Jocelyn Frank

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.

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.

Each of these tests has a cost and each has to be submitted to this special FAA doctor to review.

Each of these tests has a cost and each has to be submitted to this special FAA doctor to review.

What is that like?

What is that like?

You use the word elective, but it's required for you to come back to flying, right?

You use the word elective, but it's required for you to come back to flying, right?

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.

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.

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.

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.

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.

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.

So this is what they're dealing with while trying to get this special medical certificate.

So this is what they're dealing with while trying to get this special medical certificate.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

For example, expanding the number of medications that can be used. So that was almost immediately implemented.

For example, expanding the number of medications that can be used. So that was almost immediately implemented.

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.

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.

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.

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.

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.

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.

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.

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.

One of the key recommendations was requiring that pilots have access to peer support services.

One of the key recommendations was requiring that pilots have access to peer support services.

Peer support basically allows pilots the opportunity to talk to each other about sensitive issues that are going on in their lives.

Peer support basically allows pilots the opportunity to talk to each other about sensitive issues that are going on in their lives.

Yeah. I asked William Hoffman why he was so excited about peer support.

Yeah. I asked William Hoffman why he was so excited about peer support.

Peer support does not need to be disclosed to an AME.

Peer support does not need to be disclosed to an AME.

Even after most of his COVID symptoms subsided, his anxiety just kept going. And then he got anxiety about his anxiety.

Even after most of his COVID symptoms subsided, his anxiety just kept going. And then he got anxiety about his anxiety.

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.

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.

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.

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.

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.

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.

Can you go back as many times as you want? Like as many times as you can afford slash endure?

Can you go back as many times as you want? Like as many times as you can afford slash endure?

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.

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.

Thank you.

Thank you.

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.

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.

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.

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.

In 2015, there was a terrible crash, an airline called Germanwings. And it turned out that the co-pilot intentionally crashed the plane.

In 2015, there was a terrible crash, an airline called Germanwings. And it turned out that the co-pilot intentionally crashed the plane.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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?

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.

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.

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.

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.

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.

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.

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.

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.

Even though this was an awful tragedy, thankfully it didn't involve any passengers. But then there was another event.

Even though this was an awful tragedy, thankfully it didn't involve any passengers. But then there was another event.

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.

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.

Emerson was luckily not successful. He was escorted to the back of the plane, handcuffed to a seat.

Emerson was luckily not successful. He was escorted to the back of the plane, handcuffed to a seat.

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.

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.

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.

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.

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.

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.

And he found that 56 percent of pilots reported a history of health care avoidance due to fear of losing their flying status.

And he found that 56 percent of pilots reported a history of health care avoidance due to fear of losing their flying status.

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.

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.

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.

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.

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.

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.

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.

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.

So Finlayson achieved this mental recovery, this clarity, but the path back to piloting was still extremely murky.

So Finlayson achieved this mental recovery, this clarity, but the path back to piloting was still extremely murky.

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.

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.

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.

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.

Hi, Hannah. Thanks for having me.

Hi, Hannah. Thanks for having me.

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.

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.

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.

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.

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.

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.

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.

Each of these tests has a cost and each has to be submitted to this special FAA doctor to review.

What is that like?

You use the word elective, but it's required for you to come back to flying, right?

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.

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.

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.

So this is what they're dealing with while trying to get this special medical certificate.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

For example, expanding the number of medications that can be used. So that was almost immediately implemented.

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.

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.

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.

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.

One of the key recommendations was requiring that pilots have access to peer support services.

Peer support basically allows pilots the opportunity to talk to each other about sensitive issues that are going on in their lives.

Yeah. I asked William Hoffman why he was so excited about peer support.

Peer support does not need to be disclosed to an AME.

Even after most of his COVID symptoms subsided, his anxiety just kept going. And then he got anxiety about his anxiety.

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.

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.

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.

Can you go back as many times as you want? Like as many times as you can afford slash endure?

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.

Thank you.

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.

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.

In 2015, there was a terrible crash, an airline called Germanwings. And it turned out that the co-pilot intentionally crashed the plane.

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.

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.

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.

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.

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?

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.

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.

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.

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.

Even though this was an awful tragedy, thankfully it didn't involve any passengers. But then there was another event.

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.

Emerson was luckily not successful. He was escorted to the back of the plane, handcuffed to a seat.

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.

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.

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.

And he found that 56 percent of pilots reported a history of health care avoidance due to fear of losing their flying status.

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.

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.

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.

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.

So Finlayson achieved this mental recovery, this clarity, but the path back to piloting was still extremely murky.

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.

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.

Hi, Hannah. Thanks for having me.

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.

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.

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.