Jocelyn Frank
Appearances
Radio Atlantic
Why Pilots Don't Get Therapy
And that took an additional month. He had to be on a stable dose for six months before beginning his application. And that switch in care meant he had to start the six-month count again. And he learned there were additional requirements.
Radio Atlantic
Why Pilots Don't Get Therapy
Each of these tests has a cost and each has to be submitted to this special FAA doctor to review.
Radio Atlantic
Why Pilots Don't Get Therapy
You use the word elective, but it's required for you to come back to flying, right?
Radio Atlantic
Why Pilots Don't Get Therapy
Right, yeah. The process can cost thousands of dollars, somewhere between $10,000 or $15,000 for most pilots. And like Finlayson was saying, it's uncommon for insurance to cover these kinds of expenses, and only a very small percentage of unionized pilots flying with legacy carriers which those are some of the biggest ones, they've negotiated for this process to fall under the disability coverage.
Radio Atlantic
Why Pilots Don't Get Therapy
And that can offer pilots like Finlayson a partial paycheck, a partial paycheck to support two kids and a wife in grad school. But that is the best case scenario. And many other pilots and aspiring pilots who I interviewed for this story have had no stable income and no safety net during their process.
Radio Atlantic
Why Pilots Don't Get Therapy
They're grounded from flying or they haven't received their pilot's license to begin with. So they're not getting any kind of base level paycheck while they're going through this process. And aviation is a very expensive field to begin with. I mean, a lot of pilots take on substantial debt just to get trained.
Radio Atlantic
Why Pilots Don't Get Therapy
So this is what they're dealing with while trying to get this special medical certificate.
Radio Atlantic
Why Pilots Don't Get Therapy
Absolutely, yeah. It can take years just to gather all of your medical records, get all the paperwork organized and the testing. And once a pilot and their AME do submit the request, The documents can take months and months for the FAA to actually review. And that's a lot of time for a pilot to be waiting around on disability at best, more often unemployed.
Radio Atlantic
Why Pilots Don't Get Therapy
He's probably responsible for a few hundred people every time he shows up for work. So when he got COVID, he had no hesitation about being grounded. He immediately stopped flying.
Radio Atlantic
Why Pilots Don't Get Therapy
And I have to say, with recent cuts to federal staffing at the FAA, it's unlikely that this process is going to get any more efficient.
Radio Atlantic
Why Pilots Don't Get Therapy
It's pretty clear from those terrible suicide-type flights that we do not want a pilot in the pilot seat who is suffering from that kind of intense, untreated mental health problem. It definitely adds risk to passenger safety.
Radio Atlantic
Why Pilots Don't Get Therapy
I asked William Hoffman, that researcher, what we know about having mental health problems that you're treating, that you're addressing, or something that was on your record from the past. What do we know about how that impacts risk? And here's what he told me.
Radio Atlantic
Why Pilots Don't Get Therapy
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 has never been systematically studied in research. That's a complete assumption.
Radio Atlantic
Why Pilots Don't Get Therapy
Yeah. And it's an assumption that's costing Chris Finlayson and thousands of other pilots multiple years away from their careers. But it's nearly impossible to get pilots to raise their hands and say, hey, I'll participate in your research. I should probably be seeing a therapist.
Radio Atlantic
Why Pilots Don't Get Therapy
Or, hey, I'm secretly taking mental health medication, so study me, check my flight records, and see how well I'm doing, or calculate all the small mistakes I'm making compared to this other pilot so we can figure out if my mental health issues are actually a problem when it comes to flight safety.
Radio Atlantic
Why Pilots Don't Get Therapy
No one's volunteering for that kind of scrutiny, partially because doing so would mean admitting they had not been fully honest about their health prior to that kind of study.
Radio Atlantic
Why Pilots Don't Get Therapy
It's a catch-22. We need data to drive progress, but people are afraid to participate in research, so we can't get that data.
Radio Atlantic
Why Pilots Don't Get Therapy
So even if we don't know exactly how risky it is to fly with the current system, we do know that the current system is keeping pilots from seeking care. And that's a part of the system where risk could be reduced. One of the reasons I wanted to look into this story is because the FAA did recently request recommendations from a panel of experts about how to address that problem.
Radio Atlantic
Why Pilots Don't Get Therapy
Hoffman was one of them. The group delivered 24 suggestions to lower the barriers to mental health access. And they presented these suggestions to the FAA last year, in April of 2024. And a few were acted on really quickly.
Radio Atlantic
Why Pilots Don't Get Therapy
For example, expanding the number of medications that can be used. So that was almost immediately implemented.
Radio Atlantic
Why Pilots Don't Get Therapy
The total is now eight different drugs, but they're conditionally allowed, which means that you would still need to request a special medical certificate. And it might be granted, but it's not guaranteed.
Radio Atlantic
Why Pilots Don't Get Therapy
They also narrowed some of the requirements for neuropsychological testing that a pilot might need to undergo if they are on a medication for mood.
Radio Atlantic
Why Pilots Don't Get Therapy
So if a pilot like Chris Finlayson were to begin this medical screening again, he might have fewer tests to go through in order to request the special medical certificate. And the committee recommended a bunch of other aspects of the process be changed, too.
Radio Atlantic
Why Pilots Don't Get Therapy
They asked the FAA to modernize the system to reduce paperwork, to improve training for doctors who are reviewing all of these medical records for more consistency, wider disability coverage so pilots maybe could be covered more often. And Hoffman was excited about another recommendation, too.
Radio Atlantic
Why Pilots Don't Get Therapy
One of the key recommendations was requiring that pilots have access to peer support services.
Radio Atlantic
Why Pilots Don't Get Therapy
Peer support basically allows pilots the opportunity to talk to each other about sensitive issues that are going on in their lives.
Radio Atlantic
Why Pilots Don't Get Therapy
Yeah. I asked William Hoffman why he was so excited about peer support.
Radio Atlantic
Why Pilots Don't Get Therapy
Even after most of his COVID symptoms subsided, his anxiety just kept going. And then he got anxiety about his anxiety.
Radio Atlantic
Why Pilots Don't Get Therapy
So why not just promote therapy? It seems like dancing around the idea that people actually could benefit from therapy or could benefit from medication, but instead saying, go talk to a peer or, you know, do this other back channel thing and you don't have to report it.
Radio Atlantic
Why Pilots Don't Get Therapy
It's a great question. It's a critical question. And While in a perfect world, we could argue, we could say therapy is not reportable and you should talk to a therapist. I think more realistically where the rubber meets the road is that there's a lot of distrust and the pilot peer can be that connection between the pilot needing services and the professional support that's required.
Radio Atlantic
Why Pilots Don't Get Therapy
Chris Finlayson decided to go through the process of requesting the special medical certificate. He, like I said, had his last flight December 19th, 2021. He went through all of these different steps that took him almost two years. He submitted his paperwork. And about eight months after that, in July 2024, he heard back.
Radio Atlantic
Why Pilots Don't Get Therapy
Can you go back as many times as you want? Like as many times as you can afford slash endure?
Radio Atlantic
Why Pilots Don't Get Therapy
Last year, the FAA approved 2,800 special issuance certificates coded for mental health. As of this April, they've already approved almost that number, 2,400. But if this system continues as is, it's likely that thousands of pilots will go on flying without getting or reporting the care that they need.
Radio Atlantic
Why Pilots Don't Get Therapy
For most people in a similar situation, having stress, anxiety, even panic attacks, it would lead them to some behavioral therapy or medication. And then ideally, you just get back to a stable, typical, healthy life. But Chris Finlayson is a pilot. And for pilots, there's a different calculation.
Radio Atlantic
Why Pilots Don't Get Therapy
When pilots do seek out mental health care, they risk derailing their careers, disrupting their livelihoods, and ultimately, sometimes their permission to fly. And if they don't seek help, they could be putting their lives and the lives of hundreds of passengers at risk.
Radio Atlantic
Why Pilots Don't Get Therapy
In 2015, there was a terrible crash, an airline called Germanwings. And it turned out that the co-pilot intentionally crashed the plane.
Radio Atlantic
Why Pilots Don't Get Therapy
Even though it wasn't a U.S. airline, basically since then, the FAA has been trying to tighten their approach to mental health. They want to reduce any risk to passenger safety that's linked to any kind of serious mental health challenge.
Radio Atlantic
Why Pilots Don't Get Therapy
Thomas Jetser works as a medical consultant for the FAA. He's a certified AME, which stands for Aviation Medical Examiner. He's one of hundreds of special doctors across the United States who meet with pilots on a yearly or on a six-month basis to review their medical records and decide if they're fit to fly. And he thinks it's a pretty good system.
Radio Atlantic
Why Pilots Don't Get Therapy
Talking to Dr. Jetser, I was trying to learn how the FAA system compares to others because a pilot reporting a mental health concern, even to a doctor they've known for 35 years, could halt their career. And Dr. Jesser pointed out that the kind of scrutiny he's responsible for, it's actually not even unique to pilots.
Radio Atlantic
Why Pilots Don't Get Therapy
It's similar to other high-responsibility fields like FBI agents or people who work within the nuclear industry, and even a part of his own field, medicine.
Radio Atlantic
Why Pilots Don't Get Therapy
But if I was a doctor and I went on antidepressants, I wouldn't need to report that I'm on antidepressants unless it was impacting my work, right?
Radio Atlantic
Why Pilots Don't Get Therapy
They could each theoretically visit a psychiatrist. They could be prescribed anti-anxiety medication and just keep on with their jobs without having to report anything to a special doctor or to their boss or to take time off. And this added layer of scrutiny for pilots, I mean, they're responsible for hundreds of people at a time.
Radio Atlantic
Why Pilots Don't Get Therapy
So the FAA wants to be as sure as they can that anyone who's in the cockpit is in a really healthy state of mind.
Radio Atlantic
Why Pilots Don't Get Therapy
Yeah, it's a really good question, a really serious question. And I looked into FAA safety systems in some more detail, and it turns out that the processes that they have in place have led to some really terrible unintended consequences. Like what? In the fall of 2021, an aviation student who was attending the University of North Dakota, he took his life in a university aircraft accident.
Radio Atlantic
Why Pilots Don't Get Therapy
It was later discovered that he actually wrote a note revealing he'd been struggling emotionally, but he felt like he couldn't do anything about it because he feared losing his medical certificate. His mom actually read some of that letter out loud during a National Transportation Safety Board summit.
Radio Atlantic
Why Pilots Don't Get Therapy
Even though this was an awful tragedy, thankfully it didn't involve any passengers. But then there was another event.
Radio Atlantic
Why Pilots Don't Get Therapy
In the autumn of 2023, an off-duty Alaska Airlines pilot was catching a ride on Horizon Air. It's a travel trick that's pretty common among pilots called jump seating. And this pilot, his name is Joseph Emerson, during that flight, he's accused of trying to activate a fire suppression system that would have cut off fuel to the plane's engines in mid-flight.
Radio Atlantic
Why Pilots Don't Get Therapy
Emerson was luckily not successful. He was escorted to the back of the plane, handcuffed to a seat.
Radio Atlantic
Why Pilots Don't Get Therapy
The plane was rerouted to make an emergency landing. Emerson later told reporters that he'd been suffering from depression, and he pled not guilty to the charges that were brought against him. He wasn't piloting that day, but he did have access to the cockpit, and that means that his position, technically as a pilot, put the safety of the plane and its passengers at risk.
Radio Atlantic
Why Pilots Don't Get Therapy
So these are two pretty high-profile examples where people's lives were at stake. And in both cases, the pilots were not getting the care they needed.
Radio Atlantic
Why Pilots Don't Get Therapy
I talked with William Hoffman. He's a neurologist and an aviation medical researcher. And he and his team have been trying to figure out how the FAA's protocols impact the decisions pilots are making about their health. In 2019, Hoffman and his team launched a survey of over 3,500 pilots across North America.
Radio Atlantic
Why Pilots Don't Get Therapy
And he found that 56 percent of pilots reported a history of health care avoidance due to fear of losing their flying status.
Radio Atlantic
Why Pilots Don't Get Therapy
Well, at first, Finlayson thought he might not have to go through the full process. The way the FAA system works is basically if you go on medication and then you get off of it for 60 days and your treating psychiatrist says, you're good, the FAA can consider this as all just like a little health blip. You're grounded. You're not flying for that period of time. No regular paycheck.
Radio Atlantic
Why Pilots Don't Get Therapy
But after, you can potentially get fairly smoothly back into your job. So Finlayson was hoping for that when he went to see a nurse practitioner and he started taking a low dose SSRI for his anxiety.
Radio Atlantic
Why Pilots Don't Get Therapy
He knew he couldn't stay off the medication and feel well enough to fly. If he stayed on medication, he'd have to pursue the longer path for his medical certificate. It's called requesting a special issuance. Even with that request, there's no guarantee the FAA would decide he could ever fly again. And he felt totally stuck.
Radio Atlantic
Why Pilots Don't Get Therapy
And once Finlayson sort of let go of the possibility of that faster path back to his job, the fast path to that medical certificate, his health improved.
Radio Atlantic
Why Pilots Don't Get Therapy
So Finlayson achieved this mental recovery, this clarity, but the path back to piloting was still extremely murky.
Radio Atlantic
Why Pilots Don't Get Therapy
He was about to begin medical testing, paperwork, research, bureaucratic phone calls, all to get the FAA to decide if he could get back into the air. And it took him years, years of not flying.
Radio Atlantic
Why Pilots Don't Get Therapy
Yeah, it's a complicated system and it can take a lot of time. Actually, Chris Finlayson had so much time away from piloting and so much time feeling frustrated as he was learning all this different information about the process. He joined a nonprofit focused on pilot mental health, trying to reform the system at the same time he's in it trying to get his own permission to fly approved.
Radio Atlantic
Why Pilots Don't Get Therapy
Yeah. I recently interviewed quite a number of pilots, and one of them has really got me thinking differently about flight safety. His name is Chris Finlayson. He's been a pilot for 13 years. He's married, he has two young daughters, and he's a first officer with one of the major airlines in the U.S., It's a job that comes with a lot of responsibility. You know, a few flights every day.
Radio Atlantic
Why Pilots Don't Get Therapy
Definitely not. In 2024, out of 150,000 commercial pilots, only about 9,000 applied. And in the end, only about 3,000 were approved. So Finlayson was hoping to be one of those 3,000. He and his doctors decided he needed to take this anti-anxiety medication long-term, which meant he was going to have to enter this longer process.
Radio Atlantic
Why Pilots Don't Get Therapy
And it became clear it was going to be a really detailed and at times tedious process. According to the FAA, a lot of people get denied for failing to provide some specific requested information. It actually accounts for more than 75% of all denials. And from the start, Chris Finlayson was feeling that potential. He would think he'd checked a box, only to learn it was the wrong box.