by pilot Paul Cullen.

Still, many pilots do not report their depression.

"The real issue is the job security and the fear of loss of earnings," Cullen said his report found.

But the FAA says that fear over reporting mental health issues is a "perceived risk."

"We’re doing our best at the FAA to make that clear," former FAA administrator Steve Dickson said at the University of North Dakota Mental Health Summit in 2021.

"It is a misconception that if you report a mental health issue, you will never fly again. ... It’s just not true," he said.

Dickson emphasized a renewed focus on "aircrew peer support networks, where pilots with concerns could talk to other pilots who were specifically trained to help."

Read more: A nationwide pilot shortage is straining air travel

Despite the FAA's insistence that mental health issues can be reported, barriers still exist for struggling pilots.

The FAA still does not allow pilots to take many antidepressants. And even those drugs that pilots are allowed to take for depression "are acceptable on a case by case basis," according to the FAA.

"Approval for any psychiatric drug is very strict and does not permit applicants to be approved by an [Aviation Medical Examiner] or even the FAA office in Oklahoma City. These cases are decided by the FAA office in Washington, D.C. and many cases are not approved for a variety of reasons," the FAA says in its list of accepted medications.

Donnelly-McLay believes the FAA has to treat mental health issues the way the airline industry handled alcohol and substance abuse.

In 1974, the Air Line Pilots Assn. created the Human Intervention Motivational Study, or HIMS, using a grant to treat pilots with alcohol and substance use disorders.

Now, the majority of American airlines refer pilots to HIMS programs that work with the FAA to get pilots treatment. More than 5,400 pilots with alcohol or substance use disorders have been treated through HIMS and returned to the air after successful completion of the program.

Before HIMS, many of the same issues existed related to pilot underreporting of substance use disorders.

"Prior to 1974, the FAA had no practical rehabilitative protocol to accommodate a recovering pilot and return him/her to work with safety. To identify an alcoholic pilot meant suspension or revocation of the medical certification and immediate loss of income," according to the HIMS website.

In its 48-page report on pilot mental health after the Germanwings crash, the FAA report "investigated the concept of developing a pilot mental fitness-focused ASAP-like program" like HIMS.

"Consensus among the group as to the ability to implement such a program was not found," the authors of the report wrote.

Certain airlines have their own programs. Alaska Airlines said it had internal programs to handle pilots with mental health issues, but the company did not immediately elaborate.

Aimer said it takes incidents like the Alaska Airlines flight to bring the FAA's attention back to the critical issue.

"We are all human and we have our portion of alcoholics, mental issues," Aimer said. "The FAA needs to do some serious soul searching and find a solution for this."

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This story originally appeared in Los Angeles Times.